Ashlyn Oakes

According to a study by Yale researchers, a new tabletop simulation is a simple, cost-effective mode of learning that can boost the confidence and competency of pediatric residents in disaster scenarios.

A tabletop simulation is akin to a board game, in which participants are given a scenario and hypothetical characters are placed under certain conditions, and participants are then told to choose their responses to the conditions. The paper, conducted in part by researchers at the Medical University of South Carolina, Children’s Hospital Los Angeles and Mattel Children’s Hospital UCLA, studied a tabletop simulation created by Yale researchers. In this study, pediatric residents must triage and care for patients who have just come in from a disaster scenario — in the case of this study, an earthquake. The patients were represented by “inexpensive, commercially available dolls” and resources, such as a liter of saline or IV lines, were represented by stickers. Surveys were conducted with the residents before and immediately after the simulation to see how their perceptions, attitudes and confidence levels changed, said Rita Burke, study co-author and study lead investigator at the Children’s Hospital Los Angeles.

“We wanted to create a low-cost, portable disaster tabletop exercise that could be used by learners in both developed and developing health care systems,” said Mark Cicero, study co-author and professor at the Yale School of Medicine. “Something that could be put into a suitcase and taken to any place where a disaster, such as an earthquake, tsunami or mass gun violence, may occur.”

Training residents for disasters is often difficult, because real-time disasters do not happen often, and when they do, they are very high-stakes, Burke said. General simulations are a common means of training for disasters, because they recreate low-frequency scenarios and decrease the stakes, but still develop the appropriate skills and confidence, Cicero said. However, the drawbacks of many simulations, said Cicero, are that they are expensive to conduct and not very portable. The goal of this study was to create an effective simulation that was easily reproducible and portable, so that it could be used by clinical providers who live and work in low-resource, disaster-prone areas, such as countries in the Pacific Rim, said Rachel Whitney, study co-author, clinical fellow in pediatrics emergency medicine and lead investigator at Yale.

Whitney emphasized the low cost of the simulation. The simulation’s preparation was comprised of buying a few dolls from the store and printing out the appropriate stickers, she said.

The simulation can be used in developed nations as well. Cicero said that simulations with markers or small tabletop devices rather than life-sized equipment can take place in lecture halls and medical schools across the country. The study found that participants preferred the mode of learning through simulation to traditional didactic lecture.

The simulation can also be used to train clinical providers who go abroad to developing countries and assist in times of disasters. These providers may not realize that the availability of resources in developing countries can be very different from that with which they are used to working, Burke said. The simulation would provide what the study authors term “just-in-time” training, in which clinical providers can better anticipate the resources and the needs of patients in the immediate aftermath of a disaster, she added.

Further plans include the spread of the simulation to low-resource countries and the adaptation of the simulation to different disasters other than earthquakes and different audiences, Cicero said. An adapted version of this simulation was carried out in the Dominican Republic, where pediatric residents were trained for a month, Walter said. This simulation could be modified for a video game platform such as disaster triage for EMTs, Cicero said. It could also be modified for a school or home setting, he added.

The Dominican Republic has had 307 earthquakes in the past year.