Pilot Evaluation of an Online Resource for Learning Paediatric Chest Radiograph Interpretation.

Introduction and aims Assessment of chest radiographs is a fundamental clinical skill, often taught opportunistically. Medical students are taught how to read adult chest radiographs, however, in our experience, there is often a lack of structured training for the interpretation of pediatric chest radiographs. Our aim was to develop and evaluate an online approach for medical students to learn this skill.  Materials and methods Ericsson's expertise acquisition theory was used to develop 10 sets of 10 practice radiographs which were graded using the X-ray difficulty score. Medical student volunteers (from Keele University School of Medicine) were recruited in the paediatric rotation of their first clinical year. Pre- and post-training tests of identical difficulty were offered. A semistructured focus group was conducted after the tests, the transcription of which was analyzed using grounded theory. Results Of 117 students in the year, 54 (46%) originally volunteered. The engagement was initially high but fell during the year, particularly during the pre-examination block. The high drop-out rate made the quantitative measurement of effectiveness difficult. The focus group suggested that pressure of other work, exam preparation, technical factors, and inflexibility of the study protocol reduced engagement. Conclusions Although the topic covered was seen as important and relevant to exams, the current system requires development to make it more effective and engaging.

Developing a core outcome set for children with protracted bacterial bronchitis.

BACKGROUND: Protracted bacterial bronchitis (PBB) is a chronic endobrochial infection and a leading cause of chronic wet cough in children. There is an urgent need for a randomised controlled trial to investigate the optimal treatment but there is no core outcome set (COS) to inform choice of outcomes. A COS is a standardised set of outcomes representing the minimum that should be measured and reported in clinical trials of a specific condition. We have developed a COS for PBB. METHODS: Potential core outcomes were collated from a systematic review, interviews with parents and a clinician survey. A two-round Delphi survey of healthcare professionals identified which outcomes had consensus for inclusion. The final COS was agreed at a consensus meeting of parent representatives and clinicians. RESULTS: 20 outcomes were identified for the Delphi survey. After two rounds, 10 reached consensus. These were combined and edited at the consensus meeting into the final six: 1) Resolution of cough assessed using a cough score/diary recorded daily by parent(s) during treatment; 2) relapse of chronic wet cough and/or cumulative antibiotic treatment during ≥12 months follow-up; 3) change in child's quality of life (parent-proxy reporting for young children); 4) emergence of antibiotic resistance; 5) development of bronchiectasis diagnosed on clinically indicated computed tomography scans; and 6) microbiological clearance of identified respiratory pathogen if samples readily available. CONCLUSIONS: We have developed a COS for PBB which will reduce the outcome heterogeneity and bias of future clinical trials, as well as promoting comparison between studies.