Pediatric Boot Camp Series: Obtaining a Consult, Discussing Difficult News

The Art of the Consult Call: Improving Communication Through Shared Mental Models

Introduction

The Accreditation Council for Graduate Medical Education cites effective communication with physicians as a core competency for emergency medicine (EM) residents. However, there is no standardized curriculum dedicated to communication beyond practice in the clinical setting.

Methods

We developed a 1-hour EM didactic session on effective consultations using experiential education principles. Learners were placed in pairs of one junior learner and one senior learner. The junior learner performed a mock phone consultation using an EM patient case; the senior learner completed an online evaluation, assessing the junior learner on 13 core components of a successful consult call, based on Kessler's 5Cs consultation model. Subsequently, learners participated in an intervention, which included an artistic activity and facilitated debrief, connecting their reflections to clinical practice. Postintervention, the same paired learners completed a second mock consultation call and reevaluation. Finally, learners completed a feedback survey.

Results

Fifteen pairs completed both the pre- and postintervention evaluations. Of the junior learners simulating the consultation call, 47% were clinical medical students, and 53% were first-year EM residents. Preintervention, learners completed a mean of 51% of core consult call components compared to a mean of 84% postintervention. This 33% improvement was statistically significant (p < .001; 95% CI, 19.9-46.1). Eight participants completed the feedback survey; 100% agreed or strongly agreed with positive statements regarding overall session content.

Discussion

This engaging interactive session utilizing a mock communication exercise, unique artistic activity, and guided reflection can effectively increase junior learners' phone consultation communication skills.

Qualitative Analysis of a Virtual Near-Peer Pediatric Boot Camp Elective

OBJECTIVE

To explore fourth-year medical students' experience with a virtual, near-peer facilitated pediatric boot camp through the lens of self-determination theory (SDT).

METHODS

We developed a virtual pediatric boot camp elective for fourth-year medical students pursuing pediatric residency using Kern's six steps of curriculum development. The two-week virtual elective consisted of facilitated video conferences and small group discussions led by two senior pediatric residents. Semi-structured focus groups were conducted after elective completion. Using SDT as our conceptual framework, we explored participants' experience with the near-peer facilitation of the boot camp. Focus group recordings were transcribed and thematically analyzed using deductive coding for SDT, with inductive coding for themes outside the theory's scope. Saturation was reached after three focus groups. The codebook was iteratively revised through peer debriefing between coders and reviewed by other authors. Credibility was established through member checking.

RESULTS

Ninety-two percent of eligible medical students (n = 23/25) participated in the boot camp with attendance ranging from 18-21 students per session. Twelve students (52%) participated in three focus groups. Qualitative analysis identified five major themes. Four themes consistent with SDT emerged: competence, autonomy, relatedness to near-peers, and relatedness to specialty/institution. The learning environment, including the virtual setting, emerged as an additional, non-SDT-related theme.

CONCLUSIONS

Medical students' experience with our virtual boot camp closely aligned with SDT. Near-peer relatedness emerged as a unique theme which could be further investigated in other aspects of medical student education. Future research could evaluate higher-level learning outcomes from near-peer educational opportunities.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01466-w.

Impact of an end-of-fourth-year emergency medicine bootcamp

Background

The final months of the fourth-year of medical school are variable in educational and clinical experience, and the effect on clinical knowledge and preparedness for residency is unclear. Specialty-specific “bootcamps” are a growing trend in medical education aimed at increasing clinical knowledge, procedural skills, and confidence prior to the start of residency.

Methods

We developed a 4-week Emergency Medicine (EM) bootcamp offered during the final month of medical school. At the conclusion of the course, participants evaluated its impact. EM residency-matched participants and non-participants were asked to self-evaluate their clinical knowledge, procedural skills and confidence 1 month into the start of residency. Program directors were surveyed to assess participants and non-participants across the same domains. A Fisher’s exact test was performed to test whether responses between participants and non-participants were statistically different.

Results

From 2015 to 2018, 22 students participated in the bootcamp. The majority reported improved confidence, competence, and procedural skills upon completion of the course. Self-assessed confidence was significantly higher in EM-matched participants 1 month into residency compared to EM-matched non-participants (p = 0.009). Self-assessed clinical knowledge and procedural skill competency was higher in participants than non-participants but did not reach statistical significance. Program directors rated EM-matched participants higher in all domains but this difference was also not statistically significant.

Conclusions

Participation in an EM bootcamp increases self-confidence at the start of residency among EM-matched residents. EM bootcamps and other specialty-specific courses at the end of medical school may ease the transition from student to clinician and may improve clinical knowledge and procedural skills.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12245-021-00371-8.

An Interactive Mock Paging Curriculum to Prepare New Internal Medicine Interns for Inpatient Wards

INTRODUCTION

The July effect refers to an increase in adverse outcomes during periods of physician trainee turnover in teaching hospitals. We created an interactive resident-led curriculum to train new internal medicine interns for routine encounters on inpatient wards by role-playing through mock paging scenarios and focusing on practical information relevant to intern year.

METHODS

A formal assessment of the academic year 2018 intern boot camp curriculum revealed that interns preferred sessions that involved active learning strategies and covered common issues. In the first week of academic year 2019, interns participated in two 1-hour small-group sessions involving mock paging scenarios. Interns were divided into small groups with one facilitator who was a senior medicine resident. Within these groups, facilitators acted as the nurse and provided pages. Interns took turns answering these mock pages based on a sign-out of patients. The facilitator emphasized desired learner actions and teaching points using a provided guide.

RESULTS

Twenty interns participated in the curriculum. Interns rated the curriculum highly and felt that the sessions improved their knowledge, comfort, and skills in managing routine inpatient encounters. On a 2-week follow-up knowledge test to determine if they retained the information from the curriculum, interns scored an average of 85% (response rate: 60%, N = 12), indicating that they could apply the knowledge/skills learned to new scenarios.

DISCUSSION

This curriculum prepares medicine interns to manage common inpatient issues at the beginning of their residency. After completing the curriculum, interns reported increased confidence in handling these issues.

Pediatric Boot Camp Series: Longitudinal Care for a Child With Asthma-From the Emergency Department to Outpatient Clinic

INTRODUCTION

Childhood asthma is a major source of worldwide morbidity and mortality. Successful management requires a broad spectrum of skills. Given the prevalence, medical students should be proficient in evaluating and managing asthma, including the acute treatment of an exacerbation through the maintenance phase.

METHODS

We used a high-fidelity simulation case of a 2-year-old boy presenting to the emergency room in respiratory distress to let medical students practice the assessment and management of a patient in status asthmaticus. Small-group, case-based discussions combined with provider/parent role-playing facilitated building a framework for addressing the medical management and social aspects of asthma control. Large-group discussions and review of national asthma guidelines helped solidify the material.

RESULTS

Forty-one fourth-year medical students participated in this curriculum over a 5-year period. All participants strongly agreed with the statement "I took away ideas that I plan to apply to internship." Using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), the mean agreement with the statement "This simulation session and debrief was useful" was 5 and with "The small-group role-play and discussions were useful" was 4.5. Students reported that they had a better framework for the treatment and management of asthma.

DISCUSSION

This curriculum is unique in that it uses one unifying case through different phases of care to allow participants to demonstrate comprehensive management of childhood asthma in various practice settings. The curriculum can be used independently or in conjunction with other learning activities as part of a pediatric boot camp.

Building a Boot Camp: Pediatric Residency Preparatory Course Design Workshop and Tool Kit

INTRODUCTION

Although many medical schools are adding residency preparatory courses or boot camps to their curricula, there is little published guidance for faculty tasked with designing them. We developed a workshop and accompanying boot camp course design tool kit to assist faculty in creating a pediatric boot camp course following the initial steps of Kern's framework for curriculum development.

METHODS

Learners participated in a 2-hour workshop incorporating short didactics, guided independent reflection, and group discussions. Workshop facilitators guided faculty through the tool kit materials including a literature overview, a needs assessment worksheet, session prioritization and schedule planning worksheets, a module design worksheet, and implementation strategies.

RESULTS

Twenty-seven attendees at a national meeting of undergraduate pediatric educators participated in the workshop. Feedback was solicited via an anonymous electronic survey (41% completion rate), which indicated that attendees' self-assessed confidence significantly increased for each component of the tool kit. For the five tool kit components surveyed, average confidence increased 26% (range: 17.5%-37.1%) after completing the workshop. All respondents also indicated that the tool kit would be moderately helpful to very helpful as a stand-alone resource for independent faculty use, corresponding to a 3.57 out of 5 weighted average for this Likert-scale question.

DISCUSSION

We developed a pediatric boot camp course design workshop and tool kit to assist faculty in developing pediatric boot camps. Initial implementation was through a workshop, but the resource could be used individually and also adapted for use by other specialties.

Delivering Challenging News: An Illness-Trajectory Communication Curriculum for Multispecialty Oncology Residents and Fellows

Introduction

Published curricula to teach communication skills for postgraduate fellows in oncology are few in number despite the fact that oncologists conduct many difficult discussions with their patients and their families. Such discussions may include disclosing initial diagnosis or relapse of a patient's cancer or relaying a poor prognosis or change to palliative care.

Methods

An eight-module course on communication in oncology practice was delivered over 2 months for palliative and oncology fellows and radiation oncology residents. Learners were given a precourse survey in which they were asked to rate their proficiency in various communication tasks. Each learner then participated in a videotaped precourse objective structured clinical exam (OSCE) on breaking bad news with standardized patients (SPs). The course took place over 8 weeks with weekly didactics and role-play. At the end of the course, a second OSCE took place. After the course was completed, the fellows again filled out a proficiency survey.

Results

Twenty-two learners participated over 2 years of this course. Participants reported a significant increase in perceived competence in all areas on the postcourse survey. SP feedback on OSCEs pre- and postcourse indicated improvement in skills for learners. Pre- and postcourse OSCE video assessment revealed a significant improvement in global communication skills.

Discussion

Initial data show that this course successfully improved communication skills and increased fellows' comfort level across several domains of communication. Future directions include validating our assessment tool, expanding the topic base, and investigating the impact on practice after course completion.