Application of Simulation in Teaching Pediatric Resuscitation

  • Posted on: Wed, 12/23/2015 - 21:33
  • By: OCHIS
Due to patient safety issues in China, pediatric residents have limited opportunities to practice procedures or manage resuscitation during clinical care.  Simulation-based training will serve as an important tool to improve learning outcomes in pediatric resuscitation training.

Dealing with acute pediatric emergencies can be challenging, since children have anatomical and physiological differences that place additional demands on healthcare providers. Pediatric healthcare providers require training opportunities to acquire the knowledge and skills to appropriately manage children with critically ill children. However, trainees (i.e. residents, interns, etc.) often have few opportunities to master procedures on real patients due to patient safety issues. As a result, many pediatric trainees finish their training lacking sufficient procedural proficiency and resuscitation expertise in the care of critical ill children [1]. In the past decade, simulation has been widely used in healthcare education across various specialties in North America. The use of simulation as an educational tool provides a risk-free environment for both patients and pediatric trainees to address pertinent issues related to resuscitation training.

Simulation has been used to teach neonatal resuscitation, pediatric advanced life support, advanced airway management, procedural training (cardiopulmonary resuscitation, lumber puncture, intravascular access establishment) and crisis resource management training [2].

As simulation-based education (SBE) has been established as an effective educational modality for pediatric [3] disciplines, the next logical question is: “How should SBE be optimally designed to enhance learning outcomes?” Effective instructional design is a critical component of SBE that pediatric resuscitation educators should consider when utilizing simulation-based resuscitation training. A recent systematic review identified 10 different instructional design features for SBE and highlighted the relative benefit of each feature for various types of learning outcomes [4]. We list a few instructional designs frequently used in pediatric simulation-based education.

  1. Use of high-fidelity simulation [3] – the use of high-fidelity manikin and environment similar to workplace allows trainees to better transfer what is learned to real practice.

  2. Distributed practice [5] – small amount of teaching dispersed over a period of time decreases the cognitive load of learners and improve the retrieval of information.

  3. Deliberate practice – the main components of deliberate practice include a well-defined objective at an appropriate difficulty level, repetitive practice and immediate feedback on performance [6].

  4. Appropriate feedback [7] – a combination of real-time feedback and debriefing.

Although simulation education and research is evolving, there are still several research gaps that help to inform the future direction of pediatric simulation research. Firstly, there is a lack of research assessing actual patient outcomes. SBE has been shown to improve the satisfaction of learners and skill performance in the simulated environment, but the ultimate purpose of SBE is to improve patient outcomes in real clinical world. Secondly, little is known about how simulation should be optimally used for summative assessment. To date, simulation has been primarily used for the purpose of teaching. However, the simulated environment could also function as a standardized setting to assess team as well as individual performance for resuscitation-related behaviors or tasks. Lastly, but not the least, there is a scarcity of research assessing the cost-effectiveness of SBE for resuscitation training. The equipment and maintenance of a simulation lab is expensive. Future research should not only define the optimal means of SBE for resuscitation, but also explore cost-benefit analysis for the same SBE interventions.

Simulation based education is still in its infancy in China. Some institutions started to have funding to purchase simulation equipment and build simulation labs within hospitals and medical colleges. However, few institutions are able to design a curriculum to carry out effective simulation training. There is also a lack of professional simulation educators in China. As a result, some simulation scenarios were run without clear learning objectives. Furthermore, key elements in simulation-based training, like debriefing, were sometimes not provided sufficiently and evaluation of simulation-based learning is completely missing. Taken together, there is a scarcity in simulation-based research in China.

We recommend [2] pediatric simulations training programs in Canada for your reference:

SickKids Simulation Program is certified by Royal College of Physicians and Surgeons of Canada. (

KidSIM Simulation Education and Research Program provides training on both education and research. The program has collaboration with a number of institutions across North America for simulation-based research. The program also provides basic to advanced courses to simulation educators. (


[1] Nadel F, Lavelle J, Fein J, et al. Assessing pediatric senior residents’ training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care. 2000;16:73-76.

[2] Lin Y, Cheng A. The role of simulation in teaching pediatric resuscitation: current perspectives. 2015;6:239-248. doi:10.2147/AMEP.S64178.

[3] Cheng A, Lang TR, Starr SR, Pusic M, Cook DA. Technology-Enhanced Simulation and Pediatric Education: A Meta-analysis. Pediatrics. 2014. doi:10.1542/peds.2013-2139.

[4] Cook D a., Hamstra SJ, Brydges R, et al. Comparative Effectiveness of Instructional Design Features in Simulation-Based Education: Systematic Review and Meta-Analysis.; 2012. doi:10.3109/0142159X.2012.714886.

[5] Raman M, McLaughlin K, Violato C, Rostom A, Allard JP, Coderre S. Teaching in small portions dispersed over time enhances long-term knowledge retention. Med Teach. 2010;32(3):250-255. doi:10.3109/01421590903197019.

[6] Issenberg S, McGaghie W, Petrusa E, et al. Features and uses ofhigh-fidelity medical simulations that lead toeffective learning: A BEME systematic review. Med Teach. 2005;27:10-28.

[7] Cheng A, Eppich W, Grant V, Sherbino J, Zendejas B, Cook DA. Debiefing for technology-enhanced simulation: a systematic review and meta-analysis. Med Educ. 2014;48:657-666.

Author's Biography

Yiqun Lin

Yiqun Lin obtained his medical degree from Shanghai Medical College of Fudan University. He completed a clinical fellowship in Pediatric Emergency Medicine at the Hospital for Sick Children in Toronto in 2008 and practiced in Shanghai for a few years. In 2013, he completed a master’s program in clinical epidemiology at the University of British Columbia and joined KidSIM simulation education and research program as a simulation fellow. Meanwhile, he is pursuing his PhD specializing in Medical Education at University of Calgary. His current research interests include CPR, pediatric resuscitation, and simulation-based training.


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