European Journal of Pediatrics

, Volume 177, Issue 12, pp 1863–1867 | Cite as

Pediatric residents’ simulation-based training in patient safety during sedation

  • Nir Friedman
  • Doron Sagi
  • Amitai Ziv
  • Itai ShavitEmail author
Short Communication


In Israeli emergency departments, pediatric residents are allowed to independently perform procedural sedation after training. Preparing the residents to practice unsupervised sedations requires participation in a simulation-based training in patient safety during sedation (STPSDS). The study objective was to evaluate participants’ perception of knowledge and confidence from the STPSDS. We performed a retrospective analysis of participants’ self-reported perception of knowledge acquisition. At the end of each course, participants were requested to rate, anonymously and independently, the training contribution to their knowledge and confidence using a four-point Likert scale. Between January 2010 and December 2017, 321 pediatric residents participated in 67 STPSDS courses; 315 completed the self-assessments. Participants’ median responses of the training contribution were 4 (IQR 3–4) for overall knowledge, 4 (IQR 4–4) for understanding potential complications during sedation, 3 (IQR 3–4) for knowledge in managing adverse events, and 3 (IQR 2–4) for knowledge in practicing safe sedation. Median response for contribution to participants’ confidence in performing sedation was 3 (IQR 3–4).

Conclusion: We found that the STPSDS improved perception of knowledge and confidence among pediatric residents. Our findings suggest that this training has a valuable role in preparing pediatric residents to practice unsupervised sedations in the ED.

What is Known:

In Israel, sedation-trained pediatric residents performed sedations in the Emergency Department

Successful completion of a simulation-based training in patient safety during sedation (STPSDS) is a mandatory requirement to perform unsupervised sedation.

What is New:

The STPSDS improved perception of knowledge and confidence among pediatric residents.

This training may be valuable in preparing pediatric residents to practice unsupervised sedations


Sedation Simulation Training Residents 



Emergency Department


Simulation-based training in patient safety during sedation


Israel Center for Medical Simulation


Pediatric Emergency Medicine


Authors’ contributions

Nir Friedman collected the data and drafted the manuscript.

Nir Friedman, Doron Sagi, Amitai Ziv, and Itai Shavit analyzed and interpreted the data.

Doron Sagi, Amitai Ziv, and Itai Shavit critically revised the manuscript for important intellectual content.

Itai Shavit designed the study and the analysis plan.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by the medical ethical committee of the Sheba Medical Center (3641–16-SMC).


  1. 1.
    Webster CS, Mason KP, Shafer SL (2016) Threats to safety during sedation outside of the operating room and the death of Michael Jackson. Curr Opin Anaesthesiol 29:S36–S47. CrossRefPubMedGoogle Scholar
  2. 2.
    Monroe KK, Beach M, Reindel R, Badwan L, Couloures KG, Hertzog JH, Cravero JP (2013) Analysis of procedural sedation provided by pediatricians. Pediatr Int 55(1):17–23CrossRefGoogle Scholar
  3. 3.
    Shavit I, Steiner IP, Idelman S, Mosleh M, Hadash A, Biniamini L, Lezinger M, Kozer E (2008) Comparison of adverse events during procedural sedation between specially trained pediatric residents and pediatric emergency physicians in Israel. Acad Emerg Med 15:617–622CrossRefGoogle Scholar
  4. 4.
    Shavit I, Keidan I, Hoffmann Y, Mishuk L, Rubin O, Ziv A, Steiner IP (2007) Enhancing patient safety during pediatric sedation: the impact of simulation-based training of nonanesthesiologists. Arch Pediatr Adolesc Med 161:740–743CrossRefGoogle Scholar
  5. 5.
    Bhatt M, Kennedy RM, Osmond MH, Krauss B, McAllister JD, Ansermino JM, Evered LM, Roback MG; Consensus Panel on Sedation Research of Pediatric Emergency Research Canada (PERC) and the Pediatric Emergency Care Applied Research Network (PECARN) (2009) Consensus-based recommendations for standardizing terminology and reporting adverse events for emergency department procedural sedation and analgesia in children. Ann Emerg Med 53:426–435CrossRefGoogle Scholar
  6. 6.
    Schinasi DA, Nadel FM, Hales R, Boswinkel JP, Donoghue AJ (2013) Assessing pediatric residents’ clinical performance in procedural sedation: a simulation-based needs assessment. Pediatr Emerg Care 29:447–452CrossRefGoogle Scholar
  7. 7.
    Fehr JJ, Chao J, Kuan C, Zhong J (2016) The important role of simulation in sedation. Curr Opin Anaesthesiol 29:S14–S20CrossRefGoogle Scholar
  8. 8.
    Griswold S, Ponnuru S, Nishisaki A, Szyld D, Davenport M, Deutsch ES, Nadkarni V (2012) The emergency role of simulation education to achieve patient safety: translating deliberate practice and debriefing to save lives. Pediatr Clin North Am 59:1329–1340CrossRefGoogle Scholar
  9. 9.
    Komasawa N, Fujiwara S, Atagi K, Ueki R, Haba M, Ueshima H, Kaminoh Y, Minami T (2014) Effects of a simulation-based sedation training course on non-anesthesiologists’ attitudes toward sedation and analgesia. J Anesth 28(5):785–789CrossRefGoogle Scholar
  10. 10.
    Sauter TC, Hautz WE, Hostettler S, Brodmann-Maeder M, Martinolli L, Lehmann B, Exadaktylos AK, Haider DG (2016) Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department. Scand J Trauma Resusc Emerg Med 24:97. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Siegel NA, Kobayashi L, Dunbar-Viveiros JA, Devine J, Al-Rasheed RS, Gardiner FG, Olsson K, Lai S, Jones MS, Dannecker M, Overly FL, Gosbee JW, Portelli DC, Jay GD (2015) In situ medical simulation investigation of emergency department procedural sedation with randomized trial of experimental bedside clinical process guidance intervention. Simul Healthc 10:146–153CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nir Friedman
    • 1
    • 2
  • Doron Sagi
    • 2
  • Amitai Ziv
    • 2
    • 3
  • Itai Shavit
    • 2
    • 4
    • 5
    • 6
    Email author
  1. 1.Pediatric Emergency DepartmentSheba Medical CenterTel HashomerIsrael
  2. 2.Israel Center for Medical Simulation (MSR)Sheba Medical CenterTel HashomerIsrael
  3. 3.Sackler School of MedicineTel-Aviv UniversityTel AvivIsrael
  4. 4.Pediatric Emergency DepartmentHaifaIsrael
  5. 5.The Ruth and Bruce Rappaport, Faculty of Medicine, Technion – Israel Institute of TechnologyHaifaIsrael
  6. 6.Kibutz Maayan TzviIsrael

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