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Effect of High-Fidelity Simulation on Pediatric Advanced Life Support Training in Pediatric House Staff: A Randomized Trial

Donoghue, Aaron J. MD, MSCE*†; Durbin, Dennis R. MD, MSCE*; Nadel, Frances M. MD, MSCE*; Stryjewski, Glenn R. MD; Kost, Suzanne I. MD§; Nadkarni, Vinay M. MD, MS

doi: 10.1097/PEC.0b013e31819a7f90
Original Articles

Objectives: To assess the effect of high-fidelity simulation (SIM) on cognitive performance after a training session involving several mock resuscitations designed to teach and reinforce Pediatric Advanced Life Support (PALS) algorithms.

Methods: Pediatric residents were randomized to high-fidelity simulation (SIM) or standard mannequin (MAN) groups. Each subject completed 3 study phases: (1) mock code exercises (asystole, tachydysrhythmia, respiratory arrest, and shock) to assess baseline performance (PRE phase), (2) a didactic session reviewing PALS algorithms, and (3) repeated mock code exercises requiring identical cognitive skills in a different clinical context to assess change in performance (POST phase). SIM subjects completed all 3 phases using a high-fidelity simulator (SimBaby, Laerdal Medical, Stavanger, Norway), and MAN subjects used SimBaby without simulated physical findings (ie, as a standard mannequin). Performance in PRE and POST was measured by a scoring instrument designed to measure cognitive performance; scores were scaled to a range of 0 to 100 points. Improvement in performance from PRE to POST phases was evaluated by mixed modeling using a random intercept to account for within-subject variability.

Results: Fifty-one subjects (SIM, 25; MAN, 26) completed all phases. The PRE performance was similar between groups. Both groups demonstrated improvement in POST performance. The improvement in scores between PRE and POST phases was significantly better in the SIM group (mean [SD], 11.1 [4.8] vs. 4.8 [1.7], P = 0.007).

Conclusions: The use of high-fidelity simulation in a PALS training session resulted in improved cognitive performance by pediatric house staff. Future studies should address skill and knowledge decays and team dynamics, and clearly defined and reproducible outcome measures should be sought.

From the Divisions of *Emergency Medicine, and †Critical Care Medicine, The Children's Hospital of Philadelphia, PA; and Divisions of ‡Critical Care Medicine, and §Emergency Medicine, A.I. duPont Hospital for Children, Wilmington, DE.

Reprints: Aaron Donoghue, MD, MSCE, Divisions of Emergency Medicine and Critical Care Medicine, The Children's Hospital of Philadelphia, Room AS24, 34th St and Civic Center Blvd, Philadelphia, PA 19104 (e-mail:

This project was supported by an award from the Laerdal Foundation for Acute Medicine.

© 2009 Lippincott Williams & Wilkins, Inc.