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Schoppel K, Keilman A, Fayyaz J, Padlipsky P, Diaz MCG, Wing R, Hughes M, Franco M, Swinger N, Whitfill T, Walsh B. Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation: A Pilot Study. Pediatr Emerg Care 2024; 40:591-597. [PMID: 38809592 DOI: 10.1097/pec.0000000000003216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVES The majority of pediatric patients in the United States (US) are evaluated and treated at general emergency departments. It is possible that discrepancies in length of emergency medicine (EM) residency training may allow for variable exposure to pediatric patients, critical resuscitations, and didactic events. The goal of this pilot study was to compare leadership skills of graduating EM residents from 3- to 4-year programs during simulated pediatric resuscitations using a previously validated leadership assessment tool, the Concise Assessment of Leader Management (CALM). METHODS This was a prospective, multicenter, simulation-based cohort pilot study that included graduating 3 rd - and 4 th -year EM resident physicians from 6 EM residency programs. We measured leadership performance across 3 simulated pediatric resuscitations (sepsis, seizure, cardiac arrest) using the CALM tool and compared leadership scores between the 3 rd - and 4 th -year resident cohorts. We also correlated leadership to self-efficacy scores. RESULTS Data was analyzed for 47 participating residents (24 3 rd -year residents and 23 4 th -year residents). Out of a total possible CALM score of 66, residents from 3-year programs scored 45.2 [SD ± 5.2], 46.8 [SD ± 5.0], and 46.6 [SD ± 4.7], whereas residents from 4-year programs scored 45.5 [SD ± 5.2], 46.4 [SD ± 5.0], and 48.2 [SD ± 4.3] during the sepsis, seizure, and cardiac arrest cases, respectively. The mean leadership score across all 3 cases for the 3-year cohort was 46.2 [SD ± 4.8] versus 46.7 [SD ± 4.5] ( P = 0.715) for the 4-year cohort. CONCLUSIONS These data show feasibility for a larger cohort project and, while not statistically significant, suggest no difference in leadership skills between 3 rd - and 4 th -year EM residents in our study cohort. This pilot study provides the basis of future work that will assess a larger multicenter cohort with the hope to obtain a more generalizable dataset.
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Affiliation(s)
- Kyle Schoppel
- From the Indiana University School of Medicine/Riley Hospital for Children
| | | | - Jabeen Fayyaz
- The Hospital for Sick Children/University of Toronto
| | | | | | | | | | | | - Nathan Swinger
- From the Indiana University School of Medicine/Riley Hospital for Children
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Shaahinfar A, Ghazi-Askar ZM. Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:529-554. [PMID: 34215401 DOI: 10.1016/j.emc.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.
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Affiliation(s)
- Ashkon Shaahinfar
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Trailer 3, 747 52nd Street, Oakland, CA 94609, USA; Department of Emergency Medicine, UCSF School of Medicine, 550 16th Street, MH5552, San Francisco, CA, USA.
| | - Zahra M Ghazi-Askar
- Department of Emergency Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room M121, Alway Building MC 5768, Stanford, CA 94305, USA
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Nagler J, Auerbach M, Monuteaux MC, Cheek JA, Babl FE, Oakley E, Nguyen L, Rao A, Dalton S, Lyttle MD, Mintegi S, Mistry RD, Dixon A, Rino P, Kohn-Loncarica G, Dalziel SR, Craig S. Exposure and confidence across critical airway procedures in pediatric emergency medicine: An international survey study. Am J Emerg Med 2020; 42:70-77. [PMID: 33453618 DOI: 10.1016/j.ajem.2020.12.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described. OBJECTIVES Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children. METHODS A web-based survey of senior emergency physicians was distributed through the six research networks associated with Pediatric Emergency Research Network (PERN). Senior physician was defined as anyone working without direct supervision at any point in a 24-h cycle. Physicians were queried regarding their most recent clinical experience performing or supervising airway procedures, as well as with hands on practice time or procedural teaching. Reponses were dichotomized to within the last year, or ≥ 1 year. Confidence was assessed using a Likert scale for each procedure, with results for ETI and LMA stratified by age. Response levels were dichotomized to "not confident" or "confident." Multivariate regression models were used to assess relevant associations. RESULTS 1602 of 2446 (65%) eligible clinicians at 96 PERN sites responded. In the previous year, 1297 (85%) physicians reported having performed bag-mask ventilation, 900 (59%) had performed intubation, 248 (17%) had placed a laryngeal mask airway, 348 (23%) had changed a tracheostomy tube, and 18 (1%) had performed a surgical airway. Of respondents, 13% of physicians reported the opportunity to supervise but not provide ETI, 5% for LMA and 5% for BMV. The percentage of physicians reporting "confidence" in performing each procedure was: BMV (95%) TTC (43%), and surgical airway (16%). Clinician confidence in ETT and LMA varied by patient age. Supervision of an airway procedure was the strongest predictor of procedural confidence across airway procedures. CONCLUSION BMV and ETI were the most commonly performed pediatric airway procedures by emergency medicine physicians, and surgical airways are very infrequent. Supervising airway procedures may serve to maintain procedural confidence for physicians despite infrequent opportunities as the primary proceduralist.
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Affiliation(s)
- Joshua Nagler
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Pediatric Emergency Care Applied Research Network (PECARN), USA.
| | - Marc Auerbach
- Yale University School of Medicine, New Haven, CT, USA; Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), USA
| | - Michael C Monuteaux
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John A Cheek
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; University of Melbourne, Melbourne, Australia
| | - Ed Oakley
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; University of Melbourne, Melbourne, Australia
| | - Lucia Nguyen
- Peninsula Health, Frankston, Victoria, Australia
| | - Arjun Rao
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Sydney Children's Hospital (Randwick), NSW, Australia; University of New South Wales, Australia; Health Education Training Institute (HETI), New South Wales, Australia
| | - Sarah Dalton
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI), UK
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain; University of the Basque Country, Spain; Research in European Pediatric Emergency Medicine (REPEM), Spain; Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG), Spain
| | - Rakesh D Mistry
- Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Andrew Dixon
- University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, Canada; Pediatric Emergency Research Canada (PERC), Canada
| | - Pedro Rino
- Universidad de Buenos Aires, Argentina; Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina; Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA), Argentina
| | - Guillermo Kohn-Loncarica
- Universidad de Buenos Aires, Argentina; Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina; Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA), Argentina
| | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Paediatric Emergency Department, Monash Medical Centre, Melbourne, Australia; Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Australia
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