Resident Exposure to Critical Patients in a Pediatric Emergency Department

Chen, Esther H.; Cho, Christine S.; Shofer, Frances S.; Mills, Angela M.; Baren, Jill M.

doi:10.1097/pec.0b013e318159ffef

Cited by 83 publications

(81 citation statements)

References 19 publications

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“…Our results are similar to those of a PED of a large children's hospital, which found that only 2.5 patients per 1,000 visits required treatment in a resuscitation room. 4 Our data are also consistent with studies that found a low volume of resident exposure to critical illness and resuscitation interventions in the PED, 2,5 as well as the National Registry of Cardiopulmonary Resuscitation, which found that CPR in the PED was exceedingly rare.…”

Section: Discussionsupporting

confidence: 81%

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Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

Guilfoyle

Milner

Kissoon

2011

CJEM

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Objective: To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED). Methods and Material: This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded. Results: There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n 5 115, 35%), trauma (n 5 50, 15%), sepsis (n 5 36, 11%), seizures (n 5 37, 11%), and cardiac disease (n 5 22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions. Conclusion: Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed. RÉ SUMÉObjectif: Dé crire la fré quence des manoeuvres de ré animation et le taux de succè s dans un service des urgences pé diatriques (SUP). Ré sultats: Il y a eu 75 133 visites à l'urgence des soins pé diatriques; 304 des 329 visites (92,4 %) ré pondant aux critè res d'inclusion ont é té analysé es. Les diagnostics comprenaient : dé tresse respiratoire (n 5 115, 35 %), traumatismes (n 5 50, 15 %), sepsis (n 5 36, 11 %), convulsions (n 5 37, 11 %), et maladie cardiaque (n 5 22, 7 %). Quatre-vingt-dix-neuf patients ont né cessité une intubation. Les intubations au SUP ont é té ré alisé es par les ré sidents (20 %), les moniteurs cliniques (fellows) en mé decine d'urgence pé diatrique (15 %), les mé decins traitants du SUP (29 %), les moniteurs cliniques à l'USIP (12 %). Le taux de succè s de ces intubations à la premiè re tentative é tait de 81 %. Au SUP, 7 cathé ters centraux et 7 abords veineux intra-osseux ont é té mis en place, des inotropes ont é té administré s à 15 patients et des compressions thoraciques pratiqué es chez 9 patients. Conclusion: Des cas de maladies graves sont rares à notre service d'urgence. Les occasions de pratiquer des manoeuvres de ré animation, d'ouvrir les voies aé riennes et de poser un cathé ter central sont donc limité es. Il faut envisager une formation supplé mentaire, des relations de travail é troites entre les é quipes du SUP et de l'USIP et la mise en place de protocoles de ré animation pour une intervention pré coce de l'USIP.

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Section: Discussionsupporting

confidence: 81%

“…1 More recently, a study in a large tertiary level PED reported that residents' exposure to critical illness and their opportunities to perform lifesaving interventions were very limited. 2 We found no studies that examined all of the resuscitation interventions performed in a PED.…”

Section: Ré Sumémentioning

confidence: 90%

Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

Guilfoyle

Milner

Kissoon

2011

CJEM

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“…Additionally, Chen et al found that EM residents were more likely to treat older pediatric patients, perform only minor procedures, and see fewer critically ill patients compared to their non-EM peers. 9,10 Similarly, Langhan et al 11 reports that EM residents feel uncomfortable with pediatric and neonatal resuscitations. While we recognize that these individual reports of deficiencies in EM resident education might be attributable to individual systems problems, we believe that collectively they demonstrate the need for a more rigorous core pediatrics curriculum to guide EM resident education.…”

Section: Discussionmentioning

confidence: 99%

A Modified Delphi Study for Development of a Pediatric Curriculum for Emergency Medicine Residents

Mitzman

King

Fastle

et al. 2017

AEM Education and Training

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Objectives: Emergency medicine (EM) trainees are expected to learn to provide acute care for patients of all ages. The American Council for Graduate Medical Education provides some guidance on topics related to caring for pediatric patients; however, education about pediatric topics varies across residency programs. The goal of this project was to develop a consensus curriculum for teaching pediatric emergency care.Methods: We recruited 13 physicians from six academic health centers to participate in a three-round electronic modified Delphi project. Participants were selected on the basis of expertise with both EM resident education and pediatric emergency care. The first modified Delphi survey asked participants to generate the core knowledge, skills, and experiences needed to prepare EM residents to effectively treat children in an acute care setting. The qualitative data from the first round was reformulated into a second-round questionnaire. During the second round, participants used rating scales to prioritize the curriculum content proposed during the first round. In round 3, participants were asked to make a determination about each curriculum topic using a three-point scale labeled required, optional, or not needed. Results:The first modified Delphi round yielded 400 knowledge topics, 206 clinical skills, and 44 specific types of experience residents need to prepare for acute pediatric patient care. These were narrowed to 153 topics, 84 skills, and 28 experiences through elimination of redundancy and two rounds of prioritization. The final lists contain topics classified by highly recommended, partially recommended, and not recommended. The partially recommended category is intended to help programs tailor their curriculum to the unique needs of their learners as well as account for variability between 3-and 4-year programs and the amount of time programs allocate to pediatric education. Conclusion:The modified Delphi process yielded the broad outline of a consensus core pediatric emergency care curriculum.E mergency medicine (EM) physicians acquire proficiency in the emergent management of all patients including pediatric patients during their training. Despite the growth of pediatric EM as a subspecialty, pediatric EM (PEM) subspecialists only care for 10% to 20% of the pediatric patients in the emergency setting across the United States.1 The remaining 80% to 90% of pediatric emergency care patients are cared for by EM physicians and/or general practice pediatricians.2-5 The Accreditation Council for Graduate Medical Education (ACGME) requires EM residents to have approximately 20% of their patient encounters with patients less than 18 years of age, including the critical care of infants and children.6 While time dedicated to pediatrics has increased in recent years, 7 concerns remain as to whether this allows sufficient experience to develop the mastery level competency for the EM physician to effectively care for children. 4,7 Although the type of clinical experiences available is beyond the...

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“…[1][2][3] Studies capturing resident experience have shown gaps in clinical exposure. [4][5][6][7][8][9][10] Many training programs incorporate simulation and online modules to standardize exposure. [11][12][13][14][15][16][17][18][19][20] Web-based modules and lectures can supplement clinical experience, most effectively when used in conjunction with face-to-face instruction.…”

mentioning

confidence: 99%

A Randomized Educational Interventional Trial of Spaced Education During a Pediatric Rotation

House

Monuteaux

Nagler

2017

AEM Education and Training

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Objective: Spacing of educational material over time has been shown to improve learning efficiency and long-term knowledge retention. We evaluated the impact of adding a spaced education curriculum to a month-long pediatric rotation.Methods: This was a randomized controlled educational intervention trial of residents on a rotation in a pediatric emergency department. Participants were randomized to the standard curriculum or the standard curriculum with integrated spaced education. The intervention used an automated platform to electronically deliver questions to user e-mail or mobile devices and provided instant feedback. Our primary outcome was proportion of correctly answered questions following the rotation. Our secondary outcomes included test performance at 3 months, change in clinical confidence, and satisfaction with the spaced learning. Learner opinion of the platform was assessed by postrotation survey.Results: Of 194 eligible trainees, 122 were enrolled and randomized. A total of 107 of the enrolled residents (88%) completed the immediate postrotation assessment, 48 of whom received spaced education. Sixty residents completed the 3-month follow-up. There were no differences between the control and intervention groups in baseline knowledge. The intervention group performed better than the control group on the postrotation assessment (mean difference = 5.4%, 95% confidence interval = 0.1-10.7) when controlled for didactic attendance and clinical exposure. Change in confidence did not differ between groups. Eighty-seven percent of spaced education learners would participate in a similar model in the future. Conclusion:Spaced education during a pediatric emergency medicine rotation is an effective adjunct to a standard curriculum. Participants showed improvement on postrotation knowledge performance and enjoyed this educational approach.T he standard residency education prescribed by the Accreditation Council for Graduate Medical Education (ACGME) incorporates bedside teaching and didactic curricula.1-3 Studies capturing resident experience have shown gaps in clinical exposure.4-10 Many training programs incorporate simulation and online modules to standardize exposure. [11][12][13][14][15][16][17][18][19][20] Web-based modules and lectures can supplement clinical experience, most effectively when used in conjunction with face-to-face instruction. 21 An alternative strategy is the use of spaced education, which is the interval presentation of educational material over a prescribed period of time. Studies of surgical residents and medical students have demonstrated that spaced education initiatives spanning months to years improve learning efficiency and longterm knowledge retention. [22][23][24][25][26][27][28] Web-based spaced education may be an effective approach for residents on an emergency medicine rotation with asynchronous clinical schedules.

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Resident Exposure to Critical Patients in a Pediatric Emergency Department

Abstract: Pediatric and nonpediatric residents who rotate through a high-volume children's hospital ED are exposed to a very low number of critically ill children. Other educational formats, such as mock resuscitations or standardized patient encounters, may be required to correct this deficit.

Cited by 83 publications

References 19 publications

Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills

A Modified Delphi Study for Development of a Pediatric Curriculum for Emergency Medicine Residents

A Randomized Educational Interventional Trial of Spaced Education During a Pediatric Rotation

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