Virtual Reality for Pediatric Sedation: A Randomized Controlled Trial Using Simulation.

INTRODUCTION: Team training for procedural sedation for pediatric residents has traditionally consisted of didactic presentations and simulated scenarios using high-fidelity mannequins. We assessed the effectiveness of a virtual reality module in teaching preparation for and management of sedation for procedures. METHODS: After developing a virtual reality environment in Second Life® (Linden Lab, San Francisco, CA) where providers perform and recover patients from procedural sedation, we conducted a randomized controlled trial to assess the effectiveness of the virtual reality module versus a traditional web-based educational module. A 20 question pre- and post-test was administered to assess knowledge change. All subjects participated in a simulated pediatric procedural sedation scenario that was video recorded for review and assessed using a 32-point checklist. A brief survey elicited feedback on the virtual reality module and the simulation scenario. RESULTS: The median score on the assessment checklist was 75% for the intervention group and 70% for the control group (P = 0.32). For the knowledge tests, there was no statistically significant difference between the groups (P = 0.14). Users had excellent reviews of the virtual reality module and reported that the module added to their education. CONCLUSIONS: Pediatric residents performed similarly in simulation and on a knowledge test after a virtual reality module compared with a traditional web-based module on procedural sedation. Although users enjoyed the virtual reality experience, these results question the value virtual reality adds in improving the performance of trainees. Further inquiry is needed into how virtual reality provides true value in simulation-based education.

Association between practice setting and pediatric hospitalist career satisfaction.

BACKGROUND: Pediatric hospital medicine has become a viable long-term career choice. To retain qualified physicians, both academic and community hospital leaders seek to improve their job satisfaction. OBJECTIVE: The goal of this study was to determine whether practice in a community versus academic setting is associated with pediatric hospitalists' career satisfaction. METHODS: The study was based on data from an anonymous electronic cross-sectional survey sent to the American Academy of Pediatrics Section on Hospital Medicine Listserv between November 2009 and January 2010. Questions were rated on a standard 5-point Likert scale. A total career satisfaction score was calculated for each respondent by summing across all 23 questions. Multivariate logistic regression was conducted to assess job satisfaction according to practice setting. RESULTS: A total of 222 pediatric hospitalists responded. Sixty-six percent of respondents practiced in an academic setting and 34% in a community hospital. Fifty-eight percent of academic and 42% of community hospitalists were satisfied with their careers, defined as a mean per-question Likert score > or = 4. Adjusting for gender, average daily census, percentage of complex patients, years as a hospitalist, and years since residency graduation, academic hospitalists were more likely than community hospitalists to be satisfied with their careers (adjusted odds ratio: 2.43 [95% confidence interval: 1.25-4.72]; P = .009). CONCLUSIONS: Pediatric hospitalists practicing in academic settings seem more likely to be satisfied with their careers than those in a community hospital. Overall, however, there is room for improvement in career satisfaction for both groups. Further study is warranted to confirm and clarify these findings on a larger scale, perhaps with oversampling of community hospitalists.

Career satisfaction and the role of mentorship: a survey of pediatric hospitalists.

BACKGROUND AND OBJECTIVE: Attending physicians' career satisfaction is associated with higher patient satisfaction, better patient care, and even medical student career choice. Previous studies indicate that adequate mentorship improves job satisfaction, but finding mentors may be challenging for some hospitalists. Little is known about pediatric hospitalist career satisfaction or the role of mentorship. The goal of this study was to assess career satisfaction among pediatric hospitalists, determine which interventions may improve satisfaction, and investigate the role of mentorship in satisfaction. METHODS: This study included the use of an anonymous electronic cross-sectional survey sent to the American Academy of Pediatrics' Section on Hospital Medicine Listserv between November 2009 and January 2010. RESULTS: A total of 222 pediatric hospitalists responded; 92% agreed with the statement, "Overall, I am pleased with my work." Of the 23 satisfaction statements, "I have adequate mentorship in my career" was rated lowest (< or = .001); only 44% agreed. Adequate mentorship was significantly correlated with overall career satisfaction, having sufficient opportunity for promotion, feeling valued by one's administration, and wishing to remain at one's current hospital. Adequate mentorship was negatively correlated with planning to change specialty or leave clinical medicine. Mentorship satisfaction did not differ by age, years as a hospitalist, gender, or practice setting. Of the 15 potential interventions, creating a formal mentorship program ranked in the top 5. Only increasing base salary received a significantly higher score. CONCLUSIONS: Although surveyed hospitalists have substantial overall career satisfaction, lack of mentorship is a significant problem that spans the demographic spectrum. Establishing a mentorship program may be an effective way for hospitalist groups to improve satisfaction.