Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

Abstract

Background: Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes.

Objective: To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE.

Methods: Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE.

Results: No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n=30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention.

Conclusions: A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols.

FIGURE 1

Inpatient Guidelines for Management and Evaluation of Status Epilepticus

FIGURE 2

Scoring Checklist for Simulation Scenario

FIGURE 3

Pretest and Posttest Performance of the Status Epilepticus Management Algorithm

FIGURE 4

Percentage of Residents to Minimal Passing Score by Scenario