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Schoppel K, Keilman A, Fayyaz J, Padlipsky P, Diaz MCG, Wing R, Hughes M, Franco M, Swinger N, Whitfill T, Walsh B. Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation: A Pilot Study. Pediatr Emerg Care 2024; 40:591-597. [PMID: 38809592 DOI: 10.1097/pec.0000000000003216] [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: 05/30/2024]
Abstract
OBJECTIVES The majority of pediatric patients in the United States (US) are evaluated and treated at general emergency departments. It is possible that discrepancies in length of emergency medicine (EM) residency training may allow for variable exposure to pediatric patients, critical resuscitations, and didactic events. The goal of this pilot study was to compare leadership skills of graduating EM residents from 3- to 4-year programs during simulated pediatric resuscitations using a previously validated leadership assessment tool, the Concise Assessment of Leader Management (CALM). METHODS This was a prospective, multicenter, simulation-based cohort pilot study that included graduating 3 rd - and 4 th -year EM resident physicians from 6 EM residency programs. We measured leadership performance across 3 simulated pediatric resuscitations (sepsis, seizure, cardiac arrest) using the CALM tool and compared leadership scores between the 3 rd - and 4 th -year resident cohorts. We also correlated leadership to self-efficacy scores. RESULTS Data was analyzed for 47 participating residents (24 3 rd -year residents and 23 4 th -year residents). Out of a total possible CALM score of 66, residents from 3-year programs scored 45.2 [SD ± 5.2], 46.8 [SD ± 5.0], and 46.6 [SD ± 4.7], whereas residents from 4-year programs scored 45.5 [SD ± 5.2], 46.4 [SD ± 5.0], and 48.2 [SD ± 4.3] during the sepsis, seizure, and cardiac arrest cases, respectively. The mean leadership score across all 3 cases for the 3-year cohort was 46.2 [SD ± 4.8] versus 46.7 [SD ± 4.5] ( P = 0.715) for the 4-year cohort. CONCLUSIONS These data show feasibility for a larger cohort project and, while not statistically significant, suggest no difference in leadership skills between 3 rd - and 4 th -year EM residents in our study cohort. This pilot study provides the basis of future work that will assess a larger multicenter cohort with the hope to obtain a more generalizable dataset.
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Affiliation(s)
- Kyle Schoppel
- From the Indiana University School of Medicine/Riley Hospital for Children
| | | | - Jabeen Fayyaz
- The Hospital for Sick Children/University of Toronto
| | | | | | | | | | | | - Nathan Swinger
- From the Indiana University School of Medicine/Riley Hospital for Children
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Toto RL, Fischer J, Mamtani M, Scott KR, Bauman B, Delgado EM. Identified Needs in Pediatric Education for Emergency Medicine Physicians: A Qualitative Analysis. Pediatr Emerg Care 2024:00006565-990000000-00495. [PMID: 39043167 DOI: 10.1097/pec.0000000000003235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
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.
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Affiliation(s)
- Regina L Toto
- From the Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - Brooke Bauman
- From the Children's Hospital of Philadelphia, Philadelphia, PA
| | - Eva M Delgado
- From the Children's Hospital of Philadelphia, Philadelphia, PA
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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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Schoppel K, Spector J, Okafor I, Church R, Deblois K, Della‐Giustina D, Kellogg A, MacVane C, Pirotte M, Snow D, Hays G, Mariorenzi A, Connelly H, Sheng A. Gaps in pediatric emergency medicine education of emergency medicine residents: A needs assessment of recent graduates. AEM EDUCATION AND TRAINING 2023; 7:e10918. [PMID: 38037628 PMCID: PMC10685395 DOI: 10.1002/aet2.10918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023]
Abstract
Background More than 90% of pediatric patients presenting to emergency departments (EDs) in the United States are evaluated and treated in community-based EDs. Recent evidence suggests that mortality outcomes may be worse for critically ill pediatric patients treated at community EDs. The disparate mortality outcomes may be due to inconsistency in pediatric-specific education provided to emergency medicine (EM) trainees during residency training. There are few studies surveying recently graduated EM physicians assessing perceived gaps in the pediatric emergency medicine (PEM) education they received during residency. Methods This was a prospective, survey-based, descriptive cohort study of EM residency graduates from 10 institutions across the United States who were <5 years out from residency training. Deidentified surveys were distributed via email. Results A total of 222 responses were obtained from 570 eligible participants (39.1%). Non-ED pediatric rotations during residency training included pediatric intensive care (60%), pediatric anesthesia (32.4%), neonatal intensive care unit (26.1%), and pediatric wards (17.1%). A large percentage (42.8%) of respondents felt uncomfortable managing neonates and performing tube thoracostomy on pediatric patients (56.3%). The EM graduate's satisfaction with pediatric simulation-based training during residency was positively associated with comfort caring for neonates and infants (p < 0.0070 and p < 0.0002) and performing endotracheal intubation (p < 0.0027), lumbar puncture (p < 0.0004), and Pediatric Advanced Life Support resuscitation (p < 0.0001). Conclusions/discussion This survey-based cohort study found considerable variation in pediatric-specific experiences during EM residency training and in perceived comfort managing pediatric patients. In general, participants were more comfortable managing older children. This study suggests that the greatest perceived knowledge gaps in PEM were neonatal medicine/resuscitation and pediatric cardiac arrest. Future research will continue to address larger cohorts, representative of the PEM education provided to EM physicians in the United States to promote future educational initiatives.
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Affiliation(s)
- Kyle Schoppel
- Indiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
| | - Jordan Spector
- Boston University Chobanian & Avedisian School of MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Ijeoma Okafor
- Boston University Chobanian & Avedisian School of MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Richard Church
- University of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | | | | | | | - Casey MacVane
- Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
| | | | - David Snow
- Loyola University Medical CenterMaywoodIllinoisUSA
| | - Geoffrey Hays
- Indiana University School of Medicine, Riley Hospital for ChildrenIndianapolisIndianaUSA
| | - Amy Mariorenzi
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Haley Connelly
- Boston University Chobanian & Avedisian School of MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Alexander Sheng
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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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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Law AKK, Kelly AM. E-learning and virtual patient simulation in emergency medicine: New solutions for old problems. HONG KONG J EMERG ME 2022. [DOI: 10.1177/10249079221124754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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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Simma L, Stocker M, Lehner M, Wehrli L, Righini-Grunder F. Critically Ill Children in a Swiss Pediatric Emergency Department With an Interdisciplinary Approach: A Prospective Cohort Study. Front Pediatr 2021; 9:721646. [PMID: 34708009 PMCID: PMC8544259 DOI: 10.3389/fped.2021.721646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Delivery of prompt and adequate care for critically ill and injured children presenting to the pediatric emergency department (PED) is paramount for optimal outcomes. Knowledge of the local epidemiology, patient profile, and presentation modes are key for organizational planning, staff education strategy, and optimal care in a PED. Our aim was to analyze the profile of critically ill and injured children admitted to a tertiary, non-academic Swiss PED, to investigate potential risk factors associated with admission to the pediatric intensive care unit (PICU), and the outcomes mortality and PICU admission. Methods: Prospective cohort study of critically ill and injured children presenting to the PED over a two-year period (2018-2019). Inclusion criteria were Australasian triage scale category (ATS) 1, trauma team activation (TTA), medical emergency response (MER) activation, additional critical care consult, and transfer to an outside hospital. Results: Of 42,579 visits during the two-year period, 347 presentations matched the inclusion criteria (0.81%). Leading presentations were central nervous system (CNS) disorders (26.2%), trauma (25.1%), and respiratory emergencies (24.2%). 288 out of 347 cases (83%) arrived during the day or evening with an even distribution over the days of the week. 128 out of 347 (37%) arrived unexpectedly as walk-ins. 233 (67.15%) were ATS category 1. 51% of the cohort was admitted to PICU. Australasian triage scale category 1 was significantly more common in this group (p = 0.0001). Infants with respiratory disease had an increased risk of PICU transfer compared to other age groups (OR 4.18 [95%CI 2.46, 7.09] p = 0.0001), and this age group presented mainly as walk-in (p = 0.0001). Pediatric intensive care unit admissions had a longer hospital stay (4 [2, 8] days vs. 2 [1, 4] days, p = 0.0001) compared to other patients. 0.045% of all PED patients had to be transferred out. Three deaths (0.86%) occurred in the PED, 10 patients died in the PICU (2.9%). Conclusions: High acuity presentations in the PED were rare, more likely to be young with CNS disorders, trauma and respiratory diseases. A significant proportion were unexpected walk-in presentations, mainly during day and evening shifts. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED.
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Affiliation(s)
- Leopold Simma
- Emergency Department, Children's Hospital Lucerne, Lucerne, Switzerland.,Emergency Department, University's Children Hospital Zurich, Zurich, Switzerland
| | - Martin Stocker
- Neonatal and Pediatric Intensive Care, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Markus Lehner
- Department of Pediatric Surgery, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Lea Wehrli
- Department of Pediatric Surgery, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Franziska Righini-Grunder
- Division of Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
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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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