1. Background and Objectives
Mental Practice as an Adjunct to Improving Pediatric Resuscitation Skills
Lee Marks, MD and Linda Spillane, MD
University of Rochester Medical Center
Background and Objectives
Background & Objectives
The number of pediatric resuscitations that trainees experience is limited. Simulation is used to augment Emergency Medicine Resident experience with managing critically ill pediatric patients. Mental practice (MP), the rehearsal of cognitive or technical skills without physical performance of that skill, has been used in sports, music, and to a limited extent medicine.
MP has been used as an adjunct to improve procedural skill performance of surgical residents. The use of this technique to enhance crisis resource management performance however, has had mixed results.
We explored MP as a tool to train residents to better manage pediatric patients with respiratory failure.
Curricular Design/Station 1
MP Coaching
Details/Station 2
Observations & Conclusions
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2. Station 1 Curricular Design
Mental Practice as an Adjunct to Improving Pediatric Resuscitation Skills
Lee Marks, MD and Linda Spillane, MD
Station 1
Curricular Design
Two Stations/Sessions
Station 1 – 40 Minutes
Definition of MP
Brief EMS report
MP with respect to tasks
Team Leader
Other supportive roles
Plan for “what ifs”
Station 2 – 40 Minutes
Same case as in Station 1
Faculty observation
Knowledge application
Debriefing
EMS Report
En route with 10YO male, unresponsive on school bus. Poor respiratory effort and low O2 Sat at 76%; HR of 104; 10 minutes out.
Team leader assigned (upper level)
Members of Team
R1s, R2s, R3s, Pharmacy, Nursing
Roles assigned by team leader
Airway
IV Access
CPR/Monitor
Medications
Background & Objective
MP Coaching
Observations & Conclusions
Curricular Design/Station 1
Details/Station 2

3. Mental Practice as an Adjunct to Improving Pediatric Resuscitation Skills
Lee Marks, MD and Linda Spillane, MD
MP Coaching
Particular Example
(Airway Role)
What is MP
Brief description to the participants
Concept of “mentally rehearsing” crisis resource management and technical skills
Relating to a specific case or technical procedure
Participants asked to use mental imagery to perform their assigned role, but not physically do the skill
So what are you prepared to do? What is your actual technique and steps and can you visualize these steps?
“Set up BMV” (But what does that mean? )
“Set up to intubate” (Tell me details  e.g., what size tube; what type of blade)
“Prepare to perform RSI” (What medications and what dosing; why)
What is your backup plan?
Likewise for other assigned roles
Background & Objectives
Curricular Design/Station 1
MP Coaching
Details/Station 2
Observations & Conclusions

4. Estimated Wt of child: ~ 30 Kg ETT Size: 6.5
Mental Practice as an Adjunct to Improving Pediatric Resuscitation Skills
Lee Marks, MD and Linda Spillane, MD
Some Specific Details During Station 1
Station 2
Estimated Wt of child: ~ 30 Kg
ETT Size: 6.5
Intubating Blade Type and Size: 2/3
Medication Doses
Etomidate: 9 mg
SCh: 45 mg
Roc: 30 mg
Ativan: 3 mg
Epi: 0.3 mg (1:10,000) IV
IVF: 600 ml
Glucose: 15 – 30 gm
The patient arrives; is transferred to the bed in the resuscitation room.
Per EMS, the patient with a history of cognitive delay was on a bus going to a day program and was noted to be unresponsive. No seizure activity was noted. When EMS arrived the child was obtunded and not seizing. BG was approximately 200. The child was placed on oxygen for a low O2 Sat – not bagged en route.
Team asked to manage the patient
Background & Objectives
Curricular Design/Station 1
MP Coaching
Details/Station 2
Observations & Conclusions

5. Observations Conclusions
Mental Practice as an Adjunct to Improving Pediatric Resuscitation Skills
Lee Marks, MD and Linda Spillane, MD
Observations
Conclusions
Observation of:
Team leader skills
Team coordination
Communications between team members
Situational awareness
Clinical skills
Technique for particular procedural skills
For example: BVM; I/O placement
Appropriate weight based medications
For example: RSI medications
Knowledge application
Generation of differential diagnosis
Compared to a prior simulation of a child with respiratory failure, there was no apparent improvement in demonstrated skills. Team members, concentrating on individual roles appeared to communicate less and have difficulty coordinating tasks. Team performance may have improved with use of specific check lists during the MP session and more robust team leadership training. MP itself may be a complex skill that takes practice. It is imperative that we find ways to better educate our residents to manage less common but critically important patient presentations.
Background & Objectives
MP Coaching
Curricular Design/Station 1
Details/Station 2
Observations & Conclusions
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6. Mental Practice as an Adjunct to Improving Pediatric Resuscitation Skills
Lee Marks, MD and Linda Spillane, MD
References
Hayter MA, Bould MA, et al. Does warm-up using mental practice improve crisis resource management performance? A simulation study. British Journal of Anaesthesia 2013; 110:
Louridas M, Bonrath EM, et al. Randomized clinical trial to evaluate mental practice in enhancing advanced laparoscopic surgical performance. BJS 2015; 102: 37-44
Lorello GR, Hicks CM, et al. Mental practice: a simple tool to enhance team-based trauma resuscitation. CJEM 2016; 18(2):
Background & Objectives
Curricular Design/Station 1
MP Coaching
Details/Station 2
Observations & Conclusions