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Grant Programs

POISE Network-Patient Outcomes in Simulation Education

Yale School of Medicine

A multi-centered study to evaluate the effectiveness of simulation on patient outcomes

A critically ill infant is afforded the best opportunity for survival when pediatric providers rapidly perform life saving interventions with minimal errors. Provider performance can be improved through effective education and training. However, most providers develop their skills through a traditional trial and error process. Current training involves watching a more experienced provider perform a complex skill and then practicing that skill for the first time on the next patient. We believe this apprenticeship model of, “see one, do one, teach one,” is not ethical. The patient suffers the consequences of an inexperienced provider making mistakes while developing their skills. This method of training is unacceptable in other high stakes environments, such as aviation. Society would not allow a novice pilot to “learn from mistakes” while flying a plane. The trainee should not be expected to perform a complex procedure after watching the procedure only once and without any hands on practice. How does one perfect a technique with hands-on practice without laying hands on a patient?

Simulation training has reduced the number of accidents in the aviation industry. The pilot must demonstrate mastery in the flight simulator before they are allowed to perform in real life. Repetition and practice is an integral part of becoming a proficient expert. The American College of Graduate Medical Education has accepted simulation as an effective method for both teaching and evaluating procedural skills. Accrediting organizations such as JCAHO and AHRQ are mandating competency based performance measures that use simulation. The FDA has mandated endovascular surgeons demonstrate competence on a carotid artery simulator prior to operating and Israel has mandated simulation credentialing on procedures for anesthesia providers. Unfortunately pediatrics has lagged behind these other specialties and little data exists on the effectiveness of simulation training on patient outcomes.

Our goal is to develop an evidence base that demonstrates the effectiveness of simulation training, testing, and credentialing for improving pediatric acute care skills. Once the evidence is accumulated performing in a simulated environment could become mandatory for practitioners to become licensed to care for acutely ill and injured children. Ultimately improved training will lead to a reduction in pediatric morbidity and mortality. The overarching aim of our work is to improve outcomes in pediatric patients through the development of evidence based simulation educational interventions.

POISE (Patient Outcomes In Simulation Education) continues to develop novel educational training modules that result in measurable improvements in the health outcomes of acutely ill infants and children. Led by Dr. Marc Auerbach and Dr. David Kessler, this collaborative medical education research network, sponsored by R Baby since its inception, has trained over 550 pediatric interns (approximately 20% of all pediatric interns in the country), and approximately 200 educators at 30 leading academic medical centers. Over 100 teaching physicians are actively involved in the POISE community through a website, faculty train-the-trainer curricula, and monthly "expert" webinars. POISE research projects have been published and presented at international research conferences, and POISE has been accepted to present four papers at the 2011 International Meeting of Simulation in Healthcare and to conduct a workshop at the International Pediatric Academic Society conference. POISE is currently forming an oversight committee with some of the international leaders in the field which will help shape the network over the upcoming months in order to impact the maximum number of patients through a global simulation curriculum and modules that will be broadly disseminated, free of charge, to any provider caring for children throughout the world.

Published Findings
& Other Documents

"Sim One, Do One": Infant Lumbar Puncture Simulator Improves Resident Confidence and Skills
[0k/] posted: July 27, 2009

RePedSim: Repetitive Pediatric Simulation Training
[0k/] posted: July 27, 2009

Repetitive Pediatric Simulation Resuscitation Training
[0k/] posted: July 27, 2009

The Use of Simulation for Pediatric Training and Assessment
[0k/] posted: July 27, 2009

Simulation Training During Medical School for Pediatric Procedures: a Multi-Center Descriptive Study
[0k/] posted: January 21, 2010

The Development of POISE
[0k/] posted: January 21, 2010


Marc Auerbach, MD Full profile »
Yale School of Medicine
Office: 212-263-6425