Using the Modified Delphi Method to Develop a Tool to Assess Pediatric Residents Supervising on Inpatient Rounds

BackgroundConsensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking.ObjectiveUse modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, nonspecialty teaching rounds and pilot the checklist.Design/MethodsOne hundred and forty-one initial candidate behaviors were identified through literature review and narrowed by local stakeholders. Forty-one behaviors were submitted to national experts identified through purposive sampling to be refined using the modified Delphi method. Participants indicated agreement with behaviors’ inclusion in the checklist and whether any were nonobservable. Measures of central tendency and dispersion were used to identify consensus with a behavior's inclusion in the next cycle. A criterion was eliminated if >25% of experts felt it was not observable. Cycles continued until consensus was reached on ≤20 behaviors. The resulting checklist was piloted at 2 hospitals.ResultsAfter 2 modified Delphi cycles, consensus was obtained on 18 behaviors for inclusion in the final checklist. These were spread across 3 subcategories: teaching, leadership, and patient safety. In the pilot, the checklist of behaviors discriminated between residents with differing levels of competency in supervising trainees on inpatient rounds. For residents who had the checklist completed by 2 faculties, there was 75% agreement in behaviors observed.Conclusion(s)Based on literature review, local stakeholder input, and consensus of national experts through the modified Delphi method, we created and piloted a checklist of observable behaviors characteristic of effective clinical supervision by pediatric residents leading trainee teams on inpatient, non-ICU, nonspecialty rounds.     

Quality Improvement Skills for Pediatric Residents: From Lecture to Implementation and Sustainability

Quality improvement (QI) skills are relevant to efforts to improve the health care system. The Accreditation Council for Graduate Medical Education (ACGME) program requirements call for resident participation in local and institutional QI efforts, and the move to outcomes-based accreditation is resulting in greater focus on the resulting learning and clinical outcomes. Many programs have enhanced practice-based learning and improvement (PBLI) and systems based practice (SBP) curricula, although efforts to actively involve residents in QI activities appear to be lagging. Using information from the extensive experience of Cincinnati Children's Hospital Medical Center, we offer recommendations for how to create meaningful QI experiences for residents meet ACGME requirements and the expectations of the Clinical Learning Environment Review (CLER) process. Resident involvement in QI requires a multipronged approach that overcomes barriers and limitations that have frustrated earlier efforts to move this education from lectures to immersion experiences at the bedside and in the clinic. We present 5 dimensions of effective programs that facilitate active resident participation in improvement work and enhance their QI skills: 1) providing curricula and education models that ground residents in QI principles; 2) ensuring faculty development to prepare physicians for their role in teaching QI and demonstrating it in day-to-day practice; 3) ensuring all residents receive meaningful QI education and practical exposure to improvement projects; 4) overcoming time and other constraints to allow residents to apply their newly developed QI skills; and 5) assessing the effect of exposure to QI on resident competence and project outcomes.     

Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: A Cross-Institutional Study

Objective

To evaluate a pediatric otoscopy curriculum with the use of outcome measures that included assessment of skills with real patients.

Effectiveness of Communication Skills Training on Perceptions and Practice of Pediatric Residents

Objective  

To assess the effectiveness of a structured communication skills training workshop on the perceptions and practice of pediatric residents.     

Improvement of Skills in Cardiopulmonary Resuscitation of Pediatric Residents by Recorded Video Feedbacks

Objective

To evaluate the pediatric residents’ cardiopulmonary resuscitation (CPR) skills, and their improvements after recorded video feedbacks.

Methods

Pediatric residents from a university hospital were enrolled. The authors surveyed the level of pediatric resuscitation skill confidence by a questionnaire. Eight psychomotor skills were evaluated individually, including airway, bag-mask ventilation, pulse check, prompt starting and technique of chest compression, high quality CPR, tracheal intubation, intraosseous, and defibrillation. The mock code skills were also evaluated as a team using a high-fidelity mannequin simulator. All the participants attended a concise Pediatric Advanced Life Support (PALS) lecture, and received video-recorded feedback for one hour. They were re-evaluated 6 wk later in the same manner.

Results

Thirty-eight residents were enrolled. All the participants had a moderate to high level of confidence in their CPR skills. Over 50 % of participants had passed psychomotor skills, except the bag-mask ventilation and intraosseous skills. There was poor correlation between their confidence and passing the psychomotor skills test. After course feedback, the percentage of high quality CPR skill in the second course test was significantly improved (46 % to 92 %, p = 0.008).

Conclusions

The pediatric resuscitation course should still remain in the pediatric resident curriculum and should be re-evaluated frequently. Video-recorded feedback on the pitfalls during individual CPR skills and mock code case scenarios could improve short-term psychomotor CPR skills and lead to higher quality CPR performance.

     

Using Self-Determination Theory to Drive an Evidence-Based Medicine Curriculum for Pediatric Residents: A Mixed Methods Study

ObjectiveThe ability to incorporate evidence-based medicine (EBM) into clinical practice is an Accreditation Council for Graduate Medical Education competency, yet many pediatric residents have limited knowledge in this area. The objective of this study is to describe the effect of an EBM curriculum on resident attitudes and clinical use of EBM.MethodsWe implemented a longitudinal EBM curriculum to review key literature and guidelines and teach EBM principles. In this Institutional Review Board-exempt mixed methods study, we surveyed residents, fellows, and faculty about resident use of EBM at baseline, 6 months, and 12 months after the beginning of the intervention. We conducted point prevalence surveys of faculty about residents’ EBM use on rounds. Residents participated in focus groups, which were audio-recorded, transcribed, and coded using conventional content analysis to develop themes.ResultsResidents (N = 61 pre- and 70 post-curriculum) reported an increased appreciation for the importance of EBM and comfort generating a search question. Faculty reported that residents cited EBM on rounds, with an average of 2.4 citations/week. Cited evidence reinforced faculty's plans 79% of the time, taught faculty something new 57% of the time, and changed management 21% of the time. Focus groups with 22 trainees yielded 4 themes: 1) increased competence in understanding methodology and evidence quality; 2) greater autonomy in application of EBM; 3) a call for relatedness from faculty role models and a culture that promotes EBM; and 4) several barriers to successful use of EBM.ConclusionsAfter implementation of a longitudinal EBM curriculum, trainees described increased use of EBM in clinical practice.     

Evaluation of a National Bright Futures Oral Health Curriculum for Pediatric Residents

ObjectiveTraining in Bright Futures and oral health concepts is critical for delivery of high-quality primary care and preventive health services by residents, our future pediatric workforce. The goal of this study was to evaluate the effectiveness of an online health promotion curriculum on pediatric residents' confidence, knowledge, and clinical performance in Bright Futures and oral health practice.MethodsResidents from sites that had been stratified by size and randomized were assigned to the Bright Futures Oral Health curriculum (intervention group) or an active control group. Confidence and knowledge were measured by self-report and multiple-choice questions, respectively. Clinical performance was measured with structured clinical observations, performed by trained faculty, of Bright Futures and oral health performance before and after intervention. Mean scores between intervention and control groups were compared using a 2-tailed, repeated-measures F test.ResultsA total of 143 pediatric residents from 27 Continuity Research Network (CORNET) sites participated in the study. At a median of 3 months after intervention, the intervention group demonstrated significant improvement in general Bright Futures confidence (n = 128, F = 6.564, P = .012) and knowledge (n = 102, F = 5.296, P = .023), oral health confidence (n = 123, F = 15.220, P < .001), and clinical performance skills in oral health (n = 96, F = 11.315, P = .001) compared with the control group.ConclusionsThe Bright Futures Oral Health curriculum promoted an increase in confidence and knowledge in Bright Futures concepts and in confidence and clinical performance in oral health concepts among pediatric residents. This online curriculum demonstrated a positive impact on documented resident behavior, maintained for 3 months after intervention, and provides a replicable national training model to advance important elements of primary care pediatrics.     

The Impact of a Gamified Curriculum Using Kahoot! on Musculoskeletal Knowledge and Skill Acquisition Among Pediatric Residents

ObjectiveTo determine whether a musculoskeletal curriculum involving gamification via Kahoot! (an online classroom response system) was acceptable and more effective at teaching pediatric residents musculoskeletal knowledge and skills than a nongamified curriculum.MethodsA prospective, randomized controlled trial was conducted at an urban, academic pediatric clinic. All participants received a curriculum that included brief didactics and knowledge questions. The knowledge questions were delivered via Kahoot! to the intervention group and administered via paper to the control group. The primary outcome was knowledge and skill acquisition following curriculum participation.ResultsA total of 73 of 85 (86%) residents completed the study (intervention group: 46; control group: 27). Following participation in the curriculum, intervention and control residents demonstrated an improvement in musculoskeletal knowledge (P < .05) measured via questionnaire, as well as an improvement in physical exam skills during a standardized patient encounter (P < .05). There was no difference in knowledge or skill improvement between groups. Intervention participants indicated positive attitudes toward Kahoot!.ConclusionsOur musculoskeletal curriculum demonstrated improvements in knowledge and skills among residents, though inclusion of Kahoot! did not enhance the experimental effect. Further research is needed to identify strategies to optimize gamification for learning.     

Emergency Care Connect: Extending Pediatric Emergency Care Expertise to General Emergency Departments Through Telemedicine

Increasingly, children with common and lower-acuity conditions are being transferred from general emergency departments (EDs) to pediatric centers for subspecialty care. While transferring children with high-risk conditions has benefit, transferring children with common conditions may expose them to redundant care and added costs. Emergency Care Connect (ECC) is a novel telemedicine program that uses videoconferencing to connect general ED and urgent care providers to pediatric emergency medicine physicians with the goal of keeping children in their communities for definitive care, when safe and feasible. ECC objectives are to: 1) facilitate transfer decision-making for children receiving care in general ED and urgent care sites and 2) increase access to pediatric providers for real-time management, regardless of disposition. In its first 20 months, ECC partnered with 4 general EDs and 1 urgent care location, which together made 1327 contacts with our pediatric center, of which 202 (15%) became ECC consultations for 200 unique patients. Of those consultations, 71% patients remained locally for treatment and 25% experienced a care plan change. Overall, ECC was rated highly by surveyed families and providers. Barriers to implementation, such as lack of familiarity with telemedicine and fears of changes in workflow, were overcome with strong institutional support and frequent, sustained stakeholder engagement. With greater adoption of this model, ECC and programs like it have the potential to allow more children to be treated in their communities, minimize preventable transfers, and reserve beds in children's hospitals for those with potentially higher risk and more medically complex conditions.