Board #235 - Program Innovation A Multidisciplinary Simulation and Skills-based Curriculum Improves Resident Preparedness on ACGME-required Procedural Skills (Submission #10005)

Abstract

Objectives In 2013, the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey included a novel set of questions for graduating PGY-3 pediatric residents on their level of preparedness to perform 13 specific procedural skills without supervision. Baseline data obtained from graduating PGY-3’s at our institution revealed that 100% reported “Agree” or “Strongly Agree” on major ACGME required procedures including lumbar punctures (LP), bag and mask ventilation, neonatal intubation and resuscitation, and umbilical catheterization. However, the survey results highlighted the importance of minor procedures including placement of peripheral intravenous catheters (IV), incision and drainage of an abscess (I&D), simple joint dislocation reductions and splinting of fractures. In these categories, over 50% of our graduating PGY-3’s reported they were not comfortable performing these procedures unsupervised. Our objective was to create a multidisciplinary simulation-based curriculum for resident trainees within our established weekly lecture series with the aim of having all residents achieve competency in performing the surveyed ACGME procedures safely and without supervision by completion of their PGY-3 year. Description We created five skills workshops for procedural training. Residents, divided into groups of six to eight, received learner-directed teaching using simulated techniques from multidisciplinary experts involving critical care nurses, orthopedic nurse practitioners, ER attendings, and general pediatricians (Figure 1). All current residents were anonymously surveyed before and after the skills workshops using a 5-item Likert scale of preparedness with the same questions as the 2012-2013 ACGME Resident Survey. Based on the Kirkpatrick evaluation model, motivation will be reported as workshop attendance rates and learning will be reported via survey results. Attendance at each component of the established simulation curricula and the novel skills workshops was > 93.5%. Survey responses were analyzed using percent change from pre- and post-curricular implementation. Our baseline survey revealed that residents did not feel well prepared to perform minor procedures without supervision (I&D=28%, IV=39%, splinting=64% dislocation=80%). Post workshops, residents showed a dramatic increase in feeling well prepared to perform minor procedures (dislocation by 300%, splinting by 189%, I&D by 88%, IV insertion by 58%). Conclusion A multidisciplinary, simulation-based procedure curriculum outside of unit-specific clinical and simulator training will address all minor reportable ACGME procedural skills and facilitate graduating pediatric resident competency in performing these procedures safely without supervision. Limitations included availability of simulated models appropriate for the time frame allotted and level of training, and multidisciplinary team availability. Future applications will include curricular development to address the translation of simulated skills into confident pediatric care at the bedside. Disclosures None