- 1 Department of Pediatrics, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- 2 Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
- 3 Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
- 4 Division of Biostatistics, Washington University School of Medicine, Saint Louis, Missouri, USA
- 5 Departments of Anesthesiology and Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
- Correspondence to Dr Gayle M Smink, Department of Pediatrics, Penn State Health Milton S Hershey Medical Center, Hershey, PA 17033, USA;
Introduction We sought to evaluate paediatric oncology simulations intended to improve paediatric residents’ skills and comfort in caring for children with cancer.
Method In a non-randomised trial, controls (the first three rotations) received a standard set of lectures, and the intervention arm received these lectures plus five simulation training scenarios—fever/neutropaenia, a new leukaemia diagnosis, end-of-life care discussion, tumour lysis syndrome and a mediastinal mass. All residents were tested after the rotation on the first three scenarios; management skills were evaluated independently by two raters. Before and after training, all residents completed an emotional-appraisal questionnaire evaluating each scenario as a perceived challenge or threat. Analysis of variance (ANOVA) measured differences by study arm in skills checklist assessments and appraisals; repeated measures ANOVA measured changes in emotional-appraisal scores.
Results Forty-two residents (9 controls, 33 interventions) participated. Inter-rater agreement for skills checklist scores using average-measures intraclass correlation was high (0.847), and overall mean scores were significantly higher for the intervention than control group across both raters (p=0.005). For all residents, perceived challenge increased in the end-of-life simulation, and perceived threat decreased in all three test scenarios. The intervention group, regardless of training year, evaluated the teaching scenarios favourably and felt that challenging oncology situations were addressed, skills were enhanced and the simulations should be offered to other residents.
Conclusions It was feasible to introduce residents to difficult paediatric oncology scenarios using simulation. The intervention group performed more skills than controls when tested and perceive threat declined in all residents after their paediatric oncology rotation.
- pediatric hematology and oncology
- medical education
- resident education
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Funding DBJ was supported in part by the National Cancer Institute (NCI) Cancer Center Support Grant (P30 CA091842; PI: Timothy Eberlein) to the Alvin J Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. GMS was funded in part by the National Institutes of Health (NIH) training grant (2T32 HD007499; Program director/PI: Alan L Schwartz.
Disclaimer Contents of this paper are solely the responsibility of the authors; the NIH funding agencies did not influence the study design, data collection, analysis or manuscript preparation.
Competing interests None declared.
Ethics approval The study was approved by the Institutional Review Board at Washington University School of Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.
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