Effectiveness of a standardized scenario in teaching the management of pediatric diabetic ketoacidosis (DKA) to residents: a simulation cross-sectional study.
Diabetic ketoacidosis
Pediatrics
Simulation
Journal
BMC medical education
ISSN: 1472-6920
Titre abrégé: BMC Med Educ
Pays: England
ID NLM: 101088679
Informations de publication
Date de publication:
27 Mar 2024
27 Mar 2024
Historique:
received:
17
10
2023
accepted:
20
03
2024
medline:
28
3
2024
pubmed:
28
3
2024
entrez:
28
3
2024
Statut:
epublish
Résumé
Diabetic ketoacidosis (DKA) is a frequent manifestation at the onset of type 1 diabetes mellitus in children, possibly associated with a wide range of complications, often as a consequence of wrong or delayed treatment. Due to its complex and risky management, direct exposure to real situations alone is not sufficient to achieve adequate skills in pediatric DKA for residents. Simulation could be a valuable aid, allowing to practice a standardized scenario of a complex real-world situation. We aimed to test the effectiveness of a standardized scenario of pediatric DKA in teaching its recognition and treatment. We develop a standardized scenario able to guide step-by-step the learners through the flowchart of DKA management and considering alternative evolutions in the case of possible deviations from guidelines. It was a real-life simulation with the use of a high-fidelity pediatric simulator. It was played by 78 pediatrics 20 and emergency medicine residents. At the end of the simulation, a validated questionnaire was administered to collect feedback from participants regarding the impact of the simulation on learning. All materials to reproduce the DKA scenario are provided. Overall, the scenario was rated as realistic (mean score 4.37 ± 0.68, from 1 to 5) and relevant to professional training (4.72 ± 0.47), useful in increasing confidence in interpreting laboratory tests (3.97 ± 0.65), group organization and communication strategies (3.49 ± 0.94), and managing the treatment of DKA (3.46 ± 0.92). The use of a standardized scenario of pediatric DKA may be a valid tool to reinforce theoretical knowledge in residents, both in pediatrics and in emergency medicine, and to directly and safely practice pediatric DKA management.
Sections du résumé
BACKGROUND
BACKGROUND
Diabetic ketoacidosis (DKA) is a frequent manifestation at the onset of type 1 diabetes mellitus in children, possibly associated with a wide range of complications, often as a consequence of wrong or delayed treatment. Due to its complex and risky management, direct exposure to real situations alone is not sufficient to achieve adequate skills in pediatric DKA for residents. Simulation could be a valuable aid, allowing to practice a standardized scenario of a complex real-world situation. We aimed to test the effectiveness of a standardized scenario of pediatric DKA in teaching its recognition and treatment.
METHODS
METHODS
We develop a standardized scenario able to guide step-by-step the learners through the flowchart of DKA management and considering alternative evolutions in the case of possible deviations from guidelines. It was a real-life simulation with the use of a high-fidelity pediatric simulator. It was played by 78 pediatrics 20 and emergency medicine residents. At the end of the simulation, a validated questionnaire was administered to collect feedback from participants regarding the impact of the simulation on learning. All materials to reproduce the DKA scenario are provided.
RESULTS
RESULTS
Overall, the scenario was rated as realistic (mean score 4.37 ± 0.68, from 1 to 5) and relevant to professional training (4.72 ± 0.47), useful in increasing confidence in interpreting laboratory tests (3.97 ± 0.65), group organization and communication strategies (3.49 ± 0.94), and managing the treatment of DKA (3.46 ± 0.92).
CONCLUSIONS
CONCLUSIONS
The use of a standardized scenario of pediatric DKA may be a valid tool to reinforce theoretical knowledge in residents, both in pediatrics and in emergency medicine, and to directly and safely practice pediatric DKA management.
Identifiants
pubmed: 38539183
doi: 10.1186/s12909-024-05334-0
pii: 10.1186/s12909-024-05334-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
345Informations de copyright
© 2024. The Author(s).
Références
Katsarou A, Gudbjörnsdottir S, Rawshani A, Dabelea D, Bonifacio E, Anderson BJ, Jacobsen LM, Schatz DA, Lernmark Å. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017;3:17016. https://doi.org/10.1038/nrdp.2017.16 .
doi: 10.1038/nrdp.2017.16
Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020;6(1):40. https://doi.org/10.1038/s41572-020-0165-1 .
doi: 10.1038/s41572-020-0165-1
Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022;23(7):835–86. https://doi.org/10.1111/pedi.13406 .
doi: 10.1111/pedi.13406
Lapolla A, Amaro F, Bruttomesso D, Di Bartolo P, Grassi G, Maffeis C, Purrello F, Tumini S. Diabetic ketoacidosis: a consensus statement of the Italian Association of Medical Diabetologists (AMD), Italian society of Diabetology (SID), Italian Society of Endocrinology and Pediatric Diabetoloy (SIEDP). Nutr Metab Cardiovasc Dis. 2020;30(10):1633–44. https://doi.org/10.1016/j.numecd.2020.06.006 .
doi: 10.1016/j.numecd.2020.06.006
Rabbone I, Maltoni G, Tinti D, Zucchini S, Cherubini V, Bonfanti R, Scaramuzza A, Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetology (ISPED). Diabetic ketoacidosis at the onset of disease during a national awareness campaign: a 2-year observational study in children aged 0–18 years. Arch Dis Child. 2020;105(4):363-6. https://doi.org/10.1136/archdischild-2019-316903 . Erratum in: Arch Dis Child. 2021;106(9):e39.
Hsia DS, Tarai SG, Alimi A, Coss-Bu JA, Haymond MW. Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema. Pediatr Diabetes. 2015;16(5):338–44. https://doi.org/10.1111/pedi.12268 .
doi: 10.1111/pedi.12268
Rugg-Gunn CE, Deakin M, Hawcutt DB. Update and harmonisation of guidance for the management of diabetic ketoacidosis in children and young people in the UK. BMJ Paediatr Open. 2021;5(1):e001079. https://doi.org/10.1136/bmjpo-2021-001079 .
doi: 10.1136/bmjpo-2021-001079
Binotti M, Genoni G, Rizzollo S, De Luca M, Carenzo L, Monzani A, Ingrassia PL. Simulation-based medical training for paediatric residents in Italy: a nationwide survey. BMC Med Educ. 2019;19(1):161. https://doi.org/10.1186/s12909-019-1581-3 .
doi: 10.1186/s12909-019-1581-3
Mendpara H, Bajpai A, Patel R, Shukla R, Kapoor R. The Development and Validation of a Mobile Application for Guidance for management of severe Diabetic Ketoacidosis. Indian J Pediatr. 2022;89(12):1251–6. https://doi.org/10.1007/s12098-022-04159-3 .
doi: 10.1007/s12098-022-04159-3
Datta R, Upadhyay K, Jaideep C. Simulation and its role in medical education. Med J Armed Forces India. 2012;68(2):167–72. https://doi.org/10.1016/S0377-1237(12)60040-9 .
doi: 10.1016/S0377-1237(12)60040-9
Ojha R, Liu A, Rai D, Nanan R. Review of Simulation in Pediatrics: the evolution of a revolution. Front Pediatr. 2015;3:106. https://doi.org/10.3389/fped.2015.00106 .
doi: 10.3389/fped.2015.00106
Roberts C, Keilman A, Pearce J, Roberts A, Ching K, Kingsley J, Stephan A, Gross I, Ciener D, Augenstein J, Thomas A. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Pediatric Diabetic Ketoacidosis. MedEdPORTAL. 2021;17:11098. https://doi.org/10.15766/mep_2374-8265.11098 .
doi: 10.15766/mep_2374-8265.11098