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Perception of Realism During Mock Resuscitations by Pediatric Housestaff: The Impact of Simulated Physical Features

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/SIH.0b013e3181a46aa1
Empirical Investigations

Introduction: Physical signs that can be seen, heard, and felt are one of the cardinal features that convey realism in patient simulations. In critically ill children, physical signs are relied on for clinical management despite their subjective nature. Current technology is limited in its ability to effectively simulate some of these subjective signs; at the same time, data supporting the educational benefit of simulated physical features as a distinct entity are lacking. We surveyed pediatric housestaff as to the realism of scenarios with and without simulated physical signs.

Methods: Residents at three children's hospitals underwent a before-and-after assessment of performance in mock resuscitations requiring Pediatric Advanced Life Support (PALS), with a didactic review of PALS as the intervention between the assessments. Each subject was randomized to a simulator with physical features either activated (simulator group) or deactivated (mannequin group). Subjects were surveyed as to the realism of the scenarios. Univariate analysis of responses was done between groups. Subjects in the high-fidelity group were surveyed as to the relative importance of specific physical features in enhancing realism.

Results: Fifty-one subjects completed all surveys. Subjects in the high-fidelity group rated all scenarios more highly than low-fidelity subjects; the difference achieved statistical significance in scenarios featuring a patient in asystole or pulseless ventricular tachycardia (P < 0.04 for both comparisons). Chest wall motion and palpable pulses were rated most highly among physical features in contributing to realism.

Conclusions: PALS scenarios were rated as highly realistic by pediatric residents. Slight differences existed between subjects exposed to simulated physical features and those not exposed to them; these differences were most pronounced in scenarios involving pulselessness. Specific physical features were rated as more important than others by subjects. Data from these surveys may be informative in designing future simulation technology.

From the Division of Emergency Medicine (A.J.D, D.R.D., F.M.N.), Division of Critical Care Medicine (A.J.D., V.M.N.), Children's Hospital of Philadelphia, Pennsylvania; Division of Critical Care Medicine (G.R.S.), and Division of Emergency Medicine (S.I.K.), A. I. DuPont Hospital for Children, Wilmington, Delaware.

Supported by the Laerdal Foundation for Acute Medicine grant.

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

The authors declare no conflict of interest.

© 2010 Society for Simulation in Healthcare