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Johnston LC, Falck AJ, Vasquez MM, Dadiz R, French H, Izatt S, Bonachea E, Karpen HE, Carbajal MM, Payne A, Gillam-Krakauer M, Gray MM. Flipping the Teachers: Impact of a Standardized Physiology Curriculum on Neonatology Medical Educators. Am J Perinatol 2024; 41:e755-e764. [PMID: 36041469 DOI: 10.1055/a-1933-4893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Academic physicians must teach elements in an Accreditation Council for Graduate Medical Education (ACGME)-mandated curriculum while balancing career development and clinical workload. Exploring educator perceptions on the learning environment and comparing two instructional methods (traditional didactics [TD] vs. flipped classroom [FC]) in one pediatric subspecialty may elucidate current challenges, barriers, and strategies to optimize learning and educator satisfaction. STUDY DESIGN A randomized trial comparing effectiveness and learner preference for FC versus TD physiology teaching was conducted in ACGME-accredited neonatal-perinatal medicine (NPM) fellowship programs in 2018 to 2019. Educator preferences were elicited through online surveys pre- and postintervention. Free-text comments were provided for questions exploring strengths, challenges, and opportunities in fellowship education. Statistical analysis included comparisons of demographics and pre-post-intervention educator responses between groups. Thematic analysis of text responses was conducted to identify common subthemes. RESULTS From 61 participating programs, 114 FC educators and 130 TD educators completed surveys. At baseline, all educators experienced professional satisfaction from teaching fellows, but noted challenges with time available to create and/or deliver educational content, limited content expertise amongst faculty, colleagues' limited enthusiasm toward educating fellows, and lack of perceived value of education by institutions given limited protected time or credit toward promotion. Postintervention, educators in both groups noted a preference to teach physiology using FC due to interactivity, learner enthusiasm, and learner-centeredness. FC educators had a 17% increase in preference to teach using FC (p = 0.001). Challenges with FC included ensuring adequate trainee preparation, protecting educational time, and providing educators with opportunities to develop facilitation skills. CONCLUSION Overall, NPM educators in a trial evaluating a standardized, peer-reviewed curriculum report professional satisfaction from teaching, but described logistical challenges with developing/delivering content. Educators preferred instruction using FC, but identified challenges with learner preparedness and ensuring adequate educator time and skill. Future efforts should be dedicated to addressing these barriers. KEY POINTS · Many challenges exist for educators teaching neonatal-perinatal medicine fellows, including time, support, and recognition.. · Many educators preferred using flipped classroom methodology with a standardized curriculum due to interactivity and learner-centeredness.. · Benefits of a standardized, peer-reviewed curriculum include reduced preparation time, adaptability of content, and learning environment enhancement..
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Affiliation(s)
- Lindsay C Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Alison J Falck
- Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, California
| | - Margarita M Vasquez
- Department of Pediatrics, University of Texas Health San Antonio, San Antonio, Texas
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Heather French
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Izatt
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Elizabeth Bonachea
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, NY
| | - Heidi E Karpen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Allison Payne
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Maria Gillam-Krakauer
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Huber L, Good R, Bone MF, Flood SM, Fredericks R, Overly F, Tofil NM, Wing R, Walsh K. A Modified Delphi Study for Curricular Content of Simulation-Based Medical Education for Pediatric Residency Programs. Acad Pediatr 2024:S1876-2859(24)00151-7. [PMID: 38663801 DOI: 10.1016/j.acap.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE We sought to establish core knowledge topics and skills that are important to teach pediatric residents using simulation-based medical education (SBME). METHODS We conducted a modified Delphi process with experts in pediatric SBME. Content items were adapted from the American Board of Pediatrics certifying exam content and curricular components from pediatric entrustable professional activities (EPAs). In round 1, participants rated 158 items using a four-point Likert scale of importance to teach through simulation in pediatric residency. A priori, we defined consensus for item inclusion as ≥70% rated the item as extremely important and exclusion as ≥70% rated the item not important. Criteria for stopping the process included reaching consensus to include and/or exclude all items, with a maximum of three rounds. RESULTS A total of 59 participants, representing 46 programs and 25 states participated in the study. Response rates for the three rounds were 92%, 86% and 90%, respectively. The final list includes 112 curricular content items deemed by our experts as important to teach through simulation in pediatric residency. Seventeen procedures were included. Nine of the seventeen EPAs had at least one content item that experts considered important to teach through simulation as compared to other modalities. CONCLUSIONS Using consensus methodology, we identified the curricular items important to teach pediatric residents using SBME. Next steps are to design a simulation curriculum to encompass this content.
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Affiliation(s)
- Lorel Huber
- University of Colorado (L Huber, R Good, and MF Bone), Pediatric Critical Care Medicine, Aurora, Colo.
| | - Ryan Good
- University of Colorado (L Huber, R Good, and MF Bone), Pediatric Critical Care Medicine, Aurora, Colo
| | - Meredith F Bone
- University of Colorado (L Huber, R Good, and MF Bone), Pediatric Critical Care Medicine, Aurora, Colo
| | - Shannon M Flood
- University of Colorado (SM Flood), Pediatric Emergency Medicine, Aurora, Colo
| | - Ryan Fredericks
- Swedish Medical Center (R Fredericks), Pediatric Critical Care Medicine, Seattle, Wash
| | - Frank Overly
- Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital (F Overly and R Wing), Pediatric Emergency Medicine, Providence, RI
| | - Nancy M Tofil
- University of Alabama at Birmingham (NM Tofil), Pediatric Critical Care Medicine, Birmingham, Ala
| | - Robyn Wing
- Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital (F Overly and R Wing), Pediatric Emergency Medicine, Providence, RI
| | - Kathryn Walsh
- University of Colorado (K Walsh), Denver Health, Pediatric Critical Care Medicine, Denver Health Medical Center, Denver, Colo
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Kaur S, Lynders W, Goldman M, Bruno C, Morin J, Maruschock S, Auerbach M. Blueprint for community emergency department pediatric simulation. AEM EDUCATION AND TRAINING 2023; 7:e10925. [PMID: 38046090 PMCID: PMC10688145 DOI: 10.1002/aet2.10925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 12/05/2023]
Abstract
Background Gaps in quality of pediatric emergency care have been noted in community emergency departments (CEDs), where >85% of children receive care. In situ simulation provides opportunities for hands-on experiences and can help close these gaps. We aimed to develop, implement, and evaluate an innovative, replicable, and scalable pediatric in situ simulation-based CED curriculum, under the leadership of a local colleague, through collaborative approach with a regional academic medical center (AMC). Methods Kern's model was used as follows: problem identification and general needs assessment-pediatric readiness assessment and discussions with CED physician and nursing leadership; targeted needs assessment-review of recent pediatric transfer cases; goals and objectives-enhance pediatric knowledge and skills of interprofessional teams and detect latent safety threats; educational strategies-codeveloped by CED and AMC, included prelearning using podcasts and videos, simulation and facilitated debriefing, resource sharing after simulations; implementation-3-h simulation sessions facilitated in person by the CED team and remotely by AMC (leadership required participation and paid staff); and evaluation and feedback-retrospective pre-post survey, Simulation Effectiveness Tool-Modified (SET-M), Net Promoter Score (NPS), and review/feedback meetings. Results Based on needs assessment, the selected cases included newborn resuscitation, seizure, asthma, and tetrahydrocannabinol ingestion causing altered mental sensorium in a child. Twenty-four 3-h simulation sessions were conducted over 1 year. A total of 168 participants completed the sessions, while 75 participants (54.7% nurses, 22.7% physicians, and others) completed feedback surveys. Seventy-six percent of participants reported completing presimulation education material. Participants reported improved skills at appropriately evaluating a critically ill newborn and critically ill infant/toddler and improved teamwork during the care of a pediatric patient. The majority agreed that simulation was effective in teaching pediatric resuscitation. The NPS was 84% (excellent). Conclusions A locally facilitated CED in situ simulation curriculum was successfully developed and implemented under local leadership, with remote collaboration by AMC. The curriculum was well received and effective.
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Delgado EM, Fischer J, Scott KR, Mamtani M, Xiong R, Tay K, Verma A, Franco M, Szydlowski E, Toto RL, Conlon L, Posner JC. Perspectives on preparedness for pediatric emergencies after residency: A needs assessment. AEM EDUCATION AND TRAINING 2023; 7:e10898. [PMID: 37529175 PMCID: PMC10387828 DOI: 10.1002/aet2.10898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 08/03/2023]
Abstract
Background General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pediatric emergencies to better inform PEM curricula design. Methods In 2021, senior EM residents and graduates from the classes of 2020 and 2019 across eight EM programs with PEM rotations at the same children's hospital were recruited and surveyed electronically to assess perceived preparedness for 42 pediatric emergencies and procedures by age: infants under 1 year, toddlers, and children over 4 years. Preparedness was reported on a 5-point Likert scale with 1 or 2 defined as "unprepared." A chi-square test of independence compared the proportion of respondents unprepared to manage each condition across age groups, and a p-value < 0.05 demonstrated significance. Results The response rate was 53% (129/242), with a higher response rate from senior residents (65%). Respondents reported feeling unprepared to manage more emergency conditions in infants compared to other age groups. Respondents felt least prepared to manage inborn errors of metabolism and congenital heart disease, with 45%-68% unprepared for these conditions across ages. A heat map compared senior residents to recent graduates. More graduates reported feeling unprepared for major trauma, impending respiratory failure, and pediatric advanced life support algorithms. Conclusions This study, describing the perspective of EM senior residents and recent graduates, offers unique insights into PEM curricular needs during EM training. Future PEM curricula should target infant complaints and conditions with lower preparedness scores across ages. Other centers training EM residents could use our findings and methods to bolster PEM curricula.
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Affiliation(s)
- Eva M. Delgado
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Jason Fischer
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
- Division of Emergency MedicineBoston Children's HospitalBostonMassachusettsUSA
| | - Kevin R. Scott
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicineHospital of the University of Pennsylvania (HUP)PhiladelphiaPennsylvaniaUSA
| | - Mira Mamtani
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicineHospital of the University of Pennsylvania (HUP)PhiladelphiaPennsylvaniaUSA
| | - Ruiying Xiong
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Khoon‐Yen Tay
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Archana Verma
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Marleny Franco
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Ellen Szydlowski
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Regina L. Toto
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
| | - Lauren Conlon
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicineHospital of the University of Pennsylvania (HUP)PhiladelphiaPennsylvaniaUSA
| | - Jill C. Posner
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of PediatricsChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of Philadelphia (CHOP)PhiladelphiaPennsylvaniaUSA
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Ongoing Simulation-Based Procedural Practice: An Imperative for Attending Physicians in Emergency Medicine. Am J Med Qual 2021; 37:183-184. [PMID: 34738982 DOI: 10.1097/jmq.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burns R, Madhok M, Bank I, Nguyen M, Falk M, Waseem M, Auerbach M. Creation of a standardized pediatric emergency medicine simulation curriculum for emergency medicine residents. AEM EDUCATION AND TRAINING 2021; 5:e10685. [PMID: 34632245 PMCID: PMC8489268 DOI: 10.1002/aet2.10685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The majority of children seeking care in emergency departments are seen by general emergency medicine (EM) residency program graduates. Throughout training, EM residents manage fewer critically ill pediatric patients compared to adults, and the exposure to children with illness and injury requiring emergent assessment and management is often limited and sporadic across training sites. This report describes the creation of a robust set of simulation cases for EM trainees incorporating topics identified during a previous modified Delphi study to improve their pediatric acute care knowledge and skills. METHODS All 30 pediatric EM topics and 19/26 procedures previously identified as "must be taught by simulation" to EM residents were mapped to 15 simulation case topics. Twenty-seven authors from 16 institutions created cases and supporting materials. Each case was iteratively implemented during a peer review process at two to five sites with EM residents. Feedback from learners and facilitators was collected via electronic surveys and used to revise each case before the next implementation. RESULTS Thirty-five institutions participated in the peer review process. Fifty-one facilitators and 281 participants (90% EM residents) completed surveys. Most facilitators (98%) agreed or strongly agreed with the statement "This simulation case is relevant to the field of emergency medicine." A majority of facilitators and participants agreed or strongly agreed with the statements "The simulation case was realistic" (98% of facilitators, 94% of participants) and "This simulation case was effective in teaching resuscitation skills" (92% of facilitators, 98% of participants). Most participants reported confidence in knowledge and skills addressed in the learning objectives after participation. CONCLUSIONS Facilitators and EM residents found cases from a novel simulation-based curriculum covering critical pediatric EM topics relevant, realistic, and effective. This curriculum can help provide a standardized, uniform experience for EM residents who will care for critically ill pediatric patients in their communities.
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Affiliation(s)
- Rebekah Burns
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Manu Madhok
- Department of PediatricsChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Ilana Bank
- Department of PediatricsMcGill UniversityMontrealQuebecCanada
| | - Michael Nguyen
- Department of MedicineMorsani College of MedicineUniversity of South FloridaTampaFloridaUSA
| | - Michael Falk
- Department of PediatricsChildren's Hospital Medical CenterWashingtonDCUSA
| | - Muhammad Waseem
- Departments of Pediatrics and Emergency MedicineLincoln Medical CenterBronxNew YorkUSA
| | - Marc Auerbach
- Departments of Pediatrics and Emergency MedicineYale UniversityNew HavenConnecticutUSA
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Richards CT, Fishe JN, Cash RE, Rivard MK, Brown KM, Martin-Gill C, Panchal AR. Priorities for Prehospital Evidence-Based Guideline Development: A Modified Delphi Analysis. PREHOSP EMERG CARE 2021; 26:286-304. [PMID: 33625309 DOI: 10.1080/10903127.2021.1894276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Few areas of prehospital care are supported by evidence-based guidelines (EBGs). We aimed to identify gaps in clinical and operational prehospital EBGs to prioritize future EBG development and research funding. Methods: Using modified Delphi methodology, we sought consensus among experts in prehospital care and EBG development. Five rounds of surveys were administered between October 2019 and February 2020. Round 1 asked participants to list the top three gaps in prehospital clinical guidelines and top three gaps in operational guidelines that should be prioritized for guideline development and research funding. Based on responses, 3 reviewers performed thematic analysis to develop a list of prehospital EBG gaps, with participant feedback in Round 2. In Round 3, participants rated each gap's importance using a 5-point Likert scale, and participants' responses were averaged. In Round 4, participants rank-ordered 10 gaps with the highest mean scores identified in Round 3. In Round 5, participants indicated their agreement with sets of the highest ranked gaps. Results: Of 23 invited participants, 14 completed all 5 rounds. In Rounds 1 and 2, participants submitted 65 clinical and 58 operational gaps, and thematic analysis identified 23 unique clinical gaps and 28 unique operational gaps. The final prioritized list of clinical EBG gaps was: 1) airway management in adult and pediatric patients, 2) care of the pediatric patient, and 3) management of prehospital behavioral health emergencies, with 79% of participants agreeing. The final prioritized list of operational EBG gaps was: 1) define and measure the impact of EMS care on patient outcomes, 2) practitioner wellness, and 3) practitioner safety in the out-of-hospital environment, with 86% of participants agreeing. Conclusions: This modified Delphi study identifies gaps in prehospital EBGs that, if prioritized for development and research funding, would be expected to have the greatest impact on prehospital clinical care and operations.
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Burns R, Auerbach M, Mitzman J. Pediatric Emergency Medicine Curricula for Emergency Medicine Residents. AEM EDUCATION AND TRAINING 2021; 5:147-148. [PMID: 33521505 PMCID: PMC7821067 DOI: 10.1002/aet2.10563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 05/30/2023]
Affiliation(s)
- Rebekah Burns
- Associate Professor of PediatricsEmergency Medicine Resident Simulation Curriculum for Pediatrics (EM ResCu Peds) Chief EditorUniversity of WashingtonSeattleWAUSA
| | - Marc Auerbach
- Associate Professor of Pediatrics and Emergency Medicine and Director of Pediatric SimulationYale University School of MedicineNew HavenCTUSA
| | - Jennifer Mitzman
- Assistant Professor of Emergency Medicine and PediatricsThe Ohio State University College of MedicineColumbusOhioUSA
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