Bridging the gap in adrenal crisis management: a pilot simulation-based pre post educational intervention to improve resident knowledge

BACKGROUND: Adrenal crisis (AC) is a rare but life-threatening pediatric emergency requiring rapid recognition and immediate administration of stress-dose glucocorticoids. Because AC is infrequently encountered during clinical training, pediatric and medicine pediatric residents may lack confidence and knowledge regarding timely diagnosis of adrenal insufficiency (AI), sick-day management, appropriate hydrocortisone dosing, and appropriate acute AC management. Simulation-based education provides a controlled environment to address these critical gaps. The objective of this pilot study was to assess the immediate educational impact of a high-fidelity simulation and structured debriefing on resident knowledge of AC recognition and management. METHODS: Pediatric and medicine-pediatric residents participated in a 45-minute simulation session consisting of a novel, investigator-developed pediatric emergency department scenario involving AC, followed by a structured debrief focused on clinical decision-making, stress-dose steroid administration, dosing, and outpatient sick-day management. Residents completed a four-question knowledge assessment immediately before and after the intervention, with each question addressing a distinct domain of AC management. Responses were coded as correct or incorrect. Paired pre- and post-intervention responses were analyzed using McNemar's test for individual questions and paired tests for composite knowledge scores. RESULTS: Thirty-five residents completed paired pre- and post-simulation assessments. Baseline knowledge varied across domains, with particularly low accuracy in outpatient sick-day management (2.9%) and stress-dose hydrocortisone dosing (42.9%). Following the simulation and debriefing, correct response rates improved across all domains, with the greatest gains observed in sick-day management (85.3% post-intervention, p < 0.001) and stress-dose dosing (93.9%, p < 0.001). Recognition of first-line treatment for AC improved from 80.0% to 100% (p = 0.031). Mean composite knowledge scores increased significantly from 2.11 to 3.66 out of 4 (p < 0.001). CONCLUSIONS: A single simulation-based educational intervention with structured debriefing was associated with improved immediate knowledge of AC recognition and management among pediatric and medicine pediatric residents. Further studies are needed to evaluate long-term retention and translation to clinical performance.