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Clin J Am Soc Nephrol. 2018 Jun 7;13(6):900-906. doi: 10.2215/CJN.10460917. Epub 2018 May 2.

Teaching Pediatric Peritoneal Dialysis Globally through Virtual Simulation.

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Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.
Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts.
Division of Pediatric Nephrology, Red Cross Children's Hospital, Cape Town, South Africa; and.
Division of Pediatric Nephrology, Randall Children's Hospital, Portland, Oregon.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and the Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts;



Despite the increasing prevalence of childhood kidney disease worldwide, there is a shortage of clinicians trained to provide peritoneal dialysis (PD). E-learning technologies may provide a solution to improve knowledge in PD. We describe the development of a virtual PD simulator and report the first 22 months of online usage.


The PD simulator was developed and released on OPENPediatrics in January of 2016. A prospective study of international, multidisciplinary healthcare providers was conducted from January of 2016 through October of 2017. User action data were analyzed with descriptive statistics and linear regression. Paired t tests compared user pre- and post-test scores. User satisfaction was assessed by survey.


The simulator was accessed by 1066 users in 70 countries. Users spent a median of 35 minutes (interquartile range [IQR] 14-84) in the simulator. Users who completed the structured learning curriculum (n=300) spent a median of 85 minutes (IQR 46-95), and those who completed the entire simulator (n=63) spent a median of 122 minutes (IQR 69-195). Users who completed the simulator were more likely to scroll through text and access the simulator in multiple sessions. The 300 users that completed testing showed statistically significant increases in the post- versus pretest scores, with a mean increase of 36.4 of 100 points, SD 19.9 (95% confidence interval, 34.1 to 38.6, P<0.001). Eighty-seven percent (20 of 23) of survey respondents felt the simulator was relevant to their clinical practice, and 78% (18 of 23) would recommend it to others.


This is the first reported virtual PD simulator. Increased test scores were observed between pre- and post-tests by clinicians who completed testing, across disciplines, training levels, and resource settings.


Child; Curriculum; Global Health; Health Personnel; Humans; Kidney Diseases; Knowledge; Learning; Linear Models; Medical Education; Nephrology Education; Nursing Education; Personal Satisfaction; Prevalence; Prospective Studies; Serious Gaming; Surveys And Questionnaires; Virtual Simulation; pediatric nephrology; peritoneal dialysis

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