ESPE Abstracts (2019) 92 P1-9

A Simulation-based Intervention Teaching Illness Management Skills to Caregivers of Children with Adrenal Insufficiency: a Randomised Controlled Study

Heidi Virtanen1,2, Eileen Pyra1,2, Wendy Schawrz1,2, Helen Catena1,2, Amy Cripps1,2, Vincent Grant1,2, Adam Cheng1,2, Rebecca Perry1,2


1Alberta Children's Hospital, Calgary, Canada. 2University of Calgary, Calgary, Canada


Background: Permanent adrenal insufficiency (AI) is an uncommon but potentially life-threatening condition in children. Patients are at particular risk during times of stress. Thus, caregivers should have good illness management skills. Despite frequent teaching and seemingly good knowledge of illness management we still see a reluctance of caregivers to administer intramuscular (IM) hydrocortisone at home when indicated, preferring instead to drive themselves to the emergency department or call emergency medical services, as previously described by other centers. Simulation (SIM) is increasingly used in medical education, but its use in teaching illness management to caregivers of children with AI has not been evaluated.

Objectives: To compare the impact of illness management teaching delivered using SIM or traditional teaching on caregiver's knowledge, ability and confidence with managing illness (including intramuscular hydrocortisone injection) in a child with AI.

Methods: Subjects were randomly assigned to SIM-based teaching or traditional teaching. All participants completed knowledge/self-confidence questionnaires and performance assessments using SIM scenarios, before and after teaching.

Results: 39 caregivers of mean age (SD) 40.2 (8.7) years, of children with AI of mean duration (SD) of 6.3 (4.7) years; were randomized to receive SIM-based teaching (N=20) or traditional teaching (N=19). 61.5% of participants were female.

Within group comparisons *P<0.005TraditionalSIM
Knowledge Scores
(Max score: 10)
Pre-teaching7.0 (2.2)7.8 (1.7)P=0.226
Post-teaching8.3 (1.6)8.4 (1.0)P=0.838
Change observed+1.1 (1.4)+0.5 (1.2)P=0.186
Confidence Scores
(Max score: 40)
Pre-teaching29.3 (7.1)*31.5 (3.0)*P=0.225
Post-teaching37.8 (3.0)*38.8 (1.6)*P=0.232
Change observed+8.6 (5.6)+7.4 (3.1)P=0.416
SIM-scenario Scores
(Max score: 26)
Pre-teaching18.7 (5.4)*16.8 (5.6)*P=0.298
Post-teaching23.4 (1.7)*21.7 (2.8)*P=0.024
Change observed+4.8 (5.8)+4.9 (6.3)P=0.944

Conclusions: Caregiver confidence and performance, as assessed using simulated scenarios, improved significantly in both arms with no difference observed between SIM and the traditional teaching arms. Caregiver performance in both groups was sub-optimal at baseline. These findings highlight the importance of on-going teaching of caregivers of children with established AI and the need to refine our current teaching. The lack of difference between the 2 arms could be explained by the fact that both groups underwent the assessment using SIM-scenarios (pre- and post-) suggesting that incorporating these into the current standard of care teaching would be as beneficial as a SIM-based teaching session. Caregivers reported that they found the SIM-scenarios valuable and many encouraged their partners to subsequently participate in the study.

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