1
|
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.
Collapse
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
| |
Collapse
|
2
|
Reynolds MS, Lo C, Shi J, Mitzman J. Scheduling doesn't matter! A noninferiority study of block versus longitudinal scheduling for emergency medicine resident pediatric procedural training experience. AEM EDUCATION AND TRAINING 2023; 7:e10838. [PMID: 36703867 PMCID: PMC9850258 DOI: 10.1002/aet2.10838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emergency medicine (EM) residencies offer a wide variety of scheduling models for pediatric patient experience, including blocked weeks in pediatric emergency departments and longitudinal models with pediatric emergency pod/department shifts integrated within other clinical experiences. Concerns with autonomy, attending entrustment, and resident comfort imply that these different scheduling models may impact EM residents' pediatric procedure volumes. The purpose of this study is to quantitatively compare EM residents' pediatric procedure experience and volumes between block versus longitudinal scheduling models. We hypothesize noninferiority between the scheduling models. METHODS A retrospective review characterized the numbers and types of procedures performed by The Ohio State Emergency Medicine residents at the tertiary care pediatric hospital where residents' receive their pediatric emergency medicine clinical experience. Procedure numbers and variety were compared across six academic years: four with a block model, one reorganization year, and one integrated longitudinal year. RESULTS 2552 procedures were performed by 266 resident academic years over the 6-year period. Overall, no statistically significant differences in the number of procedures performed per year or the variety of types of procedures performed per year were found when comparing the block and longitudinal models. Differences were seen in experience of PGY1 versus PGY3 residents between scheduling models and the overall experience and volumes of the PGY2 residents during the reorganization year. CONCLUSIONS Our study quantitatively concluded that the longitudinal scheduling model is noninferior to the more traditional block scheduling model for emergency medicine residents' pediatric emergency medicine clinical experience when reviewing volumes and types of procedures performed in a pediatric emergency department. This suggests that procedural opportunities do not need to dictate scheduling models.
Collapse
Affiliation(s)
- Maegan S. Reynolds
- Division of Emergency MedicineNationwide Children's HospitalColumbusOhioUSA
- Department of Emergency MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Charmaine Lo
- Division of Emergency MedicineNationwide Children's HospitalColumbusOhioUSA
- The Abigail Wexner Research Center at Nationwide Children's HospitalColumbusOhioUSA
| | - Junxin Shi
- Division of Emergency MedicineNationwide Children's HospitalColumbusOhioUSA
- The Abigail Wexner Research Center at Nationwide Children's HospitalColumbusOhioUSA
| | - Jennifer Mitzman
- Division of Emergency MedicineNationwide Children's HospitalColumbusOhioUSA
- Department of Emergency MedicineThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
3
|
Tat S, Shaukat H, Zaveri P, Kou M, Jarvis L. Developing and Integrating Asynchronous Web-Based Cases for Discussing and Learning Clinical Reasoning: Repeated Cross-sectional Study. JMIR MEDICAL EDUCATION 2022; 8:e38427. [PMID: 36480271 PMCID: PMC9782361 DOI: 10.2196/38427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/09/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Trainees rely on clinical experience to learn clinical reasoning in pediatric emergency medicine (PEM). Outside of clinical experience, graduate medical education provides a handful of explicit activities focused on developing skills in clinical reasoning. OBJECTIVE In this paper, we describe the development, use, and changing perceptions of a web-based asynchronous tool to facilitate clinical reasoning discussion for PEM providers. METHODS We created a case-based web-based discussion tool for PEM clinicians and fellows to post and discuss cases. We examined website analytics for site use and collected user survey data over a 3-year period to assess the use and acceptability of the tool. RESULTS The learning tool had more than 30,000 site visits and 172 case comments for the 55 published cases over 3 years. Self-reported engagement with the learning tool varied inversely with clinical experience in PEM. The tool was relevant to clinical practice and useful for learning PEM for most respondents. The most experienced clinicians were more likely than fellows to report posting commentary, although absolute rate of commentary was low. CONCLUSIONS An asynchronous method of case presentation and web-based commentary may present an acceptable way to supplement clinical experience and traditional education methods for sharing clinical reasoning.
Collapse
Affiliation(s)
- Sonny Tat
- Division of Pediatric Emergency Medicine, Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, United States
| | - Haroon Shaukat
- Division of Emergency Medicine, Children's National Health System, Washington, DC, United States
| | - Pavan Zaveri
- Division of Emergency Medicine, Children's National Health System, Washington, DC, United States
| | - Maybelle Kou
- Graduate Medical Education, Inova Fairfax Medical Campus, Fairfax, MD, United States
| | - Lenore Jarvis
- Division of Emergency Medicine, Children's National Health System, Washington, DC, United States
| |
Collapse
|
4
|
Ngo QN, Chorley A, Li S, Chan TM. Learning pediatric emergency medicine over time: A realist evaluation of a longitudinal pediatric emergency medicine clinical experience. AEM EDUCATION AND TRAINING 2022; 6:e10822. [PMID: 36518231 PMCID: PMC9731310 DOI: 10.1002/aet2.10822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Emergency medicine (EM) practitioners must be proficient at caring for patients of all ages, including pediatric patients. Traditionally, EM trainees learn pediatric emergency medicine (PEM) through block rotations. This is problematic due to the seasonal nature of pediatric diseases and infrequent critical events. Spaced repetition learning theory suggests PEM would be better learned through longitudinal rotations. The transition to competency-based medical education (CBME) in Canada is accelerating the need to find novel ways to attain competencies in postgraduate training. At McMaster University, senior EM trainees can choose either traditional PEM blocks or longitudinal rotations. Our objective was to understand how learners experience these different rotations given the transition to CBME in Canada. METHODS Using a realist framework of program evaluation, we conducted semistructured interviews with key stakeholders (trainees, program directors, attending physicians) in EM. The realist framework was used to understand how context interacts with theoretical mechanisms to produce outcomes of interest. Data were analyzed using inductive, conventional content analysis. All investigators coded a subset of transcripts independently and in duplicate to achieve intercoder agreement. RESULTS A total of 13 interviews were completed with trainees (n = 11) and staff physicians (n = 2). The learning experience exists within an educational and clinical context, which are logistically distinct but inseparable. The longitudinal learning experience appears to improve learning through spaced repetition, which prevents atrophy of skills and knowledge while also benefitting from the offsetting of seasonal variability associated with many pediatric diseases. Improved feedback and entrustment are facilitated through the building of coaching relationships over time. Barriers to the learning experience are related mainly to logistical difficulties associated with resolving longitudinal and blocked learning experiences. Improved relationships with the interprofessional team may provide distinct learning opportunities and improved team functioning. Block rotations were identified as more valuable to junior trainees learning fundamental concepts. CONCLUSIONS Longitudinal learning provides numerous advantages to learning PEM, including increased case variety, spaced repetition of core concepts, and a perception of greater entrustment of the learner through formation of coaching relationships over time. Future projects looking to quantify the differences between longitudinal and block learning to objectively show a difference in skills and knowledge are needed.
Collapse
Affiliation(s)
- Quang N. Ngo
- Division of Pediatric Emergency Medicine, Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Alex Chorley
- Division of Pediatric Emergency Medicine, Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
- McMaster Education Research, Innovation, and Theory, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Division of Emergency Medicine, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Shelly‐Anne Li
- Department of Family & Community MedicineToronto Western Hospital, University Health NetworkTorontoOntarioCanada
| | - Teresa M. Chan
- McMaster Education Research, Innovation, and Theory, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Division of Emergency Medicine, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Division of Education & Innovation, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Office of Continuing Professional Development, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| |
Collapse
|
5
|
Lavoie ME, Tay KY, Nadel F. Who Trains the Trainers?: Development of a Faculty Bootcamp for Pediatric Emergency Medicine Resuscitation Procedures. Pediatr Emerg Care 2022; 38:353-357. [PMID: 35787583 DOI: 10.1097/pec.0000000000002776] [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
OBJECTIVES Attending physicians in pediatric emergency medicine (PEM) must be able to perform lifesaving procedures, yet guidelines for maintaining procedural competency do not exist. We implemented a biannual 2-hour "bootcamp" designed to help PEM faculty maintain procedural competency. METHODS A survey-based needs assessment was used to create a set of goals and objectives for the session and determine which procedural skills to include. Sessions of 4 simulated skills were held twice a year and limited to 12 faculty. Post-bootcamp evaluations were administered at the 1-year and 6-year marks to evaluate the usefulness of the training. RESULTS Twenty-eight of our 55 current faculty members (50%) responded to the 6-year follow-up evaluation. Overall, the bootcamp was felt to be beneficial, with 64% of faculty rating it "great" (5) or "highly useful" (6) on a 6-point Likert scale. The majority of participants also rated the airway, vascular access, and cardiopulmonary resuscitation/defibrillator training favorably. Faculty who later had the opportunity to perform specific resuscitation procedures clinically felt that the circulation (cardiopulmonary resuscitation/defibrillator) and airway stations contributed to the success of their procedure performance. CONCLUSIONS The clinical setting alone may be insufficient in maintaining procedural competency in lifesaving skills in PEM. Giving faculty the opportunity to practice these skills is feasible and can be effective in increasing confidence. Future training sessions should aim toward practicing to a defined mastery level.
Collapse
Affiliation(s)
- Megan E Lavoie
- From the Perelman School of Medicine at the University of Pennsylvania; and Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Kou M, Baghdassarian A, Rose JA, Levasseur K, Roskind CG, Vu T, Zuckerbraun NS, Leonard K, Shabanova V, Langhan ML. Milestone achievements in a national sample of pediatric emergency medicine fellows: impact of primary residency training. AEM EDUCATION AND TRAINING 2021; 5:e10575. [PMID: 34124521 PMCID: PMC8171745 DOI: 10.1002/aet2.10575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) fellowships recruit trainees from both pediatric and emergency medicine (EM) residencies. The Accreditation Council for Graduate Medical Education (ACGME) defines separate training pathways for each. The 2015 PEM milestones reflect a combination of subcompetencies from the two residencies. This project aims to compare the milestone achievement of PEM fellows based on their primary residency training. We hypothesize that fellows trained in pediatrics achieve PEM milestones at different rates than EM-trained fellows in the ACGME domains of patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal and communication skills. METHODS This is a multicenter, retrospective cohort study of fellows from a national sample of U.S. PEM fellowship programs. Basic demographic information and deidentified, biannual milestone scores for 23 competencies were collected for fellows training between 2015 and 2018. Subcompetencies are scored on a 5-point milestone scale. Descriptive and multivariable analyses for longitudinal data were performed to compare milestone assessments by primary residency training. RESULTS Complete data were obtained for 600 fellows; 95% (570) and 5% (30) completed pediatric and EM residency, respectively. In both year 1 and year 2 of fellowship, the mean milestone scores of EM-trained fellows were statistically higher than pediatrics-trained fellows across the majority of subcompetencies. By the final year of training, there were no statistically significant differences in milestone scores for any of the subcompetencies. CONCLUSIONS Fellow milestone achievement between groups was not significantly different by graduation. However, fellows entering PEM training from an EM background attained higher scores on the milestones than fellows from a pediatric background in the first year of fellowship.
Collapse
Affiliation(s)
- Maybelle Kou
- Emergency MedicineInova Children’s Hospital/VCU SOMFalls ChurchVirginiaUSA
| | - Aline Baghdassarian
- Pediatrics and Emergency MedicineChildren’s Hospital of Richmond at VCU/Virginia Commonwealth University SOMRichmondVirginiaUSA
| | - Jerri A. Rose
- PediatricsRainbow Babies & Children’s Hospital/Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Kelli Levasseur
- Emergency MedicineBeaumont Children’s Hospital/Oakland University William Beaumont School of MedicineRoyal OakMichiganUSA
| | - Cindy G. Roskind
- Emergency Medicine in PediatricsColumbia University Medical CenterNew YorkNew YorkUSA
| | - Tien Vu
- PediatricsChildren’s Hospital Colorado/University of Colorado School of MedicineDenverColoradoUSA
| | | | - Kathryn Leonard
- PediatricsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | | | - Melissa L. Langhan
- Pediatrics and Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| |
Collapse
|
9
|
Schoppel KA, Stapleton S, Florian J, Whitfill T, Walsh BM. Benchmark Performance of Emergency Medicine Residents in Pediatric Resuscitation: Are We Optimizing Pediatric Education for Emergency Medicine Trainees? AEM EDUCATION AND TRAINING 2021; 5:e10509. [PMID: 33898912 PMCID: PMC8052997 DOI: 10.1002/aet2.10509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The majority of children in the United States seek emergency care at community-based general emergency departments (GEDs); however, the quality of GED pediatric emergency care varies widely. This may be explained by a number of factors, including residency training environments and postgraduate knowledge decay. Emergency medicine (EM) residents train in academic pediatric EDs, but didactic and clinical experience vary widely between programs, and little is known about the pediatric skills of these EM residents. This study aimed to assess the performance of senior EM residents in treating simulated pediatric patients at the end of their training. METHODS This was a prospective, cross-sectional, simulation-based cohort study assessing the simulated performance of senior EM resident physicians from two Massachusetts programs leading medical teams caring for three critically ill patients. Sessions were video recorded and scored separately by three reviewers using a previously published simulation assessment tool. Self-efficacy surveys were completed prior to each session. The primary outcome was a median total performance score (TPS), calculated by the mean of individualized domain scores (IDS) for each case. Each IDS was calculated as a percentage of items performed on a checklist-based instrument. RESULTS A total of 18 EM resident physicians participated (PGY-3 = 8, PGY-4 = 10). Median TPS for the cohort was 61% (IQR = 56%-70%). Median IDSs by case were as follows: sepsis 67% (IQR = 50%-67%), seizure 67% (IQR = 50%-83%), and cardiac arrest 67% (IQR = 43%-70%). The overall cohort self-efficacy for pediatric EM (PEM) was 64% (IQR = 60%-70%). CONCLUSIONS This study has begun the process of benchmarking clinical performance of graduating EM resident physicians. Overall, the EM resident cohort in this study performed similar to prior GED teams. Self-efficacy related to PEM correlated well with performance, with the exception of knowledge relative to intravenous fluid and vasopressor administration in pediatric septic shock. A significant area of discrepancy and missed checklist items were those related to cardiopulmonary resuscitation and basic life support maneuvers.
Collapse
Affiliation(s)
| | | | | | - Travis Whitfill
- Department of Pediatrics and Emergency MedicineYale UniversityNew HavenCTUSA
| | | |
Collapse
|
10
|
Loftus KV, Schumacher DJ, Mittiga MR, McDonough E, Sobolewski B. A Descriptive Analysis of the Cumulative Experiences of Emergency Medicine Residents in the Pediatric Emergency Department. AEM EDUCATION AND TRAINING 2021; 5:e10462. [PMID: 33796805 PMCID: PMC7995924 DOI: 10.1002/aet2.10462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Most children seeking emergency care are evaluated in general emergency departments (EDs). The cumulative pediatric clinical experiences of emergency medicine (EM) residents are largely unknown. This study examined EM resident pediatric clinical experience through the lens of the Accreditation Council for Graduate Medical Education requirements and the Model of the Clinical Practice of Emergency Medicine. METHODS Retrospective, observational study of the cumulative clinical experience of two classes of EM residents from a 4-year training program at two pediatric EDs of a quaternary care pediatric center. A database of resident patient encounters was generated from the electronic medical record. Experiences classified included: diagnosis categories per the Model of the Clinical Practice of Emergency Medicine, procedures, and resuscitations. Results were stratified by age, acuity, and disposition. RESULTS Twenty-five EM residents evaluated 17,642 patients (median = 723). Most patients (73.5%) were emergent acuity (Emergency Severity Index triage level 2 or 3 or non-intensive care admission); 2% were critical. Residents participated in 598 (median = 22) medical resuscitations and 483 (median = 19) trauma resuscitations. Minor procedures (e.g., laceration repair) were commonly performed; critical procedures (e.g., intubation) were rare. Exposure to neonates was infrequent and pediatric deaths were rare. Abdominal pain (5.7%), asthma exacerbation (4.6%), and fever (3.8%) were the most common diagnoses. CONCLUSIONS Emergency medicine residents encountered a wide array of pediatric diagnoses throughout training and performed a substantial number of common pediatric procedures. Exposure to critical acuity and procedures, neonatal pathology, and certain pediatric-specific diagnoses, such as congenital heart disease, was limited despite training in a large, quaternary care children's hospital. Curriculum development and collaboration should focus on these areas.
Collapse
Affiliation(s)
- Kirsten V. Loftus
- From theDepartment of PediatricsNorthwestern University Feinberg School of Medicine & Division of Pediatric Emergency MedicineAnn and Robert H. Lurie Children’s Hospital of ChicagoChicagoILUSA
- theDepartment of PediatricsUniversity of Cincinnati College of Medicine & Division of Emergency MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Daniel J. Schumacher
- theDepartment of PediatricsUniversity of Cincinnati College of Medicine & Division of Emergency MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Matthew R. Mittiga
- and theDepartment of PediatricsUniversity of Colorado School of Medicine & Section of Emergency MedicineChildren's Hospital ColoradoAuroraCOUSA
| | - Erin McDonough
- and theDepartment of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Brad Sobolewski
- theDepartment of PediatricsUniversity of Cincinnati College of Medicine & Division of Emergency MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| |
Collapse
|
11
|
Morrison Ponce DP, Wolff M. Defining a Focused Pediatric Emergency Medicine Curriculum for Emergency Medicine Residents: A Case Study at Michigan Medicine. AEM EDUCATION AND TRAINING 2021; 5:70-74. [PMID: 33521493 PMCID: PMC7821070 DOI: 10.1002/aet2.10455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/04/2020] [Accepted: 04/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Emergency medicine (EM) is dedicated to the treatment of urgent and emergent illness requiring physicians to evaluate, treat, and diagnose patients of all ages. EM residency provides the foundation of knowledge enabling trainees to care for any patient. However, specific pediatric curriculum guidance from governing bodies is limited. The literature includes two potential curricula that are cumbersome to implement. Our primary objective was to identify the components of this curricula that were specific to pediatric emergency medicine (PEM). Secondary objectives were to provide a methods framework and to compare the results with the American Board of Emergency Medicine Model of Clinical Practice (EM Model). METHODS With the modified Delphi technique, iterative rounds of expert panels sought to reach consensus on PEM-specific topics. We utilized the published curricula as the foundation and focused this list using a group of local experts. Predetermined consensus was defined as 80% agreement. RESULTS The literature-derived list of 190 topics was reviewed by the expert panel. Experts identified 92 PEM-specific topics, and the remaining 98 topics were deemed adequately covered by general EM curricula. All topics reached consensus after three rounds. The final list was sorted in accordance with the EM Model categories. Redundant topics were consolidated resulting in 68 PEM topics. Of these 68 topics, we identified 20 topics (five of which are critical) that were incompletely covered by the EM Model. CONCLUSIONS Emergency medicine residency programs should focus their PEM curriculum by deliberately assessing their coverage of key PEM topics. The methods of this study can be replicated to yield locally applicable results in other EM programs. Additionally, the next iteration of the EM Model of Clinical Practice should inform their PEM topics from the available curricula in the literature.
Collapse
Affiliation(s)
- Daphne P. Morrison Ponce
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineUniversity of MichiganAnn ArborMI
| | - Margaret Wolff
- Department of Emergency MedicineDivision of Pediatric Emergency MedicineUniversity of MichiganAnn ArborMI
| |
Collapse
|
12
|
Mitzman J, Bank I, Burns RA, Nguyen MC, Zaveri P, Falk MJ, Madhok M, Dietrich A, Wall J, Waseem M, Wu T, McQueen A, Peng CR, Phillips B, Bullaro FM, Chang CD, Shahid S, Way DP, Auerbach M. A Modified Delphi Study to Prioritize Content for a Simulation-based Pediatric Curriculum for Emergency Medicine Residency Training Programs. AEM EDUCATION AND TRAINING 2020; 4:369-378. [PMID: 33150279 PMCID: PMC7592831 DOI: 10.1002/aet2.10412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Pediatric training is an essential component of emergency medicine (EM) residency. The heterogeneity of pediatric experiences poses a significant challenge to training programs. A national simulation curriculum can assist in providing a standardized foundation of pediatric training experience to all EM trainees. Previously, a consensus-derived set of content for a pediatric curriculum for EM was published. This study aimed to prioritize that content to establish a pediatric simulation-based curriculum for all EM residency programs. METHODS Seventy-three participants were recruited to participate in a three-round modified Delphi project from 10 stakeholder organizations. In round 1, participants ranked 275 content items from a published set of pediatric curricular items for EM residents into one of four categories: definitely must, probably should, possibly could, or should not be taught using simulation in all residency programs. Additionally, in round 1 participants were asked to contribute additional items. These items were then added to the survey in round 2. In round 2, participants were provided the ratings of the entire panel and asked to rerank the items. Round 3 involved participants dichotomously rating the items. RESULTS A total of 73 participants participated and 98% completed all three rounds. Round 1 resulted in 61 items rated as definitely must, 72 as probably should, 56 as possibly could, 17 as should not, and 99 new items were suggested. Round 2 resulted in 52 items rated as definitely must, 91 as probably should, 120 as possibly could, and 42 as should not. Round 3 resulted in 56 items rated as definitely must be taught using simulation in all programs. CONCLUSIONS The completed modified Delphi process developed a consensus on 56 pediatric items that definitely must be taught using simulation in all EM residency programs (20 resuscitation, nine nonresuscitation, and 26 skills). These data will serve as a targeted needs assessment to inform the development of a standard pediatric simulation curriculum for all EM residency programs.
Collapse
Affiliation(s)
- Jennifer Mitzman
- The Ohio State University Wexner Medical Center/Nationwide Children's HospitalColumbusOH
| | - Ilana Bank
- Institute of Health Sciences EducationSteinberg Centre for Simulation and Interactive Learning/Institute of Pediatric SimulationMontreal Children's HospitalMcGill UniversityMontrealQuebecCanada
| | - Rebekah A. Burns
- Seattle Children's HospitalUniversity of Washington School of MedicineSeattleWA
| | | | - Pavan Zaveri
- George Washington University School of Medicine and Health Sciences/Children's National Health SystemWashingtonDC
| | - Michael J. Falk
- George Washington University School of Medicine and Health Sciences/Children's National Health SystemWashingtonDC
| | | | - Ann Dietrich
- College of MedicineOhio University HeritageDublinOH
| | - Jessica Wall
- Seattle Children's HospitalUniversity of Washington School of MedicineSeattleWA
| | | | - Teresa Wu
- College of Medicine‐PhoenixUniversity of ArizonaPhoenixAZ
- Banner University Medical Center–PhoenixPhoenixAZ
| | - Alisa McQueen
- Comer Children's HospitalThe University of ChicagoChicagoIL
| | | | | | | | | | - Sam Shahid
- American College of Emergency PhysiciansIrvingTX
| | - David P. Way
- The Ohio State University Wexner Medical CenterColumbusOH
| | | |
Collapse
|
13
|
Kamzan A, Jun-Ihn E, Kulkarni D. On the Front Lines of Pediatric Complex Care: Are We Preparing Emergency Medicine Residents? Hosp Pediatr 2020; 10:712-714. [PMID: 32680917 DOI: 10.1542/hpeds.2020-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Audrey Kamzan
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Esther Jun-Ihn
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Deepa Kulkarni
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| |
Collapse
|
14
|
Chen WC, Chaou CH, Ng CJ, Liu YP, Chang YC. Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920926312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.
Collapse
Affiliation(s)
- Wei-Chen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung Medical Education Research Centre (CGMERC), Taoyuan City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yueh-Ping Liu
- Department of Medical Affairs, Ministry of Health and Welfare, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Che Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Chang Gung Medical Education Research Centre (CGMERC), Taoyuan City, Taiwan
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| |
Collapse
|
15
|
Klig JE, Fang A, Fox SM, Hom J, Strobel A, Tat S, Wall JJ, Bhat R, Weinberg E, Deninghoff KR, Ishimine P, Kou M. 2018 Academic Emergency Medicine Consensus Conference: Advancing Pediatric Emergency Medicine Education Through Research and Scholarship. Acad Emerg Med 2018; 25:1327-1335. [PMID: 30311285 DOI: 10.1111/acem.13632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/27/2018] [Accepted: 10/06/2018] [Indexed: 11/28/2022]
Abstract
To achieve high-quality emergency care for pediatric patients nationwide, it is necessary to define the key elements for pediatric emergency medicine (PEM) education and scholarship that would: 1) close the gaps in fundamental PEM education and 2) promote systems and standards that assure an ongoing communication of best practices between tertiary pediatric institutions, general (nonchildren's) hospital emergency departments, and urgent care centers. A working group of medical educators was formed to review the literature, develop a framework for consensus discussion at the breakout session, and then translate their findings into recommendations for future research and scholarship. The breakout session consensus discussion yielded many recommendations. The group concluded that future progress depends on multicenter collaborations as a PEM education research network and a unified vision for PEM education that bridges organizations, providers, and institutions to assure the best possible outcomes for acutely ill or injured children.
Collapse
Affiliation(s)
- Jean E. Klig
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MA
| | - Andrea Fang
- Department of Emergency Medicine Stanford University Medical Center Stanford University School of Medicine Palo Alto CA
| | - Sean M. Fox
- Department of Emergency Medicine Carolinas Medical Center Charlotte NC
| | - Jeffrey Hom
- Department of Emergency Medicine Stonybrook University Medical Center StonybrookNY
| | - Ashley Strobel
- Department of Emergency Medicine Hennepin County Medical Center and University of Minnesota Masonic Children's Hospital University of Minnesota Minneapolis MD
| | - Sonny Tat
- Department of Emergency Medicine Benioff Children's Hospital University of California San Francisco San Francisco CA
| | - Jessica J. Wall
- Department of Emergency Medicine Seattle Children's Hospital University of Washington Medical School Seattle WA
| | - Rahul Bhat
- Department of Emergency Medicine Georgetown University Hospital Washington DC
| | | | - Kurt R. Deninghoff
- Department of Emergency Medicine University of Arizona School of Medicine Tucson AZ
| | - Paul Ishimine
- Department of Emergency Medicine Rady Children's Hospital University of California San Diego San Diego CA
| | - Maybelle Kou
- Department of Emergency Medicine Inova Children's Hospital Fairfax VA
| |
Collapse
|
16
|
Hoelle RM, Vega T, Atanelov Z, Toklu H. Emergency medicine residency programs: the changing face of graduate medical education. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:9-10. [PMID: 29341955 PMCID: PMC5834821 DOI: 10.5116/ijme.5a47.8274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/30/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Robyn M. Hoelle
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
| | - Tami Vega
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
| | - Zaza Atanelov
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
| | - Hale Toklu
- University of Central Florida/HCA GME Consortium North Florida Medical Center, Gainesville, USA
| |
Collapse
|
17
|
Piva JP, Lago PM, Garcia PCR. Pediatric emergency in Brazil: the consolidation of an area in the pediatric field. J Pediatr (Rio J) 2017; 93 Suppl 1:68-74. [PMID: 28869808 DOI: 10.1016/j.jped.2017.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to present a review on the evolution, development, and consolidation of the pediatric emergency abroad and in Brazil, as well as to discuss the residency program in this key area for pediatricians. DATA SOURCES This was a narrative review, in which the authors used pre-selected documents utilized as the minimum requirements for the Residency Program in Pediatric Emergency Medicine and articles selected by interest for the theme development, at the SciELO and Medline databases, between 2000 and 2017. DATA SYNTHESIS The historical antecedents and the initial evolution of pediatric emergency in Brazil, as well as several challenges were described, regarding the organization, the size, the training of professionals, and also the regulation of the professional practice in this new specialty. Additionally, a new pediatric emergency residency program to be implemented in Brazil is described. CONCLUSIONS Pediatric emergency training will be a powerful stimulus to attract talented individuals, to establish them in this key area of medicine, where they can exercise their leadership by promoting care qualification, research, and teaching, as well as acting decisively in their management.
Collapse
Affiliation(s)
- Jefferson P Piva
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Patrícia M Lago
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Unidade de Emergência Pediátrica, Porto Alegre, RS, Brazil
| | - Pedro Celiny R Garcia
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Serviço de Medicina Intensiva e Emergência, Porto Alegre, RS, Brazil.
| |
Collapse
|
18
|
Pediatric emergency in Brazil: the consolidation of an area in the pediatric field. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
19
|
Ryan M, White P, Kiley S, Reed H, Giordano C. Managing the Complex Issues of Pediatric Nonaccidental Trauma: A Simulation-Based Case of a Critically Injured Child. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10599. [PMID: 30800801 PMCID: PMC6338257 DOI: 10.15766/mep_2374-8265.10599] [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: 02/07/2017] [Accepted: 06/21/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Trainees generally have insufficient training in managing critically ill and injured pediatric patients due to limited exposure to such patients. Patient simulation experiences allow trainees to learn management skills needed in such a crisis. Herein, we describe a case regarding a critically injured pediatric patient. This case requires trainees to use teamwork skills, medical knowledge, and technical skills to manage the patient. METHODS We developed a team-based simulation regarding the resuscitation of a critically injured child-a toddler with multiple injuries, all requiring emergent care. The case was developed for senior medical students and residents and can be completed in a single 1-hour session, including a debriefing period. We also address psychosocial issues of managing a critically injured child by having the mother and her boyfriend present for part of the case. The team must address the underlying issue of suspected nonaccidental trauma while managing a medical resuscitation. RESULTS We have performed this scenario with a cohort of 100 trainees. Through direct observations, all teams have been able to manage the patient successfully. The average response to the effectiveness of the case in terms of developing pediatric resuscitation skills was very positive, with scores of 6.7 on a scale of 1 to 7. DISCUSSION Medical simulation has been demonstrated to be a valuable tool for assessing the knowledge and skills of trainees. This pediatric simulation improved learners' general understanding of managing a pediatric resuscitation. Accordingly, this case has been incorporated as part of resident and medical student training.
Collapse
Affiliation(s)
- Matthew Ryan
- Associate Professor, Department of Emergency Medicine, University of Florida College of Medicine
| | - Peggy White
- Assistant Professor, Department of Anesthesiology, University of Florida College of Medicine
| | - Sean Kiley
- Assistant Professor, Department of Anesthesiology, University of Florida College of Medicine
| | - Heather Reed
- Assistant Professor, Department of Anesthesiology, University of Florida College of Medicine
| | - Chris Giordano
- Associate Professor, Department of Anesthesiology, University of Florida College of Medicine
| |
Collapse
|
20
|
Cloutier RL, Mistry RD, Cico S, Merritt C, Lam SHF, Auerbach M, Skaugset LM, Klig J, Wolff M, Duong M, Walthall J. Keeping Up With the Kids: Diffusion of Innovation in Pediatric Emergency Medicine Among Emergency Physicians. Acad Emerg Med 2017; 24:769-775. [PMID: 28421650 DOI: 10.1111/acem.13185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert L. Cloutier
- Emergency Medicine and Pediatrics; Oregon Health & Science University; Portland OR
| | - Rakesh D. Mistry
- Pediatrics and Emergency Medicine; University of Colorado School of Medicine; Section of Emergency Medicine; Children's Hospital Colorado; Aurora CO
| | - Stephen Cico
- Clinical Emergency Medicine & Pediatrics; Indiana University School of Medicine; Riley Hospital for Children; Indianapolis IN
| | - Chris Merritt
- Emergency Medicine & Pediatrics; Alpert Medical School of Brown University; Providence RI
| | - Samuel H. F. Lam
- UC San Diego Medical Center/Rady Children's Hospital of San Diego; San Diego CA
| | - Marc Auerbach
- Pediatrics and Emergency Medicine; Yale University School of Medicine; New Haven CT
| | | | - Jean Klig
- Pediatrics, Harvard Medical School/Massachusetts General Hospital; Boston MA
| | - Meg Wolff
- Emergency Medicine and Pediatrics; University of Michigan Medical School; Ann Arbor MI
| | - Myto Duong
- Pediatric Emergency Medicine; Southern Illinois University; Carbondale IL
| | - Jennifer Walthall
- Departments of Pediatrics and Emergency Medicine; Indiana University School of Medicine; Riley Hospital for Children; Indianapolis IN
| |
Collapse
|
21
|
House H, Monuteaux MC, Nagler J. A Randomized Educational Interventional Trial of Spaced Education During a Pediatric Rotation. AEM EDUCATION AND TRAINING 2017; 1:151-157. [PMID: 30051026 PMCID: PMC6001596 DOI: 10.1002/aet2.10025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/07/2016] [Accepted: 12/30/2016] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Spacing of educational material over time has been shown to improve learning efficiency and long-term knowledge retention. We evaluated the impact of adding a spaced education curriculum to a month-long pediatric rotation. METHODS This was a randomized controlled educational intervention trial of residents on a rotation in a pediatric emergency department. Participants were randomized to the standard curriculum or the standard curriculum with integrated spaced education. The intervention used an automated platform to electronically deliver questions to user e-mail or mobile devices and provided instant feedback. Our primary outcome was proportion of correctly answered questions following the rotation. Our secondary outcomes included test performance at 3 months, change in clinical confidence, and satisfaction with the spaced learning. Learner opinion of the platform was assessed by postrotation survey. RESULTS Of 194 eligible trainees, 122 were enrolled and randomized. A total of 107 of the enrolled residents (88%) completed the immediate postrotation assessment, 48 of whom received spaced education. Sixty residents completed the 3-month follow-up. There were no differences between the control and intervention groups in baseline knowledge. The intervention group performed better than the control group on the postrotation assessment (mean difference = 5.4%, 95% confidence interval = 0.1-10.7) when controlled for didactic attendance and clinical exposure. Change in confidence did not differ between groups. Eighty-seven percent of spaced education learners would participate in a similar model in the future. CONCLUSION Spaced education during a pediatric emergency medicine rotation is an effective adjunct to a standard curriculum. Participants showed improvement on postrotation knowledge performance and enjoyed this educational approach.
Collapse
Affiliation(s)
- Heather House
- Division of Emergency MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPA
| | - Michael C. Monuteaux
- Division of Clinical ResearchBoston Children's HospitalBostonMA
- Division of Emergency MedicineBoston Children's HospitalBostonMA
| | - Joshua Nagler
- Division of Emergency MedicineBoston Children's HospitalBostonMA
| |
Collapse
|
22
|
Mitzman J, King AM, Fastle RK, Hopson LR, Hoyle JD, Levasseur KA, Mitchell MS, O'Neill JC, Pazderka PA, Perry MA, Reynolds M, Shah PG, Skarbek‐Borowska S, Way DP, Stanley RM. A Modified Delphi Study for Development of a Pediatric Curriculum for Emergency Medicine Residents. AEM EDUCATION AND TRAINING 2017; 1:140-150. [PMID: 30051025 PMCID: PMC6001585 DOI: 10.1002/aet2.10021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/30/2016] [Accepted: 01/12/2017] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Emergency medicine (EM) trainees are expected to learn to provide acute care for patients of all ages. The American Council for Graduate Medical Education provides some guidance on topics related to caring for pediatric patients; however, education about pediatric topics varies across residency programs. The goal of this project was to develop a consensus curriculum for teaching pediatric emergency care. METHODS We recruited 13 physicians from six academic health centers to participate in a three-round electronic modified Delphi project. Participants were selected on the basis of expertise with both EM resident education and pediatric emergency care. The first modified Delphi survey asked participants to generate the core knowledge, skills, and experiences needed to prepare EM residents to effectively treat children in an acute care setting. The qualitative data from the first round was reformulated into a second-round questionnaire. During the second round, participants used rating scales to prioritize the curriculum content proposed during the first round. In round 3, participants were asked to make a determination about each curriculum topic using a three-point scale labeled required, optional, or not needed. RESULTS The first modified Delphi round yielded 400 knowledge topics, 206 clinical skills, and 44 specific types of experience residents need to prepare for acute pediatric patient care. These were narrowed to 153 topics, 84 skills, and 28 experiences through elimination of redundancy and two rounds of prioritization. The final lists contain topics classified by highly recommended, partially recommended, and not recommended. The partially recommended category is intended to help programs tailor their curriculum to the unique needs of their learners as well as account for variability between 3- and 4-year programs and the amount of time programs allocate to pediatric education. CONCLUSION The modified Delphi process yielded the broad outline of a consensus core pediatric emergency care curriculum.
Collapse
Affiliation(s)
- Jennifer Mitzman
- The Ohio State University and Nationwide Children's HospitalColumbusOH
| | - Andrew M. King
- The Ohio State University and The Ohio State University Emergency Medicine Residency ProgramColumbusOH
| | | | - Laura R. Hopson
- University of Michigan Health System and Department of Emergency MedicineUniversity of Michigan Health System/St. Joseph Mercy Hospital Emergency Medicine Residency ProgramAnn ArborMI
| | - John D. Hoyle
- Department of Emergency MedicineWestern Michigan University Stryker School of MedicineKalamazooMI
| | - Kelly A. Levasseur
- Oakland University William Beaumont School of Medicine and the Department of Emergency MedicineBeaumont Health SystemRoyal OakMI
| | - Michael S. Mitchell
- Wake Forest University School of Medicine and the Department of Emergency MedicineWake Forest Baptist Medical CenterWinston‐SalemNC
| | - James C. O'Neill
- Section of Pediatric Emergency MedicineWake Forest University School of Medicine and the Department of Emergency MedicineWake Forest Baptist Medical CenterWinston‐SalemNC
| | - Philip A. Pazderka
- Western Michigan University Stryker School of Medicine and the Department of Emergency MedicineWestern Michigan University Emergency Medicine Residency ProgramKalamazooMI
| | - Marcia A. Perry
- University of Michigan Health System and the Department of Emergency MedicineUniversity of Michigan Residency ProgramAnn ArborMI
| | - Maegan Reynolds
- Pediatric Emergency Medicine ProgramNationwide Children's HospitalColumbusOH
| | - Payal G. Shah
- Department of Emergency MedicineOakland University William Beaumont School of Medicine and Beaumont Health System Residency ProgramRoyal OakMI
| | | | - David P. Way
- Department of Emergency MedicineThe Ohio State University College of MedicineColumbusOH
| | - Rachel M. Stanley
- The Ohio State University and Nationwide Children's HospitalColumbusOH
| |
Collapse
|
23
|
Merritt C, Gaines SA, Smith J, Santen SA. A Novel Curriculum to Optimize Emergency Medicine Residents' Exposure to Pediatrics. West J Emerg Med 2016; 18:14-19. [PMID: 28116002 PMCID: PMC5226749 DOI: 10.5811/westjem.2016.10.31248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chris Merritt
- Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Providence, Rhode Island
| | - Sarah A Gaines
- Alpert Medical School of Brown University, Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island
| | - Jessica Smith
- Alpert Medical School of Brown University, Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island
| | - Sally A Santen
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
| |
Collapse
|
24
|
|
25
|
Rao A, O'Leary F. Training clinicians to care for children in emergency departments. J Paediatr Child Health 2016; 52:126-30. [PMID: 27062614 DOI: 10.1111/jpc.13108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 09/10/2015] [Accepted: 09/27/2015] [Indexed: 11/30/2022]
Abstract
Children account for 22% of presentations to Emergency Departments in Australia, the majority presenting to mixed departments. A diverse group of clinicians looks after these children. In this review, we examine the different techniques and approaches to implementing education curricula and professional development within these emergency departments with a particular focus on bedside teaching, professional coaching, skills maintenance, e-learning and simulation.
Collapse
Affiliation(s)
- Arjun Rao
- Sydney Children's Hospital, Randwick
| | - Fenton O'Leary
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Kamat PP, Hollman GA, Simon HK, Fortenberry JD, McCracken CE, Stockwell JA. Current State of Institutional Privileging Profiles for Pediatric Procedural Sedation Providers. Hosp Pediatr 2015; 5:487-494. [PMID: 26330248 DOI: 10.1542/hpeds.2015-0052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Providers from a variety of training backgrounds and specialties provide procedural sedation at institutions in the United States. We sought to better understand the privileging patterns and practices for sedation providers. METHODS Surveys were sent to 56 program directors belonging to the Society for Pediatric Sedation using Research Electronic Data Capture to 56 pediatric sedation programs. The survey was designed to gather information regarding characteristics of their sedation service and the privileging of their sedation providers. RESULTS The overall response rate was 41 (73%) of 56. Most programs surveyed (81%) said their physicians provided sedation as a part of their primary subspecialty job description, and 17% had physicians whose sole practice was pediatric sedation and no longer practiced in their primary subspecialty. Fifty-one percent of surveyed sedation programs were within freestanding children's hospitals and 61% receive oversight by the anesthesiology department at their institution. Eighty-one percent of the sedation programs require physicians to undergo special credentialing to provide sedation. Of these, 79% grant privileging through their primary specialty, whereas 39% require separate credentialing through sedation as a stand-alone section. For initial credentialing, requirements included completion of a pediatric sedation orientation and training packet (51% of programs), sedation training during fellowship (59%), and documentation of a specific number of pediatric procedural sedation cases (49%). CONCLUSIONS In this survey of pediatric sedation programs belonging to the Society for Pediatric Sedation, the process for privileging providers in procedural sedation varies significantly from institution to institution. An opportunity exists to propose privileging standards for providers of pediatric procedural sedation.
Collapse
Affiliation(s)
- Pradip P Kamat
- Department of Pediatrics, Emory University School of Medicine Atlanta, Georgia; Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia; and
| | - Gregory A Hollman
- Department of Pediatrics, University of Wisconsin American Family Children's Hospital, Madison, Wisconsin
| | - Harold K Simon
- Department of Pediatrics, Emory University School of Medicine Atlanta, Georgia; Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia; and
| | - James D Fortenberry
- Department of Pediatrics, Emory University School of Medicine Atlanta, Georgia; Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia; and
| | | | - Jana A Stockwell
- Department of Pediatrics, Emory University School of Medicine Atlanta, Georgia; Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia; and
| |
Collapse
|
27
|
Fandler M, Habersack M, Dimai HP. Have "new" methods in medical education reached German-speaking Central Europe: a survey. BMC MEDICAL EDUCATION 2014; 14:172. [PMID: 25129398 PMCID: PMC4236571 DOI: 10.1186/1472-6920-14-172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/12/2014] [Indexed: 05/11/2023]
Abstract
BACKGROUND Simulation-based-training (SBT) in the education of health professionals is discussed as an effective alternative for knowledge and skills enhancement as well as for the establishment of a secure learning environment, for learners and patients. In the Anglo-American region, SBT and simulation and training centers (STC) are numbered as standard for medical training. In German-speaking Central Europe, priority is still given to the establishment of SBT and STC. The purpose of this study was (i) to survey the status quo relating to the existence and facilities of simulation and training centers at medical universities in German-speaking Central Europe and (ii) the evaluation of training methods, especially in the area of emergency medicine skills. METHODS All public and private medical universities or medical faculties in Germany (36), Austria (4) and German-speaking Switzerland (3) were interviewed. In the survey, information regarding the existence and facilities of STCs and information with regards to the use of SBT in the area of emergency medicine was requested. The questions were partly posed in a closed-ended-, in an open-ended- and in a multiple choice format (with the possibility of selecting more than one answer). RESULTS Of a total of 43 contacted medical universities/medical faculties, 40 ultimately participated in the survey. As decisive for the establishment of a STC the potential to improve the clinical-practical training and the demand by students were listed. Obligatory training in a STC during the first and sixth academic year was confirmed only by 12 institutions, before the first invasive procedure on patients by 17 institutions. 13 institutions confirmed the use of the STC for the further training of physicians and care-staff. Training for the acute care and emergency medicine skills in the field of pediatrics, for the most part, occurs decentralized. CONCLUSIONS New methods in medical training have reached German-speaking Central Europe, but the simulation and training centers vary in size, equipment or regarding their integration into the obligatory curriculum as much as the number and variety of the offering to be trained voluntarily or on an obligatory basis.
Collapse
Affiliation(s)
- Martin Fandler
- Department of Emergency and Critical Care Medicine, Nuremberg Hospital, Prof.-Ernst-Nathan-Str., 1, 90419 Nuremberg, Germany
| | - Marion Habersack
- Office of the Vice Rector for Teaching & Studies, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Hans P Dimai
- Department of Internal Medicine, Division of Endocrinology & Metabolism, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| |
Collapse
|
28
|
The current status of procedural sedation for pediatric patients in out-of-operating room locations. Curr Opin Anaesthesiol 2012; 25:453-60. [PMID: 22732423 DOI: 10.1097/aco.0b013e32835562d8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To illustrate the changes that are occurring in the rapidly growing field of pediatric sedation. In the USA and throughout the world, children receive sedation from a multitude of specialists with varying levels of training. The current pediatric sedation literature reflects a growing body of sedation literature by medical specialists other than anesthesiologists. This article will review the controversial use of propofol by nonanesthesiologists and the manner in which this varied group of providers along with government entities, regulatory agencies, and national organizations contribute to the continuing evolution of sedation practices. RECENT FINDINGS The number of diagnostic and therapeutic procedures performed on children outside of the operating room continues to increase. The growing body of pediatric sedation literature suggests anesthesiologists are no longer at the forefront of pediatric sedation training, education, and research. Articles published by nonanesthesiologists describe pediatric sedation services, safety, and quality initiatives, drugs, and original sedation research. Medications that were considered under the realm of anesthesiologists are utilized by nonanesthesiologists to provide sedation to children. Regulating and government agencies, including the Joint Commission and the Center for Medicaid and Medicare Services have recently issued statements on the oversight and practice of sedation. SUMMARY The direction of pediatric sedation is no longer solely under the leadership of anesthesiologists. The use of anesthetic agents, including propofol, have been administered by nonanesthesiologists and reported as safe and effective agents. Nonanesthesiologists and governmental and regulatory agencies influence the delivery of sedation services. The future direction of pediatric sedation will ultimately depend upon the ability of anesthesiologists to collaborate with specialists, hospital administrators, credentialing committees, and oversight agencies in order to provide high-quality efficient sedation services to children.
Collapse
|