Critically Ill Children With Tracheostomies: Simulation Curriculum to Improve Residents’ Skills

Introduction: Despite the increasing population of tracheostomy-dependent children, pediatric residents’ exposure to these patients is expected to decrease due to the ACGME changes in inpatient and PICU rotation requirements. Children with tracheostomies are at increased risk for morbidity and mortality; pediatricians must care for these patients, including timely recognition of and intervention for acute respiratory emergencies. This study aimed to assess residents’ baseline skills and evaluate the impact of a simulation-based mastery learning curriculum delivered to residents during their PICU rotations to teach management of tracheostomy emergencies.


Methods: Considering the question, "What are the management expectations for a pediatrician during a tracheostomy emergency?”, a group with expertise in teaching tracheostomy-related education was convened to develop a checklist-based assessment and a minimum passing standard (MPS). Residents participated during their PICU rotations. A baseline assessment score was obtained by having individual residents respond to a simulated patient scenario with a tracheostomy. The simulation was designed to be mobile, low-fidelity and near the clinical space. Residents then participated in a didactic session and hands-on deliberate practice with the equipment. Residents repeated the simulation until the MPS was achieved. REDCap was used to compare scores pre and post intervention for each resident.


Results: To date, 25 residents have completed the curriculum. Pre-intervention, 0/25 residents achieved mastery level, with residents scoring between 18-63%. Post-intervention, 24/25 (96%) residents achieved the MPS, with 17 residents achieving perfect scores. 10/25 (40%) of residents achieved mastery on their first attempt following the educational intervention. 14 residents required two attempts.


Conclusions: At baseline, pediatric residents do not demonstrate mastery in managing respiratory emergencies in a patient with a tracheostomy. Implementation of a low-fidelity simulation-based mastery learning curriculum increased residents’ hands-on skills with tracheostomy emergencies. The PICU is uniquely positioned with its patient population and physicians’ skill set to provide an in-situ simulation curriculum for pediatric residents for immediate knowledge acquisition.