Learning the fine art of writing a hemodialysis prescription must be easy for adult nephrologists. By the end of the first month of fellowship, they’ve written about a hundred prescriptions and they’ve got it figured out. For pediatric nephrologists however, provision of acute dialysis is rarer and a new fellow may only find themselves writing acute orders a few times a month under the tutelage of their older, wiser (did I say older?) attendings. Add to that the complexities of size in dialysis of children (weight 3-100+ kg, multiple different filter sizes, blood volume calculations, etc.) and things start to get difficult quickly. Thus, the use of a simulator to teach acute dialysis prescription writing and hemodialysis in children is a welcome addition to nephrology educational materials.
OPENPediatrics is an online learning platform launched at Boston Children’s Hospital in 2012 with the goal of providing open access medical education to clinicians around the world. They recently launched a new simulator for pediatric hemodialysis that is truly revolutionary in pediatric nephrology education. After you launch the simulator, you go through a “knowledge guide” where there are brief educational paragraphs about various parts of the hemodialysis prescription including everything from basic concepts of diffusion and convection to fundamental prescription concepts such as blood flow, ultrafiltration rates, and clearance calculations. There are also learning modules about complications of hemodialysis from the common, hypotension, to the rarer dysequilibrium syndrome. While reading and learning, you’re also being walked through how to make changes or view information in the simulator itself. You have a mini EMR for each simulated patient with vitals, fluid balance, and lab values. Once you (think) you know what you’re doing, it’s off to the patient simulator!
There are 10 simulated patients (“tactics”) and 3 case studies including new acute hemodialysis patients of all sizes and children already receiving hemodialysis with complications that require intervention. After you enter everything in the prescription that you need, you virtually set up your machine, hook up your patient, hit “start”, and see what happens. After every step you are given feedback about your choices that reinforce the teaching concepts from the knowledge guide.
Overall, the OPENPediatrics Hemodialysis simulator is an excellent introduction to hemodialysis concepts and prescription writing in children for fellows and it felt like I was writing a real prescription. I may even break it out with the residents to start to teach them that this stuff isn’t that hard (“and wouldn’t you like to be a pediatric nephrology fellow?”). The only thing missing from the simulator was the ability to choose different sized blood lines. You are encouraged to register on the site and create a log in, which is highly recommended, because this will save your work as the simulator won’t allow you to advance to the next case until you have finished the ones before. I hope to see more innovative pediatric nephrology educational tools like this one coming soon.
Michelle Rheault, MD