High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics

J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):608-17.e1-14. doi: 10.1016/j.jaip.2013.07.006. Epub 2013 Sep 21.


Background: Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation.

Objective: To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills.

Methods: Allergy clinics were invited to Arkansas Children's Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training.

Results: Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004).

Conclusion: Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training.

Keywords: Allergic emergencies; Anaphylaxis; Anaphylaxis treatment; Hybrid simulation education; Medical education.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allergy and Immunology / education*
  • Arkansas
  • Child
  • Clinical Competence / standards
  • Emergency Medicine / education*
  • Emergency Treatment / standards
  • Equipment Design
  • Humans
  • Hypersensitivity / therapy
  • Manikins*
  • Patient Care Team / standards
  • Pediatrics / education*
  • Prospective Studies