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Yee J, Auerbach MA, Wong KU, Kaur S, Burns RA. Dissemination, Utilization, and Satisfaction With Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds) by North American Residency Programs. Pediatr Emerg Care 2024; 40:364-369. [PMID: 38262070 DOI: 10.1097/pec.0000000000003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Our research team's primary objective was to investigate how a custom standard simulation curriculum for teaching emergency medicine residents about pediatrics was being used by programs across North America. We also wanted to know if program directors were satisfied with the curriculum and whether they had challenges with implementing it. Our long-term goal is to promote the Emergency Medicine Resident Simulation Curriculum for Pediatrics for use by all programs in the United States. METHODS We distributed an electronic questionnaire to individuals who have downloaded the Emergency Medicine Resident Simulation Curriculum for Pediatrics in the form of an e-book from the Academic Life in Emergency Medicine Web site. The curriculum was marketed through national emergency medicine (EM) and pediatric emergency medicine (PEM) groups, PEM listserv, and through the International Network for Simulation-Based Pediatric Innovation, Research, and Education. We asked survey recipients how they used the curriculum, plans for future maintenance, satisfaction with curriculum use, and whether they had any challenges with implementation. Finally, we asked demographic questions. RESULTS Most survey respondents were EM or PEM health care physicians in the United States or Canada. Respondents' primary goal of using the curriculum was resident education. Through assessment with the Net Promoter Score, satisfaction with the curriculum was net positive with users largely scoring as curriculum promoters. We found COVID-19 and overall time limitations to be implementation barriers, whereas learner interest in topics was the largest cited facilitator. Most responders plan to continue to implement either selected cases or the entire curriculum in the future. CONCLUSIONS Of those who responded, our target audience of EM physicians used our curriculum the most. Further investigation on implementation needs, specifically for lower resource emergency programs, is needed.
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Affiliation(s)
- Jennifer Yee
- From the The Ohio State University, Columbus, OH
| | | | - Kei U Wong
- Rutgers New Jersey Medical School, Newark, NJ
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Cavallaro SC, Schutzman S, Li J, Pusic M. Determination, categorization, and hierarchy of content for a pediatric emergency medicine curriculum designed for emergency medicine residents. AEM EDUCATION AND TRAINING 2024; 8:e10978. [PMID: 38628286 PMCID: PMC11017767 DOI: 10.1002/aet2.10978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Background Currently, the Accreditation Council of Graduate Medical Education requires time-based pediatric experiences for emergency medicine (EM) residents in both pediatric emergency medicine (PEM) and critical care settings. The American Board of Emergency Medicine has published the Model of the Clinical Practice of Emergency Medicine, which is a list of content an EM resident should learn. However, this list is large and without prioritization and therefore can be difficult to incorporate into time-limited curricula. Objectives The primary objective of this study was to develop comprehensive categorization of PEM content using an EM lens. The second objective was to suggest a prioritization for the EM learner of the enumerated PEM elements. Methods We first assembled a comprehensive list of PEM concepts, diagnoses, and procedures that might be taught to EM residents. We then convened focus groups composed of key stakeholders to help formulate content and concept themes important for EM resident training. Once the themes were identified, we divided the list of PEM topics into appropriate themes and then carried out a second round of focus groups expanded to include more diverse expert input for prioritizing the elements of the comprehensive list within each theme. Results We prioritized 168 important PEM concepts from previous standards and emerging PEM literature among 10 identified themes: the pediatric normal, the bottom-line boil-it-down approach, common presentations, high-acuity pediatric cases and procedures, differences between children and adults, same between children and adults, red flags, infrequency of caring for a child compared with an adult, keep breadth but promote self-directed depth, and triage and disposition. Conclusions Based on input from stakeholders in EM resident education, we identified key themes within PEM education and created a framework for the hierarchical categorization of PEM content for within an EM residency.
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Affiliation(s)
- Sarah C. Cavallaro
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
| | - Sara Schutzman
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
| | - Joyce Li
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
| | - Martin Pusic
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
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Lees AF, Beni C, Lee A, Wedgeworth P, Dzara K, Joyner B, Tarczy-Hornoch P, Leu M. Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1326-1336. [PMID: 37267042 PMCID: PMC10615720 DOI: 10.1097/acm.0000000000005288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This study systematically reviews the uses of electronic health record (EHR) data to measure graduate medical education (GME) trainee competencies. METHOD In January 2022, the authors conducted a systematic review of original research in MEDLINE from database start to December 31, 2021. The authors searched for articles that used the EHR as their data source and in which the individual GME trainee was the unit of observation and/or unit of analysis. The database query was intentionally broad because an initial survey of pertinent articles identified no unifying Medical Subject Heading terms. Articles were coded and clustered by theme and Accreditation Council for Graduate Medical Education (ACGME) core competency. RESULTS The database search yielded 3,540 articles, of which 86 met the study inclusion criteria. Articles clustered into 16 themes, the largest of which were trainee condition experience (17 articles), work patterns (16 articles), and continuity of care (12 articles). Five of the ACGME core competencies were represented (patient care and procedural skills, practice-based learning and improvement, systems-based practice, medical knowledge, and professionalism). In addition, 25 articles assessed the clinical learning environment. CONCLUSIONS This review identified 86 articles that used EHR data to measure individual GME trainee competencies, spanning 16 themes and 6 competencies and revealing marked between-trainee variation. The authors propose a digital learning cycle framework that arranges sequentially the uses of EHR data within the cycle of clinical experiential learning central to GME. Three technical components necessary to unlock the potential of EHR data to improve GME are described: measures, attribution, and visualization. Partnerships between GME programs and informatics departments will be pivotal in realizing this opportunity.
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Affiliation(s)
- A Fischer Lees
- A. Fischer Lees is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Catherine Beni
- C. Beni is a general surgery resident, Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Albert Lee
- A. Lee is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Patrick Wedgeworth
- P. Wedgeworth is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Kristina Dzara
- K. Dzara is assistant dean for educator development, director, Center for Learning and Innovation in Medical Education, and associate professor of medical education, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Byron Joyner
- B. Joyner is vice dean for graduate medical education and a designated institutional official, Graduate Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Peter Tarczy-Hornoch
- P. Tarczy-Hornoch is professor and chair, Department of Biomedical Informatics and Medical Education, and professor, Department of Pediatrics (Neonatology), University of Washington School of Medicine, and adjunct professor, Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington
| | - Michael Leu
- M. Leu is professor and director, Clinical Informatics Fellowship, Department of Biomedical Informatics and Medical Education, and professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Delgado EM, Fischer J, Scott KR, Mamtani M, Xiong R, Tay K, Verma A, Franco M, Szydlowski E, Toto RL, Conlon L, Posner JC. Perspectives on preparedness for pediatric emergencies after residency: A needs assessment. AEM EDUCATION AND TRAINING 2023; 7:e10898. [PMID: 37529175 PMCID: PMC10387828 DOI: 10.1002/aet2.10898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 08/03/2023]
Abstract
Background General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pediatric emergencies to better inform PEM curricula design. Methods In 2021, senior EM residents and graduates from the classes of 2020 and 2019 across eight EM programs with PEM rotations at the same children's hospital were recruited and surveyed electronically to assess perceived preparedness for 42 pediatric emergencies and procedures by age: infants under 1 year, toddlers, and children over 4 years. Preparedness was reported on a 5-point Likert scale with 1 or 2 defined as "unprepared." A chi-square test of independence compared the proportion of respondents unprepared to manage each condition across age groups, and a p-value < 0.05 demonstrated significance. Results The response rate was 53% (129/242), with a higher response rate from senior residents (65%). Respondents reported feeling unprepared to manage more emergency conditions in infants compared to other age groups. Respondents felt least prepared to manage inborn errors of metabolism and congenital heart disease, with 45%-68% unprepared for these conditions across ages. A heat map compared senior residents to recent graduates. More graduates reported feeling unprepared for major trauma, impending respiratory failure, and pediatric advanced life support algorithms. Conclusions This study, describing the perspective of EM senior residents and recent graduates, offers unique insights into PEM curricular needs during EM training. Future PEM curricula should target infant complaints and conditions with lower preparedness scores across ages. Other centers training EM residents could use our findings and methods to bolster PEM curricula.
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Affiliation(s)
- Eva M. Delgado
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Jason Fischer
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
| | - Kevin R. Scott
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicineHospital of the University of Pennsylvania (HUP)PhiladelphiaPennsylvaniaUSA
| | - Mira Mamtani
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicineHospital of the University of Pennsylvania (HUP)PhiladelphiaPennsylvaniaUSA
| | - Ruiying Xiong
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Khoon‐Yen Tay
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Archana Verma
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Marleny Franco
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Ellen Szydlowski
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Regina L. Toto
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Lauren Conlon
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicineHospital of the University of Pennsylvania (HUP)PhiladelphiaPennsylvaniaUSA
| | - Jill C. Posner
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
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Nickerson J, Ghatak-Roy A, Donnelly KA, Thomas AA, Robinson D, Roszczynialski KN, Zhao X. The Current State of Pediatric Emergency Medicine Training in Emergency Medicine Residencies. Pediatr Emerg Care 2023; 39:167-172. [PMID: 36018727 DOI: 10.1097/pec.0000000000002819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies show that emergency medicine (EM) physicians are less comfortable caring for pediatric patients than adults. The state of pediatric training has not been comprehensively evaluated since 2000. OBJECTIVES We sought to describe current pediatric education in EM residencies and to evaluate EM Program Director (PD) confidence in graduating trainees' abilities to care for pediatric patients. METHODS We conducted an anonymous, cross-sectional survey study of EM PDs in August 2020. We collected program demographics, clinical rotations, and didactic methods. We used Likert scales to measure PD confidence in graduating residents' competence to care for pediatric and adult patients. RESULTS We found e-mail addresses for 249 (93%) of 268 EM programs. One hundred nineteen (48%) PDs completed the survey. We include denominators to account for unanswered questions. Sixty-eight (59%) of 116 programs spend 10% to 20% of clinical time seeing pediatric patients. One hundred ten (91%) of 119 require a pediatric emergency medicine (PEM) rotation, 88/119 (83%) require pediatric intensive care, and 34/119 (29%) require neonatal intensive care. Seventy (62%) of 113 have curricula designed by PEM-trained faculty, 96/113 (85%) have PEM attendings teach lectures, and 77/113 (68%) spend 10% to 20% of didactic time on pediatric topics. Twenty-three (23%) of 106 PDs stated not all residents graduate with competence in pediatric resuscitation compared with 2/106 (2%) for adult resuscitation ( P < 0.05). CONCLUSIONS Program directors report less confidence in graduating residents' competence in caring for pediatric patients compared with adult patients. We propose ideas to strengthen the quality of pediatric education in EM residencies.
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Affiliation(s)
- Jillian Nickerson
- From the Division of Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC
| | - Aditi Ghatak-Roy
- Department of Emergency Medicine, Inova Fairfax Hospital, Falls Church, VA
| | - Katie A Donnelly
- From the Division of Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC
| | - Anita A Thomas
- Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington
| | | | | | - Xian Zhao
- From the Division of Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC
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Bailey J, Nadeau N, Jordan K, Yerxa H, Lam S. The Effect of COVID-19 on United States Pediatric Emergency Departments and Its Impact on Trainees. West J Emerg Med 2022; 23:893-896. [DOI: 10.5811/westjem.2022.7.57340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PED) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models.
Methods: We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based questionnaire. The survey was sent via three national pediatric emergency medicine distribution lists, with several follow-up reminders.
Results: There were 46 questionnaires included, completed by PED directors from 25 states. Forty-two sites provided PED volume and admission data for the early pandemic (March-July 2020) and a pre-pandemic comparison period (March-July 2019). Mean PED volume decreased >32% for each studied month, with a maximum mean reduction of 63.6% (April 2020). Mean percentage of pediatric admissions over baseline also peaked in April 2020 at 38.5% and remained 16.4% above baseline by July 2020. During the study period, 33 (71.1%) sites had decreased clinician staffing at some point. Only three sites (6.7%) reported decreased faculty protected time. All PEDs reported staffing changes, including decreased mid-level use, increased on-call staff, movement of staff between the PED and other units, and added tele-visit shifts. Twenty-six sites (56.5%) raised their patient age cutoff; median was 25 years (interquartile ratio 25-28). Of 44 sites hosting medical trainees, 37 (84.1%) reported a decrease in number of trainees or elimination altogether. Thirty (68.2%) sites had restrictions on patient care provision by trainees: 28 (63.6%) affected medical students, 12 (27.3%) affected residents, and two (4.5%) impacted fellows. Fifteen sites (34.1%) had restrictions on procedures performed by medical students (29.5%), residents (20.5%), or fellows (4.5%).
Conclusion: This study highlights the marked impact of the COVID-19 pandemic on US PEDs, noting decreased patient volumes, increased admission rates, and alterations in staffing models. During the early pandemic, educational restrictions for trainees in the PED setting disproportionately affected medical students over residents, with fellows’ experience largely preserved. Our findings quantify the magnitude of these impacts on trainee pediatric clinical exposure during this period.
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Affiliation(s)
- Jessica Bailey
- Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon
| | - Nicole Nadeau
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Kamyron Jordan
- Oregon Health & Science University, Department of Pediatrics, Portland, Oregon
| | - Hannah Yerxa
- Oregon Health & Science University, Department of Pediatrics, Portland, Oregon
| | - Samuel Lam
- Sutter Medical Center Sacramento, Department of Emergency Medicine, Sacramento, California
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Sokoloff WC, Kusulas MP, Cassara M. Targeted organized teaching scripts (TOTS) in the pediatric emergency department. AEM EDUCATION AND TRAINING 2022; 6:AET210792. [PMID: 35982715 PMCID: PMC9366750 DOI: 10.1002/aet2.10792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
In the pediatric emergency department (PED), considerable challenges inhibit educational opportunities for residents outside of being precepted. The use of teaching scripts specifically addresses these challenges by allowing faculty to have prepared, hyperfocused content that can be delivered in a short time. We developed a series of teaching scripts for 10 high-yield topics in the PED and assessed their effectiveness at improving educational experiences. Teaching scripts were inconsistently used but well received. Their use also correlated with increased resident satisfaction with clinical teaching. The majority of residents and faculty showed considerable interest in expanding the TOTS program to include additional pediatric emergency medicine topics.
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Affiliation(s)
- William C. Sokoloff
- Division of Pediatric Emergency MedicineCohen Children's Medical Center, Northwell HealthQueensNew YorkUSA
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNew YorkUSA
| | - Matthew P. Kusulas
- Division of Pediatric Emergency MedicineCohen Children's Medical Center, Northwell HealthQueensNew YorkUSA
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNew YorkUSA
| | - Michael Cassara
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthHempsteadNew YorkUSA
- Department of Emergency MedicineNorthshore University Hospital, Northwell HealthManhassetNew YorkUSA
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Burns R, Madhok M, Bank I, Nguyen M, Falk M, Waseem M, Auerbach M. Creation of a standardized pediatric emergency medicine simulation curriculum for emergency medicine residents. AEM EDUCATION AND TRAINING 2021; 5:e10685. [PMID: 34632245 PMCID: PMC8489268 DOI: 10.1002/aet2.10685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The majority of children seeking care in emergency departments are seen by general emergency medicine (EM) residency program graduates. Throughout training, EM residents manage fewer critically ill pediatric patients compared to adults, and the exposure to children with illness and injury requiring emergent assessment and management is often limited and sporadic across training sites. This report describes the creation of a robust set of simulation cases for EM trainees incorporating topics identified during a previous modified Delphi study to improve their pediatric acute care knowledge and skills. METHODS All 30 pediatric EM topics and 19/26 procedures previously identified as "must be taught by simulation" to EM residents were mapped to 15 simulation case topics. Twenty-seven authors from 16 institutions created cases and supporting materials. Each case was iteratively implemented during a peer review process at two to five sites with EM residents. Feedback from learners and facilitators was collected via electronic surveys and used to revise each case before the next implementation. RESULTS Thirty-five institutions participated in the peer review process. Fifty-one facilitators and 281 participants (90% EM residents) completed surveys. Most facilitators (98%) agreed or strongly agreed with the statement "This simulation case is relevant to the field of emergency medicine." A majority of facilitators and participants agreed or strongly agreed with the statements "The simulation case was realistic" (98% of facilitators, 94% of participants) and "This simulation case was effective in teaching resuscitation skills" (92% of facilitators, 98% of participants). Most participants reported confidence in knowledge and skills addressed in the learning objectives after participation. CONCLUSIONS Facilitators and EM residents found cases from a novel simulation-based curriculum covering critical pediatric EM topics relevant, realistic, and effective. This curriculum can help provide a standardized, uniform experience for EM residents who will care for critically ill pediatric patients in their communities.
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Affiliation(s)
- Rebekah Burns
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Manu Madhok
- Department of PediatricsChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Ilana Bank
- Department of PediatricsMcGill UniversityMontrealQuebecCanada
| | - Michael Nguyen
- Department of MedicineMorsani College of MedicineUniversity of South FloridaTampaFloridaUSA
| | - Michael Falk
- Department of PediatricsChildren's Hospital Medical CenterWashingtonDCUSA
| | - Muhammad Waseem
- Departments of Pediatrics and Emergency MedicineLincoln Medical CenterBronxNew YorkUSA
| | - Marc Auerbach
- Departments of Pediatrics and Emergency MedicineYale UniversityNew HavenConnecticutUSA
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Andrada E, Danielson A, Magaña J, Tzimenatos L, Clarke S. A pirate ship sailed into the yacht club: How we built a novel pediatric emergency medicine curriculum for an emergency medicine training program. AEM EDUCATION AND TRAINING 2021; 5:e10635. [PMID: 34471791 PMCID: PMC8325435 DOI: 10.1002/aet2.10635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) has seen little progression toward a standardized PEM educational framework. The 2018 Academic Emergency Medicine Consensus Conference on Advancing PEM Education addressed this gap in core EM education. Absent elements include a "broad needs assessment to identify and evaluate existing curricula and systems gaps in EM training" and a "clearly defined core PEM curriculum that unifies and drives the learning process." PEM education innovators were called to construct a "unified foundation in PEM education for all levels of emergency care" and to "promote innovation in teaching and learning strategies in curricula." We endeavored to meet this challenge at our institution. METHODS The PEM curriculum design is based on the Kern model of curriculum development and included a needs assessment, development of goals and objectives, educational strategies, implementation, evaluation, and programmatic feedback. We committed to using effective learning strategies and active learning methods in developing our curriculum and conducted a 1-year pilot within our EM residency's didactic conference. We used exit surveys to collect feedback for each session as well as midyear focus groups to gauge the program's effectiveness. At the start and end of the pilot year residents completed the PEM survey regarding the effect of the PEM curriculum on their self-assessed knowledge, training, and comfort in managing PEM topics. RESULTS Feedback regarding the PEM curriculum was positive. Following 1 year of the pilot curriculum, learners in the PGY-1 and PGY-3 classes demonstrated statistically significant improvement in their self-assessed knowledge, training, and comfort with PEM topics. The PGY-2 class had a similar statistically significant improvement in self-assessed knowledge in PEM topics. CONCLUSIONS Our novel PEM curriculum was well received and has shown early evidence of improving self-assessed knowledge and comfort among EM residents.
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Affiliation(s)
- Emily Andrada
- Department of Emergency MedicineUniversity of California–Davis School of MedicineSacramentoCaliforniaUSA
| | - Aaron Danielson
- Department of Emergency MedicineUniversity of California–Davis School of MedicineSacramentoCaliforniaUSA
| | - Julia Magaña
- Department of Emergency MedicineUniversity of California–Davis School of MedicineSacramentoCaliforniaUSA
| | - Leah Tzimenatos
- Department of Emergency MedicineUniversity of California–Davis School of MedicineSacramentoCaliforniaUSA
| | - Sam Clarke
- Department of Emergency MedicineUniversity of California–Davis School of MedicineSacramentoCaliforniaUSA
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Kou M, Baghdassarian A, Rose JA, Levasseur K, Roskind CG, Vu T, Zuckerbraun NS, Leonard K, Shabanova V, Langhan ML. Milestone achievements in a national sample of pediatric emergency medicine fellows: impact of primary residency training. AEM EDUCATION AND TRAINING 2021; 5:e10575. [PMID: 34124521 PMCID: PMC8171745 DOI: 10.1002/aet2.10575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) fellowships recruit trainees from both pediatric and emergency medicine (EM) residencies. The Accreditation Council for Graduate Medical Education (ACGME) defines separate training pathways for each. The 2015 PEM milestones reflect a combination of subcompetencies from the two residencies. This project aims to compare the milestone achievement of PEM fellows based on their primary residency training. We hypothesize that fellows trained in pediatrics achieve PEM milestones at different rates than EM-trained fellows in the ACGME domains of patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal and communication skills. METHODS This is a multicenter, retrospective cohort study of fellows from a national sample of U.S. PEM fellowship programs. Basic demographic information and deidentified, biannual milestone scores for 23 competencies were collected for fellows training between 2015 and 2018. Subcompetencies are scored on a 5-point milestone scale. Descriptive and multivariable analyses for longitudinal data were performed to compare milestone assessments by primary residency training. RESULTS Complete data were obtained for 600 fellows; 95% (570) and 5% (30) completed pediatric and EM residency, respectively. In both year 1 and year 2 of fellowship, the mean milestone scores of EM-trained fellows were statistically higher than pediatrics-trained fellows across the majority of subcompetencies. By the final year of training, there were no statistically significant differences in milestone scores for any of the subcompetencies. CONCLUSIONS Fellow milestone achievement between groups was not significantly different by graduation. However, fellows entering PEM training from an EM background attained higher scores on the milestones than fellows from a pediatric background in the first year of fellowship.
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Affiliation(s)
- Maybelle Kou
- Emergency MedicineInova Children’s Hospital/VCU SOMFalls ChurchVirginiaUSA
| | - Aline Baghdassarian
- Pediatrics and Emergency MedicineChildren’s Hospital of Richmond at VCU/Virginia Commonwealth University SOMRichmondVirginiaUSA
| | - Jerri A. Rose
- PediatricsRainbow Babies & Children’s Hospital/Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Kelli Levasseur
- Emergency MedicineBeaumont Children’s Hospital/Oakland University William Beaumont School of MedicineRoyal OakMichiganUSA
| | - Cindy G. Roskind
- Emergency Medicine in PediatricsColumbia University Medical CenterNew YorkNew YorkUSA
| | - Tien Vu
- PediatricsChildren’s Hospital Colorado/University of Colorado School of MedicineDenverColoradoUSA
| | | | - Kathryn Leonard
- PediatricsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | | | - Melissa L. Langhan
- Pediatrics and Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
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Burns R, Auerbach M, Mitzman J. Pediatric Emergency Medicine Curricula for Emergency Medicine Residents. AEM EDUCATION AND TRAINING 2021; 5:147-148. [PMID: 33521505 PMCID: PMC7821067 DOI: 10.1002/aet2.10563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 05/30/2023]
Affiliation(s)
- Rebekah Burns
- Associate Professor of PediatricsEmergency Medicine Resident Simulation Curriculum for Pediatrics (EM ResCu Peds) Chief EditorUniversity of WashingtonSeattleWAUSA
| | - Marc Auerbach
- Associate Professor of Pediatrics and Emergency Medicine and Director of Pediatric SimulationYale University School of MedicineNew HavenCTUSA
| | - Jennifer Mitzman
- Assistant Professor of Emergency Medicine and PediatricsThe Ohio State University College of MedicineColumbusOhioUSA
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Buchanan JA, Hagan P, McCormick T, Roosevelt G, Sungar WG, Angerhofer C, Byyny R, Moreira M. A Novel Approach to Neonatal Resuscitation Education for Senior Emergency Medicine Residents. West J Emerg Med 2020; 22:74-76. [PMID: 33439810 PMCID: PMC7806316 DOI: 10.5811/westjem.2020.10.48623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022] Open
Abstract
The majority of pediatric visits occur in general emergency departments. Caring for critically ill neonates is a low-frequency but high-stakes event for emergency physicians, which requires specialized knowledge and hands-on training. We describe a novel clinical rotation for emergency medicine (EM) residents that specifically augments skills in neonatal resuscitation through direct participation as a member of the neonatal resuscitation team. The neonatal resuscitation rotation evaluation median score of 4 (interquartile range [IQR] 3,4) was higher compared to all other off-service senior resident rotations combined (median 3, IQR 3,4) for the academic year 2018–2019. Ninety-two percent of residents evaluated the curriculum change as beneficial (median 4, IQR 4,4). The neonatal resuscitation rotation was rated more favorably than the pediatric intensive care rotation (median 4 IQR 3,4 vs median 3, IQR 2, 3) at a tertiary care children’s hospital during the third year. Residency programs may want to consider implementing a directed neonatal resuscitation experience as part of a comprehensive pediatric curriculum for EM residents.
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Affiliation(s)
- Jennie A Buchanan
- Denver Health & Hospital Authority, University of Colorado, Department of Emergency Medicine, Denver, Colorado
| | - Patricia Hagan
- Denver Health & Hospital Authority, Department of Pediatrics, Denver, Colorado
| | - Taylor McCormick
- Denver Health & Hospital Authority, University of Colorado, Department of Emergency Medicine, Denver, Colorado
| | - Genie Roosevelt
- Denver Health & Hospital Authority, University of Colorado, Department of Emergency Medicine, Denver, Colorado
| | - W Gannon Sungar
- Denver Health & Hospital Authority, University of Colorado, Department of Emergency Medicine, Denver, Colorado
| | - Christy Angerhofer
- Diversity, Equity, & Inclusion, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Maria Moreira
- Denver Health & Hospital Authority, University of Colorado, Department of Emergency Medicine, Denver, Colorado
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Li J, Roosevelt G, McCabe K, Preotle J, Pereira F, Takayesu JK, Porter JJ, Monuteaux M, Bachur RG. Critically Ill Pediatric Case Exposure During Emergency Medicine Residency. J Emerg Med 2020; 59:278-285. [PMID: 32536497 DOI: 10.1016/j.jemermed.2020.04.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Eighty-eight percent of pediatric emergency department (ED) visits occur in general EDs. Exposure to critically ill children during emergency medicine (EM) training has not been well described. OBJECTIVE The objective was to characterize the critically ill pediatric EM case exposure among EM residents. METHODS This is a secondary analysis of a multicenter retrospective review of pediatric patients (aged < 18 years) seen by the 2015 graduating resident physicians at four U.S. EM training programs. The per-resident exposure to Emergency Severity Index (ESI) Level 1 pediatric patients was measured. Resident-level counts of pediatric patients were measured; specific counts were classified by age and Pediatric Emergency Care Applied Network diagnostic categories. RESULTS There were 31,552 children seen by 51 residents across all programs; 434 children (1.3%) had an ESI of 1. The median patient age was 8 years (interquartile range [IQR] 3-12 years). The median overall pediatric critical case exposure per resident was 6 (IQR 3-12 cases). The median trauma and medical exposure was 2 (IQR 0-3) and 3 (IQR 2-10), respectively. For 13 out of 20 diagnostic categories, at least 50% of residents did not see any critical care case in that category. Sixty-eight percent of residents saw 10 or fewer critically ill cases by the end of training. CONCLUSION Pediatric critical care exposure during EM training is very limited. These findings underscore the importance of monitoring trainees' case experience to inform program-specific curricula and to develop strategies to increase exposure and resident entrustment, as well as further research in this area.
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Affiliation(s)
- Joyce Li
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Genie Roosevelt
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado; University of Colorado School of Medicine, Denver, Colorado
| | - Kerry McCabe
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Jane Preotle
- Department of Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island; Alpert Medical School of Brown University, Providence, Rhode Island
| | - Faria Pereira
- Division of Emergency Medicine, Texas Children's Hospital, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - James K Takayesu
- Division of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - John J Porter
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Richard G Bachur
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
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Chen WC, Chaou CH, Ng CJ, Liu YP, Chang YC. Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920926312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.
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Affiliation(s)
- Wei-Chen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung Medical Education Research Centre (CGMERC), Taoyuan City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yueh-Ping Liu
- Department of Medical Affairs, Ministry of Health and Welfare, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Che Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung Medical Education Research Centre (CGMERC), Taoyuan City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
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