"Sim One, Do One, Teach One": A Simulation-Based Trauma Orientation for Pediatric Residents in the Emergency Department

Inclusion of the workshop model in the standardized training of emergency medicine residents

Background

Standardized training of resident physicians (STRP) includes clinical practice, professional required courses, and public required courses, among others. Of them, clinical practice is the most important as it allows residents to implement what they have learned in theoretical education to practice. Clinical practice includes different teaching methods, such as traditional lectures, bedside teaching, and workshops, and each method has its advantages and disadvantages in different situations of interest. Emergency medicine (EM) focuses on the diagnosis and treatment of urgent medical conditions and entails several emergency procedures. In this study, we aimed to compare the effects of workshop-based STRP and traditional STRP on emergency physicians.

Methods

Overall, 125 residents who received STRP in EM between January and December 2021 were selected and randomly divided into two groups: the control group (n = 60; received traditional teaching) and the intervention group (n = 65; received workshop-based training). The theoretical performance, operative performance, and satisfaction of both groups were compared and analyzed.

Results

Regarding theoretical assessment, the scores of airway management, cardiopulmonary resuscitation, and trauma management in the intervention group were 4.81 (t = 5.82, p < 0.001), 6.90 (t = 7.72, p < 0.001), and 5.25 (t = 6.14, p < 0.001), respectively. Regarding skill assessment, the scores for the same items in the intervention group were 4.43 (t = 5.30, p < 0.001), 4.55 (t = 5.61, p < 0.001), and 5.62 (t = 6.65, P < 0.001), respectively. Regarding satisfaction evaluation, the scores in the intervention group were 1.99 (t = 6.03, p < 0.001), 1.98 (t = 6.41, p < 0.001), and 1.96 (t = 6.14, p < 0.001), respectively. Overall, the scores were higher in the intervention group than in the control group.

Conclusion

The workshop training model effectively improves the theoretical knowledge and practical skills of EM residents undergoing standardized training. The residents found the training and its outcomes satisfactory, ultimately improving their emergency response and first-responder skills.

Procedural skill maintenance: Perspectives and motivations of pediatric emergency medicine faculty

BACKGROUND

Pediatric emergency medicine (PEM) physicians receive training in critical procedures, but these procedures are rare in practice. The literature on maintenance of procedural skills focuses on ways to practice (e.g., via simulation) and pays little attention to motivation's role. Understanding what motivates PEM physicians to maintain procedural skills can inform the design of supportive policies and interventions. Our study explores how PEM physicians conceptualize maintenance of procedural skills, what motivates them to maintain procedural skills, and barriers to procedural skill maintenance.

METHODS

This was a qualitative study of 12 PEM faculty guided by the self-determination theory (SDT) of motivation. SDT describes a typology that distinguishes extrinsic and intrinsic motivation, with intrinsic motivation based on autonomy, competence, and relatedness. Interviews were transcribed and coded using constant-comparative technique, and interviews continued until thematic sufficiency was achieved.

RESULTS

Participants had difficulty defining procedural skill maintenance by specific criteria and expressed ambivalence about external standards for competence, noting the need to account for individual and local practice factors. Three themes characterizing participants' motivation for procedural skills maintenance included: (1) desire to provide optimal patient care and fear of unsuccessful performance (competence), (2) procedural competence as part of the identity of a PEM physician who teaches and performs procedures (competence and relatedness), and (3) desire for accessibility and choice of options in maintaining procedural skills (autonomy). Participants identified lack of opportunities, time, and support as barriers to motivation and skills maintenance.

CONCLUSION

SDT concepts were integral to understanding faculty motivation, and this highlights the need for prioritizing faculty autonomy, competence, and relatedness in designing supports for procedural skill maintenance. Our findings regarding the difficulty in defining maintenance of skills emphasize the need for further discussion and study of this topic.

Excellence in Communication and Emergency Leadership (ExCEL): Pediatric Primary and Secondary Survey in Trauma Workshop for Residents

INTRODUCTION

Unintentional traumatic injury remains the leading cause of pediatric death in the United States. There is wide variation in the assessment and management of pediatric trauma patients in emergency departments. Resident education on trauma evaluation and management is lacking. This workshop focused on developing resident familiarity with the primary and secondary trauma survey in pediatric patients.

METHODS

This hands-on workshop utilized patient-actors and low-fidelity simulators to instruct learners on the initial assessment of trauma patients during the primary and secondary trauma surveys. It was designed for residents across all levels of training who care for pediatric trauma patients (including pediatrics, medicine-pediatrics, emergency medicine, and family medicine) and adapted for different session durations and learner group sizes.

RESULTS

Eighteen residents participated in this workshop at two separate institutions. Participants strongly agreed that the workshop was relevant and effective in teaching the initial primary and secondary trauma survey assessment of pediatric trauma patients. Residents also reported high levels of confidence in performing a primary and secondary trauma survey after participation in the workshop.

DISCUSSION

This workshop provided residents with instruction and practice in performing the primary and secondary trauma survey for injured pediatric patients. Additional instruction is needed on assigning Glasgow Coma Scale and AVPU (alert, voice, pain, unresponsive) scores to injured patients. The structure and time line of this curriculum can be adapted to the needs of an individual institution's program and the number of workshop participants.