The development and implementation of a 12-month simulation-based learning curriculum for pediatric emergency medicine fellows utilizing debriefing with good judgment and rapid cycle deliberate practice

Abstract

BackgroundThere are currently training gaps, primarily procedural and teamwork skills, for pediatric emergency medicine (PEM) fellows. Simulation-based learning (SBL) has been suggested as an educational modality to help fill those gaps. However, there is little evidence suggesting how to do so. The objective of this project is to develop and implement an SBL curriculum for PEM fellows with established curriculum development processes and instructional design strategies to improve PEM fellowship training.MethodsWe developed a 12-month longitudinal SBL curriculum focused on needs assessment, instructional strategies, and evaluation. The curriculum development process led us to combine the instructional strategies of debriefing with good judgment, rapid cycle deliberate practice, and task-training to improve core PEM skills such as procedural competence, crisis resource management, and managing complex medical and traumatic emergencies. Using multiple approaches, we measured outcomes related to learners (attendance, performance, critical procedure opportunities), instructor performance, and program structure.ResultsEight/Eight (100%) PEM fellows participated in this curriculum from July 2015 to June 2017 with an overall attendance rate of 68%. Learners self-reported high satisfaction (4.4/5, SD = 0.5) and perceived educational value (4.9/5, SD = 0.38) with the curriculum and overall program structure. Learners had numerous opportunities to practice critical procedures such as airway management (20 opportunities), defibrillator use (ten opportunities), and others (ten opportunities). Learner Debriefing Assessment for Simulation in Healthcare (short version) scores had mean scores greater than 5.8/7 (SD = 0.89) across all six elements.ConclusionsThis longitudinal SBL curriculum combining debriefing with good judgment and rapid cycle deliberate practice can be a feasible method of reducing current training gaps (specifically with critical procedure opportunities) in PEM fellowship training. More work is needed to quantify the training gap reduction and to refine the curriculum.

A novel program to enhance pediatric emergency medicine training in Thailand

“…Second, we heavily leveraged technology through an online learning management system to administer key elements of our course. In recent years there has been increasing recognition of the need to apply technology to develop collaborative networks to improve patient care in the emergency setting and beyond 36‐41 . In 2018 Barata et al 39 published the results of their consensus conference “Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps.” The authors recommended that technology and collaborative networks be utilized to generate and disseminate pediatric knowledge and prepare EDs to care for acutely ill and injured children.…”

“…In recent years there has been increasing recognition of the need to apply technology to develop collaborative networks to improve patient care in the emergency setting and beyond [36][37][38][39][40][41]. In 2018 Barata et al39 published the results of their consensus confer-…”

Using rapid cycle deliberate practice to improve primary and secondary survey in pediatric trauma

“…The confidence question asks learners what their confidence is to perform a primary and secondary survey before and after the simulation session published about the application of RCDP to pediatric trauma care education [11,13]. The one other published work involving RCDP in pediatric trauma education described a longitudinal simulation curriculum for pediatric emergency medicine fellows, with one trauma case in a 12 month curriculum [16]. Additionally, RCDP is useful when there are significant time limitations.…”

Improving the Pediatric Emergency Department Learning Experience: A Simulation-Based Orientation for Pediatric PGY 1 Residents

“…Simulation has been shown to improve test scores in surgical residents 3 and to reduce training gaps in pediatric emergency medicine (PEM) fellows. 4 Additionally, many studies report that simulation-based curricula have helped improve self-confidence in surgical residents, 5 obstetrics residents, 6 and pediatric critical care fellows. 7 In choosing relevant topics, our findings showed that most interns did not feel confident performing even the initial steps of stabilization of asthma exacerbations (50%) or severe sepsis (69%).…”