Pediatric Emergency Medicine Training Research Articles

Just-in-time procedural training for pediatric emergency medicine trainees: A randomized educational interventional trial.

Pediatric requirements include procedural skills training such as peripheral intravenous (PIV) catheter placement and bag-mask ventilation (BMV). Clinical experiences may be limited and temporally remote from scheduled teaching. Just-in-time (JIT) training prior to utilization can promote skill development and mitigate learning decay. Our objective was to assess the impact of JIT training on pediatric residents' procedural performance, knowledge, and confidence with PIV placement and BMV. Residents received standardized baseline training in both PIV placement and BMV during scheduled educational programming. Between 3 and 6 months later, participants were randomized and received JIT training for either PIV placement or BMV. JIT training included a brief video and coached practice, totaling <5 min. Each participant was videotaped performing both procedures on skills trainers. Blinded investigators scored performance using skills checklists. Pre- and postintervention knowledge was assessed using multiple-choice and short-answer items, and confidence was reported using Likert scores. Seventy-two residents completed baseline training sessions: 36 were randomized to receive JIT training for PIV and 36 for BMV. Thirty-five residents in each cohort completed the curriculum. There were no significant differences between the cohorts with regard to demographics, baseline knowledge, or prior simulation experience. JIT training was associated with improved procedural performance for PIV (median 87% vs. 70%, p < 0.001) and for BMV (mean 83% vs. 57%, p < 0.001). Results remained significant after using regression models to adjust for differences in prior clinical experience. Improvements in knowledge or confidence were not associated with JIT training in either cohort. JIT training resulted in a significant improvement in resident procedural performance with PIV placement and BMV in a simulated environment. There were no differences in outcome with regard to knowledge or confidence. Future work might explore how the demonstrated benefit translates into the clinical setting.

PEM Pandemic Pivot: A Hybrid Approach to Pediatric Emergency Medicine Training in Thailand Allows for COVID-era Flexibility.

Introduction:The COVID-19 pandemic poses challenges in maintaining global medical education partnerships, with travel restrictions and infection control concerns forcing program adaptation. The Pediatric Emergency Medicine Specialty Training and Accelerated Review (PEM-STAR) program is one such international collaboration which addresses education and training gaps in emergency care for children within Thailand. As an assessment of PEM-STAR’s ability to deliver consistent outcomes despite COVID-19 constraints, we compared program results for Cohort #1 (2018-2019, pre-pandemic) and Cohort #2 (2019-2021, spanning pandemic).Method:Oregon Health &amp; Science University and Bangkok Dusit Medical Services implemented the PEM-STAR tandem physician-nurse curriculum in 2018. The cornerstone of the year-long course is a set of 22 PEM-specific topic modules, incorporating remote-accessible voiceover slide lectures, quizzes, and scholarly references to teach pediatric emergency medicine essentials. Content is reviewed via monthly teleconferences. Baseline and final assessments include written knowledge tests and high-fidelity simulation cases led by physician-nurse teams. Cohort #1 simulations were performed with evaluators in-situ using critical action checklists and validated teamwork assessment tools. Due to COVID-19 restrictions, Cohort #2 final assessments were hybrid; students completed Thailand-based simulations while Oregon leaders assessed and debriefed teams via videoconference.Results:Written exam scores for pre-pandemic Cohort#1 improved from 48.6% (95%CI 40.30-56.9) to 92.0% (95%CI 88.1-95.9) (p&lt; 0.001). Cohort #2, during the pandemic, had scores improve similarly from 48.5% (95%CI 40.1-56.9) to 96.4% (95%CI 94.8-98.0) (p&lt; 0.001). One-hundred percent of physician-nurse teams from both Cohort #1 and Cohort #2 achieved the program’s established passing score on final simulation testing: performing &gt;85% of critical action items and scoring &gt; 85% on the teamwork tool.Conclusion:The PEM-STAR design, with its emphasis on videoconferencing, web-based content, and asynchronous learning, required minimal modifications to maintain satisfactory knowledge and skill acquisition during the pandemic. Educational partnerships emphasizing these features have distinct sustainability advantages in times of global disorder.

The paucity of pediatric emergency medicine fellowship training programs in Africa.

Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. The leading causes of mortality in pediatric populations in Africa include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries. These causes of childhood and adolescent mortality often lead to emergency room utilization due to critical presentation, placing emphasis on the importance of pediatric emergency services in Africa. Despite the criticality of pediatric emergency medicine (PEM) in the region, there is a paucity of PEM training programs in Africa. Ongoing interventions focused on addressing the poor access to PEM training and services include isolated efforts to provide PEM-specific training to nonemergency medicine (EM)-trained practitioners and expand current EM training to include PEM piloted in a single center in Kenya. Sustainable efforts require organized efforts with government and graduate medical education bodies. We discuss the existing infrastructure that can be utilized in promoting the establishment of PEM training programs and urge local governments' investment as well as other stakeholders, including graduate medical education, to address the issue of childhood mortality in Africa through the improved provision and access to PEM training.

The Current State of Pediatric Emergency Medicine Training in Emergency Medicine Residencies.

Several studies show that emergency medicine (EM) physicians are less comfortable caring for pediatric patients than adults. The state of pediatric training has not been comprehensively evaluated since 2000. We sought to describe current pediatric education in EM residencies and to evaluate EM Program Director (PD) confidence in graduating trainees' abilities to care for pediatric patients. We conducted an anonymous, cross-sectional survey study of EM PDs in August 2020. We collected program demographics, clinical rotations, and didactic methods. We used Likert scales to measure PD confidence in graduating residents' competence to care for pediatric and adult patients. We found e-mail addresses for 249 (93%) of 268 EM programs. One hundred nineteen (48%) PDs completed the survey. We include denominators to account for unanswered questions. Sixty-eight (59%) of 116 programs spend 10% to 20% of clinical time seeing pediatric patients. One hundred ten (91%) of 119 require a pediatric emergency medicine (PEM) rotation, 88/119 (83%) require pediatric intensive care, and 34/119 (29%) require neonatal intensive care. Seventy (62%) of 113 have curricula designed by PEM-trained faculty, 96/113 (85%) have PEM attendings teach lectures, and 77/113 (68%) spend 10% to 20% of didactic time on pediatric topics. Twenty-three (23%) of 106 PDs stated not all residents graduate with competence in pediatric resuscitation compared with 2/106 (2%) for adult resuscitation ( P < 0.05). Program directors report less confidence in graduating residents' competence in caring for pediatric patients compared with adult patients. We propose ideas to strengthen the quality of pediatric education in EM residencies.

Severe Epistaxis in the Pediatric Patient: A Simulation for Emergency Department Management.

Severe, uncontrolled epistaxis in a pediatric patient can lead to a compromised bloody airway and the potential need for significant volume resuscitation secondary to hemorrhagic shock if not managed emergently. In this report, a simulated 11-month-old patient with underlying liver disease presents to the emergency department setting. The goal was to familiarize advanced pediatric emergency medicine trainees and experienced providers with immediate bedside interventions and clinical management steps for a patient with severe, difficult-to-control epistaxis to increase preparedness for future clinical scenarios. Additionally, this case highlights resuscitation considerations for patients with liver disease, including sources of bleeding, consulting services, medications, and approach to massive transfusion in liver disease.

Pediatric emergency department organization and social care practices among U.S. fellowship programs.

Social care has become increasingly relevant to the emergency physician and includes activities that address health-related social risk and social needs. The literature has consistently documented substantial health care provider challenges in incorporating social care into routine practice. Yet, interventions on the health care organizational level hold promise to bring about more widespread, sustainable impact. This study was a subanalysis of the 2021 National Social Care Practices Survey data set among pediatric emergency medicine (PEM) program directors (PDs) and fellows. The purpose was to investigate the association between health care organizational factors and PEM physician social care practices and perceptions among PEM PDs and fellows. We performed binary and ordinal logistic regressions of organizational factors and five specific PEM physician social care perspective and practice outcomes. The sample population included 153 physicians-44 PDs (49% response rate) and 109 fellows (28%). PDs and fellows with access to a social care systematic workflow in their pediatric emergency department (PED) had higher odds of comfort assessing social risk (odds ratio [OR] 2.1%, 95% confidence interval [CI] 1.1-4.0), valuation of social care (OR 3.2, 95% CI 1.3-7.9), preparedness to assist families (OR 2.4, 95% CI 1.1-5.2), screening tendency (OR 2.2, 95% CI 1.1-4.5), and ability to refer to community resources (OR 2.3, 95% CI 1.2-4.6). A similarly directed, but less pronounced pattern was noted with access to a community resource database for referrals and 24-h access to a social worker in the PED. PED organizational factors-particularly access to a social care systematic workflow-appear positively associated with PEM physician practices and perceptions of social care delivery. Further research is under way to advance understanding of PEM training factors in social care.

Impact of a 1-Year Pediatric Emergency Medicine Training Program for International Medical Graduates.

The Hospital for Sick Children in Toronto has offered a 1-year subspecialty residency training program in pediatric emergency medicine (PEM) to Canadian and internationally trained pediatricians and emergency physicians since 1993. The program is intended to support clinical service delivery while simultaneously offering a unique educational opportunity to Canadian and international physicians who desire 1 year of clinically focused training. We describe the experiences and career outcomes of participants who completed this program. Two surveys were sent to the 68 individuals who completed the clinical fellowship program from its inception in 1993 until 2014. A blinded survey focused on the fellowship experience and subsequent career activities. A nonblinded survey subsequently determined whether participants had served as a medical director or training program director. Sixty of the 68 participants (88%) completed the blinded survey. Ninety-one percent were in practice in emergency medicine. Twenty-five percent of the participants were living in Canada, compared with 17% before completing the program. This net migration of 8% was not significant (P = 0.26). Thirty-six of the 50 participants (72%) who applied from outside Canada responded to the nonanonymous survey; 18 (50%) had served as an emergency department medical director, and 18 (50%) reported serving as a PEM training program director. Many participants attained leadership positions in PEM in countries outside of North America and/or participated in training program development. There was no significant change in the proportion of participants living in North America at the time of application compared with the time of survey completion.

Point-of-Care Ultrasound for Physicians in Practice - A Training Model for Specialty Specific and Clinically Relevant Skill Development.

Point-of-care Ultrasound (POCUS) skills are required competencies for emergency medicine and paediatric emergency medicine training [1,2,3,4]. Over time, more specialties will require these skills of their graduates. Experienced physicians who completed their training before POCUS requirements may ask: How can I gain POCUS skills training and competency? In this perspective piece we describe in-person and asynchronous training programs available to these clinicians in practice. We highlight these programs due to their person-centred design: they maximise the needs of the learner, provide personalised education, and expose them to respected and established POCUS faculty and training centers.

Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs.

The emergence of social emergency medicine-the incorporation of social context into the structure and practice of emergency care-has brought forth greater embracement of the social determinants of health by medical professionals, yet workforce practices and training have remained elusive. Academic literature particularly in the field of pediatric emergency medicine (PEM) fellowship training is lacking relative to general pediatrics and adult emergency medicine. The primary objective of this study was to assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows across a national cross-sectional sample. A secondary aim was to uncover key actionable areas for the development of social care curricula in PEM training programs. A social care practices assessment tool was developed via snowball sampling interviews among clinician researcher experts and disseminated to PEM PDs and fellows nationally in accredited academic PEM training institutions. A total of 153 participants-44 PDs (49% response rate) and 109 fellows (28%)-completed the assessment tool. Responses among PDs and fellows were highly concordant. Only 12% reported regular use of a standardized social needs screening tool. The majority felt unprepared to assist families with social needs and less than half felt comfortable talking to families about social need. At the same time, social care was highly valued by 73% of participants. All participants felt that providing social care training during PEM fellowship would be beneficial. PDs and fellows identified five priority areas for PEM curricular development. PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence-based approaches, best practices, and expert consensus.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice.

Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students’ knowledge or skills was sufficient as per Kirkpatrick’s model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, “decoupling” users from reality, as well as how to increase students’ motivation and engagement, should be addressed.

Development of a blended learning curriculum to improve POCUS education in a pediatric emergency medicine training program

We engaged in curriculum enhancement of POCUS training in our pediatric emergency medicine subspecialty training program using Kern's model of curricular development. We enhanced existing training to include focused asynchronous learning of image interpretation, longitudinal scanning shifts, and quarterly progress report score cards and check-ins for improved communication, transparency and reinforcement of goals. Our approach could inform other training programs looking to improve their POCUS curricula.

A national survey of pediatric emergency medicine physicians on improving education in child maltreatment recognition and reporting child abuse & neglect

BackgroundChild maltreatment is an important public health problem with serious consequences. Even in the face of increased research and enhanced public awareness over the last decade, the rate of child fatalities due to reported child maltreatment has increased. ObjectiveThis study describes pediatric emergency medicine (PEM) physicians' knowledge, training, confidence, and barriers in recognition and reporting suspected child maltreatment. Participants and settingA nationally representative sample of PEM physician members of Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) participated. MethodsA cross-sectional 36-item survey study of PEM physicians with content domains including provider knowledge, preparedness, confidence, and barriers to identifying and reporting child maltreatment was conducted and distributed. Results113 of 486 members completed the survey. Confidence with recognizing and reporting child abuse (95%) was greater than in child neglect (88%). Knowledge in child maltreatment recognition and reporting was significantly correlated with confidence in reporting and recognition (p < 0.001). There was a significant relationship between knowledge and confidence for respondents from states with training in child maltreatment recognition and reporting requirement as a condition of licensure and re-licensure compared to states without the requirement (p < 0.01). Qualitative responses revealed insightful themes to improve child maltreatment training, recognition and reporting. ConclusionOur national survey study demonstrates that PEM-trained physicians have high confidence and knowledge with the management of child maltreatment, and that inclusion of mandated child maltreatment training in residency/fellowship and mandated training for medical licensure in all states could improve child maltreatment recognition and reporting.

Development and implementation of a novel, mandatory competency-based medical education simulation program for pediatric emergency medicine faculty

BackgroundMaintaining acute care physician competence is critically important. Current maintenance of certification (MOC) programs has started to incorporate simulation-based education (SBE). However, competency expectations have not been defined. This article describes the development of a mandatory annual SBE, competency-based simulation program for technical and resuscitation skills for pediatric emergency medicine (PEM) physicians.MethodsThe competency-based medical education (CBME) program was introduced in 2016. Procedural skill requirements were based on a needs assessment derived from Royal College PEM training guidelines. Resuscitation scenarios were modified versions of pre-existing in-situ mock codes or critical incident cases. All full-time faculty were required to participate annually in both sessions. Delivery of educational content included a flipped classroom website, deliberate practice, and stop-pause debriefing. All stations required competency checklists and global rating scales.ResultsBetween 2016 and 2018, 40 physicians and 48 registered nurses attended these courses. Overall course evaluations in 2018 were 4.92/5 and 4.93/5. Barriers to implementation include the need for many simulation education experts, time commitment, and clinical scheduling during course events.ConclusionWe have developed a mandatory simulation-based, technical, and resuscitation CBME program for PEM faculty. This simulation-based CBME program could be adapted to other acute care disciplines. Further research is required to determine if these skills are enhanced both in a simulated and real environment and if there is an impact on patient outcomes.

A novel program to enhance pediatric emergency medicine training in Thailand.

In Thailand, there are few pediatric emergency medicine (PEM) fellowship-trained providers, and emergency departments (EDs) are staffed by pediatricians and emergency physicians. Our pediatric ED collaborated with Thailand's largest private hospital system to develop a training program designed to improve emergency care for children. The objective was to develop, implement, and assess the efficacy of a curriculum to improve PEM care by emergency providers in a Thai health system. We conducted a prospective study from January 2018 to July 2019. After an initial needs assessment, we developed a curriculum with 22 modules, divided into basic and advanced courses. Each course began with baseline testing, consisting of written tests and several simulated cases led by physician-nurse teams. Each course was administered longitudinally through electronic modules over 6months, with in-person shadowing and skills workshops at the course midpoint, culminating in final summative examinations and repeat simulation testing. On written examination scores for the basic course, physicians (n=5) improved by 37.6% (95% confidence interval [CI]= 29.8% to 45.4%, p<0.001), while nurses (n=5) improved by 55.7% (95% CI= 45.8% to 65.6%, p<0.001). For simulation testing among physician-nurse dyads, performance improved by 19.5% (95% CI= 3.9% to 35.1%, p=0.004) for critical action items and by 3.0 points (95% CI= 2.3 to 3.7, p<0.001) on a 16-point teamwork scale. For the advanced course, physicians improved on the written examination by 36.9% (95% CI= 29.2% to 44.7%, p<0.001) and nurses by 50.6 (95% CI= 47.3% to 54.0%, p<0.001). For simulation testing, performance improved from 22.2% (95% CI= 8.2% to 35.6%, p<0.001) for critical actions and 1.3 points (95% CI= 0.2 to 2.2, p=0.005) on teamwork measures. We designed an interdisciplinary curriculum and successfully trained Thai physicians and nurses to improve PEM knowledge and teamwork.

Pediatric Emergency Medicine Training: A Survey of Current Status in Latin America.

An electronic, multicenter survey was created and stored on Google forms. The survey was in Spanish language and included 30 questions about the characteristics of the pediatric emergency program, history of the program, and support expected from the Latin American Pediatric Emergency Society. A total of 11 PEM programs in 6 countries were acknowledged in Latin America. All programs are placed in pediatric tertiary care hospitals. All PEM programs were approved by the local universities and the Ministries of Health in each country. Difficulties to start a PEM program included a lack of physicians properly trained in PEM who could direct the program, physician instructors in specific topics, places to complete rotations of the future fellows, and getting the local health authorities to acknowledge the importance of the program. With regard to the duration of the program, 72.7% (8) have a 2-year curriculum and 27.3% (3) have a 1-year curriculum. Four (36.4%) program directors mentioned an admission examination as a requirement, 4 (36.4%) needed an examination plus an interview, 3 (27.3%) mentioned that it is necessary just like an interview, and 2 (18.2%) mentioned that the physicians are admitted with a scholarship. With regard to the structure of the programs and rotations included, most of the programs have rotations that are compulsory in different pediatric subspecialties. In 80% of the programs, fellows are evaluated based on different technical skill procedures that they need to learn and perform during PEM fellowship training. The PEM fellowship is recognized by different societies in emergency medicine and pediatrics, except in Dominican Republic where it is only recognized by the Ministry of Health and the university. After completion of the program in 90% (10) of the programs, graduates are not guaranteed a job, and in half, there is no mechanism implemented for recertification of the pediatric emergency physicians by the local medical council. In Latin America, postgraduate programs in pediatric emergencies are a response to a need for health systems. Being an innovative specialty, it surpassed each country's own challenges, until it was able to reach an internationally standardized level, with a great diversity of pedagogical methodology, which the product has been to offer a high quality of emergency care to children.

Milestone achievements in a national sample of pediatric emergency medicine fellows: impact of primary residency training.

Pediatric emergency medicine (PEM) fellowships recruit trainees from both pediatric and emergency medicine (EM) residencies. The Accreditation Council for Graduate Medical Education (ACGME) defines separate training pathways for each. The 2015 PEM milestones reflect a combination of subcompetencies from the two residencies. This project aims to compare the milestone achievement of PEM fellows based on their primary residency training. We hypothesize that fellows trained in pediatrics achieve PEM milestones at different rates than EM-trained fellows in the ACGME domains of patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal and communication skills. This is a multicenter, retrospective cohort study of fellows from a national sample of U.S. PEM fellowship programs. Basic demographic information and deidentified, biannual milestone scores for 23 competencies were collected for fellows training between 2015 and 2018. Subcompetencies are scored on a 5-point milestone scale. Descriptive and multivariable analyses for longitudinal data were performed to compare milestone assessments by primary residency training. Complete data were obtained for 600 fellows; 95% (570) and 5% (30) completed pediatric and EM residency, respectively. In both year 1 and year 2 of fellowship, the mean milestone scores of EM-trained fellows were statistically higher than pediatrics-trained fellows across the majority of subcompetencies. By the final year of training, there were no statistically significant differences in milestone scores for any of the subcompetencies. Fellow milestone achievement between groups was not significantly different by graduation. However, fellows entering PEM training from an EM background attained higher scores on the milestones than fellows from a pediatric background in the first year of fellowship.

A Telesimulation Elective to Provide Medical Students With Pediatric Patient Care Experiences During the COVID Pandemic.

Objectives/IntroductionThe Association of American Medical Colleges suggested that medical students not be involved in direct patient care activities in the United States because of the COVID pandemic. Our objectives are to (1) describe the rapid creation and implementation of a fully online simulation-based pediatric emergency medicine training intervention for medical student learners using existing simulation center staff (faculty, technicians, actors) and resources (simulation technology, scenario files) and (2) report student and faculty feedback on the intervention.MethodsThe sessions involved the use of our existing simulation center faculty, staff, and resources. Feedbacks on the sessions were collected via a survey from faculty and students at the end of each session.ResultsSixteen simulation sessions were conducted (8 febrile infant, 8 anaphylactic toddler). Forty-eight students, 2 technicians, 2 actors, and 10 faculty participated. Ninety percent of the students agreed with the statements, “I am more comfortable with pediatrics after this session,” “participating improved my pediatric knowledge/skills,” “this session was more useful than other learning activities I am involved in at this time.” Seventy percent of the students agreed with the statement, “I learned as much from observing as when I was actively involved.” All faculty agreed with the statement, “this was an effective educational strategy compared to other distance learning.” Most faculty (60%) disagreed with the statement, “virtual simulation was equal to or superior to in-person simulation.” All students and faculty strongly agreed with the statement, “I would highly recommend this to others.”ConclusionsA telesimulation intervention involving all medical students, staff, and facilitators interacting remotely for pediatric emergency training during COVID was associated with high levels of satisfaction by the majority of learners and faculty.

Comparative mortality for children at one hospital in Kenya staffed with pediatric emergency medicine specialists.

ObjectivesThree decades ago, in North America, pediatric emergency medicine was an evolving subspecialty of pediatrics, contributing in valuable and life-saving ways to the care of children. Currently, in LMICs (low middle-income countries) pediatric programs are expanding training and education in the subspecialty of pediatric emergency medicine. We aim to determine if care provided by a single institution with dedicated pediatric emergency resources and personnel in Kenya can change mortality rates in children with similar mRISC scores suffering from respiratory illness, as compared to previously published data from the same region of Eastern Africa. As mRISC is used at the time of a child's admission to the hospital to describe the severity of their respiratory illness, we will compare mortality rates by mRISC score to compare groups of patients with similar severities of illness between hospitals.MethodsA retrospective chart review was performed using written medical records of pediatric patients 30 days to 5 years of age admitted to AIC Kijabe Hospital, Kenya from 2014 to 2018 for respiratory illness. Of 2692 possible admissions identified in the hospital's pediatric database, 377 admissions were included. 34 data points were recorded for each patient admission including demographic information, information involved in calculating the mRISC score, and additional respiratory information. The primary outcomes were mRISC score and mortality.Results20 (5%) of included patients represented in-hospital mortalities. Across all mRISC scores, our mortality remained much lower than previously reported in the literature in Kenya.ConclusionsOur study does support a positive correlation between pediatric emergency medicine training and skills and decreased childhood mortality; however, correlation does not prove causation. How this decrease in mortality was accomplished was likely a combination of many smaller efforts at quality improvement that add up and make a difference as pediatricians are known to be child advocates.

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.

Pediatric Emergency Medicine Training in Procedural Sedation: Is It Time for a Standardized Curriculum?

Pediatric procedural sedation (PS) has been performed with increasing frequency by pediatric emergency physicians for recent years. Accreditation Council for Graduate Medical Education Pediatric Emergency Medicine fellowship core competency requirements do not specify the manner in which fellows should become proficient in pediatric PS. We surveyed the variety of training experience provided during fellowship and whether those surveyed felt that their training was sufficient. A 35-question survey offered to pediatric emergency fellows and recent (within 10 years) graduates collected data on pediatric PS training during fellowship. A follow-up questionnaire was sent to fellowship directors at programs where fellow or graduate respondents stated that a sedation curriculum that existed asked details of their program. There were 95 respondents to the survey, 62% of which had completed pediatric emergency medicine fellowship training. Of respondents, 65% reported having a formal sedation curriculum during fellowship. Of those who participated in a formal curriculum, 82% of respondents felt comfortable performing sedation, whereas the remaining 18% required additional preceptorship and/or more formal training to feel proficient. Fifty-six percent of respondents reported having to complete a set number of sedations before being allowed to sedate independently. Of 17 programs contacted, 9 fellowship directors responded. All 9 included didactics, 6 (66.6%) of 9 included evidence-based medicine literature review, and 6 (66.6%) of 9 included simulation. Other modalities used included supervised clinical experience in a pediatric sedation unit, a 2-week rotation with a hospital sedation team, online sedation modules, and precepted sedations using each pharmacologic agent including nitrous oxide, ketamine, propofol, and ketamine-propofol combination. Ketamine was the most frequently used agent for sedation (87%). Pediatric emergency medicine fellowship requirements lack a clearly defined pathway for training in PS. Data collected from both current and former fellows depict inconsistency in training experience and suboptimal comfort level in performing these procedures. We suggest that fellows receive a more comprehensive and varied experience with multiple teaching modalities to improve proficiency with this critical and complex aspect of emergency pediatric care.