OBJECTIVES To assess the ability of a screen-based simulation-training program to improve emergency medicine and pediatric resident performance in critical pediatric resuscitation knowledge, confidence, and skills. METHODS A pre-post, interventional design was used. Three measures of performance were created and assessed before and after intervention: a written pre-course knowledge examination, a self-efficacy confidence score, and a skills-based high-fidelity simulation code scenario. For the high-fidelity skills assessment, independent physician raters recorded and reviewed subject performance. The intervention consisted of eight screen-based pediatric resuscitation scenarios that subjects had 4 weeks to complete. Upon completion of the scenarios, all three measures were repeated. For the confidence assessment, summary pre- and post-test summary confidence scores were compared using a t-test, and for the skills assessment, pre-scores were compared with post-test measures for each individual using McNemar's chi-square test for paired samples. RESULTS Twenty-six of 35 (71.3%) enrolled subjects completed the institutional review board-approved study. Increases were observed in written test scores, confidence, and some critical interventions in high-fidelity simulation. The mean improvement in cumulative confidence scores for all residents was 10.1 (SD +/-4.9; range 0-19; p < 0.001), with no resident feeling less confident after the intervention. Although overall performance in simulated codes did not change significantly, with average scores of 6.65 (+/-1.76) to 7.04 (+/-1.37) out of 9 possible points (p = 0.58), improvement was seen in the administering of appropriate amounts of IV fluids (59-89%, p = 0.03). CONCLUSIONS In this study, improvements in resident knowledge, confidence, and performance of certain skills in simulated pediatric cardiac arrest scenarios suggest that screen-based simulations may be an effective way to enhance resuscitation skills of pediatric providers. These results should be confirmed using a randomized design with an appropriate control group.

We conducted 2 experiments to investigate the possibility that audience laughter affects perceivers' cognitive evaluations of humorous material because, under certain conditions, perceivers use it to infer audience members' evaluations of the material. We predicted that audience laughter would not affect perceivers' cognitive evaluations of the material when the laughter was constrained or otherwise known to be forged. Consistent with this prediction, the results of Experiment 1 showed that perceivers' cognitive evaluations were influenced less by audience laughter that they assumed (or were told) was canned, as compared to laughter that they assumed (or were told) was live. In Experiment 2, we found that constrained (as compared to unconstrained) laughter from an ostensibly live audience had a weaker influence on perceivers' cognitive evaluations of the humorous material because perceivers were less likely to infer that constrained laughter reflected audience members' evaluation of the material.