Pediatrics · Medical Literature
Effectiveness of situational simulation and case-based learning in pediatric intern cardiopulmonary resuscitation training: a pilot study.
Abstract
pediatric Cardiopulmonary resuscitation (CPR) is critical for saving children who experience cardiac arrest, but traditional teaching is often ineffective at improving clinical competence and teamwork. This study evaluates an innovative, understudied model: situational simulation combined with case-based learning (CBL) in CPR training among pediatric intern. This randomized controlled pilot study involved 100 pediatric interns from an academic teaching hospital. Participants were randomly assigned to either the traditional teaching group or the new teaching model group (i.e., situational simulation with CBL). Semi-structured interviews were conducted and recorded among students participating in the situational simulation with CBL. Data collection continued until data saturation was achieved. The collected data were analyzed using an inductive thematic analysis method within the constructivist paradigm. Two researchers independently coded transcripts using NVivo 12.0, identified themes iteratively, and ensured rigour through member checking. The situational simulation with CBL approach produced significant improvements in clinical operation scores: hands-on CPR (79.56 ± 6.04 vs. 94.20 ± 4.17) and bag-valve-mask ventilation (81.14 ± 6.33 vs. 93.47 ± 3.57) (P < 0.05). For the qualitative component, semi-structured interviews were conducted with 12 participants, and analysis identified 9 core themes grouped into four clusters: "social interactive construction of knowledge," "contextualized construction of knowledge," "active construction of knowledge," and "cultivation of clinical core competencies and professional qualities." The adoption of situational simulation combined with CBL approach can enhance the teaching effectiveness for pediatric interns and improve their overall clinical emergency response capabilities. Consequently, it offers an innovative teaching methodology for CPR training of pediatric interns.
Clinical relevance
In pediatric interns, does a combined situational simulation and case-based learning (CBL) model improve CPR clinical performance scores and learner experience compared with traditional teaching methods? __SNAPSHOT__ {"studyDesign":"Randomized controlled pilot study with an embedded qualitative component (mixed-methods: quantitative RCT + inductive thematic analysis of semi-structured interviews)","setting":"Single academic teaching hospital; country not explicitly stated in the abstract (author names and journal context suggest China)","sampleSize":"n=100 pediatric interns (intervention group: ~50, control group: ~50; exact per-arm allocation not reported in the abstract); 12 participants interviewed for qualitative component","population":"Pediatric interns at an academic teaching hospital; no additional inclusion/exclusion criteria reported in the abstract","intervention":"Situational simulation combined with case-based learning (CBL) for pediatric CPR training","comparator":"Traditional CPR teaching (specific components of traditional teaching not further defined in the abstract)","primaryOutcome":"Clinical operation scores: hands-on CPR skill score and bag-valve-mask (BVM) ventilation score; qualitative themes from semi-structured interviews regarding learner experience","followUp":"Not reported","fundingSource":"Not reported"}
Key findings
The situational simulation + CBL group demonstrated higher clinical operation scores than the traditional teaching group on both assessed skills: hands-on CPR (94.20 ± 4.17 vs. 79.56 ± 6.04) and bag-valve-mask ventilation (93.47 ± 3.57 vs. 81.14 ± 6.33), with both comparisons reported as statistically significant (P < 0.05). The absolute mean difference for hands-on CPR was 14.64 points (calculated) and for BVM ventilation was 12.33 points (calculated) on what appears to be a 100-point scale, though scale anchors and minimum clinically important differences were not defined in the abstract. No confidence intervals, effect sizes, or NNT/NNH were reported. For the qualitative component, 12 participants were interviewed until data saturation; thematic analysis identified 9 core themes organized into four clusters: social interactive construction of knowledge, contextualized construction of knowledge, active construction of knowledge, and cultivation of clinical core competencies and professional qualities. No adverse events or safety outcomes were reported.
Practice implications
This pilot RCT provides preliminary evidence that a combined situational simulation and CBL approach produces meaningfully larger improvements in objective CPR skill scores among pediatric interns compared with conventional instruction. The absolute score differences (~12–15 points on a 100-point scale) are numerically substantial, but clinical importance cannot be fully judged without established minimum clinically important differences for these scoring instruments, and without follow-up data linking skill scores to real-world resuscitation performance or patient outcomes. The qualitative findings add mechanistic plausibility by suggesting that the intervention promotes active, contextualized, and socially situated knowledge construction. Generalizability is constrained by the single-center design, the exclusively intern-level population, and the absence of long-term skill retention data. Patients (or future patients of these interns) who would benefit most are those in pediatric settings where workforce CPR competency is a recognized gap. This summary is based on abstract-level data only; full-text review may reveal additional methodological details, randomization procedures, blinding strategies, scoring instrument validation, and follow-up assessments not available here. __LIMITATIONS__ Pilot study with n=100 from a single institution, limiting statistical power and generalizability.,Abstract does not describe the randomization or allocation concealment method in detail, raising risk-of-bias concerns.,Blinding of assessors is not reported; unblinded scoring of clinical performance can introduce performance-assessment bias.,Outcomes are surrogate skill-performance scores, not patient-centered endpoints (e.g., return of spontaneous circulation, survival); transfer to real clinical performance is not established.,Duration of follow-up and skill retention beyond the training session are not reported, precluding conclusions about durability.,The scoring instruments used are not described or validated in the abstract; their reliability, validity, and minimum clinically important differences are unknown.,The qualitative subsample (n=12) was drawn only from the intervention arm, precluding comparisons of learner experience across groups.,Specific components of the 'traditional teaching' comparator are not defined, limiting reproducibility and contextual interpretation.,Funding source is not disclosed, so potential conflicts of interest cannot be assessed.,Single-country, single-institution design limits applicability to training programs with different curricula, resources, or cultural contexts. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this single-center pilot RCT of 100 pediatric interns, a combined situational simulation and CBL approach produced statistically and numerically larger CPR skill scores (~12–15 points higher on a 100-point scale) than traditional teaching, with qualitative data suggesting enhanced clinical reasoning and teamwork. These are promising findings, but the pilot design, surrogate skill-score endpoints, absent follow-up, and incomplete methodological reporting preclude practice-changing conclusions. Larger, multicenter, adequately powered trials with validated instruments, assessor blinding, and long-term retention and patient outcome data are needed before this model is adopted as standard CPR curriculum.