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Graef SE, Karimi N, Xu M, Petropoulos JA, Ngo QN, Bilgic E. What is the impact of simulation-based training for paediatric procedures on patient outcomes, cost and latent safety threats? CLINICAL TEACHER 2024:e13786. [PMID: 38812076 DOI: 10.1111/tct.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Simulation-based training (SBT) provides a safe space for medical trainees to experience realistic scenarios. SBT has been found to improve trainee performance in paediatric procedures. However, limited evidence exists regarding its effects on higher-level outcomes. This scoping review aims to identify studies that investigate the impact of SBT for procedural skills on T3 (patient outcomes) and T4 level outcomes (latent safety threats [LSTs], and hospital level costs) in paediatrics. METHODS Full-text articles were included if they focused on medical trainees, used simulation training for paediatric procedures and reported T3/T4 level outcomes. Six databases were searched from January 2011 to September 2022. Search strategies were developed with the assistance of a librarian. Three independent reviewers performed pilot screenings before title/abstract and full-text screenings. A data extraction sheet was created to gather information on interventions, outcomes, research design, and other study characteristics. FINDINGS After title/abstract screening of 4,076 sources, 50 were included for full-text review, with 15 articles selected for data extraction. Four were randomised control studies (RCTs), fourteen focused on T3 level outcomes including mortality rates, and one measured LSTs. There were no studies reporting cost-related data. Three of the studies focused on bag-and-mask ventilation, and eight mentioned the use of mannequins. DISCUSSION We highlight the potential effectiveness of simulation-based training of paediatric procedural skills in improving patient outcomes, such as reduced mortality rates and incidence of illness/injury. CONCLUSION Though the quality of research designs was low, researchers used different simulation modalities and outcome measures and showed a positive impact of SBT(e.g., decreased mortality rates).
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Affiliation(s)
- Samuel E Graef
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nima Karimi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maggie Xu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Quang N Ngo
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elif Bilgic
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- McMaster Education Research, Innovation and Theory (MERIT) Program, Hamilton, Ontario, Canada
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Chow CP, Hill DA, Dehority W, Greene EA. Understanding the Procedural Skills Needed in Rural Pediatric Practices: A Survey of Rural Pediatric Providers in the State of New Mexico. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241229772. [PMID: 38327826 PMCID: PMC10848801 DOI: 10.1177/23821205241229772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES There is little data evaluating procedural skills in current rural pediatric practices. In order to prepare a cadre of pediatricians to work in rural settings, we require an understanding of the unique procedural skills needed by rural pediatric providers. Our objective was to determine how often pediatricians performed various procedural skills, determine the importance of these skills to current practice, and how they differ between rural and urban pediatric providers. METHODS A survey evaluating pediatrician utilization of the 13 required Accreditation Council Graduate Medical Education procedural skills in current practice was developed and distributed to pediatric providers in New Mexico. Descriptive statistics were used to profile participants and describe survey responses. Chi-square tests were used to evaluate differences by urban setting or IHS. Fisher's exact test was employed to assess differences if cell sizes were less than five. All p-values were two sided with alpha=.05. Benjamini-Hochberg method was used to control for type 1 errors. RESULTS Fifty-two of 216 pediatric providers responded. The majority surveyed performed each of the 13 procedures less than monthly but competency in many of these procedures is important. Thirty-two respondents submitted free-text responses recommending competence with tracheostomy changes, gastrostomy-tube changes/cares, and circumcision. CONCLUSION Majority of surveyed pediatricians performed the required procedures less than monthly but deemed several procedures to be important. Rural pediatricians recommended specific procedural skills needed in rural practice. All trainees receive procedural skills training. However, trainees interested in rural practice may need additional training in specific skills different than their non-rural counterparts.
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Affiliation(s)
- Christal P. Chow
- Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, USA
| | - Deirdre A. Hill
- Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Walter Dehority
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - E. Anne Greene
- Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, USA
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Kum-Nji P. From Private Practice to Academia: The Experience of a General Academic Pediatrician. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231203828. [PMID: 38025026 PMCID: PMC10655644 DOI: 10.1177/23821205231203828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/13/2023] [Indexed: 12/01/2023]
Abstract
After pediatric residency, the author worked in a rural community where he was able to immediately practice skills acquired during training such as intubations, bag-mask ventilation, IV placement, ear irrigation, foreign body removal from eyes and ears, abscess incision and drainage, intraosseous placement for rapid hydration of a severely dehydrated infant, EKG, X-ray readings, and ear-irrigations to cite but a few examples. Furthermore, the writer acquired other high-valued procedural skills such as neonatal male circumcision, frenotomy, ligation of supernumerary digits, and manual separation of labial adhesions. The author feels that he could only have acquired and maintained these skills by working in a busy rural pediatric practice. When the writer later became a faculty member, he was able to effectively train medical students and pediatric residents to acquire these same skills. Even though there is a paucity of research information on procedural skills acquisition among general pediatric residents, the writer proposes that the recruitment of full-time general academic pediatricians with real-world experience may be potentially beneficial for the training of medical students and pediatric residents.
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Affiliation(s)
- Philip Kum-Nji
- Children's Hospital of Richmond at the Virginia Commonwealth University School of Medicine, Richmond, Richmond, Virginia, USA
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Jonathan FBH, Sridevi AT, Wicaksono BA, Friska D, Hegar B. Indonesian pediatricians’ understanding and management of infant regurgitation based on Rome IV criteria. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.6.2022.373-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background The diagnostic criteria of infant regurgitation have been well elucidated in the Rome IV criteria and pediatricians have been informed of them. However, as a functional disorder, infant regurgitation is susceptible to misdiagnosis and inappropriate management.
Objective To assess pediatricians’ diagnostic knowledge of and therapeutic approach to infant regurgitation.
Methods We conducted a cross-sectional, analytical study using a questionnaire based on Rome IV criteria for infant regurgitation diagnosis and standardized guidelines for management. The questionnaire was face-level validated by an expert and tested for both reliability and correlation using 30 test respondents. The questionnaire was then distributed electronically to 131 randomized pediatricians, who were members of the Indonesian Pediatric Society DKI Jakarta branch and graduated from pediatric residency within year 2005-2019.
Results Sixty-seven (51%) pediatricians reported applying the Rome IV criteria in daily clinical practice. Pediatricians who used Rome IV as their source of knowledge achieved mean and median diagnostic knowledge scores of 14.87 (SD 2.540) and 16 (range 8–20), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ diagnostic understanding (P=0.110), and mean and median therapeutic knowledge scores of 9.10 (SD 2.264) and 10 (range 4–12), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ therapeutic approach (P=0.486). Pediatricians’ diagnostic knowledge and therapeutic approach were not significantly different with regards to their practice experience, specialist institution, workplaces, and source of information.
Conclusion The majority of pediatricians surveyed have good diagnostic and therapeutic knowledge scores with regards to handling of Rome IV infant regurgitation.
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Al Maawali A, Amin H, Baerg K, Feldman M, Gorodzinksy F, Puran A, Dubrowski A, Bismilla Z. To sim or not to sim-choosing wisely for procedural skills training in paediatrics. Paediatr Child Health 2022; 27:220-224. [PMID: 35859687 PMCID: PMC9291393 DOI: 10.1093/pch/pxac010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Simulation is a commonly used modality to teach paediatric procedural skills, however, it is resource intensive. Which paediatric skills are best taught using simulation is not known. This study aims to examine what skills to simulate, allowing for the best use of resources in ever expanding curricula. Method We administered a questionnaire to community and hospitalist general paediatricians in Canada asking them to rate the importance of maintaining competency in each paediatric procedural skill and the frequency with which they perform the skill in their practice. Results Skills that were rated as highly important and also high frequency were: bag-mask ventilation (BMV), lumbar puncture, neonatal cardiopulmonary resuscitation (CPR), specimen procurement for infectious diseases, immunization, and ear curettage. Skills that were rated as highly important but low frequency were: paediatric CPR, intraosseous needle insertion, neonatal intubation, defibrillation, gathering specimens for evidence of child maltreatment, paediatric intubation, cervical spine immobilization, and oral/nasogastric tube placement. Conclusion Paediatric procedural skills are rated variably in terms of importance and frequency of use in general paediatric practice. Eight skills of high importance are infrequently performed and should be targeted for teaching via simulation.
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Affiliation(s)
- Ali Al Maawali
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- The Royal Hospital, Child Health Department, Muscat, Oman
| | - Harish Amin
- Department of Pediatrics, Alberta Health Services, University of Calgary, Calgary, Alberta, Canada
| | - Krista Baerg
- Department of Paediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mark Feldman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Fabian Gorodzinksy
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Allan Puran
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Dubrowski
- maxSIMhealth, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Zia Bismilla
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Gupta S, Longmore A, Drake M, Han R, Sgro M, Hollamby K, Campbell DM. The Development of a Simulated Umbilical Line Insertion Model and Curriculum in the Neonatal Intensive Care Unit. Cureus 2021; 13:e13418. [PMID: 33763314 PMCID: PMC7980722 DOI: 10.7759/cureus.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background Insertion of an umbilical venous catheter (UVC) is a required skill for pediatric residents to learn and perform effectively. However, there is known variability in the ability of residents to perform this essential neonatal skill. Objective The objective of our study was to create a competency-based curriculum for umbilical vein catheter insertion using a human umbilical tissue simulated model, and to assess the feasibility of the curriculum on resident learners during their neonatology rotations. Methods We evaluated the curriculum by assessment of resident learning, reactions, and behaviours. Performance was assessed using the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Results A total of 14 residents were included for analysis. The majority were 'senior' residents (postgraduate year (PGY)-3 and PGY-4 n = 10; PGY-1 n =4), and they reported a wide range of previous experience with UVC insertion prior to this curriculum implementation. The residents' reaction to the curriculum was overwhelmingly positive. All residents maintained or improved in their knowledge assessment. O-SCORE results showed improvement in UVC insertion before and after curriculum completion for both junior (2.5 +/- 0.71 to 4.5 +/- 0.41) and senior (3.55 +/- 0.42 to 4.95 +/- 0.15, p < 0.001) residents. The mean improvement in O-SCORE was greater for junior residents than senior residents. Conclusion The results of this study demonstrate the feasibility and emerging impact of a competency-based curriculum using simulation for procedural skills.
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Affiliation(s)
- Sunayna Gupta
- Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
| | | | - Madeline Drake
- Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
| | - Ra Han
- Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
- Pediatrics, University of Toronto, Toronto, CAN
| | - Michael Sgro
- Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
- Pediatrics, University of Toronto, Toronto, CAN
| | - Kathleen Hollamby
- Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, CAN
- Pediatrics, University of Toronto, Toronto, CAN
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Haviland C, Lucas A, Chen YC, Paolino J, Dzara K, Frey-Vogel AS. Simulated Umbilical Venous Catheter Placement Improves Resident Competence and Confidence. Cureus 2020; 12:e10810. [PMID: 33163314 PMCID: PMC7641490 DOI: 10.7759/cureus.10810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022] Open
Abstract
Background Pediatric ACGME (Accreditation Council for Graduate Medical Education) requirements include demonstrated competence in umbilical line placement. Given a waning number of these procedures clinically available to residents, new methods of procedural teaching must be employed. We developed a simulation-based strategy, using adult-learning principles, to teach umbilical venous catheter (UVC) placement to pediatric residents. We also determined whether procedural teaching via simulation increased confidence and competence among pediatric residents in performing the procedure. Methods Out of 23 first-year pediatric residents, eight participated in the study. Participants completed a survey evaluating their self-perceived competence and confidence in umbilical line placement. Their simulated umbilical line placement was assessed using a standardized checklist. Residents were then trained on simulated line placement in small groups by neonatologists. Six months later, residents completed a post-training survey and were assessed while placing simulated lines. Statistical analysis was completed using a paired t-test for parametric data, Wilcoxon signed-rank sum test for non-parametric data, and McNemar's chi-squared test for categorical data. Spearman's correlation was used for ordinal variables and Pearson's correlation was used for continuous variables. Results Nine PGY-1 (post-graduate year-1) residents completed the pre-training survey and simulation, while eight residents completed the post-training survey and simulation. There was an increase in resident confidence in placing umbilical lines six months after completion of the training session (p = 0.015) even though there was no difference in the number of umbilical lines that residents had placed in the intervening time. The residents performed a greater number of steps correctly after the training compared to their performance before the training (p=0.001). There was a statistically significant positive correlation between resident confidence and the number of steps performed correctly (rs(14)= 0.649, p = 0.006). There was no correlation between confidence and the number of umbilical lines placed on live subjects. Conclusion A teaching strategy that allows pediatric residents to struggle to perform UVC placement in a simulated setting, before receiving expert instruction, is effective at increasing their confidence and competence, even in the absence of exposure to human subjects.
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Affiliation(s)
| | | | - Yih-Chieh Chen
- Division of Allergy and Clinical Immunology, Jeff and Penny Vinik Center for Allergic Diseases Research, Brigham and Women's Hospital, Boston, USA
| | - Jonathan Paolino
- Cancer and Blood Disorders Center, Dana-Farber/Boston Children's Hospital, Boston, USA
| | - Kristina Dzara
- Brigham Education Institute, Brigham and Women's Hospital, Boston, USA
- Pediatrics and Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA
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Vetere P, Cooke S. Preparedness to practice paediatric hospital medicine. Paediatr Child Health 2019; 25:447-454. [PMID: 33173556 DOI: 10.1093/pch/pxz113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background The field of paediatric hospital medicine (PHM) is evolving to meet the needs of an increasingly complex paediatric population, lead quality improvement initiatives, and conduct field-specific teaching and research. Over 50 subspecialty PHM fellowship programs exist in the USA and Canada and more are under active development to ensure trainees are prepared to perform competencies specific to the field following transition to independent practice. Objective The objective of this study was to assess the perceived preparedness of recently graduated general paediatric residents and recently certified staff paediatricians in Canada with respect to the practice of PHM. Methods A survey based on the 'Objectives of Training in Pediatrics' of the Royal College of Physicians and Surgeons of Canada (RCPSC) was distributed to graduating paediatric residents and recently graduated staff paediatricians (2013 to 2017) practicing in the hospital setting. Qualitative comments were also obtained. Results Fifty-five surveys were completed (50%). Respondents perceived that, at the on-set of starting practice, they would require assistance or consultation with the majority of representative PHM task competencies. Differences in perception between the two groups were minimal. Our study identified sub-sets of perceived areas of particular strengths (Professional) and deficiencies (Medical Expert, Manager, and Scholar). Conclusions Results may help inform future curricula for general paediatric residency programs and provide insight into competencies that may be better targeted for PHM fellowship training programs. This study may also stimulate discussion regarding entrustable professional activities for paediatric curricula as the medical community shifts to a new paradigm of outcome-based assessment.
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Affiliation(s)
- Peter Vetere
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Section of Hospital Pediatrics, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta
| | - Suzette Cooke
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Section of Hospital Pediatrics, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta
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Iyer MS. A Comparison of National Pediatric Procedures Training Guidelines With Actual Clinical Practice in Ohio. J Grad Med Educ 2019; 11:159-167. [PMID: 31024647 PMCID: PMC6476089 DOI: 10.4300/jgme-d-18-00746.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/27/2018] [Accepted: 01/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) and Pediatrics Review Committee (RC) recommends the clinical procedures residents should master during their training. These guidelines may be partially based on consensus opinion or tradition rather than actual need. The literature defining which procedures general pediatricians actually perform in practice is limited. OBJECTIVE Our objective was to determine how often general pediatricians perform procedures recommended by accreditation bodies, how well prepared they feel to perform them, and how important the procedures are to their practice. METHODS We categorized recommended procedures as emergent, urgent, or office-based, then developed and administered a survey in 2017 based on these classes. We randomly sampled and polled 439 general pediatricians from urban, suburban, or rural regions across central Ohio. Responses were compared using the Welch ANOVA, Mann Whitney U, and post-hoc tests. RESULTS The response rate was 60% (265 of 439). Pediatricians almost never performed 11 of 13 recommended procedures, yet felt well prepared to perform them all and believed that all were important. Rural pediatricians performed significantly more emergent and office-based procedures and rated them as more important. Commonly performed non-ACGME/RC procedures were circumcision, wart removal, cerumen removal, umbilical cauterization, and suture removal. CONCLUSIONS Findings suggest that pediatricians rarely perform most of the recommended procedures, but think they are important. There are several office-based non-ACGME recommended procedures that pediatricians commonly perform. Regional differences suggest the need for customized training based on future practice plans.
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