Teaching Paediatric Recovery Skills with Simulators - Course development and initial findings

Lauder GL, Forrest FC, McIndoe AK
Bristol Medical Simulation Centre

Bristol Medical Simulation Centre (BMSC) was opened in January 1997 and was initially equipped with an adult 'METI' Human Patient Simulator (HPS). Our paediatric anaesthetic colleagues were interested in the concept of simulation based training and identified a need to train theatre and recovery nurses looking after children. However, during 1997 and 1998 they were only able to make use of an adult manikin with the physiology of a 12 year old child. A temporary solution to this problem was identified in the summer of 1998 when BMSC purchased an Anaesthetic Computer Controlled Emergency Situation Simulator (ACCESS) for use with an adult manikin. This solution was the immediate development of 'Paed' ACCESS at BMSC as an adjunct to the adult system. Scenarios were reconfigured with appropriate paediatric pathophysiology to be used with a Drager Megacode Kid manikin. Consequently we had a child-sized manikin and basic airway and cardiovascular scenarios which could be applied for teaching about problems arising in the recovery environment. By December 1999 we had developed a Paediatric Recovery Course with lectures and scenarios based on PaedACCESS and the 12 year old on the HPS. Following the purchase of METI's PediaSim in February 2000, subsequent courses have been run with PediaSim and PaedACCESS.

Our aims have been to monitor and evaluate the different elements of the course over the first year and thereafter to modify the course appropriately. In particular we were interested to know whether the introduction of PediaSim would make PaedACCESS redundant.

Three courses for theatre and recovery nurses (35 attendees) have been run and all elements of the course (lectures and scenarios) were appraised by all the participants using a 5 point scale (1= very poor, 2= poor. 3= fair, 4 = good and 5= excellent)

Mean scores for presentation, content and relevance for lectures, HPS and ACCESS components are shown:

Friedman 2-way ANOVA analysis confirmed no statistically significant difference between results obtained using the three teaching modalities (Presentation p=0.74; Content p=0.75; Relevance p=0.81)

Scores were generally good or excellent. Seemingly PaedACCESS remains popular despite the introduction of PediaSim. Whilst this is reassuring to the faculty, with small numbers it is difficult to show significant differences between teaching modalities. A provisional power analysis suggested approximately 600 attendees would be required to do this. Changing our scoring system to a 6 point scale may help to identify any differences more quickly.

Most centres can only afford one high fidelity simulator. PaedACCESS was developed at a fraction of the cost of a high fidelity simulator (£3500 initial outlay for manikin and software) and these results suggest that it is a useful simulator for basic recovery scenario teaching. The simultaneous use of small groups rotating through lectures and multiple simulator stations means the teacher to pupil ratio remains high but a larger number of nurses are trained per course.

Ref: Enquiries about ACCESS should be directed to: Dr A. J. Byrne, Department of Anaesthesia, Morriston Hospital, Swansea, SA6 6NL, UK. Tel. (+44)1792 703491. Fax. (+44)1792 703556

Acknowledgements: Dr Tim Lovell for his statistical advice.