# Implementation of a Novel, Intensive, Two-Week Simulation Rotation for Pediatric Residents to Teach Crisis Resource Management Skills

## TL;DR

A new two-week simulation program for pediatric residents improves their crisis management and leadership skills during patient resuscitations.

## Contribution

A novel, intensive simulation rotation to teach pediatric residents crisis resource management skills.

## Key findings

- Residents reported significant improvements in confidence and capability after the rotation.
- Leadership scores, measured by the CALM tool, improved significantly from the first to last simulation.
- The program was deemed feasible and acceptable, with 71% of participants completing both pre- and post-surveys.

## Abstract

Background

Pediatric residents must be competent in leading resuscitations, but have few clinical opportunities to develop their crisis resource management (CRM) skills. Simulation-based medical education (SBME), including CRM training, can supplement resident education where clinical experience is lacking.

Objectives

To develop and evaluate the feasibility, acceptability, and effectiveness of an SBME rotation for pediatric residents to improve competency and confidence in CRM skills.

Methodology

We designed a 10-day rotation with 31 unique simulations for residents interested in developing their CRM skills. A pre- and post-course survey evaluated the acceptability and effectiveness of the rotation. To assess leadership skills, a core component of CRM, we used the Concise Assessment of Leader Management (CALM) tool.

Results

Over six rotations, 38 residents participated, and 27 (71%) completed both the pre- and post-surveys. All 27 residents would recommend the rotation to other residents. After completing the course, the residents reported improvement in confidence (median (interquartile range, IQR): 2 (2, 3) vs. 4 (3, 4), P-value < 0.0001, n = 27) and capability (median (IQR): 3 (2, 3) vs. 4 (4, 4), P-value < 0.0001, n = 27) when approaching a patient requiring resuscitation. CALM scores improved for the residents in their last simulation compared to their first simulation (median (IQR): 52.50 (49.25, 55.00) vs. 30.50 (20.75, 35.50), P-value < 0.0001, n = 16), indicating an improvement in leadership.

Conclusions

We developed a novel, intensive, simulation-based rotation for pediatric residents that was feasible, acceptable, and improved residents’ capability, confidence, and leadership skills when approaching a patient resuscitation.