55 Outside the comfort zone: Evaluation of a simulation-based curriculum in managing agitated patients for paediatric residents

Given the prevalence of mental health comorbidity in the paediatric population, it is important that paediatricians/paediatric trainees possess competence in the management of acute psychiatric emergencies, including agitation. Experiential learning through simulation is used for safety training when high-risk decisions must be made safely and rapidly. Simulation-based training in the management of acutely agitated patients has been studied in the context of psychiatric training programs; however, limited studies exist to inform effective methods of training paediatric residents in the management of agitation. This study assessed a simulation-based workshop on the knowledge, competence and confidence of paediatric trainees in the management of agitated patients compared to a didactic lecture or no formal educational intervention. This was a prospective comparative cohort study. Paediatric residents were divided among three study groups: Group 1 - a 1-hour didactic lecture on agitation management; Group 2 - a simulation-based workshop on managing the agitated patient; and Group 3 -no intervention. Confidence and knowledge were assessed in groups 1 and 2 using a pre- and post- intervention self-efficacy questionnaire and a clinical vignette. All three groups completed an agitated patient station in the 2018 in-training Objective Structured Clinical Examination (OSCE) assessment. Univariate analysis was completed on the pre- and post- intervention self-efficacy questionnaires, and clinical vignette scores were analyzed using a t-test. Analysis of variance was used to compare OSCE scores between groups. A subgroup analysis was performed to assess OSCE scores by postgraduate year (PGY). Simulation-based workshop participants performed better in the OSCE scenario as demonstrated by their OSCE score (mean 81.7%, CI: 75.1–88.3) compared to those from groups 1 (mean 74.6%, CI: 71.4–77.8) and 3 (mean 71.6%, CI: 69.2–74.0). The most significant difference was present between groups 2 and 3 (p=0.0055), whereas differences in the means between groups 1 and 2 were not as prominent (p=0.0577). No difference in mean OSCE scores was found between groups 1 and 3 (p= 0.1424). Subgroup analysis of OSCE scores by PGY of training did not demonstrate a statistically significant difference (p=0.0615). Scores for this scenario did not improve with increased level of training, demonstrating a persistent knowledge gap amongst trainees. Simulation-based learning may be an effective educational strategy for paediatric residents to acquire skills in managing acute agitation.