1
|
High variability in cardiac education and experiences during United States paediatric critical care fellowships. Cardiol Young 2023; 33:366-370. [PMID: 35241196 PMCID: PMC9440946 DOI: 10.1017/s1047951122000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paediatric cardiac critical care continues to become more sub-specialised, and many institutions have transitioned to dedicated cardiac ICUs. Literature regarding the effects of these changes on paediatric critical care medicine fellowship training is limited. OBJECTIVE To describe the current landscape of cardiac critical care education during paediatric critical care medicine fellowship in the United States and demonstrate its variability. METHODS A review of publicly available information in 2021 was completed. A supplemental REDCap survey focusing on cardiac ICU experiences during paediatric critical care medicine fellowships was e-mailed to all United States Accreditation Council of Graduate Medical Education-accredited paediatric critical care medicine fellowship programme coordinators/directors. Results are reported using inferential statistics. RESULTS Data from 71 paediatric critical care medicine fellowship programme websites and 41 leadership responses were included. Median fellow complement was 8 (interquartile range: 6, 12). The majority (76%, 31/41) of programmes had a designated cardiac ICU. Median percentage of paediatric critical care medicine attending physicians with cardiac training was 25% (interquartile range: 0%, 69%). Mandatory cardiac ICU time was 16 weeks (interquartile range: 13, 20) with variability in night coverage and number of other learners present. A minority of programmes (29%, 12/41) mandated other cardiac experiences. Median CHD surgical cases per year were 215 (interquartile range: 132, 338). When considering the number of annual cases per fellow, programmes with higher case volume were not always associated with the highest case number per fellow. CONCLUSIONS There is a continued trend toward dedicated cardiac ICUs in the United States, with significant variability in cardiac training during paediatric critical care medicine fellowship. As the trend toward dedicated cardiac ICUs continues and practices become more standardised, so should the education.
Collapse
|
2
|
Holcomb J, Ferguson GM, Thornton L, Highfield L. Development, implementation, and evaluation of Teach Back curriculum for community health workers. Front Med (Lausanne) 2022; 9:918686. [PMID: 36405583 PMCID: PMC9669070 DOI: 10.3389/fmed.2022.918686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2023] Open
Abstract
Teach Back is a commonly used communication method to improve patient understanding and retention of health information. The method has been shown to be effective in improving patient and healthcare system outcomes, including patient health literacy and hospital readmissions. Community health workers (CHWs) are frontline healthcare workers who can help address patient health and social needs associated with hospital readmissions. However, a gap exists in Teach Back curricula and training methods reflecting the scope of work for CHWs. The objective of this training was to provide CHWs with didactic information and skill building practice curriculum focused on the integration of Teach Back into clinical patient interactions, care coordination, and follow-up support. A multidisciplinary team of academic and clinical partners at a large academic health university developed, implemented, and evaluated a 3-week pilot Teach Back training with CHWs through a quality improvement approach. The CHWs reported overall satisfaction with the training and instructors. The academic clinical partnership allowed the training to be tailored to the daily clinical workflow as reflected in the CHWs agreement that the training was relevant and practical. With the repeated exposure to Teach Back each week, the CHWs also reported an increase in confidence and conviction in using Teach Back. Additional implementation and evaluation of the training curriculum for CHWs is needed to gain further insights into Teach Back and training best practices and translation into practice.
Collapse
Affiliation(s)
- Jennifer Holcomb
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Gayla M. Ferguson
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Logan Thornton
- Division of Population Health and Evidence-Based Practice, Healthcare Transformation Initiatives, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, TX, United States
| | - Linda Highfield
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
- Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, TX, United States
| |
Collapse
|
3
|
Thim S, Henriksen TB, Laursen H, Schram AL, Paltved C, Lindhard MS. Simulation-Based Emergency Team Training in Pediatrics: A Systematic Review. Pediatrics 2022; 149:185292. [PMID: 35237809 DOI: 10.1542/peds.2021-054305] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The rare event of handling critically ill children often challenge the emergency care team. Several studies have investigated effects of simulation-based team training to prepare for such events, but the body of evidence remains to be compiled. We performed a systematic review of the effects of simulation-based team training on clinical performance and patient outcome. METHODS From a search of MEDLINE, Embase, CINAHL, and Cochrane Library, we included studies of team training in emergency pediatric settings with reported clinical performance and patient outcomes. We extracted data using a predefined template and assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials 2.0 and the Newcastle Ottawa Quality Assessment Scale. RESULTS We screened 1926 abstracts and included 79 studies. We identified 15 studies reporting clinical health care professional performance or patient outcomes. Four studies reported survival data, 5 reported time-critical clinical events, 5 reported adherence to guidelines, checklists or tasks, and 2 reported on airway management. Randomized studies revealed improved team performance in simulated reevaluations 2 to 6 months after intervention. A meta-analysis was impossible because of heterogeneous interventions and outcomes. Most included studies had significant methodological limitations. CONCLUSIONS Pediatric simulation-based team training improves clinical performance in time-critical tasks and adherence to guidelines. Improved survival was indicated but not concluded because of high risk of bias. Team performance and technical skills improved for at least 2 to 6 months. Future research should include longer-term measures of skill retention and patient outcomes or clinical measures of treatment quality whenever possible.
Collapse
Affiliation(s)
- Signe Thim
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Laursen
- Medical Library, Regional Hospital Central Jutland, Viborg, Denmark
| | | | | | | |
Collapse
|
4
|
Development and application of "Special defibrillator for teaching and training". Eur J Med Res 2022; 27:33. [PMID: 35236410 PMCID: PMC8889708 DOI: 10.1186/s40001-022-00657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background To provide an economical and practical defibrillator for first aid teaching and training, to reduce the cost of teaching and training, increase teaching and training equipment, provide trainees with more hands-on training sessions, and improve first aid capabilities. Methods Developing a special teaching defibrillator with the same structure and operation configuration as the clinical medical emergency defibrillator. The appearance, structure and operating accessories of the two defibrillators are the same. The difference between the defibrillator and the clinical medical emergency defibrillator are as follows: the clinical medical emergency defibrillator can be energized, and there are expensive electronic accessories and defibrillation accessories for charging and discharging in the machine. When discharging, the electrode plate has current discharged into the human body; the power plug of the “special defibrillator for teaching and training” is a fake plug. When the power is plugged in, no current enters the body and the machine. There are no expensive electronic accessories and defibrillation accessories for charging and discharging, and no current is discharged during discharge. Then compare the teaching effect of the special defibrillator for teaching and training and the clinical medical emergency defibrillator (including operation score and attitude after training). Results The scores of defibrillator operation in the experimental group of junior college students (87.77 ± 4.11 vs. 83.30 ± 4.56, P < 0.001) and the experimental group of undergraduate students (90.40 ± 3.67 vs. 89.12 ± 3.68, P = 0.011) were higher than those in the corresponding control group; The attitude of junior college students in the experimental group and undergraduate students in the experimental group after training was more positive than that of the corresponding control group (P < 0.05). Conclusions The special defibrillator for teaching and training can save the purchase cost of teaching equipment, increase teaching and training resources, and improve the trainee’s defibrillation ability, defibrillation confidence and defibrillation security.
Collapse
|
5
|
Walsh H, Nicholson L, Patterson M, Zaveri P. Code Response Training: Improving Interprofessional Communication. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11155. [PMID: 34079907 PMCID: PMC8131416 DOI: 10.15766/mep_2374-8265.11155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/12/2021] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Using simulation to improve team performance in emergencies is commonplace. Decreasing codes hospital-wide can be challenging. To address these needs, hospital leaders requested a simulation program to provide team training across an institution focused on patient safety and communication techniques. METHODS We developed a multimodal approach pairing three online modules on communication techniques with a simulation-based learning session. The three modules required 1 hour, followed by a 1-hour, in-person, simulation-based, interprofessional, small-group session of clinical staff. In ad hoc teams, participants managed two cases: a toddler with airway obstruction and a child developing septic shock. A focused debriefing included discussion of mental models, team formation and expertise, and communication techniques to create a common language to use in ad hoc team formation and patient care. RESULTS Through more than 200 training sessions reaching over 1,400 staff members, we executed code response training. A nurse and physician facilitated each session, emphasizing the interprofessional nature needed for patient care. Participants rated the learning experience highly on a 5-point Likert scale (1 = low/poor, 5 = high/excellent), with an average rating of 4.3 for achieving objectives and an average rating of 4.8 for facilitator effectiveness. DISCUSSION Through engaging leadership and frontline clinicians, the simulation program provided code response training hospital-wide, emphasizing the importance of teamwork and communication in critical situations. Such hospital-wide training can emphasize a shared language to empower clinicians at all levels to deliver safe, quality patient care.
Collapse
Affiliation(s)
- Heather Walsh
- Simulation Program Manager, Simulation Program, Children's National
- Corresponding author:
| | - Laura Nicholson
- Simulation Education Specialist, Simulation Program, Children's National
| | - Mary Patterson
- Associate Dean and Professor, Lou Oberndorf Professor in Healthcare Technology, Center for Experiential Learning and Simulation, Department of Emergency Medicine, University of Florida
| | - Pavan Zaveri
- Medical Director, Simulation Program, Division of Emergency Medicine, Children's National
| |
Collapse
|
6
|
Lemke DS. Rapid Cycle Deliberate Practice for Pediatric Intern Resuscitation Skills. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11020. [PMID: 33241116 PMCID: PMC7678026 DOI: 10.15766/mep_2374-8265.11020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION For pediatric interns, it takes deliberate practice to translate the knowledge of what to do in emergencies into the procedural and communication skills required of a team member or team leader. This curriculum taught interns through simulations with rapid cycle deliberate practice (RCDP). This method focused on teaching time-sensitive team-based activities in simulation. The RCDP structure alternated practice with immediate expert feedback. This alternating pattern gave the learner chances to practice the correct way to perform these skills. METHODS The curriculum was developed iteratively based on common gaps in intern skills and knowledge; it was well suited for groups of four to six interns and to be given by one or two instructors over a 6-hour period of time. After an initial warm-up case, a series of simulations used RCDP to move interns through cases focusing on management of respiratory distress, upper airway obstruction, shock, intubation, complications of intubation, and pulseless arrest. Feedback was interspersed throughout the experience with detailed explanations provided as the interns required them to complete the simulations. RESULTS This technique was well received by a group of 81 interns who provided positive feedback on the sessions. In particular, when asked if the course "improved my teamwork and leadership skills" they agreed with a mean score of 4.9 out of 5. DISCUSSION This curriculum taught and integrated the procedural skills, communication skills, and teamwork needed to participate in pediatric resuscitations. The methods described in this curriculum improved confidence of pediatric interns and merits further study.
Collapse
Affiliation(s)
- Daniel S. Lemke
- Associate Professor of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital
| |
Collapse
|
7
|
Wing R, Tsao HS, Toomey V, Mercurio L, Carillo M, Brown LL, Kelley MN. Excellence in Communication and Emergency Leadership (ExCEL): Pediatric First 5 Minutes Workshop for Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10980. [PMID: 33005733 PMCID: PMC7521066 DOI: 10.15766/mep_2374-8265.10980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In-hospital pediatric cardiopulmonary arrest is associated with high morbidity and mortality, and appropriate initial management has been associated with improved clinical outcomes. Despite current training, pediatric residents often do not feel confident in their ability to deliver this initial management. This workshop focused on the initial management of critically ill pediatric patients and performance of high-quality CPR. METHODS This hands-on workshop utilized skill stations with low- and medium-fidelity simulators to instruct learners on initial management during the first 5 minutes of a code, including high-quality CPR. It was designed for residents across all levels of training who care for pediatric patients (including pediatrics, medicine-pediatrics, pediatrics, psychiatry, and child psychiatry, family medicine, and emergency medicine residents) and can be adapted for different session durations and group sizes. RESULTS This workshop was conducted at two separate institutions with a total of 18 resident participants. Participants strongly agreed that this workshop was relevant and effective in teaching the initial assessment and management of the critical pediatric patient, including how to best perform high-quality CPR. Residents further reported high levels of confidence in initially assessing and managing a critically ill patient, describing the markers of high-quality CPR, and performing high-quality CPR. DISCUSSION This workshop provided residents with additional instruction and practice in the initial management of critically ill pediatric patients in cardiopulmonary arrest. The structure and timeline of this curriculum can be adapted to the needs of the individual institution's program and the number of workshop participants.
Collapse
Affiliation(s)
- Robyn Wing
- Assistant Professor, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Director of Pediatric Simulation, Lifespan Medical Simulation Center
| | - Hoi See Tsao
- Fellow, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, The Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital
| | - Vanessa Toomey
- Clinical Fellow, The Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School and Boston Children's Hospital
| | - Laura Mercurio
- Fellow, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, The Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital
| | - Marie Carillo
- Fellow, Department of Cardiology, Children's National Medical Center
| | - Linda L. Brown
- Associate Professor, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Director of the Lifespan Medical Simulation Center
| | - Mariann Nocera Kelley
- Assistant Professor, Departments of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's; Director of Simulation, University of Connecticut School of Medicine
| |
Collapse
|
8
|
Jackson JM, Strowd LC, Peters TR. The Simulated Virology Clinic: A Standardized Patient Exercise for Preclinical Medical Students Supporting Basic and Clinical Science Integration. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10957. [PMID: 32934980 PMCID: PMC7485908 DOI: 10.15766/mep_2374-8265.10957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Virology is inherently challenging due to the sheer volume of information medical students are responsible for learning. Cognitive integration of this content is critical for early medical students to practice applying this knowledge to diagnostic problem-solving. Simulation offers learners engaging opportunities to practice cognitive integration. We developed a simulated clinic activity for first-year medical students consisting of standardized patient (SP) encounters representing viral infections. METHODS Student small groups rotated through eight SP encounters during which they collected patient histories, reviewed physical exam findings, and developed a differential diagnosis and diagnostic plan for each case. The instructor debriefed students on the cases afterward. We assessed students' evaluation of the activity through online surveys. RESULTS Two hundred seventy-eight students participated in the simulated clinic in 2018 and 2019. Students rated the activity as very effective for learning about the infections represented and for providing opportunities to integrate clinical skills. Students agreed that the event's instructional design was appropriate for its objectives and that the problem-solving aspect was intellectually stimulating. They indicated that the most effective aspects were solidifying illness scripts for the infections represented, integrating knowledge and skills to diagnose patients in a realistic clinical context, and working collaboratively to problem-solve. DISCUSSION The simulated virology clinic is an effective method for providing students opportunities to integrate microbiology and clinical skills and has been positively received by students. This instructional method offers learners an opportunity to solidify illness scripts for viral infections using an interactive, collaborative approach.
Collapse
Affiliation(s)
- Jennifer M. Jackson
- Associate Professor, Department of Pediatrics, Wake Forest School of Medicine; Co-Course Director, Clinical Skills Curriculum, Wake Forest School of Medicine; Co-Course Director, Virology Course, Wake Forest School of Medicine; Assistant Dean for Curricular Innovation, Wake Forest School of Medicine
| | - Lindsay C. Strowd
- Assistant Professor, Department of Dermatology, Wake Forest School of Medicine; Director, Dermatology Thread, Wake Forest School of Medicine
| | - Timothy R. Peters
- Professor, Department of Pediatrics, Wake Forest School of Medicine; Associate Dean for Educational Strategy & Innovation, Wake Forest School of Medicine; Co-Course Director, Virology Course, Wake Forest School of Medicine
| |
Collapse
|
9
|
Mannarino C, Bradley E, Puro A, Sung D, Wolfe K. Pathophysiology for the Pediatric Critical Care Fellow: Three Representative Simulation Cases. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10931. [PMID: 32733996 PMCID: PMC7384746 DOI: 10.15766/mep_2374-8265.10931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/15/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION During the course of fellowship training, pediatric critical care fellows are expected to develop a broad and in-depth understanding of the pathophysiology of multiple disease processes. The simulation-based pediatric critical care pathophysiology curriculum we present uses scenarios created by pediatric critical care fellows to teach complex pathophysiology. METHODS Each of the three representative cases presented covered a specific pathophysiologic process and required participants to acutely manage (1) an 18-year-old patient with altered mental status in the setting of hepatic encephalopathy; (2) an 8-year-old patient with sepsis, coagulopathy, and acute kidney injury; or (3) a 12-year-old patient with status epilepticus. Each case could be conducted in a simulation suite or an acute care unit bed. We assessed learners' knowledge and attitudes at the end of these simulations with a structured debriefing session and via completion of an evaluation form. The simulations were then followed by a 30-minute interactive didactic session on the topic. RESULTS Each scenario had six fellow participants who completed evaluations. After completing each of the three case scenarios presented, the majority of participating pediatric critical care fellows indicated that the content was relevant and sufficiently challenging. They also indicated that these simulation scenarios would improve their clinical practice. DISCUSSION This fellow-developed simulation curriculum is novel, highlighting the relevance for critical care fellows' understanding of realistic clinical scenarios while promoting advanced management skills with a pathophysiology focus.
Collapse
Affiliation(s)
- Candace Mannarino
- Fellow, Pediatric Cardiac Critical Care Medicine, Northwestern University Feinberg School of Medicine; Fellow, Pediatric Cardiac Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Erin Bradley
- Clinical Instructor, Pediatric Critical Care Medicine, Neonatology Associates of Atlanta PC; Clinical Instructor, Pediatric Critical Care Medicine, Children's Healthcare of Atlanta
| | - Amanda Puro
- Instructor, Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas
| | - Deborah Sung
- Fellow, Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine; Fellow, Pediatric Cardiac Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Katie Wolfe
- Instructor, Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine; Instructor, Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| |
Collapse
|
10
|
Bergman CM, Howell J. Critical Cardiopulmonary Event Series: Four Simulations for Pediatric ICU Fellows, Critical Care Nurses, and Pediatric Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10889. [PMID: 32342011 PMCID: PMC7182043 DOI: 10.15766/mep_2374-8265.10889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/22/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Critical cardiopulmonary events arising from congenital or acquired heart diseases are infrequent in some pediatric critical care units but can be associated with significant morbidity and mortality when encountered. We developed four simulation cases for interprofessional pediatric critical care teams (fellows, residents, and nurses) to provide participants with high-acuity cardiopulmonary scenarios in safe learning environments. The included cases were coarctation of the aorta, Kawasaki disease, myocarditis, and tetralogy of Fallot. METHODS The simulations were typically 15 minutes in duration and took place within the pediatric intensive care unit. The scenarios began with handoff of the patient to the primary nurse, who recruited the assistance of resident physicians and ultimately a pediatric critical care medicine fellow as the scenario escalated. Upon completion, participants engaged in a structured, interactive debriefing session for 40 minutes. Afterward, they were asked to complete an anonymous feedback form that was collected and analyzed. RESULTS Based on aggregate postsimulation survey responses from 114 learners, participants reported that these simulation exercises improved their knowledge and ability to manage acutely deteriorating cardiac patients. Additionally, learners rated the impact of the simulation on their practice highly (average score >4 for each group of participants on a 5-point Likert scale). Feedback was analyzed and categorized into three domains: (1) Pediatric Medicine Learning Objectives, (2) Teamwork Strategies, and (3) Opportunities for Simulation Improvements. DISCUSSION This series advances self-reported learner knowledge and skills surrounding management of cardiopulmonary events while also providing opportunities to enhance teamwork and communication skills.
Collapse
Affiliation(s)
- Charles Mac Bergman
- Pediatric Resident (PGY 4), New York Presbyterian–Weill Cornell Medical Center
| | - Joy Howell
- Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Pediatric Critical Care Medicine, New York Presbyterian–Weill Cornell Medical Center
- Pediatric Critical Care Medicine Fellowship Program Director, New York Presbyterian–Weill Cornell Medical Center
- Vice Chair for Diversity, New York Presbyterian–Weill Cornell Medical Center
| |
Collapse
|
11
|
Doymaz S, Rizvi M, Orsi M, Giambruno C. How Prepared Are Pediatric Residents for Pediatric Emergencies: Is Pediatric Advanced Life Support Certification Every 2 Years Adequate? Glob Pediatr Health 2019; 6:2333794X19876809. [PMID: 31555721 PMCID: PMC6747847 DOI: 10.1177/2333794x19876809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/11/2019] [Accepted: 08/21/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives. We assessed pediatric residents’ retention of knowledge and clinical skills according to the time since their last American Heart Association Pediatric Advanced Life Support (AHA PALS) certification. Methods. Sixty-four pediatric residents were recruited and divided into 3 groups based on the time since their last PALS certification, as follows: group 1, 0 to 8 months; group 2, 9 to 16 months, and group 3, 17 to 24 months. Residents’ knowledge was tested using 10 multiple-choice AHA PALS pretest questions and their clinical skills performance was assessed with simulation mock code scenarios using 2 different AHA PALS checklists, and mean scores were calculated for the 3 groups. Differences in the test scores and overall clinical skill performances among the 3 groups were analyzed using analyses of variance, χ2 tests, and Jonckheere-Terpstra tests. Statistical significance was set at P < .05. Results. The pediatric residents’ mean overall clinical skills performance scores declined within the first 8 months after their last AHA PALS certification date and continued to decrease over time (87%, 82.6%, and 77.4% for groups 1, 2, and 3, respectively; P = .048). Residents’ multiple-choice test scores declined in all 3 groups, but the scores were not significantly different. Conclusions. Residents’ clinical skills performance declined within the first 8 months after PALS certification and continued to decline as the time from the last certification increased. Using mock code simulations and reinforcing AHA PALS guidelines during pediatric residency deserve further evaluation.
Collapse
Affiliation(s)
- Sule Doymaz
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Munaza Rizvi
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | | |
Collapse
|
12
|
Peddy SB. Acute Hypoxemia in Infants With Cyanotic Complex Cardiac Anatomy: Simulation Cases for Pediatric Fellows. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10706. [PMID: 30800906 PMCID: PMC6342404 DOI: 10.15766/mep_2374-8265.10706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/21/2018] [Indexed: 06/09/2023]
Abstract
Introduction Cardiopulmonary compromises are infrequent but high-acuity events that occur at pediatric hospitals. Simulation is a powerful modality to teach fellows in pediatric critical care, cardiology, and neonatology important clinical skills in managing complex cardiorespiratory pathophysiology in infants with cyanotic heart disease. Methods We developed three simulation cases of hypoxemia involving differing complex cardiorespiratory pathophysiology in neonates/infants with cyanotic heart disease. Through teamwork, the participants were expected to recognize hypoxemia, work through a differential diagnosis, and implement the medical intervention needed to temporize while awaiting further procedures. Assessment of the participants' performance was via direct observation during the simulated activity. Debriefing occurred immediately using a formal debriefing framework. Results In 10 years, these three cases have been utilized approximately 48 times. Participants subjectively increased their confidence in managing cardiopulmonary events and improved their teamwork and communication skills in similar high-stress events. Discussion This unique module advanced learners' knowledge by building on their Pediatric Advanced Life Support and Neonatal Resuscitation Program foundation, identified management deficits in the care of patients with complex cardiorespiratory pathophysiology, and taught effective teamwork with role assignment and closed-loop communication.
Collapse
Affiliation(s)
- Stacie B. Peddy
- Assistant Professor of Clinical Anesthesiology and Critical Care, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania
- Cardiac Intensivist, Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia
| |
Collapse
|
13
|
Wongsirimeteekul P, Mai CL, Petrusa E, Minehart R, Hemingway M, Pian-Smith M, Eromo E, Phitayakorn R. Identifying and Managing Intraoperative Arrhythmia: A Multidisciplinary Operating Room Team Simulation Case. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10688. [PMID: 30800888 PMCID: PMC6342395 DOI: 10.15766/mep_2374-8265.10688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/28/2018] [Indexed: 05/29/2023]
Abstract
Introduction Resuscitation of a critically ill patient is challenging for both novice learners and experienced health care providers. During a critical event, not only is it important to identify the correct underlying diagnosis, it is equally crucial that the appropriate Advance Cardiac Life Support algorithm, medications, and defibrillator modality are implemented. This scenario features a 56-year-old female who presents for excisional biopsy of an inguinal lymph node to evaluate lymphadenopathy concerning for lymphoma. Intraoperatively, she goes into cardiopulmonary arrest. Participants must identify and manage three different scenarios: (1) ventricular fibrillation, (2) unstable ventricular tachycardia, and (3) bradycardia, including the use of the defibrillator. Method Weekly simulation sessions were conducted in the in situ simulation operating room at Massachusetts General Hospital. Surgical residents, anesthesiology residents, nurses, and surgical technicians participated in a multidisciplinary operating room team. Each approximately 60-minute session included an orientation, the case, and the debriefing. Equipment included a simulation operating room with general surgery supplies, general anesthesia equipment, a high-fidelity SimMan patient simulator, a code cart, and a defibrillator. Results Ninety-one multidisciplinary participants completed this scenario from September to December 2015. Participants reported that the scenario was applicable to their clinical practice (96%), promoted teamwork skills (88%), and encouraged interprofessional learning (94%). Discussion Intraoperative cardiac arrest is a devastating event that can result in poor patient outcomes if the care team is not thoroughly prepared for crisis management. This simulation case scenario was implemented to train multidisciplinary learners in the identification and management of such an event.
Collapse
Affiliation(s)
- Praelada Wongsirimeteekul
- Ophthalmology Resident, Chiang Mai University, Chiang Mai, Thailand
- Surgical Education Research Fellow, Department of Surgery, Massachusetts General Hospital
| | | | - Emil Petrusa
- Surgical Education Researcher, Department of Surgery, Massachusetts General Hospital
| | | | | | | | - Ersne Eromo
- Anesthesiologist, Massachusetts General Hospital
| | - Roy Phitayakorn
- General and Endocrine Surgeon, Massachusetts General Hospital
- Director of Medical Student Education and Surgery Education Research, Department of Surgery, Massachusetts General Hospital
- Senior Education Research and Development Consultant, NEJM Group
| |
Collapse
|