Educational Strategies in Pediatric Trauma Resuscitation Across Disciplines: A Scoping Review

INTRODUCTION

Trauma is the leading cause of death and disability in children. Differences in mechanism, injury pattern, severity, and physiology in this population distinguish pediatric trauma patients from adults. Educational techniques including simulation and didactics may improve pediatric readiness in this setting. We summarize the literature across disciplines, highlighting the curricular approaches, target provider population, educational content, content delivery method, and Kirkpatrick level for pediatric trauma resuscitation education.

METHODS

The MEDLINE (via Ovid), Embase (via Elsevier), Cumulative Index to Nursing & Allied Health Literature Complete (via EBSCO), Education Database (via ProQuest), and Web of Science Social Science Citation Index and Science Citation Index (via Clarivate) were searched. We reviewed 90 manuscripts describing pediatric trauma resuscitation education programs. When available, target provider population, curricular content, delivery method, and Kirkpatrick level were obtained.

RESULTS

Nurses (50%), residents (45%), and attending physicians (43%) were the most common participants. Airway management (25%), shock (25%), and general trauma (25%) were the most frequently taught concepts, and delivery of content was more frequently via simulation (65%) or didactics (52%). Most studies (39%) were Kirkpatrick Level 1.

CONCLUSIONS

This review suggests that diverse strategies exist to promote pediatric readiness. Most training programs are interdisciplinary and use a variety of educational techniques. However, studies infrequently report examining the impact of educational interventions on patient-centered outcomes and lack detail in describing their curriculum. Future educational efforts would benefit from heightened attention to such outcome measures and a rigorous description of their curricula to allow for reproducibility.

Medical student perspectives on radiology subspecialties prior to core clerkship

RATIONALE AND OBJECTIVES

Radiology remains underrepresented in U.S. medical school clinical curricula, and preconceived opinions about the field may impact whether students pursue elective exposure. A core radiology clerkship at one academic institution presents an opportunity to evaluate students' early preferences for different radiology subspecialties, thus informing curricular design and inspiring student recruitment.

MATERIALS AND METHODS

At a single allopathic medical school, a required, four-week, clinical-year radiology clerkship that occurs in the second year includes immersive one-week experiences in two subspecialties. Prior to their clerkship, students rank their immersion preferences by distributing 100 points across eight fields, the values of which were analyzed as a proxy for interest. A secondary survey was distributed to active first- and second-year medical students to further investigate the factors drawing them to radiology.

RESULTS

Immersive experiences in musculoskeletal, body, and breast imaging were most preferred, earning ≥20 points from 41.6 %, 34.3 %, and 31.9 % of students, respectively. Women were significantly more likely than men to express interest in breast imaging (35.8 % vs. 24.8 %, p = 0.037) and pediatric radiology (28.8 % vs. 12.8 %, p = 0.001). Men were significantly more likely than women to prefer body imaging (41.9 % vs. 30.2 %, p = 0.034), neuroradiology (29.1 % vs. 19.5 %, p = 0.048), and nuclear medicine (11.1 % vs. 5.1 %, p = 0.044).

CONCLUSION

Early in their clinical education, medical students prefer certain subspecialties, especially musculoskeletal, body, and breast imaging. Women expressed significantly stronger interest in breast imaging and pediatric radiology, while men indicated significantly stronger interest in body imaging, neuroradiology, and nuclear medicine.

Comparative Performance of 2018 LI-RADS versus Modified LIRADS (mLI-RADS): An Individual Participant Data Meta-Analysis

BACKGROUND

LI-RADS version 2018 (v2018) is used for non-invasive diagnosis of hepatocellular carcinoma (HCC). A recently proposed modification (known as mLI-RADS) demonstrated improved sensitivity while maintaining specificity and positive predictive value (PPV) of LI-RADS category 5 (definite HCC) for HCC. However, mLI-RADS requires multicenter validation.

PURPOSE

To evaluate the performance of v2018 and mLI-RADS for liver lesions in a large, heterogeneous, multi-national cohort of patients at risk for HCC.

STUDY TYPE

Systematic review and meta-analysis using individual participant data (IPD) [Study Protocol: https://osf.io/duys4].

POPULATION

2223 observations from 1817 patients (includes all LI-RADS categories; females = 448, males = 1361, not reported = 8) at elevated risk for developing HCC (based on LI-RADS population criteria) from 12 retrospective studies.

FIELD STRENGTH/SEQUENCE

1.5T and 3T; complete liver MRI with gadoxetate disodium, including axial T2w images and dynamic axial fat-suppressed T1w images precontrast and in the arterial, portal venous, transitional, and hepatobiliary phases. Diffusion-weighted imaging was used when available.

ASSESSMENT

Liver observations were categorized using v2018 and mLI-RADS. The diagnostic performance of each system's category 5 (LR-5 and mLR-5) for HCC were compared.

STATISTICAL TESTS

The Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2 was applied to determine risk of bias and applicability. Diagnostic performances were assessed using the likelihood ratio test for sensitivity and specificity and the Wald test for PPV. The significance level was P < 0.05.

RESULTS

17% (2/12) of the studies were considered low risk of bias (244 liver observations; 164 patients). When compared to v2018, mLR-5 demonstrated higher sensitivity (61.3% vs. 46.5%, P < 0.001), similar PPV (85.3% vs. 86.3%, P = 0.89), and similar specificity (85.8% vs. 90.8%, P = 0.16) for HCC.

DATA CONCLUSION

This study confirms mLR-5 has higher sensitivity than LR-5 for HCC identification, while maintaining similar PPV and specificity, validating the mLI-RADS proposal in a heterogeneous, international cohort.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

Individual Participant Data Meta-Analysis of LR-5 in LI-RADS Version 2018 versus Revised LI-RADS for Hepatocellular Carcinoma Diagnosis

Background A simplification of the Liver Imaging Reporting and Data System (LI-RADS) version 2018 (v2018), revised LI-RADS (rLI-RADS), has been proposed for imaging-based diagnosis of hepatocellular carcinoma (HCC). Single-site data suggest that rLI-RADS category 5 (rLR-5) improves sensitivity while maintaining positive predictive value (PPV) of the LI-RADS v2018 category 5 (LR-5), which indicates definite HCC. Purpose To compare the diagnostic performance of LI-RADS v2018 and rLI-RADS in a multicenter data set of patients at risk for HCC by performing an individual patient data meta-analysis. Materials and Methods Multiple databases were searched for studies published from January 2014 to January 2022 that evaluated the diagnostic performance of any version of LI-RADS at CT or MRI for diagnosing HCC. An individual patient data meta-analysis method was applied to observations from the identified studies. Quality Assessment of Diagnostic Accuracy Studies version 2 was applied to determine study risk of bias. Observations were categorized according to major features and either LI-RADS v2018 or rLI-RADS assignments. Diagnostic accuracies of category 5 for each system were calculated using generalized linear mixed models and compared using the likelihood ratio test for sensitivity and the Wald test for PPV. Results Twenty-four studies, including 3840 patients and 4727 observations, were analyzed. The median observation size was 19 mm (IQR, 11-30 mm). rLR-5 showed higher sensitivity compared with LR-5 (70.6% [95% CI: 60.7, 78.9] vs 61.3% [95% CI: 45.9, 74.7]; P < .001), with similar PPV (90.7% vs 92.3%; P = .55). In studies with low risk of bias (n = 4; 1031 observations), rLR-5 also achieved a higher sensitivity than LR-5 (72.3% [95% CI: 63.9, 80.1] vs 66.9% [95% CI: 58.2, 74.5]; P = .02), with similar PPV (83.1% vs 88.7%; P = .47). Conclusion rLR-5 achieved a higher sensitivity for identifying HCC than LR-5 while maintaining a comparable PPV at 90% or more, matching the results presented in the original rLI-RADS study. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sirlin and Chernyak in this issue.

The Use of Structured Oral Exams for the Assessment of Medical Students in their Radiology Clerkship

RATIONALE & OBJECTIVES

There is increasing interest in narrative feedback and competency-based evaluation in medical student education. This study evaluates the implementation of a structured oral exam for a required radiology clerkship in furtherance of these aims.

MATERIALS & METHODS

A structured oral exam was instituted in academic year (AY) 20-21. Students prepared to discuss 5 varied imaging cases as they would to a medical colleague and as to a patient. For AY 20-21, students took the oral and a written exam. In AY 21-22, students took the oral exam alone and the written exam was discontinued. The perceived educational value of clerkship components, including the oral and written exam, were scored by the students on a 5-point Likert scale.

RESULTS

All students in AY 20-21 received a passing score on the written (mean 89.0, SD 4.59) and oral exams. All students in AY 21-22 received a passing score on the oral exam. In AY 20-21, the educational value of the oral exam was rated significantly higher than that of the written exam (4.30 vs 4.02, P = 0.021). There was no significant difference in rating of the oral exam between AY 20-21 and AY 21-22 (4.30 vs 4.38; P = 0.499).

CONCLUSION

The implementation of a structured final oral exam for a required radiology clerkship was felt to be successful in the aims of delivering educational value while evaluating students for competency. Further evaluation of oral exams for radiology medical student education are warranted to optimize the career preparation of future physicians.

Infant Brain Structural MRI Analysis in the Context of Thoracic Non-cardiac Surgery and Critical Care

Objective: To determine brain magnetic resonance imaging (MRI) measures of cerebrospinal fluid (CSF) and whole brain volume of full-term and premature infants following surgical treatment for thoracic non-cardiac congenital anomalies requiring critical care. Methods: Full-term (n = 13) and pre-term (n = 13) patients with long-gap esophageal atresia, and full-term naïve controls (n = 19) < 1 year corrected age, underwent non-sedated brain MRI following completion of thoracic non-cardiac surgery and critical care treatment. Qualitative MRI findings were reviewed and reported by a pediatric neuroradiologist and neurologist. Several linear brain metrics were measured using structural T1-weighted images, while T2-weighted images were required for segmentation of total CSF and whole brain tissue using the Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS) tool. Group differences in absolute (mm, cm³) and normalized (%) data were analyzed using a univariate general linear model with age at scan as a covariate. Mean normalized values were assessed using one-way ANOVA. Results: Qualitative brain findings suggest brain atrophy in both full-term and pre-term patients. Both linear and volumetric MRI analyses confirmed significantly greater total CSF and extra-axial space, and decreased whole brain size in both full-term and pre-term patients compared to naïve controls. Although linear analysis suggests greater ventricular volumes in all patients, volumetric analysis showed that normalized ventricular volumes were higher only in premature patients compared to controls. Discussion: Linear brain metrics paralleled volumetric MRI analysis of total CSF and extra-axial space, but not ventricular size. Full-term infants appear to demonstrate similar brain vulnerability in the context of life-saving thoracic non-cardiac surgery requiring critical care as premature infants.