Pediatric Residents Research Articles

Impact of High-Fidelity Simulation on the Confidence Level of Pediatric Residents to Manage Pediatric Emergencies

Background: Children having seriously ill health conditions pose new challenges to healthcare professionals in pediatric emergencies. The training based on simulation is a promising procedure for equipping junior professionals with the required potential. Objectives: Studying the impact of High-Fidelity Simulation (HFS) on the confidence levels of pediatric residents for taking care of patients having complications that are critical and also considering emergency procedures. Methodology: A quasi-experimental design utilized having surveys done before and after training to evaluate confidence levels. The research was executed in October 2023. The evaluation model of Kirkpatrick was supposed to evaluate the training program impact. After that, data was collected and entered into MS Excel and then analyzed on SPSS. Results: The research executed two sorts of surveys, including a pre-course survey and a post-course survey. Out of 40 residents, only 30 gave responses with a 75% rate. Descriptive analysis revealed varying levels of confidence across different domains of pediatric care. However, statistical analysis revealed no significant changes in confidence levels post-training in certain areas. These findings suggest that while the training program may have positively influenced confidence in some domains, further investigation is needed to determine its comprehensive impact on the confidence of residents. Conclusion: Our study emphasizes the effectiveness of HFS in enhancing the confidence of pediatric residents in managing critically ill patients and emergency procedures. While statistical significance was not achieved across all domains, the overall trend indicates a positive impact on residents' perceptions of their abilities in pediatric emergency care. Research in the future should revolve around more strategies augmenting the confidence of the residents in the care of pediatric emergencies.

Longitudinal email-based electrocardiogram interpretation curriculum for paediatric residents.

Electrocardiograms are frequently obtained in infants and children. Training specific to paediatric electrocardiogram interpretation is necessary given that cardiac physiology and electrocardiogram findings in children are different than adults and change throughout infancy and childhood. Distributed practice may be an effective method to improve paediatric residency electrocardiogram education efforts. A pre-survey was administered to paediatric and internal medicine/paediatrics residents to ascertain baseline comfort with electrocardiogram interpretation. Subsequently, residents were emailed a clinical vignette with an associated electrocardiogram and multiple-choice question 1-2 times monthly. After submitting their answer, residents were taken to a webpage explaining key concepts explored in the clinical vignette. After 6 and 12 months, a survey was administered asking residents to again rate their confidence in the same electrocardiogram interpretation skills. The longitudinal email-based curriculum increased exposure to electrocardiogram training. Six months of participation in the curriculum correlated with significant increases in confidence in electrocardiogram interpretation skills. While there was no further increase in confidence seen at 12 months, the improvement seen at 6 months was durable. Participation in the curriculum most significantly correlated with changes in confidence in ability to utilise a stepwise approach for electrocardiogram interpretation. The curriculum resulted in durable improvement in confidence in electrocardiogram interpretation skills for paediatric residents at our centre, suggesting that email-based distributive practice can be an effective method for skill and knowledge improvement for complex educational topics.

Implementing a resident-led transition-specific bootcamp curriculum during pediatric residency training: Our 3-year experience

ABSTRACT Objectives Postgraduate programs that use ‘bootcamps’ to help trainees transition into new clinical roles usually solely target entry to residency, failing to address other critical transition periods. We developed, implemented, and evaluated a resident-led transition-specific bootcamp curriculum in our Pediatrics program and described our first 3 years of experience. Methods Our bootcamp curriculum was developed around Kern’s framework. A needs assessment identified key transition periods (Incoming Resident [IR]; Night Float [NF]; Ward Senior [WS]). Teaching content and methods were informed by Residents-As-Teacher principles. Program evaluation included surveys exploring trainees’ satisfaction, and perceived knowledge and self-efficacy before and after bootcamp participation. For the IR bootcamp, knowledge and behaviour were objectively assessed through written examinations and Observed Structured Clinical Examinations (OSCEs). Results Twenty-seven pediatric residents participated in the IR bootcamp, 26 in the NF bootcamp, and 25 in the WS bootcamp. Trainees’ baseline self-reported knowledge and confidence around clinical skills taught showed an improving trend post-bootcamp in all transition periods. Strengths identified included the level-appropriate teaching content and residents’ engagement as teachers. Conclusions Bootcamps can help residents adapt to new roles and should target all key transitions within the training continuum. Capitalizing on resident leadership for bootcamp curriculum development and implementation is instrumental to its success.

Evaluation of Knowledge, Attitudes, and Practices About HPV Vaccine: A Survey Study of Pediatric and Obstetrics and Gynecology Residents in İzmir, Türkiye

Purpose: The main objective of this study was to evaluate the knowledge, attitudes, and practices of obstetrics and gynecology (OB/GYN) and pediatric residents in Izmir, Turkey, regarding the HPV vaccination. Materials and Methods: This cross-sectional survey study was conducted in five hospitals in Izmir, Turkey, between May and July 2019. The data for this study were obtained from 299 pediatric and 126 OB/GYN residents via an online web-based questionnaire. The statistical analyses were performed using SPSS®. Results: The overall participation rate was 72%. Only 25.2% of the participating residents demonstrated adequate knowledge about the HPV vaccine. The OB/GYN residents had significantly higher knowledge scores than the pediatric residents (median [IQR] = 9.4 [8.4-10.6] vs. 8.4 [7.4-9.8], p=0.007). The vaccination rate among residents was low, with female residents having higher rates of vaccination than male residents (13.6% vs. 1.1%, p

Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study.

Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee's experiences using existing tools. This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020-2022) were compared with class and graduated resident (classes of 2016-2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education.

Gauging Medical Students' Interests in Infectious Diseases.

Infectious diseases is a crucial specialty in medicine, yet applications for fellowship have declined even as the United States faces an imminent shortage of infectious disease physicians. Career interests often develop in medical school, but little is known about which interests and experiences are associated with interest in ID. Evaluate interest in ID among medical students and identify factors associated with interest and disinterest in ID careers. We developed a 26-question survey to gauge interest in infectious diseases (ID). All 16 medical schools in Texas were contacted and invited to participate. A total of 262 students across 9 medical school campuses completed the survey. Those interested in ID as a career had a significantly higher interest in public health (p<0.0001) and global (p<0.0003) health. The presence of an ID campus interest group (p<0.0015) and direct experience with the ID profession (p<0.0001) were also associated with interest. The most common reasons for lack of interest were lack of interest in pursuing internal medicine or pediatric residency, lack of compensation, and lack of procedures. Those interested in ID expressed interest in a wide variety of career pathways within ID, the most common being general inpatient and outpatient ID, as well as medical microbiology and global health/tropical medicine/travel medicine. Based on this survey, recruitment efforts for new ID fellows might include focusing on students with interests in public and global health, as well as increasing direct exposure to ID at the medical school level.

Intraprofessional boundary crossing in acute paediatric care: A rich journey for general practice and paediatric residents.

Achieving optimal collaboration between general practitioners and hospital-based critical care doctors is vital yet challenging, necessitating targeted collaborative training during residency. Despite apparent benefits, implementing intraprofessional learning faces constraints. Understanding its occurrence is crucial for engaging and educating residents. Considering boundaries' learning potential, we developed and evaluated an educational programme for general practitioner (GP) and paediatric (P) residents in paediatric emergency care based on Akkerman's Boundary Crossing Theory. The study investigated how intraprofessional learning mechanisms occurred and what learning conditions facilitated or impeded learning of GP and P residents, aiming to optimise educational programme design for intraprofessional collaboration. We developed an educational programme with three activities: joint medical assessments of paediatric patients in each other's context, mutually mini-Clinical Evaluation Exercises (mini-CEXs) about intraprofessional collaboration skills and educational meetings about collaborative care. We performed a qualitative study with a constructivist approach to explore experiences of the programme. We conducted focus group interviews and analysed mini-CEXs, utilising Boundary Crossing theory for template analysis. Ten GP and eight P residents participated in our study. Learning mechanisms of identification and coordination dominated the joint medical assessments. Mini-CEXs stimulated reflection. Educational meetings with supervisors about intraprofessional barriers initiated transformation. Facilitated learning conditions were bidirectional crossing, enthusiastic supervisors, residents being familiar with each other, clear mini-CEX design and authentic paediatric cases. Unclear mutual expectations during joint medical assessments impeded learning of residents. Working in each other's context triggers learning mechanisms of identification, coordination and reflection, forming the basis for intraprofessional learning in paediatric emergency care for GP and P residents. For development of new collaboration practices, supervisors are necessary to translate reflection into transformation. Mutual responsibilities and expectations should be made more explicit to create a safer intraprofessional learning environment. Our findings extend to other medical training contexts, leveraging boundaries for learning.

Is “No News is Good News” Enough? A Thematic Analysis Exploring Clinical Reasoning Assessment in Pediatric Residency Programs

ObjectiveClinical reasoning (CR) includes numerous essential skills for clinicians, but how these skills are assessed in pediatric residency training is not well described. This study aimed to explore pediatric residency program leader perspectives on clinical reasoning assessment and identification of trainee deficiencies in this area. MethodsTaking a social constructionist worldview, we conducted a thematic analysis of 20 semi-structured interviews with pediatric residency program leaders. Interviews explored how pediatric residency programs assess CR and how deficiencies are identified. Recruitment and analysis continued iteratively until thematic sufficiency was reached. Member checking enhanced trustworthiness of the results. ResultsParticipants noted a perceived lack of a shared mental model for CR assessment between program leaders and clinical supervisors. Four themes were generated to highlight CR assessment in pediatric residency programs: 1) Clinical supervisors escalate concerns about behaviors representing symptoms of CR deficits rather than diagnosing CR competency deficiencies and that CR assessment requires: 2) an outward display of autonomous decision-making, 3) psychologically safe environments for inquiry, and 4) longitudinal, individualized observation. Elements of pediatric residency programs that impede CR assessment were identified, including family-centered rounds and team-based clinical care. ConclusionsThis study identified key components necessary for CR assessment and barriers that may lead to missed identification of deficiencies. While no single solution can create an ideal environment for CR assessment, this study identifies elements for enhancing assessment opportunities for early identification of deficiencies.

Pediatric Palliative Care Simulation Improves Resident Learning Outcomes: an 11-Year Review

Context: Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation. Co-facilitation of the simulated difficult conversation by a bereaved parent or family member enhances the learning experience. Objectives: To report 11-years’ experience simulating difficult conversations with bereaved parent-actors. Methods: PPC physicians developed two simulations to teach difficult conversations to clinical learners at a midwestern quaternary pediatric medical center. Bereaved parents and hospital chaplains co-facilitated the simulation. The first portrayed the death of an infant following emergency resuscitation, and the second, a goals-of-care conversation with the parent of a child with a degenerative condition. A de-novo evaluation rubric was prepared using the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies to evaluate the participant's performance in the simulation. Results: For the first simulated scenario (N=194 residents; N=16 fellows), residents improved significantly on 16/21 ACGME-based criteria between encounters; for the second (N=118 residents; N=14 fellows), residents improved significantly on 10/21 criteria. Fellows’ performance did not improve significantly in either scenario, but they presented with high baseline scores. Conclusions: Simulations with bereaved parent actors improved general pediatrics residents’ performance and comfort during difficult conversations and are transportable to diverse settings.

The impact of reduced pediatric emergency care hours on the patterns of emergency department utilization

Purpose: The declining recruitment rate of pediatric residents in Korea has led to a decrease in the number of emergency departments (EDs) offering a 24/7 pediatric emergency care (PEC). This study evaluated the impact of reduced PEC hours on the utilization patterns of a single ED.Methods: We reviewed medical records of pediatric patients who were defined as individuals aged 14 years or younger undergoing pediatricians’ practices in a tertiary hospital ED in Korea. Given the reduction of PEC hours from full-time to 08:00-24:00 on September 27, 2022, the patients were grouped as those who visited during March 27, 2022-September 26, 2022 (“control”), and those who visited during September 27, 2022-March 26, 2023 (“reduction”). The following variables were analyzed between the 2 periods: the number of patients, age, sex, visits via ambulances, severity by the Korean Triage and Acuity Scale with high acuity (a level 1-2 of the scale), disease-related visits, time of visit, ED length of stay (EDLOS), disposition, chief complaints, and diagnoses.Results: Among 3,577 pediatric patients, 1,315 visited the ED during the reduction period, down by 41.9% in numbers from the control period. From the control to reduction periods, we observed an increase in the median age (from 3.0 years [interquartile range, 1.0-7.0] to 4.0 years [1.0-8.0]; P = 0.005) and decreases in the median EDLOS (from 140.0 minutes [80.0-217.0] to 104.0 minutes [54.0-169.8]; P &lt; 0.001) and proportion of hospitalization (from 22.1% to 12.6%; P &lt; 0.001). No change was observed in the proportions of highacuity cases or chief complaints. We noted decreases in infection-related diagnoses during the reduction.Conclusion: Reducing PEC hours was associated with shorter EDLOS, fewer hospitalizations, and older age, with no difference in the severity. Even with reduced PEC hours, relevant resources should be redistributed to ensure the accessibility to PEC.

59 Enhancing career development in paediatrics residency: A needs assessment

Abstract Background Mentorship is a cornerstone of professional growth within medical training, yet the role of formal mentorship in career advising for medical residents remains understudied. In 2020, our Paediatrics Residency program introduced the role of faculty advisors as part of the Competence by Design framework, with a mission to guide academic growth, professional development, and excellence in patient care. However, it is unclear to what extent career advising is occurring in this advisor-advisee relationship. Objectives The primary aim of this study was to complete a needs assessment for Paediatric residents to inform faculty advisor roles and responsibilities and effectively support paediatric residents in their career development. This included examination of the current state, identification of the ideal state, followed by a gap analysis and recommendations to create a comprehensive advising program. Design/Methods This study utilized a mixed methods approach, using quantitative and qualitative survey methodologies. The survey questions (n=20) were designed from background literature and pilot testing. An anonymous survey was administered through the Qualtrics platform to the Paediatrics residents (n=59). The protocol was submitted for REB review and was granted an exemption as a quality improvement project. Thematic analysis of the qualitative content was completed by two investigators, utilizing the Braun &amp; Clarke six-phase framework. Results The response rate for the survey reached 34% (n=20) with the final sample including 16% PGY1, 42% PGY2, 16% PGY3, and 26% PGY4 residents. Alarmingly, most residents (63%) did not have a well-defined plan for monitoring career goals. No residents claimed to have sufficient career mentorship at present (0%), with majority (84%) expressing their interest in regular career planning sessions. A significant proportion (79%) also underscored the importance of considering life context when setting career goals. Our thematic analysis revealed that career advising currently follows a non-formal, self-initiated process, with time constraints as the primary obstacle. Primary themes elicited emphasized career exploration (n=15), networking (n=7) including discussions around life context (n=6), mentorship (n=6), and advisor role clarity (n=6). Conclusion Our findings affirm a compelling need for enhanced career development within our Paediatrics Residency program. In response, we propose a multi-faceted approach advocating for structured formal career development. This entails scheduled information sessions, resident goal setting, and formal mentorship. We recommend creating opportunities for networking to enable personalized career development considerations. Exploring an adjunctive role to faculty advisors may be necessary to ensure the success of these recommendations in optimizing resident career education.

Does Early Exposure Change Pediatric Residents' Perceptions of Developmental-Behavioral Pediatric Care?

ABSTRACT Objective: To explore the impact of a new “Intro to DBP” rotation on pediatric residents' interest in developmental-behavioral pediatrics (DBP) and comfort in providing DBP care. Methods: All first-year pediatric residents participated in a new 1-week DBP rotation. Experiences included clinic visits; interdisciplinary evaluations; asynchronous online learning; and lectures, journal clubs, and/or case conferences. Participants completed pre- and postrotation surveys. Surveys focused on awareness of the DBP field; career plans; and perceived importance of, comfort with, and interest in learning about DBP care. We analyzed data using descriptive statistics and Bhapkar's test to compare distribution differences on pre- and postrotation Likert scales; we reviewed open-ended questions to identify themes. Results: Thirty-two residents participated; 56% had no previous exposure to DBP. After the rotation, there was a statistically significant increase in resident-reported importance of DBP care (p &lt; 0.0001), comfort in providing DBP care (p &lt; 0.0001), and interest in pursuing a DBP fellowship (p = 0.0048). Themes identified from open-ended responses suggested that the rotation led to a broader understanding of the DBP field, reinforcement and expansion of knowledge pertinent to all pediatric care, and improved understanding of systems of care. Conclusion: Brief, early exposure to DBP during pediatric residency training led to increased awareness of and comfort in providing DBP care. Residents described a broader understanding of the depth and breadth of DBP and its applicability to all aspects of pediatric care. Early introduction to DBP during residency training may stimulate greater interest in the field and greater comfort among general pediatricians to provide DBP care.

48 Evaluation without representation: Paediatric residents perspectives on CBME

Abstract Background Paediatrics transitioned in 2021 to Competence By Design (CBD), a postgraduate education model spearheaded by the Royal College of Physicians and Surgeons of Canada (Royal College). CBD replaced a time-based training system with one based on competencies demonstrated through regular observations of trainee performance. Although intended to be learner-centered, resident voices have been underrepresented in CBD’s design. Objectives We sought to (1) understand how paediatric residents perceived CBD as impacting their education and evaluation, and (2) explore their ideas to improve its implementation. Design/Methods We compared three Canadian postgraduate paediatric residency programs. First, we reviewed Royal College and program-specific documents regarding CBD to understand local and national priorities for its implementation. Program directors and local education leads were then interviewed to understand local priorities and implementation practices at these programs. Lastly, we conducted interviews with paediatric residents that began residency the year that CBD was launched. We used reflexive, inductive analysis to analyze their perspectives on how CBD has affected their education and develop learner-informed recommendations for improvement. Results We interviewed six program directors and CBD leads. Identified programmatic benefits included improved trainee surveillance, facilitated curriculum change, and competency committees. Challenges included untrained faculty, workplace-based assessment tensions, and administrative burden on residents and staff. Subsequent interviews with ten paediatric residents demonstrated CBD as having limited benefit to their education, leading to a checklist mentality of EPA completion and disengagement with the CBD system. These perceptions were influenced by (1) administrative burden, (2) poor quality feedback from disengaged staff with limited coaching experience, and (3) a lack of collaborative communication between the residents, their programs, and the Royal College. Residents suggested improvements, including: decreasing the number of assessments to alleviate time burden on both residents and faculty; implementing formal coaching instruction for residents and staff; and improving dialogue between Royal College, competency committees, and residents and physician evaluators to build buy-in with the system and facilitate continuing process improvement. Conclusion If we are to effectively adapt postgraduate educational systems to equip learners with the skills to meet the needs of the societies they serve, centering resident voices in curricular revision is paramount to maximize learner buy-in, minimize unintended administrative burden, and guide the development of necessary institutional supports (e.g., formal coaching) to ensure successful system transformation.

57 Resident education in the NICU: A curriculum innovation project

Abstract Background For paediatrics residents, much of newborn care is learned during Neonatal Intensive Care Unit (NICU) rotations. However, the NICU is a high-stress and specialized learning environment. Today’s residents often have less NICU exposure during their training than in the past, leading to concerns from trainees that they are inadequately prepared for neonatal care and resuscitation upon graduation. Objectives We aimed to develop, implement and evaluate a paediatric residency NICU curriculum aimed to augment and improve learning on rotation. Design/Methods We utilized Kern’s Six Step Approach for Curriculum Development. Step 1: We identified that our paediatric residents consistently expressed dissatisfaction with the quality and quantity of learning opportunities on their NICU rotations. Step 2: A collaborative working group of residents, paediatricians, and neonatologists identified learning needs. Step 3: Needs were mapped to specific general paediatrics educational objectives within the Royal College Competency Based Medical Education (CBME) curriculum. Step 4: Suitable learning strategies were selected including simulation, procedural skill training, embedded time with the neonatal resuscitation team, and lunch and learn seminars. Steps 5 and 6: The curriculum was piloted during the 2021-2022 academic year and resident reactions evaluated. Results The detailed curriculum is shown in Table 1. At the start of each NICU rotation, all paediatrics residents on rotation attended a half-day simulation based “boot-camp” consisting of a didactic Neonatal Resuscitation Program (NRP) refresher course, relevant procedural skills stations (intubation, UVC placement, needle thoracocentesis), and simulated neonatal resuscitation scenarios. Junior residents were scheduled for protected time to attend deliveries with a dedicated multidisciplinary resuscitation team to ensure familiarity and begin to solidify skills. Learning was further augmented by weekly, resident-led lunch and learn sessions on topics mapped to level of training. To evaluate this curriculum, resident satisfaction was assessed using surveys post bootcamp and at the end of their rotation. Overall, the curriculum was well received. Bootcamp was the highest rated element; 96% of residents agreed or strongly agreed that the session was useful for their education (Figure 1). Post curriculum implementation, there was significant improvement in resident NICU rotation feedback; residents expressed that the NICU learning environment and resident experience has improved. Conclusion We successfully implemented a NICU curriculum for paediatrics residents, with high satisfaction ratings and improved overall rotation feedback. This program shows promise in addressing a long standing educational gap. More research is needed to investigate whether it leads to improved competency in practice.

14 Exploring factors contributing to Secondary Traumatic Stress in residents during a child maltreatment paediatrics rotation

Abstract Background Secondary Traumatic Stress (STS) refers to the distress and emotional disruption experienced by individuals caring for those who have experienced trauma. STS is increasingly recognised in child serving professions, especially in medical trainees and clinicians working in Child Maltreatment Paediatrics (CMP). Paediatric resident physicians are typically of younger age, work long hours in stressful conditions, and have limited CMP experience. This makes them particularly vulnerable to experiencing STS. In addition to affecting the wellbeing of trainees, STS can impede performance at work and affect patient care. Thus, it is important to understand and mitigate the development of STS among paediatric trainees during their CMP rotation. Objectives This study aims to identify key factors contributing to STS among medical residents at a tertiary care paediatric hospital during a CMP rotation. Design/Methods Qualitative interviews and focus groups were conducted to explore the experiences and perceptions of CMP trainees, staff physicians, and psychologists. Quality Improvement methods including a Fishbone diagram (figure 1), 5-whys analysis, and Pareto analysis (figure 2) were used to analyze the factors that contribute to residents developing STS symptoms. Results Our analysis revealed the following themes contributing to STS symptoms in paediatric residents: (1) limited awareness and education on STS symptoms, (2) lack of planned case debriefing, (3) residency-related burn out, (4) limited experience in CMP, (5) hidden curriculum of residency, and (6) limited opportunity to discuss STS symptoms. Conclusion Our study identified factors related to both limited knowledge around STS, and limited opportunities to debrief cases that may contribute to the development of STS among residents. These factors can, in part, be addressed on a program level. This aligns with existing STS literature which emphasizes implementing program level strategies to support professionals in addition to prioritizing self-care. Next steps involve implementing targeted interventions within the rotation to help mitigate STS effects on trainees.

83 What is social paediatrics and how do we teach it? A scoping review of social medicine curricula in the child and youth health context across health disciplines

Abstract Background Social paediatrics is a field that focuses on addressing social and environmental factors that affect children’s health and wellbeing1. Over recent years in medical education, social paediatrics has become increasingly recognized as foundational to undergraduate and postgraduate paediatrics curricula. Paediatric residency programs worldwide have been developing and offering social paediatrics curricula, yet we lack understanding of effective strategies for teaching it to medical trainees. 1. Spencer N, Colomer C, Alperstein G, et al. Social paediatrics. J Epidemiol Community Health. 2005;59(2):106-108. doi:10.1136/jech.2003.017681 Objectives We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics. Design/Methods We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics. Our literature search first drew upon Ovid MEDLINE and MedEd PORTAL, with subsequent studies identified through reference searching in relevant articles. We included studies that described and/or evaluated educational interventions aimed to teach elements of social paediatrics. We excluded studies published before 2000. We extracted data from the selected articles and conducted thematic analysis. Results Our search yielded 443 articles. Initial screen by title and/or abstract and subsequent screen by abstract and/or full text yielded 28 papers. Where it was unclear if studies met inclusion criteria, two additional researchers reviewed the full text. With the addition of articles found in references of the provisional articles, a total of 36 papers were included in the review. Of those, 17 (47%) described curricular interventions at the level of paediatric residency, 7 (19%) described medical school curricula, and 8 (22%) included non-medicine fields such as dentistry, nursing, research, and others. Fifty percent of curricula required self-directed learning, while a different 50% subset had a formal reflection process as part of learning consolidation. We organized the literature thematically into the following themes: interdisciplinary collaboration, community partnership, advocacy training, and experiential learning. Conclusion Our scoping review describes a variety of curricular interventions aimed to teach elements of social paediatrics, with a large focus on social determinants of health, primarily poverty, and a relative lack of focus on the underlying structural, systemic, and social justice issues underpinning these health determinants. We need to consider how the pedagogical strategies on offer can be purposed towards the development of more robust social paediatrics curricula at the postgraduate level.

58 A hospital paediatrics education curriculum: Quality improvement for inpatient paediatric learner education on CTU

Abstract Background Paediatric learners experience the bulk of their inpatient medicine on the wards. While bedside teaching is invaluable, ward learning can be impacted by seasonal exposure, clinical homogeneity, and volume. Locally our learners requested more formal ward teaching to encourage dialogue around common topics perhaps not encountered on rotation. We queried whether having a database of interactive guideline-based educational experiences would minimize barriers (eg. time, resources) to providing formal inpatient learner education. Objectives We sought to enhance general paediatrics ward teaching by developing a curriculum of guideline-based interactive educational content on common inpatient paediatric topics. Design/Methods This study was conducted at a Canadian tertiary care paediatric hospital with a range of learners (MSI3, MSI4, paediatric residents (R1-R4)) over 12 months. 1) Needs Assessment: We surveyed residents, hospitalist fellows, and CTU physicians regarding a) perceived need for a curriculum, b) content (top 5 CPS guidelines and top 5 non-CPS topics), c) teaching modality, d) need for handouts, and e) curriculum structure. 2) Curriculum generation: Curriculum was developed according to needs assessment results. 3) Quality improvement: Learners were surveyed after each session with four Likert scale questions (5=strongly agree) regarding teaching quality, clinical translatability, enhanced knowledge/understanding, and improved clinical confidence. Results 1) Needs assessment: Needs assessment (N=25) unanimously supported a structured curriculum. Eleven CPS statements and twelve non-CPS guideline-based topics were identified for content. Three preferred teaching formats were highlighted, and handouts were important to 88% of respondents. The curriculum was favoured to be 50-75% standardized. 2) Curriculum generation: We developed a curriculum of 13 topics with different delivery modalities (e.g. case-based powerpoints, whiteboard talks, Jeopardy, simulation). All were guideline-based, interactive, and had fill-in-the-blank learner handouts. The curriculum was standardized with 4/6 CTU teaching sessions per block being derived from the curriculum bank, and the remainder being at educator discretion (e.g. curriculum bank, interesting case). 3) Quality improvement: Likert scales (5=strongly agree) were positive from all learners (MSI3-R4; N=52), with scores of 4.9+/-0.2 for teaching quality, translatability to practice, and improved understanding, and 4.8+/-0.3 for improved clinical confidence. Conclusion Here we present an interactive and guideline-based paediatric inpatient learner education curriculum whose development, from content to delivery modality, was directed by community needs. We are now seeking funding to prepare for national distribution (e.g. peer-review, licensure), and intend to publish on platform where the curriculum would be downloadable for use by all educators (i.e. senior residents, staff).

Workplace affordances and learning engagement in a Thai paediatric intensive care unit.

Workplace learning in critical care settings is complex and challenging. Research has explored learner-, teacher-, and context-related factors that influence medical residents' engagement in critical care workplaces in Western but not in non-Western cultures. This limits our understanding of workplace learning globally and how we can better support resident learning in diverse cultures. To explore how paediatric residents engage in workplace learning in a Thai Paediatric Intensive Care Unit (PICU) and how this culturally situated workplace shapes their learning. In this qualitative study, we recruited paediatric residents (n = 16) from a tertiary care hospital in Thailand for semi-structured interviews. We used reflexive thematic analysis to describe, analyse and interpret residents' experiences of workplace learning, and to capitalise on our own experience as an analytic resource. We constructed three themes to represent participants' narratives: PICU cases and context as dynamic affordances; impact of psychological safety; and the role of attending physicians. While Thai PICU cases and context could afford participation and thus learning, Thailand's collectivist culture, which prioritises group needs over individual needs, contributed to a sense of psychological safety within culturally-endorsed, professional and social hierarchies, and set the stage for workplace learning. Despite their higher status in these hierarchies, attending physicians facilitated resident learning by fostering open dialogue, joint problem-solving and a low-stress atmosphere. Workplace learning in a Thai PICU while challenging, is uniquely facilitated by Thailand's collectivist culture that fosters psychological safety and attending physicians' invitation in, and learn from, the workplace optimises learning.

Culture of safety in an adult and paediatric emergency department before and after the COVID-19 pandemic

BackgroundThe WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in...

Pediatric pain physician workforce: an assessment of supply and demand.

Many youth with pain lack access to pediatric pain expertise. There is a critical shortage of pediatric pain physicians, due partly to a paucity of training programs in Pediatric Pain Medicine. Pain fellowships are Anesthesiology-based and there is no pathway to fellowship training or Pain Medicine board certification for pediatricians. This workforce assessment sought to examine the current state of Pediatric Pain Medicine in the United States and future interest in pursuing Pain Medicine among pediatricians. A multidisciplinary working group of Pain Medicine clinicians designed three surveys to examine pediatric comprehensive pain programs in the US, practice patterns of pediatricians and their motivations and opinions regarding Pain Medicine board certification, and current residents' exposure to and interest in Pediatric Pain Medicine. Wait times for initial evaluations are two months or longer for two-thirds of responding centers, and barriers to increase staff size and resources were reported, including an inadequate number of trained or available physicians. Pediatricians expressed interest in earning board certification in Pain Medicine, given the opportunity. Additionally, there is interest among pediatric residents in pursuing Pediatric Pain Medicine, and qualitative data highlight information residents perceived needing in order to pursue a career in the field. Results demonstrate the need for increased training opportunities in pediatric pain medicine. A formal pathway to Pain Medicine for Pediatricians should be developed to increase the potential workforce and to address the lack of trained pediatric pain specialists, thereby improving access to care for youth with pain.