(1582) Verbalization Versus Recognition of Sepsis by Residents in a Virtual Reality Simulation

Introduction: Sepsis is a major cause of pediatric mortality, and early management saves lives. Residents play a key role in recognition & management of septic patients. This requires the skill to recognize sepsis & communicate the diagnosis. To effectively target interventions to improve resident recognition & response, we must understand current practices. Virtual reality (VR) simulation provides trainees with a simulation experience that prioritizes clinical exam. Our research question was to assess differences in identifying sepsis on a questionnaire versus verbalizing concern during a VR simulation.

Methods: This was a retrospective review of simulations that investigated resident-nurse teamwork in the same VR environment in response to a septic patient. Pediatric residents were from a single, large academic center. Two minutes into the scenario, participants completed a survey about their main clinical concern. We reviewed simulations for resident verbalization of "sepsis" or "shock", vital signs, and interventions prior to the survey pause. These findings were compared to recognition of sepsis on the survey using descriptive statistics.

Results: A total of 33 simulations were reviewed. Sixteen residents (48%) verbalized concern for sepsis while 76% (25/33) reported concern for sepsis on the initial survey (p=0.01). Among those who identified sepsis on the survey, 56% (14/25) verbalized that concern. For the 52% (17/33) who did not verbalize sepsis, 65% (11/17) verbalized multiple vital sign abnormalities. Fever was most frequently verbalized (76%, 25/33). Tachycardia was verbalized by 64% (21/33), hypotension by 61% (20/33), with 82% (27/33) ordering a fluid bolus.

Conclusions: During a VR-based simulation, residents recognized sepsis when prompted but less often verbalized that concern. Instead of saying “sepsis”, residents tended to note associated vital sign abnormalities. Without a shared mental model, the urgency required to treat sepsis may be lost. Implementing interventions that focus on enhancing clear communication during high-stakes events could increase shared situation awareness and speed of intervention, ultimately saving lives. Utilization of novel, high fidelity simulation modalities, such as VR based simulation, makes this a prime target for future research.