1
|
Naus A, Carroll M, Gerk A, Mooney DP, Yanchar NL, Ferreira J, Poenaru D, Gripp KE, Ouellet C, Botelho F. Implementation of a Global Pediatric Trauma Course in an Upper Middle-Income Country: A Pilot Study. J Surg Res 2024; 298:355-363. [PMID: 38663262 DOI: 10.1016/j.jss.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/25/2024] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Over 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. METHODS A 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants' performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal-Wallis tests, and Wilcoxon rank-sum tests. RESULTS Twenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. CONCLUSIONS Completion of global TRIK improved surgeons' confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.
Collapse
Affiliation(s)
- Abbie Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Lahey Hospital and Medical Center, Beth Israel Lahey, Burlington, MA. https://twitter.com/abbieEnaus
| | - Madeleine Carroll
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Yale New Haven Hospital, New Haven, CT
| | - Ayla Gerk
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Natalie L Yanchar
- Department of Surgery, Alberta Children's Hospital, Calgary, AB, Canada
| | - Julia Ferreira
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - Dan Poenaru
- Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - Karen E Gripp
- Emergency Department, The Children's Hospital of Winnipeg, Winnipeg, MB, Canada
| | - Caroline Ouellet
- Emergency Department, Montreal Children's Hospital, Montreal, QC, Canada
| | - Fabio Botelho
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada.
| |
Collapse
|
2
|
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).
Collapse
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
| |
Collapse
|
3
|
Al Wachami N, Chahboune M, Youlyouz-marfak I, Mesradi MR, Lemriss H, Hilali A. Improving the quality of care and patient safety in oncology, the contribution of simulation-based training: A scoping review. Int J Nurs Sci 2024; 11:187-196. [PMID: 38707685 PMCID: PMC11064576 DOI: 10.1016/j.ijnss.2024.03.005] [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] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
Objective Simulation-based training (SBT) is an effective educational method widely used in many clinical settings, including oncology. This study aimed to undertake a scoping review of research related to SBT in oncology to provide a comprehensive understanding of the role of SBT in enhancing the skills of healthcare professionals and thereby improving the quality of care and patient safety in oncology. Methods We conducted a scoping review to map published studies in Medline, Scopus, and Web of Science databases. Peer-reviewed articles about data on the role of SBT in improving and enhancing the skills of healthcare professionals in oncology published in English and French from 2012 to 2022 were retrieved. Two researchers screened, extracted, and analyzed all identified studies independently. Results Of the 1,013 publications identified in the initial phase, 29 studies were included in the analysis. Twenty-five of these studies focused on non-technical skills, such as decision-making, communication, teamwork, and cognitive abilities. Thirteen studies focused on technical skills. The results of all included studies showed significant improvement in the skills of oncology healthcare professionals through SBT programs. Fourteen studies subjectively assessed the role of this educational tool, while nine objectively evaluated it. Six studies used a combined subjective and objective evaluation method. Conclusions SBT is a very effective tool for improving the skills of healthcare professionals in oncology. Supporting and promoting SBT is essential to providing high-quality care and ensuring patient safety in all areas of health care.
Collapse
Affiliation(s)
- Nadia Al Wachami
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat, Morocco
| | - Mohamed Chahboune
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat, Morocco
| | - Ibtissam Youlyouz-marfak
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat, Morocco
| | - Mohamed Reda Mesradi
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat, Morocco
| | - Hajar Lemriss
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat, Morocco
| | - Abderraouf Hilali
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Sciences and Health Technologies, Settat, Morocco
| |
Collapse
|
4
|
Henkel EB, Lemke D, Rubalcava D, Naik-Mathuria B, Gautreaux KM, Eggers J, Doughty C. Multidisciplinary Simulation for Blunt and Penetrating Pediatric Trauma Utilizing Standard and Rapid Cycle Deliberate Practice Models. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11390. [PMID: 38504967 PMCID: PMC10948622 DOI: 10.15766/mep_2374-8265.11390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/18/2023] [Indexed: 03/21/2024]
Abstract
Introduction Pediatric trauma resuscitations are low-frequency, high-stakes events that require skilled multidisciplinary teams with strong medical knowledge and communication skills. Methods This pediatric trauma simulation training session included two cases and formats. The first case was designed in a traditional format and featured a 12-month-old child with inflicted blunt head and abdominal trauma. The second case was organized in successive rounds utilizing the rapid cycle deliberate practice (RCDP) model and featured an 18-month-old with gunshot wounds to the abdomen and chest. Educational objectives included effective communication in a multidisciplinary team, timely completion of primary and secondary surveys, awareness of systems and processes related to trauma care, and increasing competency with low-frequency pediatric trauma skills. Necessary equipment included high-fidelity toddler-sized mannequins, chest tube task trainer or applicable mannequin and equipment, intubation equipment and supplies, intraosseous access, and blood products with rapid delivery infusers. This training session was designed for learners in a multidisciplinary team including physician trainees, nurses, and advanced practice providers; adjustments could be made to the team members as desired. Results Quantitative and qualitative evaluations demonstrated high learner satisfaction and engagement, particularly in the RCDP style of learning. Discussion Multidisciplinary team practice of pediatric trauma scenarios, particularly utilizing the RCDP simulation model, provides the opportunity to improve teamwork and communication, practice procedural skills, and deepen team members' understanding of and comfort with trauma resuscitations.
Collapse
Affiliation(s)
- Erin B. Henkel
- Assistant Professor, Department of Pediatrics, Baylor College of Medicine; Associate Trauma Medical Director, Division of Pediatric Emergency Medicine, Texas Children's Hospital
| | - Daniel Lemke
- Associate Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine; Associate Medical Director of Simulation Center, Texas Children's Hospital
| | - Daniel Rubalcava
- Assistant Professor, Department of Pediatrics, Baylor College of Medicine; Associate Trauma Director, Division of Pediatric Emergency Medicine, Texas Children's Hospital
| | - Bindi Naik-Mathuria
- Professor, Division of Pediatric Surgery, Department of Surgery, University of Texas Medical Branch
| | | | - Jeannie Eggers
- Manager for Quality Education and Simulation, Texas Children's Hospital
| | - Cara Doughty
- Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Simulation, Texas Children's Hospital
| |
Collapse
|
5
|
Koźlik M, Kosiuk J, Cogiel M, Kost J, Hemmerling D, Staniszewski M, Szczęsna A, Wojakowski W, Jadczyk T. Assessment of novel electrophysiology simulator-a survey study. Adv Simul (Lond) 2024; 9:9. [PMID: 38351092 PMCID: PMC10865533 DOI: 10.1186/s41077-024-00280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Invasive electrophysiology (EP) training requires intellectual skills related to the interpretation of intracardiac electrograms. The classic approach to the education of young electrophysiologists focused solely on theoretical knowledge and overseen procedures in patients as no real-life-like simulation of EP studies was available. OBJECTIVE The purpose of this study was to assess a novel tool for EP training based on fully interactive, online simulator providing real clinical experience to the users. METHODS EP simulator users access a system with simulated electrocardiogram, mimicking signals recorded by a catheter. Assessment of EP simulator by 40 electrophysiologists from 16 countries was collected via online questionnaire. RESULTS The realism of ECG signals was described as excellent or very good by 90% of responders, of intracardial signals by 82.5%. Realism of signal interactions and user experience was judged as excellent or very good by 75% and 70% accordingly. One hundred percent of users agree definitely or mostly that EP Simulator helps to translate theoretical into practical knowledge. Of responders, 97.5% would include it in EP training programs as it is extremely or very useful for training purposes in the opinion of 87.5%. Of responders, 72.5% think that training on EP simulator can potentially reduce the rate of complications. In 87.5%, the overall experience was completely or mostly satisfying and would be recommended by 100% of responders. CONCLUSION EP simulator is a feasible tool for training of young electrophysiologist, and it may be potentially included in the cardiologist curriculum. We should particularly emphasize the positive respondents' assessment of EP simulator overall realism.
Collapse
Affiliation(s)
- Maciej Koźlik
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, 40055, Poland.
| | - Jędrzej Kosiuk
- Departament of Cardiology, Helios Klinik Koethen, Koethen, 06366, Germany
| | - Michał Cogiel
- QSystems.pro sp. z o.o, Mochnackiego 34, Bytom, 41907, Poland
| | - Jan Kost
- AGH University of Science and Technology, Kraków, 30059, Poland
| | | | - Michał Staniszewski
- Department of Computer Graphics, Vision and Digital Systems, Silesian University of Technology, Akademicka 16, Gliwice, 44100, Poland
| | - Agnieszka Szczęsna
- Department of Computer Graphics, Vision and Digital Systems, Silesian University of Technology, Akademicka 16, Gliwice, 44100, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, 40055, Poland
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, 40055, Poland
| |
Collapse
|
6
|
Wang J, Lv C, Song X, Hu Y, Hao W, He L, Chen Y, Gan Y, Han X, Yan S. Current situation and needs analysis of medical staff first aid ability in China: a cross-sectional study. BMC Emerg Med 2023; 23:128. [PMID: 37919639 PMCID: PMC10623825 DOI: 10.1186/s12873-023-00891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES We aim to understand the current situation of the first aid ability and training needs of Chinese medical personnel to provide a scientific basis for formulating the contents and methods of emergency medical rescue training and thereby improve the first aid level of Chinese medical personnel. METHODS A cross-sectional survey was conducted between June 2022 and February 2023 using a two-stage cluster sampling method with a structured questionnaire sent to medical workers in 12 provinces in China. 14,527 questionnaires were included in this study. Data were collected on demographic characteristics, first aid knowledge and skills, and training needs. Variance analysis was used to compare the difference between the first aid ability and training needs of medical staff in different hospitals, and multiple linear regression analysis was carried out to evaluate first aid ability and training needs. RESULT The study included 6041 patients (41.6%) in tertiary hospitals, 5838 patients (40.2%) in secondary hospitals, and 2648 patients (18.2%) in primary hospitals. There were significant differences in the first aid ability and training needs of medical staff in hospitals of different levels (p < 0.001). The score of first aid knowledge and skills in tertiary hospitals was the highest (209.7 ± 45.0), and the score of training needs in primary hospitals was the highest (240.6 ± 44.0). There was a significant correlation between first aid ability and training needs score (p < 0.001). Multiple linear regression analysis shows that geographic region, age, work tenure, gender, job title, department, professional title, monthly income, and hospital level are the influencing factors of training demand. CONCLUSION Medical staff in primary hospitals generally have low first aid knowledge and skills and a strong willingness to train. Therefore, it is imperative to strengthen the training of first aid ability and research training strategies. The level of the hospital is closely related to the level of first aid, so it is necessary to recognize the commonalities and differences in medical staff's demand for first aid knowledge and skills and carry out targeted education and training.
Collapse
Affiliation(s)
- Juntao Wang
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Chuanzhu Lv
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Xingyue Song
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yanlan Hu
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Wenjie Hao
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Lanfen He
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Yu Chen
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaotong Han
- Department of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabolomics, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China.
| | - Shijiao Yan
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China.
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China.
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.
| |
Collapse
|
7
|
Buck Sainz-Rozas P, Casal Angulo C, García Molina P. Quality assessment in initial paediatric trauma care: Systematic review from prehospital care to the paediatric intensive care unit. Nurs Crit Care 2023; 28:1143-1153. [PMID: 37621180 DOI: 10.1111/nicc.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/21/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Trauma is the most common cause of death and disability in the paediatric population. There are a huge number of variables involved in the care they receive from health care professionals. AIM The aim of this study was to review the available evidence of initial paediatric trauma care throughout the health care process with a view to create quality indicators (QIs). STUDY DESIGN A systematic review was performed from Cochrane Library, Medline, Scopus and SciELO between 2010 and 2020. Studies and guidelines that examined quality or suggested QI were included. Indicators were classified by health care setting, Donabedian's model, risk of bias and the quality of the publication with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment. RESULTS The initial search included 686 articles, which were reduced to 22, with 15 primary and 7 secondary research articles. The snowball sampling technique was used to add a further seven guidelines and two articles. From these, 534 possible indicators were extracted, summarizing them into 39 and grouping the prehospital care indicators as structure (N = 5), process (N = 12) and outcome (N = 3) indicators and the hospital care indicators as structure (N = 4), process (N = 10) and outcome (N = 6) indicators. Most of the QIs have been extracted from US studies. They are multidisciplinary and in some cases are based on an adaptation of the QIs of adult trauma care. CONCLUSIONS There was a clear gap and large variability between the indicators, as well as low-quality evidence. Future studies will validate indicators using the Delphi method. RELEVANCE TO CLINICAL PRACTICE Design a QI framework that may be used by the health system throughout the process. Indicators framework will get nurses, to assess the quality of health care, detect deficient areas and implement improvement measures.
Collapse
Affiliation(s)
- Pablo Buck Sainz-Rozas
- Facultad de Enfermería y Podología, Universidad de Valencia, Valencia, Spain
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carmen Casal Angulo
- Facultad de Enfermería y Podología, Universidad de Valencia, Valencia, Spain
- Servicio de Emergencias Sanitarias (SES) de Valencia, Valencia, Spain
| | - Pablo García Molina
- Facultad de Enfermería y Podología, Universidad de Valencia, Valencia, Spain
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| |
Collapse
|
8
|
Mallory LA, Doughty CB, Davis KI, Cheng A, Calhoun AW, Auerbach MA, Duff JP, Kessler DO. A Decade Later-Progress and Next Steps for Pediatric Simulation Research. Simul Healthc 2022; 17:366-376. [PMID: 34570084 DOI: 10.1097/sih.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT A decade ago, at the time of formation of the International Network for Pediatric Simulation-based Innovation, Research, and Education, the group embarked on a consensus building exercise. The goal was to forecast the facilitators and barriers to growth and maturity of science in the field of pediatric simulation-based research. This exercise produced 6 domains critical to progress in the field: (1) prioritization, (2) research methodology and outcomes, (3) academic collaboration, (4) integration/implementation/sustainability, (5) technology, and (6) resources/support/advocacy. This article reflects on and summarizes a decade of progress in the field of pediatric simulation research and suggests next steps in each domain as we look forward, including lessons learned by our collaborative grass roots network that can be used to accelerate research efforts in other domains within healthcare simulation science.
Collapse
Affiliation(s)
- Leah A Mallory
- From the Tufts University School of Medicine (L.A.M.), Boston, MA; Department of Medical Education (L.A.M.), The Hannaford Center for Simulation, Innovation and Education; Section of Hospital Medicine (L.A.M.), Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; Section of Emergency Medicine (C.B.D.), Department of Pediatrics, Baylor College of Medicine; Simulation Center (C.B.D.), Texas Children's Hospital, Pediatric Emergency Medicine, Baylor College of Medicine; Section of Critical Care Medicine (K.I.D.), Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX; Departments of Pediatrics and Emergency Medicine (A.C.), University of Calgary, Calgary, Canada; Division of Pediatric Critical Care (A.W.C.), University of Louisville School of Medicine and Norton Children's Hospital, Louisville, KY; Section of Emergency Medicine (M.A.A.), Yale University School of Medicine, New Haven, CT; Division of Critical Care (J.P.D.), University of Alberta, Alberta, Canada; and Columbia University Vagelos College of Physicians and Surgeons (D.O.K.), New York, NY
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Establishing National Stakeholder Priorities for Quality Improvement in Pediatric Trauma Care: Consensus Results Using a Modified Delphi Process. J Trauma Acute Care Surg 2022; 93:467-473. [PMID: 35713930 DOI: 10.1097/ta.0000000000003731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Quality improvement (QI) efforts within pediatric trauma centers (PTCs) are robust, but the majority of children do not receive initial post-injury care at PTCs. Disparities in access to quality trauma care remain, particularly for children that initially access the trauma system outside of a PTC. The purpose of this project was to identify unmet needs for injured children within the pediatric emergency care system, and to determine national priorities for quality improvement across the continuum of pediatric trauma care. METHODS A panel of delegates representing patients and families, prehospital providers, federal funding partners, nurses, and physicians was recruited from ten national stakeholder organizations. Potential targets were identified using an initial stakeholder meeting followed by a free text response survey. Free text items were coded and condensed as themes, then ranked by the panel using a modified Delphi approach to determine consensus priorities. Items not achieving >35% prioritization on a given iteration were dropped from subsequent iterations. Consensus was defined as 75% of members designating an item as a top-four priority. RESULTS Nineteen themes were identified as potential targets for QI initiatives. Four iterations of panel ranking were utilized to achieve consensus, with four priorities identified: 1) creation of a toolkit and standard provider training for pediatric trauma triage, shock recognition, and early recognition for need to transfer to higher level of care; 2) development of minimum standards for pediatric trauma resuscitation and stabilization capability in non-pediatric centers; 3) facilitating creation of local nursing and physician champions for pediatric trauma; and 4) development and dissemination of best practice guidelines to improve imaging practices for injured children. CONCLUSIONS System-level quality improvement priorities for pediatric trauma care should focus resources on developing and implementing minimum pediatric standards for injury care, frontline provider training, stabilization protocols, imaging guidelines, and local pediatric champions. LEVEL OF EVIDENCE Level V.
Collapse
|
10
|
Huber T, Hüttl F, Braun B, Blank B, Schierholz S, Fritz T, Kroeplin J. [Fridays for future! - All days for surgery! : Thoughts of young surgeons on a modern promotion of the next generation]. Chirurg 2022; 93:250-255. [PMID: 35132445 DOI: 10.1007/s00104-022-01577-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/10/2023]
Abstract
In order to be able to exploit the increasing complexity of modern surgery as best as possible in the future, the focus of young surgeons is on horizontal networking in addition to vertical networking: More interdisciplinary cooperation, more diversity, more perspectives. Future effective project work thrives on the exchange of young specialist society forums, junior resident spokespersons and junior student representation. However, the increasing establishment of mentoring programs and the experiences from daily practice show that this does not work without the experience and the readiness of the "greats" to impart knowledge. This article sketches the current challenges for the next generation of surgeons in the three fields of surgical training, life and surgery as well as promotion of excellence in academic surgery.
Collapse
Affiliation(s)
- Tobias Huber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55130, Mainz, Deutschland.
| | - Florentine Hüttl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55130, Mainz, Deutschland
| | - Benedikt Braun
- Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Beate Blank
- Klinik für Plastische und Handchirurgie, Klinikum Kulmbach, Kulmbach, Deutschland
| | - Stefanie Schierholz
- Klinik für Chirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Tobias Fritz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Juliane Kroeplin
- Mund-Kiefer- und Gesichtschirurgie, Helios Kliniken Schwerin, Schwerin, Deutschland
| |
Collapse
|
11
|
Brunner S, Kröplin J, Meyer HJ, Schmitz‑Rixen T, Fritz T. [Use of surgical simulators in further education-A nationwide analysis in Germany]. Chirurg 2021; 92:1040-1049. [PMID: 33399900 PMCID: PMC8536651 DOI: 10.1007/s00104-020-01332-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In addition to learning theoretical knowledge, the medical specialist training in surgery necessitates the acquisition of practical surgical competences. Simulation-based teaching concepts represent an alternative to education and advanced training on patients. The aim of this study was to analyze the distribution and implementation of surgical simulators in German hospitals. METHODS The data analysis was carried out based on an individual on-line questionnaire with a total of 19 standardized questions. This was sent to the senior surgeons in hospitals and clinics via the email distributors of specialist societies for surgery in Germany. RESULTS A total of 267 complete datasets were analyzed (response rate 12%). Of the participants 84% reported that they were active in a teaching hospital. At the time of the investigation 143 surgical simulators were in use at 35% of the hospitals and clinics included in the evaluation. There were clear regional differences between the individual federal states. Of the participants, 21.1% did not have a simulator at the hospital but the acquisition of one was planned. Simulation training was most frequently used by students (41.1%) and physicians during further education (32.5%). Simulators were not integrated into advanced surgical training in 81.8%. Of the participating hospitals, 94% showed an interest in integration into surgical specialist training in the future. CONCLUSION The results of this survey confirmed the special importance of simulation-based training for surgical education in German hospitals; however, at the same time there were clear deficits in information concerning user behavior and a deficiency in the perceived integration of simulation training in advanced training for surgery.
Collapse
Affiliation(s)
- Stefanie Brunner
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937 Köln, Deutschland
| | - Juliane Kröplin
- Klinik für Mund‑, Kiefer- und Gesichtschirurgie – Plastische Operationen, Helios Kliniken Schwerin, Wismarsche Str. 393–397, 19055 Schwerin, Deutschland
| | - Hans-Joachim Meyer
- Deutsche Gesellschaft für Chirurgie, Berlin, Deutschland
- Berufsverband der Deutschen Chirurgen e. V. (BDC), Berlin, Deutschland
| | - Thomas Schmitz‑Rixen
- Deutsche Gesellschaft für Chirurgie, Berlin, Deutschland
- Klinik für Gefäß- und Endovascularchirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Tobias Fritz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
- Perspektivforum Junge Chirurgie, Deutsche Gesellschaft für Chirurgie, Berlin, Deutschland
| |
Collapse
|
12
|
Endo A, Kojima M, Hong ZJ, Otomo Y, Coimbra R. Open-chest versus closed-chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:541. [PMID: 32873326 PMCID: PMC7465718 DOI: 10.1186/s13054-020-03259-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
Background The effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Although current guidelines state that the presence of signs of life (SOL) is an indication for OCCPR, scientific evidence corroborating this recommendation has been scarce. This study aimed to compare the effectiveness of OCCPR to closed-chest cardiopulmonary resuscitation (CCCPR) in severe trauma patients with SOL upon arrival at the emergency department (ED). Methods A retrospective cohort study analyzing data from the Trauma Quality Improvement Program (TQIP) database, a nationwide trauma registry in the USA, between 2010 and 2016 was conducted. Severe trauma patients who had SOL upon arrival at the hospital and received cardiopulmonary resuscitation within the first 6 h of ED admission were identified. Survival to hospital discharge was evaluated using logistic regression analysis, instrumental variable analysis, and propensity score matching analysis adjusting for potential confounders. Results A total of 2682 patients (OCCPR 1032; CCCPR 1650) were evaluated; of those 157 patients (15.2%) in the OCCPR group and 193 patients (11.7%) in the CCCPR group survived. OCCPR was significantly associated with higher survival to hospital discharge in both the logistic regression analysis (adjusted odds ratio [95% confidence interval] = 1.99 [1.42–2.79], p < 0.001) and the instrumental variable analysis (adjusted odds ratio [95% confidence interval] = 1.16 [1.02–1.31], p = 0.021). In the propensity score matching analysis, 531 matched pairs were generated, and the OCCPR group still showed significantly higher survival at hospital discharge (89 patients [16.8%] in the OCCPR group vs 58 patients [10.9%] in the CCCPR group; odds ratio [95% confidence interval] = 1.66 [1.13–2.42], p = 0.009). Conclusions Compared to CCCPR, OCCPR was associated with significantly higher survival at hospital discharge in severe trauma patients with SOL upon ED arrival. Further studies to confirm these results and to assess long-term neurologic outcomes are needed.
Collapse
Affiliation(s)
- Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Mitsuaki Kojima
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
| | - Zhi-Jie Hong
- Riverside University Health System, Comparative Effectiveness and Clinical Outcomes Research Center, 26520 Cactus Avenue, CPC Suite 102-5, Moreno Valley, CA, 92555, USA.,Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Raul Coimbra
- Riverside University Health System, Comparative Effectiveness and Clinical Outcomes Research Center, 26520 Cactus Avenue, CPC Suite 102-5, Moreno Valley, CA, 92555, USA.
| |
Collapse
|