235 - Pediatric Nephrology Simulation-Based Curriculum: Hypotension during hemodialysis.

Publication Number: 235.6239

Rajavee A. Panchal, Emory University School of Medicine, Decatur, GA, United States; Linda O.. Lewin, Emory University School of Medicine, Atlanta, GA, United States; Roshan P. George, Emory University School of Medicine, Atlanta, GA, United States; Chia-shi Wang, Emory University School of Medicine, Atlanta, GA, United States; Larry A. Greenbaum, Emory University School of Medicine, Decatur, GA, United States; Vikramjeet Kakade, Emory University School of Medicine, Decatur, GA, United States; Sabina Kennedy, Emory University School of Medicine, Atlanta, GA, United States

Background: Hypotension is a common complication during hemodialysis (HD). There are few validated approaches for teaching and assessing trainee competency in managing HD-associated hypotension.

Objective: To improve medical knowledge and provider competency in dealing with hypotension during HD.

Design/Methods: We developed a simulation program (Fig 1) aimed at enhancing pediatric nephrology trainees' medical knowledge and management skills. The process involved defining learning objectives and conducting a needs assessment to identify knowledge gaps. We designed the program by creating a simulation blueprint that included appropriate scenarios and resources. During the development phase, we built the simulation with realistic elements and conducted rigorous testing. Next, we moved to the evaluation phase. Six pediatric nephrology fellows participated with pre-training medical knowledge assessed by a questionnaire. During the simulation session, we used a checklist to assess the evidence-based management of each trainee. We debriefed the fellows on their management using the plus-delta technique. We evaluated the efficacy of the training program using an educational evaluation tool (Kirkpatrick model) that measured their reactions, learning, and behavior changes through questionnaires. The same simulation case was conducted again after 3 months. We described fellow’s medical knowledge and management skills pre- and post-training alongside their self-perceived confidence (5-point Likert scale). We described fellows’ evaluation of the program’s effectiveness in increasing their knowledge and their assessment of inclusion of the program in their fellowship training.

Results: The knowledge survey of all six participants showed a pre-training mean score of 72.7% (SD 6) and the post-training mean score of 82.7% (SD 11.7). Checklist scores of two participants, showed a mean score of 75% (SD 5) in the first simulation and a mean score of 95% (SD 5) in the second. Five of six fellows rated the simulation training as excellent for increasing knowledge; one rated it very good. All reported increased confidence in dealing with acute hypotension of dialysis (5 reported definite, 1 reported probable) and taking immediate steps in management (6 reported definite increase). Additionally, all the fellows reported that simulation-based education should definitely be included in their fellowship training.

Conclusion(s): This pilot program suggests that simulation-based education was well received by pediatric nephrology fellows, positively impacting their learning and clinical skills in management of acute hypotension during HD.

Figure 1.
Comprehensive Simulation Program for Pediatric Nephrology Trainees: A stepwise approach to developing a simulation program to train and assess management skills for acute hypotension during hemodialysis.