273 - Piloting a Simulation Case-based Toxicology Curriculum for Pediatric Residents

Poster Number: 273
Publication Number: 273.331

Ankit Singla, UCLA Mattel Childrens Hospital, Playa Vista, CA, United States; michael Levine, ucla, Los Angeles, CA, United States; Sarah Gustafson, Harbor-UCLA Medical Center; Lundquist Institute; University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Brian Chang, UCLA Mattel Children's Hospital, Culver City, CA, United States; Myung Sim, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States

Background: Poisoning can have devastating consequences for children. Most reported cases are pediatric cases according to data from the National Poison Data System, and "poisoning/toxic exposure" is included as an ABP content specification for pediatric residents. Despite this, there is no formal toxicology curriculum at our institution for pediatric residents. Existing published toxicology simulation curricula are largely designed for general emergency medicine learners and are not pediatric-focused.

Objective: We introduced a simulation-based curriculum designed for pediatric residents with exclusively pediatric simulation cases to address resident comfort with and preparedness for common toxic ingestions and hypothesized that implementation of our curriculum would improve residents' reported level of comfort and knowledge.

Design/Methods: We used Kern's Six Steps for curriculum development. After completing a needs assessment of local and national ingestion data review and informal interviews of residents, our team chose three scenarios based on prevalence and lethality of pediatric toxic ingestions: acetaminophen, anticholinergic, and opioid. We focused case objectives on patient management and scripted scenarios to address the objectives with detailed review from the UCLA Simulation Center expert faculty and staff.
The expert toxicologist on the team wrote questions that addressed each curriculum objective for our pre- and post-test, which assessed knowledge and comfort. The questions were reviewed by an expert in educational assessments and edited through cognitive interviews with the resident on our team.
We piloted the simulation curriculum at UCLA across 5 sessions with a total of 16 second- and third-year resident participants, recruited via assignment by the residency program director based on resident availability. We scheduled sessions based on resident and simulation center availability. We assessed participants using the pre- and post-test. We also administered the pre-test via survey to 6 non-participants to assess similarity of participants to non-participants.

Results: Participants demonstrated an improvement on paired sample t-tests in knowledge assessment scores (mean increase of 4.2 questions or 24.6%, p < 0.0001) and McNemar's tests in comfort assessment scores (p < 0.03 for all questions), with no significant baseline difference between participants and non-participants.Conclusion(s): Our simulation-based toxicology curriculum pilot demonstrated feasibility of integration into the senior resident schedule, and improved resident knowledge of and comfort with common pediatric toxicology topics.
Curriculum Vitae for Ankit SinglaAnkit CV-Hospitalist.pdf
Comfort scoresSelf-reported confidence scores for 8 skills demonstrate significant improvement for both second- and third-year participants with no major difference in amount of improvement between second- and third-year participants or in baseline scores among second-year non-participants, second-year participants, and third-year participants