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Mazze N, Mak O, Pavalagantharajah S, Hunter A. An evaluation of a Transition to Foundations curriculum for first year pediatric residents in Competency Based Medical Education. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:88-90. [PMID: 38827899 PMCID: PMC11139797 DOI: 10.36834/cmej.77525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
A Transition to Foundations (TTF) curriculum that includes didactic and simulation components prepares first-year pediatric residents for increased roles and responsibilities in the Foundations of Discipline stage of Competency Based Medical Education, including junior night float rotations. Simulations of acute presentations improve resident comfort before overnight on-call experiences.
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Affiliation(s)
- Nina Mazze
- Department of Pediatrics, McMaster University, McMaster Children’s Hospital, Ontario, Canada
| | - Orianna Mak
- Department of Pediatrics, McMaster University, McMaster Children’s Hospital, Ontario, Canada
| | | | - Andrea Hunter
- Department of Pediatrics, McMaster University, McMaster Children’s Hospital, Ontario, Canada
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Kronish A, Alanko D, Quinn VR, Wulff C, Stone E, Wing R. De-escalation of the Agitated Pediatric Patient: A Standardized Patient Case for Pediatric Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11388. [PMID: 38463716 PMCID: PMC10920402 DOI: 10.15766/mep_2374-8265.11388] [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: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 03/12/2024]
Abstract
Introduction Over the past 5 years, pediatric mental health emergencies requiring emergency safety evaluations and inpatient boarding of pediatric patients requiring psychiatric admission have increased. Pediatric trainees must learn to effectively and safely de-escalate a patient with agitated or aggressive behavior, as mental health patients take up a larger proportion of their patient population. This standardized patient case addresses gaps in knowledge and skills to ameliorate the care of children and adolescents with behavioral crises in the hospital. Methods Resident learners were presented with a teenage patient admitted to the hospital and awaiting inpatient psychiatric placement for suicidal ideation who became acutely agitated with aggressive behaviors. Learners were expected to attempt to verbally de-escalate the patient and select an appropriate pharmacologic agent for decreasing agitation in the patient. A standardized debrief was conducted with the assistance of child and adolescent mental health experts. Results Twenty-two learners participated in this activity. Residents' confidence in their management skills of the acutely agitated pediatric patient significantly increased after completion of the activity. Seventy-three percent of learners felt confident or very confident in their de-escalation skills at the end of the case, and 86% agreed that the case improved their confidence in managing acute agitation scenarios on the inpatient wards. Discussion This case led to overall increased self-efficacy in caring for the acutely agitated pediatric patient. Future iterations may include multidisciplinary learners of various skill levels and evaluating changes in patient-centered outcomes, such as restraint use, after implementation of the case.
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Affiliation(s)
- Adam Kronish
- Second-Year Fellow, Division of Adolescent Medicine, Children's Hospital of Philadelphia
| | - Daniel Alanko
- Second-Year Fellow, Department of Pediatric Emergency Medicine, Children's Hospital of New Jersey at Newark Beth Israel Medical Center
| | - Victoria R. Quinn
- First-Year Fellow, Department of Pediatric Emergency Medicine, Hasbro Children's Hospital
| | - Charles Wulff
- Attending Psychiatrist, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School
| | | | - Robyn Wing
- Associate Professor, Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Director of Pediatric Simulation, Lifespan Medical Simulation Center
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Bahaidarah SA, Boker AM. Comparison of Cardiac Auscultation Features on Four Different Simulation Mannequins Performed by Pediatric Residents. Cureus 2023; 15:e45127. [PMID: 37842489 PMCID: PMC10569741 DOI: 10.7759/cureus.45127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Cardiac murmurs are a common problem in pediatric clinical practice. Studies demonstrated low accuracy in detecting and diagnosing various cardiac murmurs at all levels of medical training. So, supplementary training methods started to evolve, including simulation for auscultation skills training. Over the years, mannequins have evolved with different types of technology. Therefore, we decided to compare cardiac auscultation accuracy among high-fidelity mannequins as the primary objective and compare the performance of various postgraduate-level residents as a secondary objective. METHOD Pediatric residents at King Abdulaziz University Hospital were given a lecture on the basics of cardiac auscultation and then requested to auscultate four mannequins, namely SimJumior® (Laerdal Medical, Stavanger, Norway), SimBaby™ (Laerdal Medical), Pediatric HAL® (Gaumard Scientific, Miami, FL, USA), and Cardiac Patient Simulator K-Plus (Kyoto Kagaku Co. Ltd., Kyoto, Japan). The accuracies of murmur type, diagnosis, and auscultation time were compared. Results: A total of 56 pediatric residents were enrolled. Median murmur accuracy ranged from 50% to 53% (p-value 0.79), and median diagnosis accuracy ranged from 33% to 36% (p-value 0.77), with a nonsignificant difference between mannequins. Comparing resident levels in all mannequins, median murmur accuracy ranged from 49% to 56% (p-value 0.70), and median diagnosis accuracy ranged from 29% to 41% (p-value 0.09). While the median average auscultation time was between 41 and 50 seconds (p-value 0.34). CONCLUSION Auscultation skills can be taught through simulation on any mannequin used in this comparison, not necessarily the cardiac one. For better accuracy, future comparisons might include more advanced cardiac mannequins based on cardiac auscultation expertise (i.e., consultant level). The introduction of an auscultation program from the undergraduate level throughout the training process and monitoring of these skills are mandated.
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Affiliation(s)
- Saud A Bahaidarah
- Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Abdulaziz M Boker
- Clinical Skills and Simulation Centre, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Maleknia L, Boshuizen V, Caputo H, Shah R. Improving Procedural Skill Confidence in Pediatric Residents: A Longitudinal Simulation-Based Workshop Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11322. [PMID: 37469525 PMCID: PMC10352469 DOI: 10.15766/mep_2374-8265.11322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/03/2023] [Indexed: 07/21/2023]
Abstract
Introduction Exit surveys among our pediatric residency graduates found 50% were not confident performing required procedures. While procedural competency poses many curricular challenges, simulation is an effective educational modality many programs have adopted, though often only through onetime workshops limited to single procedures, clinical settings, or levels of training. We sought to develop a comprehensive, recurring, yearlong, simulation-based curriculum covering many important pediatric procedures. Methods We created a longitudinal curriculum of recurring monthly workshops using both low- and high-fidelity simulators, highlighting 17 pediatric procedures. Comprehensive facilitator guides contained equipment lists, instructions, competency checklists, and quizzes for each workshop. Correlation between attendance and confidence was assessed for skills in which residents attended two or more workshops on the same skill. ACGME exit surveys compared graduates' confidence regarding procedural skills before and after curriculum implementation. Results On exit surveys, graduates who agreed or strongly agreed to feeling comfortable with the procedures in our curriculum improved from 50% to 66% after 2 years, and those who disagreed or strongly disagreed decreased from 40% to 22%. A positive correlation existed between repeated workshop attendance and confidence in many procedures (R2 range, .60-.99). Discussion Longitudinal simulation is an effective educational modality that increases learner confidence in performing procedures. Our curriculum addresses adult learners' need for repetition and can be adopted by other programs to improve graduates' confidence. The curriculum's sustainability is underscored by use of cost-reducing low-fidelity simulators and comprehensive guides that allow any instructor to conduct the workshop.
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Affiliation(s)
- Lydia Maleknia
- Fellow, Department of Pediatric Hospital Medicine, Kaiser Permanente Oakland Medical Center
| | | | - Heather Caputo
- Faculty Hospitalist, Department of Pediatric Hospital Medicine, Kaiser Permanente Oakland Medical Center
| | - Rina Shah
- Associate Program Director, Kaiser Permanente Northern California Pediatric Residency Program; Assistant Chief and Faculty Hospitalist, Department of Pediatric Hospital Medicine, Kaiser Permanente Oakland Medical Center
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010032. [PMID: 35053657 PMCID: PMC8773981 DOI: 10.3390/children9010032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/11/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.
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Frey-Vogel A, Rogers A, Sparger K, Mehta R, Mirchandani-Shah D, Mangold K, Mitchell D, Wood A. Taking the Pulse on Pediatric Simulation: A National Survey of Pediatric Residency Programs' Simulation Practices and Challenges. Pediatr Emerg Care 2021; 37:e1303-e1307. [PMID: 31977771 DOI: 10.1097/pec.0000000000002013] [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 There is abundant literature on simulation use in individual pediatric residency programs but limited overall data on simulation in US pediatric residency programs. This study sought to determine how US pediatric residency programs use simulation for teaching and assessment and the challenges programs face in their use of simulation. METHODS The Association of Pediatric Program Director's Healthcare Simulation in Pediatrics Learning Community members developed a 15-multipart question survey on the use of simulation in US pediatric residency programs using best practices in survey design. The survey was distributed electronically to US pediatric residency program directors. Qualitative questions were analyzed by content analysis and quantitative questions using descriptive statistics. RESULTS The survey response rate was 21%; respondents were disproportionately from large academic medical centers. Qualitative analysis found that respondents use simulation to teach pediatric residents in the areas of urgent/emergent situations, procedures, and communication, and common challenges to simulation implementation are time, physical resources, expertise, competing priorities, logistics, and buy-in. Quantitative analysis demonstrated that, although respondents are largely confident that their simulation programs improve resident preparedness and competence, few objectively evaluate their simulation programs. CONCLUSIONS Pediatric residency programs use simulation for similar purposes and face similar challenges. By collaborating, the resources of the national pediatric simulation community can be leveraged to collect evidence for best practices for simulation use in pediatric residency training.
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Affiliation(s)
- Ariel Frey-Vogel
- From the Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Amanda Rogers
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Katherine Sparger
- From the Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Renuka Mehta
- Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, GA
| | | | - Karen Mangold
- Departments of Pediatrics and Medical Education, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Diana Mitchell
- Department of Pediatrics, The University of Chicago Comer Children's Hospital, Chicago, IL
| | - Amy Wood
- Department of Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, LA
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Abulebda K, Whitfill T, Montgomery EE, Kirby ML, Ahmed RA, Cooper DD, Nitu ME, Auerbach MA, Lutfi R, Abu-Sultaneh S. Improving Pediatric Diabetic Ketoacidosis Management in Community Emergency Departments Using a Simulation-Based Collaborative Improvement Program. Pediatr Emerg Care 2021; 37:543-549. [PMID: 30870337 DOI: 10.1097/pec.0000000000001751] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The majority of pediatric patients with diabetic ketoacidosis (DKA) present to community emergency departments (CEDs) that are less prepared to care for acutely ill children owing to low pediatric volume and limited pediatric resources and guidelines. This has impacted the quality of care provided to pediatric patients in CEDs. We hypothesized that a simulation-based collaborative program would improve the quality of the care provided to simulated pediatric DKA patients presenting to CEDs. METHODS This prospective interventional study measured adherence of multiprofessional teams caring for pediatric DKA patients preimplementation and postimplementation of an improvement program in simulated setting. The program consisted of (a) a postsimulation debriefing, (b) assessment reports, (c) distribution of educational materials and access to pediatric resources, and (d) ongoing communication with the academic medical center (AMC). All simulations were conducted in situ (in the CED resuscitation bay) and were facilitated by a collaborative team from the AMC. A composite adherence score was calculated using a critical action checklist. A mixed linear regression model was performed to examine the impact of CED and team-level variables on the scores. RESULTS A total of 91 teams from 13 CEDs participated in simulated sessions. There was a 22-point improvement of overall adherence to the DKA checklist from the preintervention to the postintervention simulations. Six of 9 critical checklist actions showed statistically significant improvement. Community emergency departments with medium pediatric volume showed the most overall improvement. Teams from CEDs that are further from the AMC showed the least improvement from baseline. CONCLUSIONS This study demonstrated a significant improvement in adherence to pediatric DKA guidelines in CEDs across the state after execution of an in situ simulation-based collaborative improvement program.
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Affiliation(s)
- Kamal Abulebda
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | | | | | | | - Rami A Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | - Dylan D Cooper
- Department of Emergency Medicine, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | - Mara E Nitu
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | | | - Riad Lutfi
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | - Samer Abu-Sultaneh
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
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Nguyen MC, Elliott NC, Begany DP, Best KM, Cook MD, Jong MR, Matuzsan ZM, Morolla LA, Partington SS, Kane BG. Assessment of Emergency Medicine Resident Performance in a Pediatric In Situ Simulation Using Multi-Source Feedback. Cureus 2021; 13:e16812. [PMID: 34522472 PMCID: PMC8425063 DOI: 10.7759/cureus.16812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Multi-source feedback (MSF) is an evaluation method mandated by the Accreditation Council for Graduate Medical Education (ACGME). The Queen’s Simulation Assessment Tool (QSAT) has been validated as being able to distinguish between resident performances in a simulation setting. The QSAT has also been demonstrated to have excellent MSF agreement when used in an adult simulation performed in a simulation lab. Using the QSAT, this study sought to determine the degree of agreement of MSF in a single pediatric (Peds) simulation case conducted in situ in a Peds emergency department (ED). Methods This Institutional Review Board-approved study was conducted in a four-year emergency medicine residency. A Peds resuscitation case was developed with specific behavioral anchors on the QSAT, which uses a 1-5 scale in each of five categories: Primary Assessment, Diagnostic Actions, Therapeutic Actions, Communication, and Overall Assessment. Data was gathered from six participants for each simulation. The lead resident self-evaluated and received MSF from a junior peer resident, a fixed Peds ED nurse, a random ED nurse, and two faculty (one fixed, the other from a dyad). The agreement was calculated with intraclass correlation coefficients (ICC). Results The simulation was performed on 35 separate days over two academic years. A total of 106 MSF participants were enrolled. Enrollees included three faculty members, 35 team leaders, 34 peers, 33 ED registered nurses (RN), and one Peds RN; 50% of the enrollees were female (n=53). Mean QSAT scores ranged from 20.7 to 23.4. A fair agreement was demonstrated via ICC; there was no statistically significant difference between sources of MSF. Removing self-evaluation led to the highest ICC. ICC for any single or grouped non-faculty source of MSF was poor. Conclusion Using the QSAT, the findings from this single-site cohort suggest that faculty must be included in MSF. Self-evaluation appears to be of limited value in MSF with the QSAT. The degree of MSF agreement as gathered by the QSAT was lower in this cohort than previously reported for adult simulation cases performed in the simulation lab. This may be due to either the pediatric nature of the case, the location of the simulation, or both.
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Affiliation(s)
- Michael C Nguyen
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Nicole C Elliott
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Diane P Begany
- Department of Pediatrics, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Katie M Best
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Matthew D Cook
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Michael R Jong
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Zachary M Matuzsan
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Louis A Morolla
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Suzanne S Partington
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
| | - Bryan G Kane
- Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine, Allentown, USA
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Auerbach M, Patterson M, Mills WA, Katznelson J. The Implementation of a Collaborative Pediatric Telesimulation Intervention in Rural Critical Access Hospitals. AEM EDUCATION AND TRAINING 2021; 5:e10558. [PMID: 34124506 PMCID: PMC8171786 DOI: 10.1002/aet2.10558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Over 5.8 million pediatric visits to rural emergency department (EDs) occur each year in the United States. Most rural EDs care for less than five pediatric patients per day and are not well prepared for pediatrics. Simulation has been associated with improvements in pediatric preparedness. The implementation of pediatric simulation in rural settings is challenging due to limited access to equipment and pediatric specialists. Telesimulation involves a remote facilitator interacting with onsite learners. This article aims to describe the implementation experiences and participant feedback of a 1-year remotely facilitated pediatric emergency telesimulation program in three critical-access hospitals. METHODS Three hospitals were recruited to participate with a nurse manager serving as the on-site lead. The managers worked with a study investigator to set up the simulation technology during an in-person pilot testing visit with the off-site facilitators. A curriculum consisting of eight pediatric telesimulations and debriefings was conducted over a 12-month period. Participant feedback was collected via a paper survey after each simulation. Implementation metrics were collected after each session including technical and logistic issues. RESULTS Of 147 participant feedback surveys 90% reported that pediatric simulations should be conducted on a regular basis and overall feedback was positive. Forty-seven of 48 simulations were completed on the first attempt with few major technologic issues. The most common issue encountered related to the simulator not working correctly locally and involved the facilitator running the session without the heart and lung sounds. All debriefings occurred without any issues. CONCLUSIONS This replicable telesimulation program can be used in the small, rural hospital setting, overcoming time and distance barriers and lending pediatric emergency medicine expertise to the education of critical-access hospital providers.
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Affiliation(s)
- Marc Auerbach
- Departments of Emergency Medicine and PediatricsYale University School of MedicineNew HavenCTUSA
| | - Mary Patterson
- Department of Emergency MedicineUniversity of Florida College of MedicineGainsvilleFLUSA
| | - William A Mills
- Department of PediatricsUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - Jessica Katznelson
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMDUSA
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van den Bos-Boon A, van Dijk M, Adema J, Gischler S, van der Starre C. Professional Assessment Tool for Team Improvement: An assessment tool for paediatric intensive care unit nurses' technical and nontechnical skills. Aust Crit Care 2021; 35:159-166. [PMID: 34167890 DOI: 10.1016/j.aucc.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 02/19/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Cardiorespiratory arrests are rare in paediatric intensive care units, yet intensive care nurses must be able to initiate resuscitation before medical assistance is available. For resuscitation to be successful, instant decision-making, team communication, and the coordinating role of the first responsible nurse are crucial. In-house resuscitation training for nurses includes technical and nontechnical skills. OBJECTIVES The aim of this study was to develop a valid, reliable, and feasible assessment instrument, called the Professional Assessment Tool for Team Improvement, for the first responsible nurse's technical and nontechnical skills. METHODS Instrument development followed the COnsensus-based Standards for the selection of health Measurement Instruments guidelines and professionals' expertise. To establish content validity, experts reached consensus via group discussions about the content and the operationalisation of this team role. The instrument was tested using two resuscitation assessment scenarios. Inter-rater reliability was established by assessing 71 nurses in live scenario sessions and videotaped sessions, using intraclass correlation coefficients and Cohen's kappa. Internal consistency for the total instrument was established using Cronbach's alpha. Construct validity was assessed by examining the associations between raters' assessments and nurses' self-assessment scores. RESULTS The final instrument included 12 items, divided into four categories: Team role, Teamwork and communication, Technical skills, and Reporting. Intraclass correlation coefficients were good in both live and videotaped sessions (0.78-0.87). Cronbach's alpha was stable around 0.84. Feasibility was approved (assessment time reduced by >30%). CONCLUSIONS The Professional Assessment Tool for Team Improvement appears to be a promising valid and reliable instrument to assess both technical and nontechnical skills of the first responsible paediatric intensive care unit nurse. The ability of the instrument to detect change over time (i.e., improvement of skills after training) needs to be established.
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Affiliation(s)
- Ada van den Bos-Boon
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Monique van Dijk
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jan Adema
- Cito, Institute for Educational Testing, Arnhem, the Netherlands
| | - Saskia Gischler
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Cynthia van der Starre
- Pediatric Intensive Care Unit and Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands; Neonatal Intensive Care Unit, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
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Rao S, Chowdhury N, Naithani M, Singh A, Singh N, Gupta AK, Kathrotia R. Alternative Strategy Adopted in Practical Assessment for Pathology Postgraduate Certification Examination Amidst COVID-19 Nationwide Lockdown: An Indian Experience with a Novel Hybrid Method of Assessment. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1-9. [PMID: 33447127 PMCID: PMC7802903 DOI: 10.2147/amep.s286423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/11/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND A major concern and challenge faced by the educational institution during coronavirus disease (COVID-19) pandemic and consequent lockdown is the timely conduct of the summative assessment. Unlike cognitive assessment, real-time practical assessment through online mode, without compromising principles of assessment is difficult. This study was performed to analyze an alternative hybrid approach adopted for the postgraduate practical summative assessment in pathology. MATERIALS AND METHODS Evaluation of the process of summative assessment was done where internal and external examiners synchronously assessed examinees real-time on-site (face to face) and off-site (remotely through live videoconferencing) respectively. A pre-validated questionnaire on a novel approach for assessment and feedback (with close-ended on 5-point Likert scale and open-ended questions) were administered to nine participants comprising three final year postgraduates in pathology, four examiners (two internal and two externals) and two technical experts from the Department of Pathology. Overall scores obtained by all examinees were recorded. A pre-validated questionnaire and feedback were administered to the participants to assess the novel approach to assessment. RESULTS The mean performance score obtained by examinees was 63.5% in the summative assessment. Feedback analysis revealed that 85% of participants strongly agreed and the rest (15%) agreed that essential minor deviations introduced in this novel mode of assessment did not compromise basic principles and goals of assessment. Quality of assessment through this mode of assessment was graded as good to excellent. All participants responded that this mode of examination may be applied in the future under similar circumstances. CONCLUSION This study concludes that an alternative novel hybrid method of real-time synchronous assessment with on-site and off-site examiners may be a feasible and successful model for conducting summative assessment and can be practiced in time of need.
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Affiliation(s)
- Shalinee Rao
- Department of Pathology & Advanced Center of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nilotpal Chowdhury
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manisha Naithani
- Department of Biochemistry & Advanced Center of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Singh
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Neha Singh
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arvind Kumar Gupta
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajesh Kathrotia
- Department of Physiology & Advanced Center of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Abulebda K, Thomas A, Whitfill T, Montgomery EE, Auerbach MA. Simulation Training for Community Emergency Preparedness. Pediatr Ann 2021; 50:e19-e24. [PMID: 33450035 DOI: 10.3928/19382359-20201212-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most infants and children who are ill and injured are cared for in community-based settings across the emergency continuum. These settings are often less prepared for pediatric patients than dedicated pediatric settings such as academic medical centers. Disparities in health outcomes exist and are associated with gaps in community emergency preparedness. Simulation is an effective technique to enhance emergency preparedness to ensure the highest quality of care is provided to all pediatric patients. In this article, we summarize the pediatric emergency care provided across the emergency continuum and outline the key features of simulation used to measure and improve pediatric preparedness in community settings. First, we discuss the use of simulation as a training tool and as an investigative methodology to enhance emergency preparedness across the continuum. Next, we present two examples of successful simulation-based programs that have led to improved emergency preparedness. [Pediatr Ann. 2021;50(1):e19-e24.].
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Mallory L, Floyed R, Doughty C, Thompson T, Lopreiato J, Chang TP. Validation of a Modified Jefferson Scale of Empathy for Observers to Assess Trainees. Acad Pediatr 2021; 21:165-169. [PMID: 32540426 DOI: 10.1016/j.acap.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE "Demonstrate insight and understanding into emotion" is a competency amenable to simulation-based assessment. The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) has validity evidence for patients to assess provider empathy. A version adapted for a third-party observers does not exist. Our aim was to modify the JSPPPE and use recorded standardized encounters to obtain validity evidence. METHODS This cross-sectional study used video and data collected from 2 pediatric residencies. In 2018, 4 raters reviewed 24 videos of 12 interns communicating with standardized patients (SP) in 2 encounters and completed a modified JSPPE for observers (JSEO). Reliability between raters was established using Intraclass Correlations (ICC). JSEO mean scores were correlated to Essential Elements of Communication (EEC), JSPPPE, and faculty composite interpersonal communication (IC) scores using Spearman Rank. RESULTS The mean ICC for all 4 raters was 0.573 (0.376-0.755). When ICC was calculated for pairs of raters, Rater 1 was an outlier. ICCs for mean scores for pairs among the 3 remaining raters was 0.81 to 0.84. Mean JSEO scores from the four raters correlated with the JSPPPE (rho = 0.45, P = .03) and IC (rho = 0.68, P < .001), but not the EEC (rho = 0.345, P = .1). CONCLUSIONS We found validity evidence for the use of a modified JSPPPE for an observer to assess empathy in a recorded encounter with a SP. This may be useful as medical educators shift toward competency-based tracking. The brevity of this tool and potential assessment using video are also appealing.
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Affiliation(s)
- Leah Mallory
- Tufts University School of Medicine (L Mallory), The Hannaford Simulation Center at Maine Medical Center, Maine.
| | - Rebecca Floyed
- Dell Medical School (R Floyed), University of Texas at Austin, Tex
| | - Cara Doughty
- Baylor College of Medicine (C Doughty), Texas Children's Hospital Simulation Center, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
| | - Tonya Thompson
- University of Arkansas for Medical Sciences (T Thompson), Little Rock, Ark
| | - Joseph Lopreiato
- Uniformed Services University of the Health Sciences (J Lopreiato), The Val G. Hemming Simulation Center, Silver Spring, Md
| | - Todd P Chang
- Keck School of Medicine of USC (TP Chang), Children's Hospital Los Angeles, Los Angeles, Calif
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Effects of Infection Control Education for Nursing Students Using Standardized Patients vs. Peer Role-Play. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010107. [PMID: 33375222 PMCID: PMC7794753 DOI: 10.3390/ijerph18010107] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
This study was conducted to identify and compare the effects of two education programs for infection control―a simulation using standardized patients and a peer role-play―on standard precaution knowledge, standard precaution awareness, infection-related anxiety, and infection control performance. This study used a nonequivalent control group pretest-posttest design. A total of 62 undergraduate nursing students in their 3rd year participated in the study, and were assigned to the experimental and control groups, accordingly. The infection control education program was developed based on the analysis, design, development, implementation, and evaluation model. The program for the experimental group included lectures, skills training, simulation using standardized patients, and debriefing, while the control group participated in the usual infection control education, consisting of lectures, skills training, and peer tutoring practices. Both groups exhibited statistically significant increases in knowledge, awareness of standard precaution, and infection control performance after the intervention. Infection-related anxiety and infection control performance were significantly higher in the simulation using a standardized patient group. Both education programs influenced compliance with the standard precaution for infection control. The results of this study contribute to the evidence regarding effective educational methods to improve infection control.
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Zhao S, Xiao X, Wang Q, Zhang X, Li W, Soghier L, Hahn J. An Intelligent Augmented Reality Training Framework for Neonatal Endotracheal Intubation. INTERNATIONAL SYMPOSIUM ON MIXED AND AUGMENTED REALITY : (ISMAR) [PROCEEDINGS]. IEEE AND ACM INTERNATIONAL SYMPOSIUM ON MIXED AND AUGMENTED REALITY 2020; 2020:672-681. [PMID: 33935605 PMCID: PMC8084704 DOI: 10.1109/ismar50242.2020.00097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Neonatal Endotracheal Intubation (ETI) is a critical resuscitation skill that requires tremendous practice of trainees before clinical exposure. However, current manikin-based training regimen is ineffective in providing satisfactory real-time procedural guidance for accurate assessment due to the lack of see-through visualization within the manikin. The training efficiency is further reduced by the limited availability of expert instructors, which inevitably results in a long learning curve for trainees. To this end, we propose an intelligent Augmented Reality (AR) training framework that provides trainees with a complete visualization of the ETI procedure for real-time guidance and assessment. Specifically, the proposed framework is capable of capturing the motions of the laryngoscope and the manikin and offer 3D see-through visualization rendered to the head-mounted display (HMD). Furthermore, an attention-based Convolutional Neural Network (CNN) model is developed to automatically assess the ETI performance from the captured motions as well as identify regions of motions that significantly contribute to the performance evaluation. Lastly, augmented user-friendly feedback is delivered with interpretable results with the ETI scoring rubric through the color-coded motion trajectory that classifies highlighted regions that need more practice. The classification accuracy of our machine learning model is 84.6%.
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Affiliation(s)
| | | | | | | | - Wei Li
- George Washington University
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Leviter JI, Sojar S, Ayala NK, Wing R. Thyrotoxicosis in a Postpartum Adolescent: A Simulation Case for Emergency Medicine Providers. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10967. [PMID: 32934982 PMCID: PMC7485909 DOI: 10.15766/mep_2374-8265.10967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Thyroid storm is a rare but life-threatening disease process that may be difficult to recognize and mimics other disease processes. It is critical for the emergency medicine clinician to be able to recognize thyroid storm in patients in order to effectively stabilize and treat them. METHODS In this standardized patient case, learners were faced with a 17-year-old postpartum woman presenting to the emergency department with respiratory distress and altered mental status secondary to thyroid storm. The target learners were emergency department providers, including residents, medical students, and advanced practice practitioners. Providers were expected to identify signs and symptoms of thyroid storm and to initiate appropriate diagnostic workup and management of this complex patient. Debriefing followed the simulation using a debriefing guide and PowerPoint presentation. RESULTS Thirty-four learners participated in this simulation. All learners agreed or strongly agreed that the simulation case was relevant to their work, and 97% agreed or strongly agreed that it was effective in teaching thyroid storm management skills. Eighty-five percent felt that following the simulation, they would be confident in their ability to recognize thyroid storm in a postpartum patient and to recognize and manage respiratory distress and altered mental status in a postpartum patient. DISCUSSION Learners felt that this case was effective in teaching the skills necessary for caring for postpartum patients with respiratory distress and altered mental status. Future directions include conducting the simulation in situ to include multidisciplinary teams and increasing the learner pool to include OB/GYN residents.
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Affiliation(s)
- Julie I. Leviter
- Assistant Professor of Clinical Pediatrics, Department of Pediatric Emergency Medicine, Yale University School of Medicine
| | - Sakina Sojar
- Pediatric Emergency Medicine Fellow, Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University and Hasbro Children's Hospital/Rhode Island Hospital
| | - Nina K. Ayala
- Maternal Fetal Medicine Fellow, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
| | - Robyn Wing
- Assistant Professor, Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Director of Pediatric Simulation, Lifespan Medical Simulation Center
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Cicero MX, Adelgais K, Hoyle JD, Lyng JW, Harris M, Moore B, Gausche-Hill M. Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP. PREHOSP EMERG CARE 2020; 25:294-306. [PMID: 32644857 DOI: 10.1080/10903127.2020.1794085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Millions of patients receive medications in the Emergency Medical Services (EMS) setting annually, and dosing safety is critically important. The need for weight-based dosing in pediatric patients and variability in medication concentrations available in the EMS setting may require EMS providers to perform complex calculations to derive the appropriate dose to deliver. These factors can significantly increase the risk for harm when dose calculations are inaccurate or incorrect. METHODS We conducted a scoping review of the EMS, interfacility transport and emergency medicine literature regarding pediatric medication dosing safety. A priori, the authors identified four research topics: (1) what are the greatest safety threats that result in significant dosing errors that potentially result in harm to patients, (2) what practices or technologies are known to enhance dosing safety, (3) can data from other settings be extrapolated to the EMS environment to inform dosing safety, and (4) what impact could standardization of medication formularies have on enhancing dosing safety. To address these topics, 17 PICO (Patient, Intervention, Comparison, Outcome) questions were developed and a literature search was performed. RESULTS After applying exclusion criteria, 70 articles were reviewed. The methods for the investigation, findings from these articles and how they inform EMS medication dosing safety are summarized here. This review yielded 11 recommendations to improve safety of medication delivery in the EMS setting. CONCLUSION These recommendations are summarized in the National Association of EMS Physicians® position statement: Medication Dosing Safety for Pediatric Patients in Emergency Medical Services.
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Hazwani TR, Harder N, Shaheen NA, Al Hassan Z, Antar M, Alshehri A, Alali H, Kazzaz YM. Effect of a Pediatric Mock Code Simulation Program on Resuscitation Skills and Team Performance. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Procedural Training and Assessment for Pediatric Emergency Medicine Physicians Within the United States and Canada: A Survey Study. Pediatr Emerg Care 2020; 36:e180-e184. [PMID: 29189596 DOI: 10.1097/pec.0000000000001362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to determine current practices in procedural training and skill assessment for attending physicians working in pediatric emergency departments within the United States and Canada and identify barriers to providing training and assessment. METHODS This was a cross-sectional survey study. Members of the pediatric emergency medicine fellowship program directors and associate program directors Listserv were invited to participate in an anonymous survey about attending physician training and assessment practices for 9 specific procedures and barriers to training and assessment. RESULTS Eighty-two (56.2%) of 146 recipients responded, with 79 surveys fully completed; 58.5% of responders report that their division offers procedural training, whereas 14.6% report assessment of procedural skills. The most common procedure for which participants report training and assessment is orotracheal intubation (53.1% and 7.5%, respectively), with training rates for other procedures ranging from 2.5% to 43.0%. Most sites that report training use simulation in some form for education. For assessment, simulation is used almost exclusively. Cost (50.6%), lack of faculty interest (36.7%), and lack of standardized guidelines (36.7%) are the most common barriers to training. Lack of standardized guidelines (51.9%), cost (43.0%), and lack of faculty interest (38.0%) are the most common barriers for assessment. CONCLUSIONS Although pediatric emergency medicine physicians may be required to perform emergent procedures, opportunities to receive training and assessment in these procedures are limited. Simulation and other educational modalities are being used to provide skill training and assessment, but cost and lack of resources, standardized protocols, and faculty interest are barriers to the implementation of training and assessment programs.
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Abstract
OBJECTIVES When obtaining informed permission from parents for invasive procedures, trainees and supervisors often do not disclose information about the trainee's level of experience. The objectives of this study were 3-fold: (1) to assess parents' understanding of both academic medical training and the role of the trainee and the supervisor, (2) to explore parents' preferences about transparency related to a trainee's experience, and (3) to examine parents' willingness to allow trainees to perform invasive procedures. METHODS This qualitative study involved 23 one-on-one interviews with parents of infants younger than 30 days who had undergone a lumbar puncture. In line with grounded theory, researchers independently coded transcripts and then collectively refined codes and created themes. Data collection and analysis continued until thematic saturation was achieved. In addition, to triangulate the findings, a focus group was conducted with Yale School of Medicine's Community Bioethics Forum. RESULTS Our analysis revealed 4 primary themes: (1) the invasive nature of a lumbar puncture and the vulnerability of the newborn creates fear in parents, which may be mitigated by improved communication; (2) parents have varying degrees of awareness of the medical training system; (3) most parents expect transparency about provider experience level and trust that a qualified provider will be performing the procedure; and (4) parents prefer an experienced provider to perform a procedure, but supervisor presence may be a qualifying factor for inexperienced providers. CONCLUSIONS Physicians must find a way to improve transparency when caring for pediatric patients while still developing critical procedural skills.
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Zurca AD, Olsen N, Lucas R. Development and Validation of the Pediatric Resuscitation and Escalation of Care Self-Efficacy Scale. Hosp Pediatr 2019; 9:801-807. [PMID: 31554648 DOI: 10.1542/hpeds.2019-0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To validate a scale to assess pediatric providers' resuscitation and escalation of care self-efficacy and assess which provider characteristics and experiences may contribute to self-efficacy. METHODS Cross-sectional cohort study performed at an academic children's hospital. Pediatric nurses, respiratory therapists, and residents completed the Generalized Self-Efficacy Scale (GSES) and Pediatric Resuscitation Self-Efficacy Scale (PRSES) as well as a survey assessing their experiences with pediatric escalation of care. RESULTS Four hundred participants completed the GSES and PRSES. A total of 338 completed the survey, including 262 nurses, 51 respiratory therapists, and 25 residents. Cronbach α for the PRSES was 0.905. A factor analysis revealed 2 factors within the scale, with items grouped on the basis of expertise required. Multiple logistic regression analyses controlling for GSES score, number of code blue events participated, number of code blue events activated, number of rapid response team events participated, number of rapid response team response events called, performance on a knowledge assessment of appropriate escalation of care, and years of experience demonstrated that PRSES performance was significantly associated with GSES scores and number of escalation of care events (code blue and rapid response) previously participated in (R 2 = 0.29, P < .001). CONCLUSIONS The PRSES can be used to assess pediatric providers' pediatric resuscitation self-efficacy and could be used to evaluate pediatric escalation of care interventions. Pediatric resuscitation self-efficacy is significantly associated with number of previous escalation of care experiences. In future studies, researchers should focus on assessing the impact of increased exposures to escalation of care, potentially via mock codes, to accelerate the acquisition of resuscitation self-efficacy.
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Affiliation(s)
- Adrian D Zurca
- Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania;
| | - Nils Olsen
- Department of Organizational Sciences and Communication, Columbian College of Arts and Sciences and
| | - Raymond Lucas
- Department of Emergency Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC
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Thorvaldsen NØ, Flingtorp LD, Wisborg T, Jeppesen E. Implementation of new guidelines in the prehospital services: a nationwide survey of Norway. Scand J Trauma Resusc Emerg Med 2019; 27:83. [PMID: 31464620 PMCID: PMC6716817 DOI: 10.1186/s13049-019-0660-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 12/01/2022] Open
Abstract
Background A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. Method An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. Results In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. Conclusion Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline. Electronic supplementary material The online version of this article (10.1186/s13049-019-0660-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nina Øye Thorvaldsen
- Emergency Medical Services, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway. .,Faculty of Health Science, University of Stavanger, Stavanger, Norway.
| | - Lars Didrik Flingtorp
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo, Norway
| | - Torben Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
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Improved Team Performance During Pediatric Resuscitations After Rapid Cycle Deliberate Practice Compared With Traditional Debriefing: A Pilot Study. Pediatr Emerg Care 2019; 35:480-486. [PMID: 27741071 DOI: 10.1097/pec.0000000000000940] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Simulation-based medical education (SBME) improves medical knowledge compared with no intervention. In traditional SBME, more time is spent debriefing than practicing skills. Rapid cycle deliberate practice (RCDP) simulation allows learners to practice skills repetitively, receive brief interspersed feedback, and has been shown to improve individual performance of resuscitation skills in simulation; it has not been compared with traditional simulation methods. OBJECTIVE The aim of the study was to compare traditional and RCDP SBME. METHODS Four pediatric resuscitation cases (3 for teaching and 1 for testing) were developed. For the RCDP arm, traditional cases were deconstructed into sequences of progressively difficult rounds. The last RCDP round served as the traditional arm scenario.Learners received 1 type of instruction on 2 separate days. Pretest and posttest performance during simulation were video recorded and scored using the Simulation Team Assessment Tool; satisfaction surveys were collected. RESULTS Pretest team performance was similar in both groups. Simulation Team Assessment Tool score improvement for RCDP was 7.2% (95% confidence interval, 3.4% to 11%) and traditional was 0.8% (95% confidence interval, -11% to 13%). The difference in improvement of the human factors subscore was statistically significant; RCDP improved 10.2% and traditional improved 1.7% (P = 0.013). The RCDP technique was well received by learners but caused fatigue. CONCLUSIONS This pilot study showed a trend toward greater improvement in team performance and significantly greater improvement for human factors with RCDP compared with traditional simulation. Future studies comparing RCDP with other methods are needed to identify best practices and applications of RCDP, including which learners and learning objectives are best suited to RCDP.
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Zhou L, Zhang P, Zhang Z, Fan L, Tang S, Hu K, Xiao N, Li S. A Bibliometric Profile of Disaster Medicine Research from 2008 to 2017: A Scientometric Analysis. Disaster Med Public Health Prep 2019; 13:165-172. [PMID: 29717685 PMCID: PMC7113417 DOI: 10.1017/dmp.2018.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ABSTRACTThis study analyzed and assessed publication trends in articles on "disaster medicine," using scientometric analysis. Data were obtained from the Web of Science Core Collection (WoSCC) of Thomson Reuters on March 27, 2017. A total of 564 publications on disaster medicine were identified. There was a mild increase in the number of articles on disaster medicine from 2008 (n=55) to 2016 (n=83). Disaster Medicine and Public Health Preparedness published the most articles, the majority of articles were published in the United States, and the leading institute was Tohoku University. F. Della Corte, M. D. Christian, and P. L. Ingrassia were the top authors on the topic, and the field of public health generated the most publications. Terms analysis indicated that emergency medicine, public health, disaster preparedness, natural disasters, medicine, and management were the research hotspots, whereas Hurricane Katrina, mechanical ventilation, occupational medicine, intensive care, and European journals represented the frontiers of disaster medicine research. Overall, our analysis revealed that disaster medicine studies are closely related to other medical fields and provides researchers and policy-makers in this area with new insight into the hotspots and dynamic directions. (Disaster Med Public Health Preparedness. 2019;13:165-172).
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Affiliation(s)
- Liang Zhou
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Ping Zhang
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhigang Zhang
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Lidong Fan
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Shuo Tang
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Kunpeng Hu
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Nan Xiao
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Shuguang Li
- Research Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing, China
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Ahluwalia T, Toy S, Kennedy C. Use of Cognitive Task Analysis to Understand Decision-making for Management of Blunt Abdominal Trauma in Children. Cureus 2019; 11:e4095. [PMID: 31032155 PMCID: PMC6472713 DOI: 10.7759/cureus.4095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Study objective To use cognitive task analysis (CTA) to elicit experts’ knowledge and outline their clinical decision-making process for the management of pediatric blunt abdominal injury. Methods This was a mixed-methods study involving in-depth interviews and a focus group with local experts followed by a review survey with a panel of experts from numerous pediatric trauma centers across the United States. All experts specialized in pediatric emergency medicine and pediatric trauma surgery. Results Common themes that emerged during seven in-depth interviews with local experts included: clinical management, clinical reasoning, situational awareness, potential errors/novice traps, knowledge and skills, communication, and quality indicators. A total of 17 external experts responded to the survey for a response rate of 77%. External experts indicated that the information outlined in the CTA was complete and accurate, and provided valuable insights into the discrepancies that were unresolved during the focus group with local experts. They indicated agreement with potential errors/novice traps reported by local experts. Specifically, they indicated that the failure in coordinating team activities, maintaining the big picture, and performing a thorough physical examination posed serious threats to novices when managing a child with blunt abdominal trauma. Conclusion CTA may be applied to pediatric management of blunt abdominal injury to identify critical steps and potential errors to serve as a framework for education in pediatric emergency medicine and pediatric trauma surgery. Future studies may apply CTA to other types of traumatic injuries and/or involve an interdisciplinary approach.
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Affiliation(s)
- Tania Ahluwalia
- Emergency Medicine, Children's Mercy Hospital, Kansas City, USA
| | - Serkan Toy
- Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Chris Kennedy
- Emergency Medicine, Children's Mercy Hospital, Kansas City, USA
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Status Quo in Pediatric and Neonatal Simulation in Four Central European Regions: The DACHS Survey. Simul Healthc 2019; 13:247-252. [PMID: 29381587 DOI: 10.1097/sih.0000000000000296] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Simulation has acquired wide acceptance as an important component of education in health care and as a key tool to increase patient safety. This study aimed at identifying to what extent and how pediatric and neonatal simulation-based training (SBT) was being carried out in four Central European regions. METHODS We surveyed all pediatric and neonatal health care institutions in Germany, Austria, Switzerland, and South Tyrol on their current state of SBT using an online questionnaire. RESULTS We dispatched 440 questionnaires with a 45.9% response rate. Sixty-one percent (61.4%) of institutions performed SBT (algorithm training, 87.4%; skill training, 62.2%; high-fidelity SBT, 56.8%). Training was conducted interprofessionally at 88.9% of surveyed institutions. Physicians and nurses most often received SBT once per year. Lack of financial (62.2%) and personnel (54.1%) resources were the most frequent impediments to establish SBT. CONCLUSIONS Although delivered heterogeneously, widespread use of pediatric simulation and a considerable number of already existing SBT programs are the key findings of this survey. These data are encouraging enough to promote more effective networking in simulation-based research, education, training, and quality improvement, as we aim to ultimately increase patient safety for neonates, infants, and children.
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Joseph MM, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Brown K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Readiness in the Emergency Department. J Emerg Nurs 2019; 45:e3-e18. [DOI: 10.1016/j.jen.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Heiss KF, Beierle E, Besner GE, Downard CD, Fallat ME, Gow KW, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N, AMERICAN ACADEMY OF PEDIATRICS Committee on Pediatric Emergency Medicine and Section on Surgery, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Pediatric Emergency Medicine Committee, EMERGENCY NURSES ASSOCIATION Pediatric Committee. Pediatric Readiness in the Emergency Department. Pediatrics 2018; 142:peds.2018-2459. [PMID: 30389843 DOI: 10.1542/peds.2018-2459] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.
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Affiliation(s)
- Katherine Remick
- National Emergency Medical Services for Children Innovation and Improvement Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas
- Dell Children’s Medical Center, Austin, Texas
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California
- Department of Emergency Medicine and Pediatrics, David Geffen School of Medicine and Harbor–University of California, Los Angeles Medical Center, University of California, Los Angeles, Los Angeles, California
- Department of Emergency Medicine, Los Angeles Biomedical Research Institute, Los Angeles, California
| | - Madeline M. Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
- University of Florida Health Sciences Center–Jacksonville, Jacksonville, Florida
| | - Kathleen Brown
- Departments of Pediatrics and Emergency Medicine, School of Medicine and Health Sciences, George Washington University and Children’s National Medical Center, Washington, District of Columbia
| | | | - Joseph L. Wright
- University of Maryland Capital Region Health, University of Maryland Medical System, Cheverly, Maryland; and
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland
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Smink GM, Jeffe DB, Hayashi RJ, Al-Hammadi N, Fehr JJ. Pediatric-Oncology Simulation Training for Resident Education. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:155-160. [PMID: 31485338 DOI: 10.1136/bmjstel-2018-000347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction We sought to evaluate pediatric oncology simulations intended to improve pediatric residents' skills and comfort in caring for children with cancer. Method In a non-randomized trial, controls (the first three rotations) received a standard set of lectures, and the intervention arm received these lectures plus five simulation-training scenarios-fever/neutropenia, a new leukemia diagnosis, end-of-life care discussion, tumor lysis syndrome, and a mediastinal mass. All residents were tested after the rotation on the first three scenarios; management skills were evaluated independently by two raters. Before and after training, all residents completed an emotional-appraisal questionnaire evaluating each scenario as a perceived challenge or threat. Analysis of variance (ANOVA) measured differences by study arm in skills-checklist assessments and appraisals; repeated-measures ANOVA measured changes in emotional-appraisal scores. Results Forty-two residents (9 control, 33 intervention) participated. Inter-rater agreement for skills-checklist scores using average-measures intraclass correlation was high (0.847), and overall mean scores were significantly higher for the intervention than control group across both raters (P = 0.005). For all residents, perceived challenge increased in the end-of-life simulation, and perceived threat decreased in all three test scenarios. The intervention group, regardless of training year, evaluated the teaching scenarios favorably and felt that challenging oncology situations were addressed, skills were enhanced, and the simulations should be offered to other residents. Conclusions It was feasible to introduce residents to difficult pediatric oncology scenarios using simulation. The intervention group performed more skills than controls when tested, and perceive threat declined in all residents after their pediatric oncology rotation.
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Affiliation(s)
- Gayle M Smink
- Assistant Professor of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Donna B Jeffe
- Professor of Medicine and director of the Health Behavior, Communication, and Outreach Core, Department of Medicine, and director of the Medical Education Research Unit, Office of Education, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert J Hayashi
- Professor of Pediatrics, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- statistical data analyst, Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James J Fehr
- Professor of Anesthesiology and Pediatrics, Departments of Anesthesiology and Pediatrics, Washington University School of Medicine, and medical director of the Saigh Pediatric Simulation Center at St. Louis Children's Hospital, St. Louis, Missouri, USA
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Auerbach M, Gausche-Hill M, Newgard CD. National Pediatric Readiness Project: Making a Difference Through Collaboration, Simulation, and Measurement of the Quality of Pediatric Emergency Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nhan C, Young M, Bank I, Nugus P, Fisher R, Azzam M, Nguyen LHP. Interdisciplinary Crisis Resource Management Training: How Do Otolaryngology Residents Compare? A Survey Study. OTO Open 2018; 2:2473974X18770409. [PMID: 30480212 PMCID: PMC6239147 DOI: 10.1177/2473974x18770409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/04/2017] [Accepted: 03/22/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Emergent medical crises, such as acute airway obstruction, are often managed by interdisciplinary teams. However, resident training in crisis resource management traditionally occurs in silos. Our objective was to compare the current state of interdisciplinary crisis resource management (IDCRM) training of otolaryngology residents with other disciplines. Methods A survey study examining (1) the frequency with which residents are involved in interdisciplinary crises, (2) the current state of interdisciplinary training, and (3) the desired training was conducted targeting Canadian residents in the following disciplines: otolaryngology, anesthesiology, emergency medicine, general surgery, obstetrics and gynecology, internal medicine, pediatric emergency medicine, and pediatric/neonatal intensive care. Results A total of 474 surveys were completed (response rate, 12%). On average, residents were involved in 13 interdisciplinary crises per year. Only 8% of otolaryngology residents had access to IDCRM training, as opposed to 66% of anesthesiology residents. Otolaryngology residents reported receiving an average of 0.3 hours per year of interdisciplinary training, as compared with 5.4 hours per year for pediatric emergency medicine residents. Ninety-six percent of residents desired more IDCRM training, with 95% reporting a preference for simulation-based training. Discussion Residents reported participating in crises managed by interdisciplinary teams. There is strong interest in IDCRM and crisis resource management training; however, it is not uniformly available across Canadian residency programs. Despite their pivotal role in managing critical emergencies such as acute airway obstruction, otolaryngology residents received the least training. Implication IDCRM should be explicitly taught since it reflects reality and may positively affect patient outcomes.
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Affiliation(s)
- Carol Nhan
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Québec, Canada
| | - Meredith Young
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Ilana Bank
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Pediatric Emergency Medicine, McGill University, Montréal, Québec, Canada
| | - Peter Nugus
- Center for Medical Education, McGill University, Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Rachel Fisher
- Department of Anesthesiology, McGill University, Montréal, Québec, Canada
| | - Milène Azzam
- Department of Anesthesiology, McGill University, Montréal, Québec, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, Québec, Canada.,Center for Medical Education, McGill University, Montréal, Québec, Canada
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Raffaeli G, Ghirardello S, Vanzati M, Baracetti C, Canesi F, Conigliaro F, Gentilino V, Macchini F, Fumagalli M, Ciralli F, Pesenti N, Passera S, Neri S, Franzini S, Leva E, Plevani L, Mosca F, Cavallaro G. Start a Neonatal Extracorporeal Membrane Oxygenation Program: A Multistep Team Training. Front Pediatr 2018; 6:151. [PMID: 29896465 PMCID: PMC5986935 DOI: 10.3389/fped.2018.00151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022] Open
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) is a complex life-saving support for acute cardio-respiratory failure, unresponsive to medical treatment. Emergency events on ECMO are rare but require immediate and proficient management. Multidisciplinary ECMO team members need to acquire and maintain over time cognitive, technical and behavioral skills, to safely face life-threatening clinical scenarios. Methods: A multistep educational program was delivered in a 4-year period to 32 ECMO team members, based on guidelines from the Extracorporeal Life Support Organization. A first traditional module was provided through didactic lectures, hands-on water drills, and laboratory animal training. The second phase consisted of a multi-edition high-fidelity simulation-based training on a modified neonatal mannequin (SimNewB®). In each session, participants were called to face, in small groups, ten critical scenarios, followed by debriefing time. Trainees underwent a pre-test for baseline competency assessment. Once completed the full training program, a post-test was administered. Pre- and post-test scores were compared. Trainees rated the educational program through survey questionnaires. Results: 28 trainees (87.5%) completed the full educational program. ECMO staff skills improved from a median pre-test score of 7.5/18 (IQR = 6-11) to 14/18 (IQR = 14-16) at post-test (P < 0.001, Wilcoxon rank test). All trainees highly rated the educational program and its impact on their practice. They reported high-fidelity simulations to be beneficial to novice learners as it increased self-confidence in ECMO-emergencies (according to 100% of surveyed), theoretical knowledge (61.5%) and team-work/communicative skills (58%). Conclusions: The multistep ECMO team training increased staff' knowledge, technical skills, teamwork, and self-confidence, allowing the successful development of a neonatal respiratory ECMO program. Conventional training was perceived as relevant in the early phase of the program development, while the active learning emerged to be more beneficial to master ECMO knowledge, specific skills, and team performance.
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Affiliation(s)
- Genny Raffaeli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Mara Vanzati
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Chiara Baracetti
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Francesco Canesi
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.,Betamed Perfusion Service, Rome, Italy
| | - Federica Conigliaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.,Betamed Perfusion Service, Rome, Italy
| | - Valerio Gentilino
- Department of Pediatric Surgery, Ospedale Filippo Del Ponte Varese, Varese, Italy.,Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabrizio Ciralli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Sofia Passera
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Simona Neri
- Pediatric Anesthesiology and Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Franzini
- Pediatric Anesthesiology and Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Plevani
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Faudeux C, Tran A, Dupont A, Desmontils J, Montaudié I, Bréaud J, Braun M, Fournier JP, Bérard E, Berlengi N, Schweitzer C, Haas H, Caci H, Gatin A, Giovannini-Chami L. Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics. J Pediatr 2017; 188:252-257.e6. [PMID: 28456389 DOI: 10.1016/j.jpeds.2017.03.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/08/2017] [Accepted: 03/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. STUDY DESIGN Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. RESULTS Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. CONCLUSIONS RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations.
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Affiliation(s)
- Camille Faudeux
- Pediatric Emergency Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France; Pediatric Nephrology Department, CHU de Nice, Nice, France
| | - Antoine Tran
- Pediatric Emergency Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France; Medical Simulation Center, Faculty of Medicine of Nice, Université de Nice Sophia-Antipolis, Nice, France
| | - Audrey Dupont
- Medical Simulation Center, Faculty of Medicine of Nice, Université de Nice Sophia-Antipolis, Nice, France; Pediatric Intensive Care Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Jonathan Desmontils
- Pediatric Emergency Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Isabelle Montaudié
- Pediatric Emergency Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Jean Bréaud
- Medical Simulation Center, Faculty of Medicine of Nice, Université de Nice Sophia-Antipolis, Nice, France; Université de Nice-Sophia Antipolis, Nice, France
| | - Marc Braun
- University Centre for Education by Medical Simulation (CUESIM)-The Virtual Hospital of Lorraine of the Faculty of Medicine of Nancy, France; Université de Nancy, Nancy, France
| | - Jean-Paul Fournier
- Medical Simulation Center, Faculty of Medicine of Nice, Université de Nice Sophia-Antipolis, Nice, France; Université de Nice-Sophia Antipolis, Nice, France
| | - Etienne Bérard
- Pediatric Nephrology Department, CHU de Nice, Nice, France; Université de Nice-Sophia Antipolis, Nice, France
| | - Noémie Berlengi
- Pediatric Emergency Department, Hôpital d'enfants de Nancy, Nancy, France
| | - Cyril Schweitzer
- Université de Nancy, Nancy, France; Pediatric Emergency Department, Hôpital d'enfants de Nancy, Nancy, France
| | - Hervé Haas
- Pediatric Emergency Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Hervé Caci
- Pediatric Outpatient Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Amélie Gatin
- University Centre for Education by Medical Simulation (CUESIM)-The Virtual Hospital of Lorraine of the Faculty of Medicine of Nancy, France; Pediatric Emergency Department, Hôpital d'enfants de Nancy, Nancy, France
| | - Lisa Giovannini-Chami
- Medical Simulation Center, Faculty of Medicine of Nice, Université de Nice Sophia-Antipolis, Nice, France; Pediatric Intensive Care Unit, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France; Université de Nice-Sophia Antipolis, Nice, France; Pediatric Pulmonology and Allergology Department, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France.
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Mann JA, Roland D. What are the measures that can be used to assess performance during in situ Paediatric Emergency Medicine Simulation? BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 3:83-87. [PMID: 35518909 PMCID: PMC8990193 DOI: 10.1136/bmjstel-2016-000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/07/2016] [Accepted: 02/17/2017] [Indexed: 12/29/2022]
Abstract
Background Paediatric in situ simulation within emergency departments is growing in popularity as an approach for improving multidisciplinary team working, enabling clinical skills development and exploring the importance of human factors in the clinical setting. However, measuring the success of such programmes is often through participant feedback of satisfaction and not measures of performance, which makes it difficult to assess whether such programmes lead to improvements in clinical behaviour. Objective To identify the measures that can be used to assess performance during in situ paediatric emergency medicine simulations. Study selection A literature search of EMBASE, ERIC and MEDLINE was performed using the key terms (Paediatrics and Emergency and Simulation.) MeSH and subheadings were used to ensure all possible variations of the key terms were included within the search. Findings The search revealed 607 articles, with 16 articles meeting inclusion criteria. Three themes of evaluation strategy were identified-the use of feedback forms (56% n=9/16), performance evaluation methods (63% n=10/16) or other strategies (25% n=4/16), which included provider comfort scores, latent safety threat identification and episodes of suboptimal care and their causation. Conclusions The most frequently used method of assessment in paediatric emergency department simulation are performance evaluation methods. None of the studies in this area have looked at patient level outcomes and this is therefore an area which should be explored in the future.
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Affiliation(s)
- Jennifer Amanda Mann
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK
- SAPPHIRE group, Health Sciences, Leicester University, Leicester, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK
- SAPPHIRE group, Health Sciences, Leicester University, Leicester, UK
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Wesson HK, Plant V, Helou M, Wharton K, Fray D, Haynes J, Bagwell C. Piloting a pediatric trauma course in Western Jamaica: Lessons learned and future directions. J Pediatr Surg 2017; 52:1173-1176. [PMID: 28132766 DOI: 10.1016/j.jpedsurg.2017.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 12/05/2016] [Accepted: 01/05/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pediatric injuries are a leading cause of death in low- and middle-income countries (LMICs). Despite this, there are few formal pediatric-specific trauma educational initiatives available in LMICs. While new educational tools are being developed to address this, they have not been piloted in LMICs. In Jamaica, pediatric injuries are a leading cause of hospital admission but care is limited by a lack of training in triage and stabilization. Our objective was to implement and evaluate a pediatric trauma course in Jamaica to determine the impact this may have on further course development. MATERIALS AND METHODS A pediatric trauma course was conducted at the Cornwall Regional Hospital in Montego Bay, Jamaica sponsored by the Children's Medical Services International, a nonprofit organization. Participants took part in six didactic modules, an infant airway intubation skills session, and three clinical simulation scenarios. Participants completed a postcourse survey at the conclusion of the course. RESULTS Twenty-five participants including surgical, pediatric, and emergency medicine residents from regional- and district-level hospitals in Jamaica participated in the course. Participants viewed the course favorably. Strengths included good review of pediatric trauma physiology, short modules, hands-on practice, and applicable clinical scenarios. Using a Likert-type rating scale of 1 to 10, with 1 being minimal and 10 being very knowledgeable, precourse knowledge was ranked as 5.9, which increased to 9.2 after the course. Using a similar scale, the precourse comfort level to run a pediatric trauma was 4.9 and increased to 8.5 following the course. DISCUSSION Implementation of this pilot pediatric trauma course was feasible and successful through collaboration with the hosting regional hospital. The lack of formal pediatric training can be overcome by a course such as this which includes both didactics and hands-on clinical patient simulations. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Hadley K Wesson
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Valerie Plant
- Division of Pediatric Surgery, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Marieka Helou
- Department of Pediatrics, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Karen Wharton
- Department of Neonatology, Mednax, Richmond, VA, USA
| | - Delroy Fray
- Department of Pediatric Surgery, Cornwall Hospital, Montego Bay, Jamaica
| | - Jeffrey Haynes
- Division of Pediatric Surgery, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Charles Bagwell
- Division of Pediatric Surgery, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA.
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Bedside Infant Manikins for Teaching Newborn Examination to Medical Undergraduates. Indian Pediatr 2017; 54:208-210. [PMID: 27889715 DOI: 10.1007/s13312-017-1032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study whether using infant manikins during clinical posting could help in teaching newborn examination to undergraduate medical students. METHODS 111 final MBBS students were taught newborn examination either by the new method which included practice on infant manikins at the bedside before examining babies (Group 1) or by the traditional method which involved directly examining babies (Group 2). They were tested the next day by validated OSCE stations on important aspects of the newborn examination. Marking was done as 0 (completely incorrect), 1 (partially correct) or 2 (completely correct). Student feedback was also taken. RESULTS Scores were higher, with lesser variance, in Group 1. Student feedback was positive, favoring the new method. CONCLUSION Use of infant manikins at the bedside during clinical posting improves the performance of undergraduate students in newborn examination.
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Abstract
Objectives: To evaluate medical students’ satisfaction with simulation based learning strategy (SBL). Methods: A cross-sectional survey was conducted between October and November 2013 at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. All third and fourth year medical students (n=185) both males and females were included. A self-developed questionnaire on the effect of SBL was used. Items included were related to knowledge, skill, environment, resources, and faculty. The questionnaire was validated by an expert reviewer, and the reliability was calculated for all the questionnaire items. Responses were measured on a 5 point Likert-type scale, and statistical analysis was carried out. Results: The response rate for this study was 62% (n=115). The alpha coefficient for all items was 0.73. Overall, respondents from both years’ students were satisfied with teaching strategy, use of mannequins, and learning environment. The challenges reported were lack of skill-laboratories facilities, students’ cooperation, allocated time for skill-laboratories, and knowledge of instructor. There was a small, but significant difference between the satisfaction scores among genders (p=0.001). Whereas no difference was identified between the participants’ scores on satisfaction with SBL and year of education (p=0.62). Conclusion: Although there were few challenges, most of the students were satisfied that SBL improved their knowledge retention, skills, and communication.
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Affiliation(s)
- Sajida Agha
- Medical Education Department, King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. E-mail.
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Thomas AA, Uspal NG, Oron AP, Klein EJ. Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department. J Grad Med Educ 2016; 8:754-758. [PMID: 28018542 PMCID: PMC5180532 DOI: 10.4300/jgme-d-15-00730.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. OBJECTIVE We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. METHODS Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. RESULTS Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills (P < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use (P = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use (P < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use (P < .05, paired difference -0.4 points). CONCLUSIONS Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.
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Affiliation(s)
- Anita A. Thomas
- Corresponding author: Anita A. Thomas, MD, MPH, Seattle Children's Hospital, Department of Emergency Medicine, Mailstop MB.7.520, 4800 Sand Point Way NE, Seattle, WA 98145, 206.987.2599, fax 206.729.3070,
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Larson-Williams LM, Youngblood AQ, Peterson DT, Zinkan JL, White ML, Abdul-Latif H, Matalka L, Epps SN, Tofil NM. Interprofessional, multiple step simulation course improves pediatric resident and nursing staff management of pediatric patients with diabetic ketoacidosis. World J Crit Care Med 2016; 5:212-218. [PMID: 27896145 PMCID: PMC5109920 DOI: 10.5492/wjccm.v5.i4.212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/15/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the use of a multidisciplinary, longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis.
METHODS A multidisciplinary, multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department. Effectiveness of the simulation for the residents was measured with a pre- and post-test and a reference group not exposed to simulation. A follow up post-test was completed 3-6 mo after the simulation. Nurses completed a survey regarding the education activity.
RESULTS Pediatric and medicine-pediatric residents (n = 20) and pediatric nurses (n = 25) completed the simulation course. Graduating residents (n = 16) were used as reference group. Pretest results were similar in the control and intervention group (74% ± 10% vs 76% ± 15%, P = 0.658). After completing the intervention, participants improved in the immediate post-test in comparison to themselves and the control group (84% ± 12% post study; P < 0.05). The 3-6 mo follow up post-test results demonstrated knowledge decay when compared to their immediate post-test results (78% ± 14%, P = 0.761). Residents and nurses felt the interdisciplinary and longitudinal nature of the simulation helped with learning.
CONCLUSION Results suggest a multidisciplinary, longitudinal simulation improves immediate post-intervention knowledge but important knowledge decay occurs, future studies are needed to determine ways to decrease this decay.
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Castro D, Tcharmtchi MH, Thammasitboon S. A Practical Application of Educational Theories in Developing a Boot Camp Program for Pediatric Critical Care Fellows. Acad Pediatr 2016; 16:707-711. [PMID: 27772694 DOI: 10.1016/j.acap.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Danny Castro
- Department of Pediatrics, Baylor College of Medicine and the Section of Critical Care Medicine, Texas Children's Hospital, Houston, TX.
| | - M Hossein Tcharmtchi
- Department of Pediatrics, Baylor College of Medicine and the Section of Critical Care Medicine, Texas Children's Hospital, Houston, TX
| | - Satid Thammasitboon
- Department of Pediatrics, Baylor College of Medicine and the Section of Critical Care Medicine, Texas Children's Hospital, Houston, TX
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Abstract
Introduction Non-pediatric trainees working in pediatrics in the UK are expected to attend newborn deliveries and provide initial newborn life support if needed. In Swindon, new junior doctors receive a 90-minute teaching session at the start of their pediatrics rotation, but the content has not previously been standardized, and it may be several weeks before a doctor attends a newborn delivery. Thus, the confidence and competence in newborn resuscitation of doctors attending deliveries can vastly vary. Methods A standardized teaching package was developed as part of the pediatrics induction program. This includes an interactive lecture on the physiology of the newborn, skills stations, and mini-simulations to consolidate skills. This is accompanied by a program of regular neonatal mini-simulations as part of the departmental morning teaching program. These sessions allow junior doctors to practice their skills in a safe, simulated environment and reinforce the newborn life support pathway. Results Qualitative and quantitative feedback was sought following delivery of the induction training session. Junior doctors were asked to rate their confidence before and after the induction session using Likert scales from 1 (least confident) to 5 (most confident). Median confidence in attending term deliveries increased from 2 (range 1 - 4) to 4 (2 - 5), P=0.008. There was evidence that confidence was maintained at one month following induction. Conclusions A simulation program has been successful at improving confidence among junior doctors in attending newborn deliveries. This has the potential to improve patient care and trainees’ experiences of their pediatrics placement.
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Affiliation(s)
- Phil J Peacock
- Department of Paediatrics, Great Western Hospital, Swindon
| | | | - Wendy McCay
- Department of Paediatrics, Great Western Hospital, Swindon
| | - Sarah E Bates
- Department of Paediatrics, Great Western Hospital, Swindon
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Sagalowsky ST, Wynter SA, Auerbach M, Pusic MV, Kessler DO. Simulation-Based Procedural Skills Training in Pediatric Emergency Medicine. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cheng A. Simulation Applied to Pediatric Emergency Medicine: From Luxury to Necessity. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hunt EA, Duval-Arnould J, Chime NO, Auerbach M, Kessler D, Duff JP, Shilkofski N, Brett-Fleegler M, Nadkarni V, Cheng A. Building consensus for the future of paediatric simulation: a novel ‘KJ Reverse-Merlin’ methodology. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2016; 2:35-41. [DOI: 10.1136/bmjstel-2015-000072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 11/04/2022]
Abstract
ObjectivesThis project aims to identify guiding strategic principles to optimise simulation-based educational impact on learning, patient safety and child health.MethodsStudy participants included 39 simulation experts who used a novel ‘KJ Reverse-Merlin’ consensus process in the systematic identification of barriers to success in simulation, grouped them in themes and subsequently identified solutions for each theme.Results193 unique factors were identified and clustered into 6 affinity groups. 6 key consensus strategies were identified: (1) allocate limited resources by engaging health systems partners to define education and research priorities; (2) conduct and publish rigorous translational and cost-effectiveness research; (3) foster collaborative multidisciplinary research and education networks; (4) design simulation solutions with systems integration and sustainability in mind; (5) leverage partnerships with industry for simulation, medical and educational technology; (6) advocate to engage the education community, research funding agencies and regulatory bodies.ConclusionsSimulation can be used as a research, quality improvement and or educational tool aimed at improving the quality of care provided to children. However, without organisation, strategy, prioritisation and collaboration, the simulation community runs the risk of wasting resources, duplicating and misdirecting the efforts.
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Mallory LA, Calaman S, Lee White M, Doughty C, Mangold K, Lopreiato J, Auerbach M, Chang TP. Targeting Simulation-Based Assessment for the Pediatric Milestones: A Survey of Simulation Experts and Program Directors. Acad Pediatr 2016; 16:290-7. [PMID: 26456040 DOI: 10.1016/j.acap.2015.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/22/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine which of the 21 general pediatrics milestone subcompetencies are most difficult to assess using traditional methodologies and which are best suited to simulation-based assessment. METHODS We surveyed 2 samples: pediatric simulation experts and pediatric program directors. Respondents were asked about current use of simulation for assessment and to select 5 of the 21 pediatric subcompetencies most difficult to assess using traditional methods and the 5 best suited to simulation-based assessment. Spearman rank correlation was used to determine a correlation between how the 2 samples ranked the subcompetencies. RESULTS Forty-eight percent (29 of 60) simulation experts and 20% (115 of 571) program directors completed the survey. Few respondents reported using simulation for summative assessment. There are clear differences across the pediatric subcompetencies in perceived difficulty of assessment and suitability to simulation-based assessment. The 3 most difficult to assess subcompetencies were "recognize ambiguity," "demonstrate emotional insight," and "identify one's own strengths and deficiencies." The subcompetencies most suitable to assessment using simulation were "interprofessional teamwork," "clinical decision making," and "effective communication." Program directors and simulation experts had high agreement for both questions: difficult to assess (rho = 0.76, P < .001) and suitable to simulation-based assessment (rho = 0.94, P < .001). CONCLUSIONS Several general pediatrics milestone subcompetencies were identified by pediatric simulation experts and pediatric program directors as difficult to assess using current methodologies and as amenable to simulation-based assessment. The pediatric simulation community should target development of simulation-based assessment tools to these areas.
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Affiliation(s)
- Leah A Mallory
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine/The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
| | - Sharon Calaman
- Division of Pediatric Critical Care, Department of Pediatrics, Drexel University College of Medicine/St Christopher's Hospital for Children, Philadelphia, Pa
| | - Marjorie Lee White
- Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Cara Doughty
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
| | - Karen Mangold
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago/Feinberg School of Medicine at Northwestern University, Chicago, Ill
| | - Joseph Lopreiato
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md
| | - Marc Auerbach
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
| | - Todd P Chang
- Division of Emergency Medicine and Transport, Department of Pediatrics, Children's Hospital Los Angeles/Keck School of Medicine at University of Southern California, Los Angeles, Calif
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Alone we can do so little, together we can do so much. J Trauma Acute Care Surg 2016; 80:685-8. [PMID: 26808036 DOI: 10.1097/ta.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Spinal muscular atrophy and respiratory failure. How do primary care paediatricians act in a simulated scenario? An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.02.002] [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
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