Creation of a standardized pediatric emergency medicine simulation curriculum for emergency medicine residents

Identified Needs in Pediatric Education for Emergency Medicine Physicians: A Qualitative Analysis

OBJECTIVES

General emergency medicine (EM) physicians provide most pediatric emergency care in the United States, yet EM physicians feel underprepared to manage pediatric emergencies. Pediatric emergency medicine (PEM) education during EM residency is variable, and learner preferences regarding educational experiences have not been widely explored through a qualitative lens. We aimed to better describe EM physicians' PEM educational needs and preferred teaching methods.

METHODS

In 2021, as part of a survey querying senior EM residents and recent graduates from 8 diverse EM programs regarding perceived preparedness for PEM emergencies, educational needs and content delivery methods were assessed using 2 free-text questions. Qualitative analysis included deidentification and iterative coding of the data with double coding of 100% of the comments. We performed conventional content analysis of responses to identify emerging themes.

RESULTS

The overall response rate for the survey was 53% (N = 129 out of 242 eligible participants) with 84 distinct free-text responses. Major themes included: 1) desire for education regarding neonates, infants, and critically ill children, especially airway management and 2) need for help translating lessons from PEM rotations to community EM practice. Respondents desired more autonomy during training. Their preferred PEM educational modality was simulation, and they appreciated online clinical pathways for just-in-time decision support.

CONCLUSIONS

This qualitative study of EM physicians proximal to training adds to a prior needs assessment by describing in detail desired pediatric content and preferred delivery. The findings can be used to better inform the development of PEM curricula for this group of EM physicians.

General emergency physician perceptions of caring for children: A qualitative interview study

Background

Emergency physicians care for most children presenting to U.S. emergency departments (EDs). Pediatric exposure during emergency medicine (EM) residency can be variable and critically ill children are rarely encountered. A recent needs assessment revealed that emergency physicians feel less prepared to manage various conditions in children and that infants, regardless of presenting complaint, pose particular challenges. Emergency physician perceptions of the experience of caring for pediatric patients have not been widely examined through a qualitative lens.

Methods

We designed an interview-based qualitative study to explore emergency physician perspectives on pediatric patient care. We recruited emergency physicians who graduated from residency in 2015-2019 and all rotated through the same large tertiary children's hospital. Four trained interviewers conducted in-depth, one-on-one virtual interviews. An interdisciplinary team transcribed and then coded the interviews. The team performed a conventional content analysis for themes. Recruitment continued until thematic saturation was achieved.

Results

Twelve participants completed interviews. These participants trained in five diverse residency programs. Likewise, the participants now practice in a variety of settings. Three major themes emerged from the data: (1) experience and exposure are key to establishing comfort caring for children; (2) simulation, pathways, and the pediatric anesthesia rotation are educationally useful; and (3) caring for children poses unique emotional challenges. Participants shared many recommendations for future pediatric education for EM trainees, including increasing autonomy and exposure to neonates and considering how care might differ in a community setting.

Conclusions

This interview-based qualitative study elucidates key themes in recently graduated emergency physicians' perceived experience of caring for children. Our findings have important educational implications for this group of emergency physicians and those who share similar experiences in training and practice.

Current gaps in emergency medicine core content education for oncologic emergencies: A targeted needs assessment

Objective

The core content of emergency medicine (EM) residency training includes the management of oncologic emergencies; however, documented knowledge gaps continue to exist in this subtopic. This study represents a targeted needs assessment as indicated by Step 2 of Kern's curriculum design to determine the specific training gaps to be addressed within the oncologic EM curriculum.

Methods

A multi-institutional cross-sectional survey of oncologists (surgical and medical) and emergency physicians (attendings and residents) was conducted during 2023 at five institutions. The voluntary survey consisted of general and specialty-specific questions exploring gaps in oncologic emergency-specific training/education topics. Descriptive statistics reported responses as frequencies and percentages.

Results

Of the 833 surveys sent across the five sites, 302 (36.3%) were accessed by link; of these, 271 (89.7%) surveys were completed. There were no differences in the responses between early and later respondents and no differences in the characteristics of respondents between sites. A vast majority of the oncologist and EM groups (91.2% and 83.0%, respectively) reported a belief that emergency physicians would benefit from additional oncologic emergency training. Our survey identified 16 important topics for inclusion in an oncologic EM curriculum, including five topics not present on the 2022 Model of Clinical Practice of Emergency Medicine.

Conclusions

Based on this needs assessment, an oncologic EM curriculum should include the topics listed under oncologic emergencies in the 2022 Model of the Clinical Practice of Emergency Medicine along with our respondent-identified topics of radiation therapy adverse effects, stem cell transplant complications, and the management of cancer-specific postsurgical complications, pain, and common diseases in patients with cancer.

Flipping the Teachers: Impact of a Standardized Physiology Curriculum on Neonatology Medical Educators

OBJECTIVE

Academic physicians must teach elements in an Accreditation Council for Graduate Medical Education (ACGME)-mandated curriculum while balancing career development and clinical workload. Exploring educator perceptions on the learning environment and comparing two instructional methods (traditional didactics [TD] vs. flipped classroom [FC]) in one pediatric subspecialty may elucidate current challenges, barriers, and strategies to optimize learning and educator satisfaction.

STUDY DESIGN

A randomized trial comparing effectiveness and learner preference for FC versus TD physiology teaching was conducted in ACGME-accredited neonatal-perinatal medicine (NPM) fellowship programs in 2018 to 2019. Educator preferences were elicited through online surveys pre- and postintervention. Free-text comments were provided for questions exploring strengths, challenges, and opportunities in fellowship education. Statistical analysis included comparisons of demographics and pre-post-intervention educator responses between groups. Thematic analysis of text responses was conducted to identify common subthemes.

RESULTS

From 61 participating programs, 114 FC educators and 130 TD educators completed surveys. At baseline, all educators experienced professional satisfaction from teaching fellows, but noted challenges with time available to create and/or deliver educational content, limited content expertise amongst faculty, colleagues' limited enthusiasm toward educating fellows, and lack of perceived value of education by institutions given limited protected time or credit toward promotion. Postintervention, educators in both groups noted a preference to teach physiology using FC due to interactivity, learner enthusiasm, and learner-centeredness. FC educators had a 17% increase in preference to teach using FC (p = 0.001). Challenges with FC included ensuring adequate trainee preparation, protecting educational time, and providing educators with opportunities to develop facilitation skills.

CONCLUSION

Overall, NPM educators in a trial evaluating a standardized, peer-reviewed curriculum report professional satisfaction from teaching, but described logistical challenges with developing/delivering content. Educators preferred instruction using FC, but identified challenges with learner preparedness and ensuring adequate educator time and skill. Future efforts should be dedicated to addressing these barriers.

KEY POINTS

· Many challenges exist for educators teaching neonatal-perinatal medicine fellows, including time, support, and recognition.. · Many educators preferred using flipped classroom methodology with a standardized curriculum due to interactivity and learner-centeredness.. · Benefits of a standardized, peer-reviewed curriculum include reduced preparation time, adaptability of content, and learning environment enhancement..

Blueprint for community emergency department pediatric simulation

Background

Gaps in quality of pediatric emergency care have been noted in community emergency departments (CEDs), where >85% of children receive care. In situ simulation provides opportunities for hands-on experiences and can help close these gaps. We aimed to develop, implement, and evaluate an innovative, replicable, and scalable pediatric in situ simulation-based CED curriculum, under the leadership of a local colleague, through collaborative approach with a regional academic medical center (AMC).

Methods

Kern's model was used as follows: problem identification and general needs assessment-pediatric readiness assessment and discussions with CED physician and nursing leadership; targeted needs assessment-review of recent pediatric transfer cases; goals and objectives-enhance pediatric knowledge and skills of interprofessional teams and detect latent safety threats; educational strategies-codeveloped by CED and AMC, included prelearning using podcasts and videos, simulation and facilitated debriefing, resource sharing after simulations; implementation-3-h simulation sessions facilitated in person by the CED team and remotely by AMC (leadership required participation and paid staff); and evaluation and feedback-retrospective pre-post survey, Simulation Effectiveness Tool-Modified (SET-M), Net Promoter Score (NPS), and review/feedback meetings.

Results

Based on needs assessment, the selected cases included newborn resuscitation, seizure, asthma, and tetrahydrocannabinol ingestion causing altered mental sensorium in a child. Twenty-four 3-h simulation sessions were conducted over 1 year. A total of 168 participants completed the sessions, while 75 participants (54.7% nurses, 22.7% physicians, and others) completed feedback surveys. Seventy-six percent of participants reported completing presimulation education material. Participants reported improved skills at appropriately evaluating a critically ill newborn and critically ill infant/toddler and improved teamwork during the care of a pediatric patient. The majority agreed that simulation was effective in teaching pediatric resuscitation. The NPS was 84% (excellent).

Conclusions

A locally facilitated CED in situ simulation curriculum was successfully developed and implemented under local leadership, with remote collaboration by AMC. The curriculum was well received and effective.

Perspectives on preparedness for pediatric emergencies after residency: A needs assessment

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.