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AimsTransition to Leadership course (T2L) is a well-established educational programme endorsed by RCPCH, aimed to guide senior house officers (SHOs) developing into paediatric registrars. Due to the Covid-19 pandemic, this face-to-face course was converted to the free virtual 3 days course since 2020, open to paediatric trainees national-wide. This course offered easily accessible online resources with educational materials and recordings, serial webinars and small group working based on clinical scenarios. The first course in 2020 was well-received with positive impacts (published in 2021 RCPCH conference). The faculty has taken recommendations from the candidates and modified the course contents in line with efficient virtual teaching with more comprehensive online resources. We evaluated the effectiveness of this virtual training, especially in boosting a confidence level in candidates in multiple domains in becoming a paediatric registrar.MethodsWe hosted two online courses in 2020 and 2021 during the height of the COVID-19 pandemic, made available national-wide. For the 2021 course, candidates were asked to fill two questionnaires based on the 4-point Likert scale, before and after the course. The questionnaire entailed 10 domains of being a great paediatric registrar such as dealing with common neonatal and paediatric presentations, leading resuscitations, child death, conflict, leading at night, dealing with mistakes, consents, calling consultants, safeguarding. We asked candidates in their confidence level before and after the course and their responses have been analysed using a paired T-test.ResultsA total of 39 anonymised and paired responses was received for analysis from pre and post course questionnaires. There was a significant increase in candidates’ confidence in almost all the domains;common neonatal problems, knowing when to call consultants, leading a team, dealing with mistakes and coping with a greater amount of responsibility and accountability (p<0.05). Even more significant benefit was seen in domains such as managing cases with safeguarding concerns, difficulties regarding consent and death in children (p<0.005). Confidence in dealing with common paediatric problems and leading a resuscitation did not change significantly, since SHOs are more frequently exposed to these scenarios. The difference in pre and post course survey on their overall confidence level to a specific question ‘How well prepared do you feel to become a paediatric registrar?’ was extremely statistically significant (p-value = 0.0002, confidence interval: -0.93 to -0.31).In the post course questionnaire of 60 responses, 56% would like to attend the course face-to-face, which remained similar to the last year of 53%. A remarkable 98% of candidates agreed that this course should be a mandatory training to aid the transition from SHOs to paediatric registrars.ConclusionFor 2 years in a row, T2L course from LSP helped SHOs transitioning to become paediatric registrars in a virtual set-up during the COVID-19 pandemic. We demonstrated that candidates gained significant confidence in multiple domains in their preparation to step up to a senior role.As we are rising from the pandemic as a society, we envisage to offer a hybrid programme with our well-established online resources, face-to-face peer discussion and networking in the future.
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BackgroundPIMS-TS has emerged as a novel disease entity. A recent systematic review reported on 662 patients diagnosed with PIMS-TS. Most of these previous studies have focused on children’s presentation at the time of admission to tertiary centres and the subsequent investigations and outcomes.ObjectivesThis case series aims to analyse the clinical features of PIMS-TS at initial presentation and admission to explore if there are any early features of disease, which could enable earlier identification of these patients.MethodsRetrospective data was analysed for all children (aged 0–16 years) seen in North Middlesex University Hospital Paediatric Emergency Department (PED) between March and May 2020 with an eventual discharge diagnosis of ‘PIMS-TS’ or who fulfilled the RCPCH case definition criteria for PIMS-TS. 11 patients met the criteria for inclusion. Data was collected based on the RCPCH guideline including patient demographics, presenting symptoms and laboratory findings.ResultsThe mean age at presentation was 7.8 years (Range 18 months -13 years). Six patients were ‘re-presentations’. The mean time interval between first presentation and eventual admission was 2.7 days (Range 0 - 5 days). The most common symptoms at first presentation were: fever (100%), vomiting (67%), headache (50%) and rash (50%). Two patients were ambulated on IV antibiotics whilst the remaining four patients were reassured and discharged from PED with no follow up. All three patients who had bloods tested on first presentation had a raised CRP and lymphopenia. Two patients had hyponatraemia (67%).The most common presenting symptoms at admission were fever (100%), abdominal pain (73%), rash (55%), vomiting (55%) and difficulty in breathing (55%). Four patients (36%) were hypotensive on initial assessment. The pathology results showed that nearly all patients had a raised CRP (91%) and five patients were lymphopenic (45%). The mean CRP was markedly elevated (212 mg/L). ESR was measured in two patients and was raised in both. Eight patients were hyponatraemic (73%). Fibrinogen, D Dimer and fibrinogen results were elevated in all cases where these were measured. Swab results for SARS-COV-2 PCR were negative in all 11 cases. Five patients tested positive for SARS-COV-2 antibody tests. Kawasaki symptoms were underrepresented in this case series with no such symptoms at first presentation and only some such as conjunctivitis (27%) and mucous membrane involvement (9%) appearing in a small number at admission.ConclusionsThe results of this case series suggest that children with early PIMS-TS can present to PED with a non-specific febrile illness a few days before they become unwell with the more severe later features. There is a suggestion that certain abnormal blood test results at this point may indicate early PIMS-TS. Further research is needed to ascertain the significance of these findings. The authors support routine nationalised data collection for all cases of PIMS-TS. In addition to exploring optimal treatment options, a review of early signs, symptoms and investigation results will assist in answering the question of whether current accepted practices for investigation and follow up for patients with fever and nonspecific symptoms are adequate to ensure timely diagnosis of PIMS-TS.
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588 Table 1Comparison of candidates’ perceived competence ratings in various skills domainsRated Domain Mean Competency Rating (1–5) Pre-Course Post Course Mean Difference P value Knowing when to call my Consultant 2.98 3.22 0.23 0.050 Leading during a resuscitation 2.62 2.88 0.27 0.027 Managing conflict 2.57 2.78 0.22 0.046 Managing cases with safeguarding concerns 2.67 2.90 0.23 0.049 Difficulties regarding consent 2.37 2.80 0.43 <0.001 Managing when a child dies on the ward 2.07 2.70 0.63 <0.001 Leading and managing a team 2.92 3.08 0.17 0.106 Making mistakes and coping with increased responsibility and accountability 2.55 2.90 0.35 0.001 Control Domains Dealing with common neonatal problems 3.08 3.13 0.05 0.618 Dealing with common paediatric problems 3.12 3.18 0.07 0.464 ConclusionsOur newly curated virtual Transition to Leadership Course clearly provides SHOs with appreciable gains in core leadership and management attributes, as effectively as previous face-to-face courses, but with the ability to reach a much wider audience. Future courses must employ a blended-learning programme, creating easily accessible user-friendly online resources, alongside opportunities for peer discussion and networking, to deliver the best of both pre- and post- Covid-19 education models.
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Introduction: Research into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation. Methods: Single centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital. Results: Six patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients. Interpretation: The results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.