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Improving the Quality of Pediatric Health Care Using Simulation

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Simulation is a technique that allows for the recreation of real-life clinical events so that participants can build their current knowledge and skillsets and improve health care delivery to real patients. Fortunately for pediatric health care, this technique was in full force at the 2018 American Academy of Pediatrics (AAP) National Conference and Exhibition (NCE) in Orlando, Florida.

Since its establishment in July 2016, the AAP Provisional Section on Simulation and Innovative Learning Methods (SoSILM) has been charged to support the education and research of AAP members in the optimization of health care delivery and patient safety. With over 450 members representing 44 states and 20 countries, the section SILM was recognized for Outstanding Service in Member Recruitment at the 2018 AAP Annual Leadership Forum, and made a debut in Orlando with its education program, "Simulation for the Difficult Office Conversation: HPV Refusal and More."

Claire Daniels, MD, Professor of Pediatrics at Walter Reed National Military Medical Center and Uniformed Services University, opened the program with an update on the human papillomavirus (HPV) vaccine and an overview on how to discuss HPV vaccine safety and efficacy with patients and their parents. She pointed out that in addition to stating the risks of HPV disease and benefits of vaccination for kids at age 11-12, it is important to provide a strong recommendation for the HPV vaccine based on AAP guidelines and to demonstrate effective communication by responding to parental concerns with evidence-based guidelines. SoSILM Executive Committee Member, Joseph Lopreiato, MD, MPH, and Chair, Taylor Sawyer, DO, MEd, then introduced the second part of the program where attendees were asked to "suspend their disbelief," and participate in standardized patient (SP) sessions where they discussed HPV vaccinations with actors trained to play the role of vaccine-hesitant parents. Following the session, trained facilitators including SoSILM Executive Committee Members Marjorie White, MD, Traci Wolbrink, MD, and Theodora Stavroudis, MD, and Liaison, Richard Calderone, DO, and the SPs guided the discussion and provided feedback to participants.

The conversation and discussion flowed as participants shared their experiences both from their clinic-based practices and from the SP sessions. Facilitators advocated for application of SP methodologies in the office setting as a means to not only conduct a needs assessment of staff and physician to identify areas for improvement but then to also provide ongoing training through the same modality. Take-home messages were sought and handouts and job aids were provided at the conclusion of the program. In addition, tool kits were made available on e-platforms for access and use after the NCE. Last but not least, participation in a collaborative was offered to attendees in order to provide ongoing support to members and their staff as they seek to deploy SP-based simulation methods and techniques in their offices after they returned home from the NCE.

SoSILM also had a presence at the 2018 NCE Course on Neonatal and Pediatric Critical Care Transport Medicine sponsored by the AAP Section on Transport Medicine. SoSILM Executive Committee Members, Lou Halamek, MD and Theodora Stavroudis, MD, provided a presentation on "Simulation: Training the Transport Team," where they gave an overview of simulation techniques and methods that can be deployed to address the wide range of clinical environments and patient scenarios that Pediatric Transport Teams are ascribed to practice in every day. From individual to team training and from task trainers to computer-operated mannequin use during practice-run ambulance rides and helicopter and fixed-wing flights, a spectrum of simulation platforms was presented as a way to enhance current training programs. Additionally, the development and utilization of individual learning profiles for individual skill assessment and training was discussed and the importance of integrating debriefing techniques into current training programs was stressed in order to identify targets for intervention and optimize best practices and patient outcomes. The course ended with a pledge for both sections of the AAP to continue working together to support the learning needs of their members.

NCE 2019 similarly seeks to satisfy as simulation continues to integrate into educational programs on how to apply debriefing techniques for patient critical event analysis, employ simulation to teach anaphylaxis management in the community setting, utilize role-play methods to understand and improve the care of opiate-addicted patients, and introduce the use of virtual reality and screen-based technologies for education and patient safety. For more information and on ways to participate and join the efforts of the AAP SoSILM, please visit the AAP website.

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