Pediatric Emergency Medicine Fellowship Programs Research Articles

Simulation in Pediatric Emergency Medicine Fellowships.

Graduate medical education faces challenges as programs transition to the next accreditation system. Evidence supports the effectiveness of simulation for training and assessment. This study aims to describe the current use of simulation and barriers to its implementation in pediatric emergency medicine (PEM) fellowship programs. A survey was developed by consensus methods and distributed to PEM program directors via an anonymous online survey. Sixty-nine (95%) fellowship programs responded. Simulation-based training is provided by 97% of PEM fellowship programs; the remainder plan to within 2 years. Thirty-seven percent incorporate >20 simulation hours per year. Barriers include the following: lack of faculty time (49%) and faculty simulation experience (39%); limited support for learner attendance (35%); and lack of established curricula (32%). Of those with written simulation curricula, most focus on resuscitation (71%), procedures (63%), and teamwork/communication (38%). Thirty-seven percent use simulation to evaluate procedural competency and resuscitation management. PEM fellows use simulation to teach (77%) and have conducted simulation-based research (33%). Thirty percent participate in a fellows' "boot camp"; however, finances (27%) and availability (15%) limit attendance. Programs receive simulation funding from hospitals (47%), academic institutions (22%), and PEM revenue (17%), with 22% reporting no direct simulation funding. PEM fellowships have rapidly integrated simulation into their curricula over the past 5 years. Current limitations primarily involve faculty and funding, with equipment and dedicated space less significant than previously reported. Shared curricula and assessment tools, increased faculty and financial support, and regionalization could ameliorate barriers to incorporating simulation into PEM fellowships.

158: Present and Future of Emergency Point-of-Care Ultrasound in Pediatric Emergency Fellowship Programs in Canada

Pediatric Emergency Point-of-care Ultrasound (POCUS) has become more and more important in the emergent care of ill and injured children over the last years. No information is currently available about its adoption and integration into Canadian pediatric emergency medicine (PEM) fellowship programs. The objective of this study was to describe current state as well as requests for POCUS training offered by Canadian PEM fellowship programs as perceived by both program directors and actively training fellows. Two web-based surveys were created by the survey authors: one for fellowship program directors and one for actively training fellows. The survey was tested and refined, and posted on a web-based survey site. The links for both questionnaires were distributed to all PEM fellowship program directors in Canada for dissemination to their fellows. A modified Dillman's method was used to maximize survey responses. Survey questions explored: current use of POCUS clinically at the training sites, existing POCUS curriculum and training opportunities, and interest in future curriculum development. A total of 9/10 (90%) fellowship program directors as well as 42/60 (70%) fellows responded. Currently a formal curriculum in POCUS is established in five of nine PEM programs. Most fellows (83%) had no training in POCUS before their fellowship but 74% reported a formal training during fellowship (FAST and focused cardiac examination mainly). Only 33% of fellows reported specific pediatric POCUS training. 50% of fellows stated using POCUS at least once a week, while directors indicated that the majority of faculty rarely uses POCUS (70%) in clinical practice. Main application in both groups is the FAST exam. For fellows and fellowship directors the major barrier in learning POCUS was the lack of trained faculty (95% and 90%, respectively), followed by faculty time, and interest in the technology. Finally, 86% of fellows described training in POCUS as very important or essential and they expressed their need for more training. While demand from PEM fellows is high, there is a great variability in implantation of POCUS training in Canadian PEM programs. The most important barrier in POCUS training is related to the lack of trained faculty, a fact that needs to be addressed by program directors. Canadian PEM programs should develop a conjoint standardized POCUS curriculum.

Point-of-care Ultrasonography by Pediatric Emergency Medicine Physicians.

In 2001 the American College of Emergency Physicians (ACEP) first published specialty-specific guidelines for point-of-care ultrasound (US) in emergency medicine (EM). At the same time, the Accreditation Council for Graduate Medical Education mandated that EM residents graduate with competency in point-of-care US. The guidelines and call for competency have since gained broad professional society acceptance.1-6 Several of the point-of-care US applications described in the ACEP guidelines and in the EM literature are not necessarily relevant to the practice of pediatric EM (PEM). In addition, there are applications that have not been well delineated in EM and are applicable to PEM practitioners. To date, the majority of PEM physicians have completed pediatrics residencies without point-of-care US training. In addition, point-of-care US only recently became a core competency for PEM fellowship training.7 Consequently, PEM as a specialty has been slower to adopt and incorporate point-of-care US into clinical practice. Over the past several years, point-of-care US has gained acceptance by PEM providers. There is a dedicated PEM point-of-care textbook,8 PEM fellowship training guidelines,7 and an organization devoted to PEM point-of-care US providers (www.P2network.com). Moreover, PEM physician use of point-of-care US has increased dramatically. Specifically, 95% of emergency departments with a PEM fellowship program incorporate point-of-care US into patient care, and 88% provide training for PEM fellows.9 The demand for training is increasing, and as of 2015 there are 12 PEM-specific US fellowships.10 This month, the American Academy of Pediatrics (AAP) published the first guideline for point-of-care US use by PEM physicians. The AAP policy statement11 and accompanying technical report12 provide background and a framework for PEM physicians, who currently use or are planning to incorporate point-of-care US into their practice. The documents represent a joint effort by the AAP, the Society for Academic Emergency Medicine, ACEP, and the World Interactive Network Focused on Critical Ultrasound.

Pediatric emergency medicine fellowship programs.

Pediatric Emergency Care: April 2015 - Volume 31 - Issue 4 - p 308-314 doi: 10.1097/PEC.0000000000000431

Pediatric Emergency Medicine Fellowship Programs

Pediatric Emergency Medicine Fellowship Programs

Evaluation of Hypertrophic Pyloric Stenosis by Pediatric Emergency Physician Sonography

The objective was to evaluate the accuracy of pediatric emergency physician (EP) sonography for infants with suspected hypertrophic pyloric stenosis (HPS). This was a prospective observational pilot study in an urban academic pediatric emergency department (PED). Patients were selected if the treating physician ordered an ultrasound (US) in the department of radiology for the evaluation of suspected HPS. Sixty-seven patients were enrolled from August 2009 through April 2012. When identifying the pylorus, pediatric EPs correctly identified all 10 positive cases, with a sensitivity of 100% (95% confidence interval [CI] = 62% to 100%) and specificity of 100% (95% CI = 92% to 100%). There was no statistical difference between the measurements obtained by pediatric EPs and radiology staff for pyloric muscle width or length (p = 0.5 and p = 0.79, respectively). Trained pediatric EPs can accurately assess the pylorus with US in the evaluation of HPS with good specificity.

Pediatric Emergency Medicine Fellowship Programs

Pediatric Emergency Medicine Fellowship Programs

Pediatric Emergency Medicine Fellow Training in Ultrasound: Consensus Educational Guidelines

The importance of point-of-care emergency ultrasound (EUS) to the practice of emergency medicine (EM) is well established, and mounting research continues to demonstrate how EUS can benefit pediatric emergency department (ED) patients. As members of the EM community, pediatric EM (PEM) physicians should understand the potential value of EUS and seek opportunities to incorporate EUS into their daily practice. Currently, EUS education and training is at an early developmental stage for PEM fellows and varies greatly between programs. The goal of this article is to provide consensus education guidelines and to describe a sample curriculum that can be used by PEM fellowship programs when developing or revising their US training curricula. The authors recognize that programs may be at different stages of EUS development and will consequently need to tailor curricula to individual institutional needs and capabilities. This guideline was developed through a collaborative process between EUS educators and members of the American Academy of Pediatrics Section of EM Fellowship Directors Subcommittee. The guideline includes the following topics: important considerations regarding EUS in PEM, PEM US program framework, PEM US curriculum, PEM US education program, and competency assessment.

The Role of High-Fidelity Simulation in Training Pediatric Emergency Medicine Fellows in the United States and Canada

The American Academy of Pediatrics Section on Emergency Medicine's Simulation Interest Group developed a survey targeting pediatric emergency medicine (PEM) fellowship program directors to assess the use of high-fidelity simulation (HFS) in PEM fellow training. Content experts in simulation and in PEM developed a 38-item Internet-based questionnaire that was distributed to PEM program directors via e-mail though www.surveymonkey.com. Seventy-seven percent (51/66) of PEM program directors in the United States and Canada responded to the survey. Sixty-three percent of programs incorporate HFS in PEM fellowship training. For programs with HFS, the most frequent uses of HFS include (1) decision making for trauma resuscitations (97%, 31/32) and medical emergencies (91%, 29/32), and for the application of advanced life support (84%, 27/32); (2) technical skills: intubation (100%, 31/31), bag-mask ventilation (94%, 29/31), cardioversion/defibrillation (90%, 28/31), and difficult airway management (84%, 26/31). Of program directors without simulation, a majority valued simulation for PEM fellow training, and 59% (11/19) plan on expanding efforts. Perceived barriers to an active simulation program exist: lack of financial support (79%, 15/19), lack of simulator equipment (74%, 14/19), lack of a dedicated physical space (68%, 13/19), and insufficiently experienced simulation faculty (58% 11/19). Sixty-three percent of PEM fellowship programs integrate HFS-based activities. The majority of PEM fellowship program directors value the role of HFS in augmenting clinical experience and documenting procedural skills. Regional simulation centers are one possible solution to offer HFS training to fellowships with limited financial support and/or lack of experienced simulation faculty.

Use of Emergency Ultrasound in United States Pediatric Emergency Medicine Fellowship Programs in 2011

The purpose of this study was to evaluate the use of and training in emergency ultrasound (US) in pediatric emergency departments (EDs) with pediatric emergency medicine (EM) fellowship programs. We hypothesized that emergency US use and pediatric EM fellow training have become widespread and that more structured training is being offered. A survey instrument was sent via e-mail to all 69 United States pediatric EM fellowship directors or associate directors in the spring of 2011. We used descriptive summary statistics and χ(2) tests to determine characteristics associated with having a formal emergency US training program for pediatric EM fellows. The survey response rate was 87% (60 of 69). Among responding programs, 40 (67%) resided within a children's hospital (versus general ED). Fifty-one (85%) were designated level 1 pediatric trauma centers. Fifty-seven programs (95%) endorsed the use of emergency US in their EDs. Fifty-three (88%) provided at least some emergency US training to fellows, and 42 (70%) offered a structured emergency US rotation. Training has existed for a median of 3 years (interquartile range, 2-4 years). Twenty-eight programs (67%) with emergency US rotations provided fellow training in the both a general ED as well as a pediatric ED. There were no hospital or program level factors statistically associated with having a formal training program for pediatric EM fellows. As of 2011, nearly all pediatric EDs with pediatric EM fellowship programs use emergency US. Pediatric EM fellowship programs provide emergency US training to their fellows, with a structured rotation being offered by most of these programs.

Bedside Ultrasound Education in Pediatric Emergency Medicine Fellowship Programs in the United States

As the use of bedside ultrasound becomes more prevalent in pediatric emergency departments, the need for a national curriculum for fellows' training in pediatric emergency medicine (PEM) has increased. The objectives of this study were to describe the current state of bedside ultrasound education among existing PEM fellowship programs and to explore the interest in a national curriculum. A 20-question survey was sent to all 57 PEM fellowship directors in the United States in February 2011. Weekly reminders were sent for 4 weeks. The response rate was 58% (33/57). Although 91% of respondents reported having an ultrasound machine available, only 16% reported an ultrasound curriculum designed specifically for PEM. Another 25% reported no curriculum, and 28% use a curriculum designed for general emergency medicine physicians. Most (>83%) directors thought an ultrasound curriculum for PEM fellows should include the focused assessment with sonography for trauma, bladder size assessment, soft tissue foreign body localization, skin and soft tissue infection evaluation, guidance for central and peripheral line insertion, and arthrocentesis. Some directors (40%-68%) thought that cardiac ultrasound, thoracic ultrasound, abdominal ultrasound, lumbar puncture guidance, fracture reduction, nerve blocks, and testicular ultrasounds should also be included. Forty-two percent plan to create a bedside ultrasound curriculum in the next 5 years, and 40% reported the lack of a national curriculum as a barrier to creating a curriculum. Bedside ultrasound use in pediatric emergency departments is very common, and PEM fellowship directors would welcome the development of a standard curriculum.

Pediatric Emergency Medicine Fellowship Programs

Pediatric Emergency Medicine Fellowship Programs

Attrition Rates of Pediatric Emergency Medicine Fellowship Graduates

ObjectivesTo identify the percentage of alumni of one Pediatric Emergency Medicine (PEM) fellowship program who consider themselves to still practice in the field.MethodsA brief survey (5 questions) was sent to...

Utilization of Emergency Ultrasound in Pediatric Emergency Departments

This study aimed to determine the utilization of emergency ultrasound (EUS) in pediatric emergency departments (EDs) and in pediatric emergency medicine (PEM) fellowship training programs and to assess if PEM fellowship programs provided formal training in EUS. A Web-based survey was administered to pediatric emergency medical directors, fellowship directors, and graduating fellows. A response was received from 60% of individuals and 68% of institutions. Of the responders, 27% reported that their institution had a EUS program. Also, 96% of the responders reported having a dedicated US machine in the ED, but only 61% reported using EUS for managing ED patients. Responders reported using EUS for the focused assessment by sonography for trauma examination (93%), abscess management (82%), vascular access (78%), bladder scanning (70%), cardiac activity confirmation (59%), and pericardial effusion detection (59%). For pediatric emergency staff physicians, 63% of the responders reported obtaining EUS training from general emergency physicians and 59% from a commercial ultrasound course and from pediatric emergency physicians. For PEM fellows, 34% reported having a standardized EUS training program. Of the responders, 69% reported receiving training from general emergency physicians during adult ED rotations and 38% reported receiving training from pediatric emergency physicians. Only 28% of programs reported using criteria established by the American College of Emergency Physicians for the number of scans performed to attain competence. In our study sample, there is wide variation in the uses of EUS and the training pediatric emergency physicians receive in its use.

Pediatric Emergency Medicine Fellowship Programs

Pediatric Emergency Care: May 2011 - Volume 27 - Issue 5 - p 455-467 doi: 10.1097/PEC.0b013e31821b74d0

Rubric Evaluation of Pediatric Emergency Medicine Fellows

To develop and validate a rubric assessment instrument for use by pediatric emergency medicine (PEM) faculty to evaluate PEM fellows and for fellows to use to self-assess. This is a prospective study at a PEM fellowship program. The assessment instrument was developed through a multistep process: (1) development of rubric format items, scaled on the modified Dreyfus model proficiency levels, corresponding to the 6 Accreditation Council for Graduate Medical Education core competencies; (2) determination of content and construct validity of the items through structured input and item refinement by subject matter experts and focus group review; (3) collection of data using a 61-item form; (4) evaluation of psychometrics; (5) selection of items for use in the final instrument. A total of 261 evaluations were collected from 2006 to 2007; exploratory factor analysis yielded 5 factors with Eigenvalues >1.0; each contained ≥4 items, with factor loadings >0.4 corresponding with the following competencies: (1) medical knowledge and practice-based learning and improvement, (2) patient care and systems-based practice, (3) interpersonal skills, (4) communication skills, and (5) professionalism. Cronbach α for the final 53-item instrument was 0.989. There was also significant responsiveness of the tool to the year of training. A substantively and statistically validated rubric evaluation of PEM fellows is a reliable tool for formative and summative evaluation.

A Simulation-Based Acute Care Curriculum for Pediatric Emergency Medicine Fellowship Training Programs

Currently, many pediatric hospitals are using simulation technology to teach trainees the skills required to effectively succeed in managing critically ill patients. Unfortunately, no curricula integrating the use of simulation have been described for pediatric emergency medicine (PEM) fellowship programs. Our objective was to outline our experience with the development, integration, and evaluation of a simulation-based, acute care curriculum into our current PEM fellowship training program. Using the American Board of Pediatrics and the Royal College of Physicians and Surgeons of Canada learning objectives for PEM as a guide, 12 modules composed of 43 scenarios were developed to address the skill sets required for PEM fellows. Six modules were identified as "core," allocated for completion in year 1 of fellowship, whereas the remaining modules were "subspecialty," designed for completion in year 2 of training. A 12-question survey (5-point Likert scale) was used to evaluate trainee satisfaction with regard to 4 domains: level of realism, utility of debriefing, quality of instruction, and overall satisfaction. A total of 66 surveys were collected between March and July 2007. Twenty-five surveys were completed by PEM fellows. Trainees responded favorably for all 4 domains, reporting that the new simulation curriculum provided realistic scenarios with high-quality debriefing, instruction, and an overall excellent learning experience. We have successfully integrated a simulation-based acute care curriculum into our PEM fellowship program. Satisfaction ratings were high for this program. Research to assess educational outcomes related to this curriculum is necessary.

Pediatric Emergency Medicine Fellowship Program

Pediatric Emergency Care: April 2010 - Volume 26 - Issue 4 - p 323-331 doi: 10.1097/01.pec.0000370974.17054.66

Markers of Overcrowding in a Pediatric Emergency Department

The objective of this study was to identify markers of overcrowding in pediatric emergency departments (PEDs) according to expert opinion and then to use statistical methods to further explore the underlying construct of overcrowding. A cross-sectional survey of all PED directors (n = 12) and pediatric emergency medicine fellowship program directors (n = 10) across Canada was conducted to elicit expert opinion on relevant markers of emergency department (ED) crowding. The list of markers was reduced to those specific to the ED for which data could be extracted from one tertiary care PED from an existing computerized patient tracking system. Data representing 2,190 consecutive shifts and 138,361 patient visits were collected between April 2005 and March 2007. Common factor analysis (CFA) was used to determine the underlying factors that best represented overcrowding as determined by markers identified by experts in pediatric emergency medicine The main markers of overcrowding identified by the survey included measures of patient volume (25%), ED operational processes (55%), and delays in transferring patients to inpatient beds (13%). Data collected on 41 markers were retained for the CFA. The results of the CFA indicated that the largest portion of variation in the data (48%) was accounted for by markers describing patient volumes and flow through the ED. Measures of admission delays accounted for a smaller proportion of variability (9%). The results suggest that for this tertiary PED, markers of ED operational processes and patient volume may be more relevant for determination of overcrowding than markers reflecting delays in transferring patients to inpatient beds. This study provides a foundation for further research on markers of overcrowding specific to the pediatric setting.

Final Evaluation of the 2005 to 2007 National Pediatric Emergency Medicine Fellows' Conferences

Evaluate the effectiveness of the 2005 to 2007 National Pediatric Emergency Medicine (PEM) Fellows Conference series in achieving predefined objectives in the domains of scholarship, leadership, and partnership. Conference attendees included fellows in the existing PEM fellowship programs. Self-administered preconference and postconference questionnaires measured knowledge, research-related confidence, beliefs about institutional support for Emergency Medical Services for Children (EMSC) research, and intentions to engage in 7 specific behaviors relating to scholarship, leadership, and partnership. Pearson product-moment correlations measured relationships among continuous variables. Repeated-measures analysis of variance measured change between preconference and postconference measures. Hierarchical multiple linear regression models identified predictors of postconference intentions to engage in each of the 7 specific behaviors, controlling for preconference intention. Approximately one third of all PEM fellows attended the conference each year. Preconference and postconference questionnaires were completed by at least 70% of attendees each year. Because several fellows attended more than one conference, data were analyzed from the first conference that a fellow attended. In each year, we observed significant increases in attendees' conference-specific knowledge, confidence, and intentions to continue in EMSC research, join national collaborative research networks, and establish national mentoring relationships. The National PEM Fellows' Conference is an effective means to increasing fellows' knowledge about scholarship, leadership, and partnership in EMSC and increasing their confidence and intentions to conduct research in EMSC.