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1.
BMC Med Educ ; 18(1): 287, 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514279

RESUMO

BACKGROUND: Traditionally, quizzes have been applied as a tool for summative assessment, though literature suggests their use as a formative assessment can improve motivation and content retention. With this premise, we implemented a series of intermittent, online quizzes known as the Board Examination Simulation Exercise (BESE). We sought to demonstrate an association between BESE participation and scores and performance on the American Board of Pediatrics (ABP) Certifying Examination (CE). METHODS: Residents were assigned online quizzes on a single topic at 2 week intervals that consisted of 20 multiple choice questions written by the study authors. This analysis includes graduates of 3 Pediatric and Internal Medicine-Pediatrics residency programs. RESULTS: Data were available for 329 residents. The overall BESE score weakly correlated with ABP CE score (n = 287; r = 0.39, p < 0.0001). ABP CE pass rates increased from 2009 to 2016 at all programs combined (p = 0.0001). A composite BESE score ≤ 11 had sensitivity of 54% and specificity of 80% for predicting ABP CE failure on the first attempt. There was no difference in ABP CE failure rates or scores by number of completed quizzes. CONCLUSION: Intermittent online quizzes implemented at three pediatric residency programs were associated with overall increasing ABP CE pass rates. BESE increased program emphasis on board preparation. Residents with lower BESE scores more often failed ABP CE. Though additional data are needed, BESE is a promising tool for pediatric resident learning and board preparation. It may also aid in earlier identification of residents at higher risk of failing the ABP CE and facilitate targeted interventions.


Assuntos
Certificação , Competência Clínica/normas , Instrução por Computador , Internato e Residência/métodos , Pediatria/educação , Avaliação Educacional , Humanos , Pediatria/normas , Avaliação de Programas e Projetos de Saúde , Conselhos de Especialidade Profissional , Estados Unidos
3.
Simul Healthc ; 11(3): 149-56, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27093505

RESUMO

INTRODUCTION: Controversy exists in the simulation community as to the emotional and educational ramifications of mannequin death due to learner action or inaction. No theoretical framework to guide future investigations of learner actions currently exists. The purpose of our study was to generate a model of the learner experience of mannequin death using a mixed methods approach. METHODS: The study consisted of an initial focus group phase composed of 11 learners who had previously experienced mannequin death due to action or inaction on the part of learners as defined by Leighton (Clin Simul Nurs. 2009;5(2):e59-e62). Transcripts were analyzed using grounded theory to generate a list of relevant themes that were further organized into a theoretical framework. With the use of this framework, a survey was generated and distributed to additional learners who had experienced mannequin death due to action or inaction. Results were analyzed using a mixed methods approach. RESULTS: Forty-one clinicians completed the survey. A correlation was found between the emotional experience of mannequin death and degree of presession anxiety (P < 0.001). Debriefing was found to significantly reduce negative emotion and enhance satisfaction. Sixty-nine percent of respondents indicated that mannequin death enhanced learning. These results were used to modify our framework. CONCLUSIONS: Using the previous approach, we created a model of the effect of mannequin death on the educational and psychological state of learners. We offer the final model as a guide to future research regarding the learner experience of mannequin death.


Assuntos
Atitude Frente a Morte , Manequins , Pediatria/educação , Treinamento por Simulação , Adulto , Ansiedade/psicologia , Educação de Pós-Graduação em Medicina , Educação de Pós-Graduação em Enfermagem , Emoções , Feminino , Grupos Focais , Teoria Fundamentada , Humanos , Masculino , Estudos Retrospectivos
4.
J Grad Med Educ ; 8(5): 739-746, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28018540

RESUMO

BACKGROUND: Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. OBJECTIVE: We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. METHODS: A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. RESULTS: Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P < .001). CONCLUSIONS: A comprehensive, integrated communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.


Assuntos
Comunicação , Currículo , Internato e Residência , Pediatria/educação , Educação de Pós-Graduação em Medicina , Hospitais Pediátricos , Humanos , Negociação , Transferência da Responsabilidade pelo Paciente
5.
Pediatr Crit Care Med ; 3(3): 244-249, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12780964

RESUMO

OBJECTIVE: To determine whether end-tidal CO(2) (Petco(2)) measurement provides a reliable estimate of ventilation in critically ill children who are mechanically ventilated. DESIGN: Prospective, nonrandomized, consecutive enrollment study. SETTING: A university-affiliated children's hospital pediatric intensive care unit. PATIENTS: All intubated, mechanically ventilated pediatric patients. INTERVENTIONS: All Petco(2)-Paco(2) pairs were from patients ventilated with a Servo 300 Ventilator (Siemens-Elema AB, Stockholm, Sweden). When a blood gas sample was obtained, Petco(2) as measured by a continuous mainstream Petco(2) capnograph was recorded. Measurements: The results of blood gas measurements and corresponding Petco(2) measurements were recorded. Demographic data and primary diagnosis were noted. Petco(2)-Paco(2) pairs obtained from patients with intracardiac shunts or obtained during high-frequency oscillation or extracorporeal membrane oxygenation at the time of measurement were excluded from analysis. Linear regression was used to analyze Petco(2)-Paco(2) pairs. Repeated measure analysis of variance with the mixed-model algorithm in SAS software (SAS Institute, Carey, NC) was used to analyze the trend in the Petco(2) and Paco(2) relationship. Chi-square was used to analyze categorical data. Statistical significance was considered p <.05. RESULTS: A total of 129 children were enrolled, and 1708 paired Paco(2) and Petco(2) measurements were recorded. The mean age +/- sd was 4.1 +/- 5.6 yrs. Paco(2) positively correlated with Petco(2). The linear equation for the regression analysis was y = 0.71x (95% confidence interval, 0.69-0.73) + 8.93 (95% confidence interval, 7.89-9.97), with r (2) =.716 and p <.001. The Petco(2)-Paco(2) difference was 10 mm Hg (1.33 kPa) difference between the Petco(2) and Paco(2). However, only 111 of 1068 (10%) Petco(2)-Paco(2) pairs had a difference of >10 mm Hg (1.33 kPa) in patients with a Pao(2)/Fio(2) ratio >200. Trend analysis showed the Petco(2)-Paco(2) difference increased with increasing duration of mechanical ventilation. CONCLUSION: In most intubated, mechanically ventilated infants and children, Petco(2) reliably estimates ventilation.

6.
J Grad Med Educ ; 6(1): 100-5, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24701318

RESUMO

BACKGROUND: Innovative online technology can enhance the practice of medicine, yet it also may be a forum for unprofessional behavior. OBJECTIVE: We surveyed program directors regarding their perceptions and experiences with residents' use of social networking sites (SNS). METHODS: In September 2011, we sent an online survey to program directors and associate program directors of pediatrics residency programs within the United States who are members of the Association of Pediatric Program Directors. RESULTS: A total of 162 program directors or associate program directors (representing 50% of residency programs) responded to the survey. One-third of respondents are "very familiar" with SNS and 23% use them "daily or often." Most respondents (70%) rated "friending" peers as "completely appropriate," whereas only 1% of respondents rated "friending" current or past patients as "completely appropriate." More than one half of respondents believe inappropriate behavior on SNS is "somewhat" or "very" prevalent, and 91% are "somewhat" or "very" concerned that the prevalence of inappropriate behavior on SNS may increase. The most commonly reported problematic online activity was posting inappropriate comments about the workplace. Posting of inappropriate comments about self, patients, and staff also was observed. Residency programs commonly educate trainees about SNS during intern orientation (45%), or using written guidelines (29%) and ad hoc remediation (16%). CONCLUSIONS: As educators teach trainees principles of online professionalism, appropriate use of SNS needs to be included in the training process. Curricular efforts may be hindered by some program directors' lack of familiarity with SNS.

8.
Simul Healthc ; 6(6): 337-44, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21937963

RESUMO

INTRODUCTION: Simulation is an effective teaching tool, but many hospitals do not possess the space or finances to support traditional simulation centers. Our objective is to describe the feasibility of an in situ simulation program model that uses minimal permanent space and "redirected" cost-neutral faculty educational time to address these issues. METHODS: Two pediatric simulators and audiovisual equipment were purchased. Course faculty were derived from a group of physicians and nurses with a percentage work assignment apportioned to education. A portion of this was subsequently redirected toward simulation. After 2 years of operation, faculty were surveyed regarding time devoted to the program. Program growth and quality statistics were examined descriptively. RESULTS: The program supported 786 learner encounters in 166 sessions over 2 years. Simulation hours per month increased over sixfold during that period (P < 0.001). Program initiation cost was $128920.89, with subsequent yearly costs of $11,695. Mean program ratings ranged between 4.5/5 for Crisis Resource Management and 4.4/5 for communication skills training. Resident (2.6 h/y increase, P value <0.001) and nursing (2.2 h/y increase, P < 0.001) simulation hours increased significantly. Faculty involvement averaged between 3% and 32% of total work hours. CONCLUSION: This report demonstrates the feasibility of implementing an in situ simulation program using minimal permanent institutional space and cost-neutral redirected faculty time. This type of programmatic structure is conducive to short- and medium-term growth, is well received by participants, and allows for substantial cost savings. Future work will be needed to determine what growth limitations are inherent in this staffing and structural model.


Assuntos
Simulação por Computador , Docentes/organização & administração , Pessoal de Saúde/educação , Manequins , Pediatria/educação , Análise Custo-Benefício , Estudos de Viabilidade , Humanos , Capacitação em Serviço/métodos , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo , Interface Usuário-Computador
9.
J Grad Med Educ ; 3(1): 88-94, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22379528

RESUMO

BACKGROUND: Few validated instruments exist to measure pediatric code team skills. The goal of this study was to develop an instrument for the assessment of resuscitation competency and self-appraisal using multirater and gap analysis methodologies. METHODS: Multirater assessment with gap analysis is a robust methodology that enables the measurement of self-appraisal as well as competency, offering faculty the ability to provide enhanced feedback. The Team Performance during Simulated Crises Instrument (TPDSCI) was grounded in the Accreditation Council for Graduate Medical Education competencies. The instrument contains 5 competencies, each assessed by a series of descriptive rubrics. It was piloted during a series of simulation-based interdisciplinary pediatric crisis resource management education sessions. Course faculty assessed participants, who also did self-assessments. Internal consistency and interrater reliability were analyzed using Cronbach α and intraclass correlation (ICC) statistics. Gap analysis results were examined descriptively. RESULTS: Cronbach α for the instrument was between 0.72 and 0.69. The overall ICC was 0.82. ICC values for the medical knowledge, clinical skills, communication skills, and systems-based practice were between 0.87 and 0.72. The ICC for the professionalism domain was 0.22. Further examination of the professionalism competency revealed a positive skew, 43 simulated sessions (98%) had significant gaps for at least one of the competencies, 38 sessions (86%) had gaps indicating self-overappraisal, and 15 sessions (34%) had gaps indicating self-underappraisal. CONCLUSIONS: The TPDSCI possesses good measures of internal consistency and interrater reliability with respect to medical knowledge, clinical skills, communication skills, systems-based practice, and overall competence in the context of simulated interdisciplinary pediatric medical crises. Professionalism remains difficult to assess. These results provide an encouraging first step toward instrument validation. Gap analysis reveals disparities between faculty and self-assessments that indicate inadequate participant self-reflection. Identifying self-overappraisal can facilitate focused interventions.

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