Program directors’ perceptions of importance of pediatric procedural skills and resident preparedness

Background The Royal College of Physicians and Surgeons of Canada (RCPSC) objectives for training in pediatrics include 26 procedural skills, 11 of which are included in the final in-training evaluation report (FITER). The importance of each procedure for practice and the preparedness of pediatric residency graduates to perform these procedures are not known. Methods A questionnaire was distributed to all pediatric residency program directors and members of the RCPSC Specialty Committee in Pediatrics (N = 21) in October 2010, requesting them to rate the perceived importance and preparedness of graduating pediatric residents in all procedural skills on a 5 point Likert scale, as well as the presence of a curriculum and documentation for each procedure. Mean importance and preparedness were calculated for each procedure. Results Response rate was 16/21 (76 %). Perceived preparedness was significantly lower than importance for the majority of procedures (p 3) but a low mean preparedness rating (<3). Presence of a curriculum and documentation for procedures varied across centers, and their presence was correlated with both perceived importance and preparedness (p < 0.0001). Conclusions Many procedures in which pediatric residents are required to be competent by the RCPSC are felt to be important. Residents are not felt to be adequately prepared in several of the required procedures by the time of graduation. Procedures with high ratings of importance but low preparedness ratings should be targeted for curricular interventions

Évaluation qualitative de la contribution des rôles CanMEDS dans la création de diplômes de domaine de compétence ciblée

Background: While many Area of Focused Competency (AFC) Diplomas are available to those who have completed Pediatric residency training, it is not known which competencies are enhanced within each AFC discipline. Our objective was to determine which CanMEDS roles were targeted by existing AFCs available to those who have completed Pediatric residency training and identify gaps within CanMEDs roles that may be fulfilled by the development of new AFCs. Methods: A qualitative study was undertaken using document analysis methodology to compare CanMEDS competencies across AFCs available to those with Royal College examination eligibility or certification in Pediatrics.  RCPSC Competency Training Requirements documents were used to compare and contrast the competencies in each AFC with competencies established in Pediatric residency training. Key and Enabling Competencies were compared for each CanMEDS role to identify differences. Results: Ten AFCs were identified with eligibility requirements including Royal College examination eligibility or certification in Pediatrics. All 10 AFCs included at least one new Medical Expert competency, for a total of 42 unique competencies in this role across all AFCs. The Scholar role had only 10 new competencies across seven AFCs, while only one AFC added a single unique competency in the Collaborator role. Conclusions: The majority of new competencies contributed by AFCs lie within the CanMEDS role of Medical Expert. The Scholar and Collaborator roles have the least differences when comparing competencies of existing AFCs to those competencies established in Pediatric residency training. Developing additional AFCs that offer advanced skills in these roles may help close this gap within the discipline of Pediatrics.Contexte : Bien que de nombreux diplômes de domaines de compétence ciblée (DCC) soient accessibles aux personnes ayant terminé leur résidence en pédiatrie, nous ne savons pas quelles sont les compétences qui sont approfondies dans chaque discipline de DCC. Notre objectif était de déterminer les rôles CanMEDS visés par les DCC actuellement accessibles aux personnes ayant terminé leur résidence en pédiatrie et de repérer les lacunes dans les rôles CanMEDS qui pourraient être comblées par l’élaboration de nouveaux DCC. Méthodes : Nous avons réalisé une étude qualitative au moyen d’analyse de documents pour comparer les compétences CanMEDS dans les DCC ouverts aux personnes admissibles à l’examen du Collège royal ou ayant une certification en pédiatrie. Les documents sur les exigences de formation du CRMCC ont été utilisés pour comparer les compétences de chaque DCC et les compétences visées dans le cadre de la formation postdoctorale en pédiatrie. Les compétences clés et les compétences habilitantes ont été comparées pour chaque rôle CanMEDS afin de repérer les différences. Résultats : Nous avons trouvé 10 DCC dont les conditions d’admissibilité comprennent l’admissibilité à l’examen du Collège royal ou la certification en pédiatrie. Chacun de ces 10 DCC comprenait au moins une nouvelle compétence d’expert médical et un total de 42 nouvelles compétences propres à ce rôle ont été répertoriées pour l’ensemble des DCC. Pour le rôle d’érudit, nous n’avons trouvé que 10 nouvelles compétences dans sept programmes de DCC, et pour celui de collaborateur, il n’y a qu’une nouvelle compétence dans un programme de DCC. Conclusions : La majorité des nouvelles compétences développées dans les DCC relèvent du rôle CanMEDS d’expert médical. Les rôles d’érudit et de collaborateur présentent le moins de différences lorsqu’on compare les compétences ciblées dans les DCC existants et celles visées dans le cadre de la formation postdoctorale en pédiatrie. La création de DCC supplémentaires permettant l’acquisition de compétences plus poussées dans ces rôles pourrait contribuer à combler cette carence au sein de la discipline de la pédiatrie

Exploring the lived experience of patients and families who speak language other than English (LOE) for healthcare: developing a qualitative study

Abstract Background Patients who use Languages other than English (LOE) for healthcare communication in an English-dominant region are at increased risk for experiencing adverse events and worse health outcomes in healthcare settings, including in pediatric hospitals. Despite the knowledge that individuals who speak LOE have worse health outcomes, they are often excluded from research studies on the basis of language and there is a paucity of data on ways to address these known disparities. Our work aims to address this gap by generating knowledge to improve health outcomes for children with illness and their families with LEP. Body We describe an approach to developing a study with individuals marginalized due to using LOE for healthcare communication, specifically using semi-structured qualitative interviews. The premise of this study is participatory research—our overall goal with this systematic inquiry is to, in collaboration with patients and families with LOE, set an agenda for creating actionable change to address the health information disparities these patients and families experience. In this paper we describe our overarching study design principles, a collaboration framework in working with different stakeholders and note important considerations for study design and execution. Conclusions We have a significant opportunity to improve our engagement with marginalized populations. We also need to develop approaches to including patients and families with LOE in our research given the health disparities they experience. Further, understanding lived experience is critical to advancing efforts to address these well-known health disparities. Our process to develop a qualitative study protocol can serve as an example for engaging this patient population and can serve as a starting point for other groups who wish to develop similar research in this area. Plain English Summary Providing high-quality care that meets the needs of marginalized and vulnerable populations is important to achieving an equitable, high-quality health care system. Children and families who use a Language other than English (LOE) in English dominant regions for healthcare have worse health outcomes including a significantly increased risk of experiencing adverse events, longer lengths of stay in hospital settings, and receiving more unnecessary tests and investigations. Despite this, these individuals are often excluded from research studies and the field of participatory research has yet to meaningfully involve them. This paper aims to describe an approach to conducting research with a marginalized population of children and families due to using a LOE. We detail protocol development for a qualitative study exploring the lived experiences of patients and families who use a LOE during hospitalization. We aim to share considerations when conducting research within this population of families with LOE. We highlight learning applied from the field of patient-partner and child and family-centred research and note specific considerations for those with LOE. Developing strong partnerships and adopting a common set of research principles and collaborative framework underlies our approach and initial learnings, which we hope spark additional work in this area

Program directors’ perceptions of importance of pediatric procedural skills and resident preparedness

Abstract Background The Royal College of Physicians and Surgeons of Canada (RCPSC) objectives for training in pediatrics include 26 procedural skills, 11 of which are included in the final in-training evaluation report (FITER). The importance of each procedure for practice and the preparedness of pediatric residency graduates to perform these procedures are not known. Methods A questionnaire was distributed to all pediatric residency program directors and members of the RCPSC Specialty Committee in Pediatrics (N = 21) in October 2010, requesting them to rate the perceived importance and preparedness of graduating pediatric residents in all procedural skills on a 5 point Likert scale, as well as the presence of a curriculum and documentation for each procedure. Mean importance and preparedness were calculated for each procedure. Results Response rate was 16/21 (76 %). Perceived preparedness was significantly lower than importance for the majority of procedures (p 3) but a low mean preparedness rating (<3). Presence of a curriculum and documentation for procedures varied across centers, and their presence was correlated with both perceived importance and preparedness (p < 0.0001). Conclusions Many procedures in which pediatric residents are required to be competent by the RCPSC are felt to be important. Residents are not felt to be adequately prepared in several of the required procedures by the time of graduation. Procedures with high ratings of importance but low preparedness ratings should be targeted for curricular interventions

Qualitative evaluation of the contribution of CanMEDS roles in the development of area of focused competence diplomas

Background: While many Area of Focused Competency (AFC) Diplomas are available to those who have completed Pediatric residency training, it is not known which competencies are enhanced within each AFC discipline. Our objective was to determine which CanMEDS roles were targeted by existing AFCs available to those who have completed Pediatric residency training and identify gaps within CanMEDs roles that may be fulfilled by the development of new AFCs.Methods: A qualitative study was undertaken using document analysis methodology to compare CanMEDS competencies across AFCs available to those with Royal College examination eligibility or certification in Pediatrics. RCPSC Competency Training Requirements documents were used to compare and contrast the competencies in each AFC with competencies established in Pediatric residency training. Key and Enabling Competencies were compared for each CanMEDS role to identify differences.Results: Ten AFCs were identified with eligibility requirements including Royal College examination eligibility or certification in Pediatrics. All 10 AFCs included at least one new Medical Expert competency, for a total of 42 unique competencies in this role across all AFCs. The Scholar role had only 10 new competencies across seven AFCs, while only one AFC added a single unique competency in the Collaborator role.Conclusions: The majority of new competencies contributed by AFCs lie within the CanMEDS role of Medical Expert. The Scholar and Collaborator roles have the least differences when comparing competencies of existing AFCs to those competencies established in Pediatric residency training. Developing additional AFCs that offer advanced skills in these roles may help close this gap within the discipline of Pediatrics.Contexte : Bien que de nombreux diplômes de domaines de compétence ciblée (DCC) soient accessibles aux personnes ayant terminé leur résidence en pédiatrie, nous ne savons pas quelles sont les compétences qui sont approfondies dans chaque discipline de DCC. Notre objectif était de déterminer les rôles CanMEDS visés par les DCC actuellement accessibles aux personnes ayant terminé leur résidence en pédiatrie et de repérer les lacunes dans les rôles CanMEDS qui pourraient être comblées par l’élaboration de nouveaux DCC.Méthodes : Nous avons réalisé une étude qualitative au moyen d’analyse de documents pour comparer les compétences CanMEDS dans les DCC ouverts aux personnes admissibles à l’examen du Collège royal ou ayant une certification en pédiatrie. Les documents sur les exigences de formation du CRMCC ont été utilisés pour comparer les compétences de chaque DCC et les compétences visées dans le cadre de la formation postdoctorale en pédiatrie. Les compétences clés et les compétences habilitantes ont été comparées pour chaque rôle CanMEDS afin de repérer les différences.Résultats : Nous avons trouvé 10 DCC dont les conditions d’admissibilité comprennent l’admissibilité à l’examen du Collège royal ou la certification en pédiatrie. Chacun de ces 10 DCC comprenait au moins une nouvelle compétence d’expert médical et un total de 42 nouvelles compétences propres à ce rôle ont été répertoriées pour l’ensemble des DCC. Pour le rôle d’érudit, nous n’avons trouvé que 10 nouvelles compétences dans sept programmes de DCC, et pour celui de collaborateur, il n’y a qu’une nouvelle compétence dans un programme de DCC.Conclusions : La majorité des nouvelles compétences développées dans les DCC relèvent du rôle CanMEDS d’expert médical. Les rôles d’érudit et de collaborateur présentent le moins de différences lorsqu’on compare les compétences ciblées dans les DCC existants et celles visées dans le cadre de la formation postdoctorale en pédiatrie. La création de DCC supplémentaires permettant l’acquisition de compétences plus poussées dans ces rôles pourrait contribuer à combler cette carence au sein de la discipline de la pédiatrie

MOESM1 of Program directors’ perceptions of importance of pediatric procedural skills and resident preparedness

Additional file 1. Pediatric procedural skills survey

Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study.

BACKGROUND: Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. OBJECTIVE: To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. DESIGN: Prospective Type 2 Hybrid effectiveness implementation study. SETTINGS AND PARTICIPANTS: Residents from diverse specialties across 32 hospitals (12 community, 20 academic). INTERVENTION: External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. MAIN OUTCOME AND MEASURES: Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality. RESULTS: 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p &lt; .05) and 17.5 to 9.3 minor events/person-year (p &lt; .001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p &lt; .001, n = 4812) and written (10% vs. 74%, p &lt; .001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p &lt; .001) and written (29% vs. 78%, p &lt; .001) patient summaries, verbal (29% vs. 78%, p &lt; .001) and written (24% vs. 73%, p &lt; .001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p &lt; .001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic)