Differential Diagnosis: Approaches and Pitfalls - A Pediatric Case-Based Session for 3rd Year Medical Students

This ninety minute session seeks to provide a systematic framework for medical students relatively new to the differential diagnosis process. Via a combined lecture/case-based approach, the session presents basic clinical reasoning concepts and specific heuristics to guide the differential process followed by an opportunity to apply the tools to simulated pediatric cases. It also introduces the concept of cognitive biases and presents strategies to mitigate their effects. The session has been successfully used with third year medical students during the first week of their pediatrics clerkship. However, with minor adaptation, a similar approach could be used at other levels of medical training or in other clinical settings. For over 4 years, this session has been given to third year pediatric clerkship students at the George Washington University School of Medicine and Health Sciences, during the first week of their pediatric clerkship at Children\u27s National Medical Center. Between 25-35 students typically participate in the session. Students are asked to provide feedback about teaching effectiveness, and the session has routinely been very well received with average ratings over 4.8 out of 5 (maximum)

Written and Online Residency Guidebook to Improve Resident Efficiency and Knowledge of Best Patient Care Practices

**Contains time-sensitive information that will likely be inaccurate, obsolete, or irrelevant by December 01, 2018** Residents at most institutions change rotations every 2 to 4 weeks. It often takes significant time for residents to become acclimated to the different protocols, expectations, and environments of each unique rotation. As a result, residents often spend time searching for answers, time that could be spent in outside learning and direct patient care. The goal of this resource is to provide a novel guidebook that improves residents’ efficiency and knowledge of best patient care practices. The guidebook begins with an introductory chapter with key contact information that can be filled in for the user’s institution, which is followed by 16 rotation-specific chapters. A rotation-based approach was chosen as it focuses the content on the most pertinent information. Thus, trainees can quickly read a chapter to cover the most pertinent content for their current rotation. As a surrogate marker for efficiency, noon-conference attendance logs were queried to assess improvement in on-time attendance after introduction of the guidebook. After introduction of the learning resources, on-time arrival to noon conference improved for all residents and interns. Guidebook survey results were universally favorable; however, around half of respondents stated that they used the guidebook once or less per rotation. Underutilization of these resources potentially contributed to the lack of a statistically significant improvement overall. Future directions should focus on augmenting the quality and utilization of the guidebook and then reevaluating if, once well adopted, there is a sustained benefit. AAMC MedEdPORTAL publication ID 10424. Link to origina

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

Virtual Coaching and Deliberate Practice to Enhance Medical Students\u27 Clinical Reasoning during Oral Case Presentations

ABSTRACT: Introduction Oral case presentations (OP) provide an opportunity for medical students to practice clinical reasoning and communication skills, and for faculty to provide assessment. Specific teaching strategies are needed to improve students’ OP skills. Objective To compare the effectiveness of Virtual Coaching (VC) to Small Group (SG) discussion or Traditional Feedback (TF/control) in improving clinical reasoning during OP, using a validated PBEAR (Problem Representation, Background Evidence, Analysis, Recommendation) tool. Design/Methods Students from two medical schools were randomly assigned to three groups during their inpatient pediatric clerkship. All completed an eLearning module about using illness scripts to promote clinical reasoning and presenting in the PBEAR format. TF/control students completed online “Aquifer” cases; VC students recorded abstracted data from the same cases with on-line faculty feedback and self-reflection; SG students attended faculty facilitated discussions of the same cases. Students were video recorded presenting pre- and post-curriculum cases. Reviewers blinded to assignment groups rated pre and post videos with the PBEAR OP tool. Results The overall score and sub-scale scores improved for all groups. VC students significantly improved in the Analysis subscale compared to SG or controls. Students rated the SG teaching sessions as more enjoyable and effective in improving their clinical reasoning and presentation skills. Conclusions A blended learning curriculum using VC significantly improved students’ clinical reasoning as assessed by the Analysis subscale

Development of Maine Ongoing Outreach Simulation Education (MOOSE), a Novel Telesimulation Program, to Improve Neonatal Resuscitation in a Rural Community Hospital

Objective- To implement monthly neonatal resuscitation telesimulation team training sessions in a rural community hospital delivery room that is feasible, sustainable, and replicable at other sites.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1010/thumbnail.jp

A Simulation-Based Outreach Program Improves Delivery Room Team Confidence in Neonatal Resuscitation at Rural Community Hospitals

Objective- Our goal is to pilot the use of an onsite Neonatal Community Outreach Education Program to improve provider confidence with procedural skills and neonatal resuscitation in the delivery room.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1008/thumbnail.jp

An educational intervention to facilitate appropriate subspecialty referrals: a study assessing resident communication skills

BACKGROUND: Our goal was to improve pediatric residents\u27 advanced communication skills in the setting of referral to address the entrustable professional activity of subspecialty referral identified by the American Board of Pediatrics. To accomplish this aim, we created a referral and consultation curriculum to teach and assess core communication skills in subspecialty referral involving an adolescent with syncope, an anxiety-provoking symptom that is rarely associated with serious pathology. METHODS: We utilized blended multimodal educational interventions to improve resident communication skills in referral of patients. Trainees participated in 1) an interactive online module on syncope focusing on red-flag symptoms that would warrant a subspecialty cardiology referral and 2) a 4-h intervention with Standardized Parents (SPs), focusing on the case-based application of communication skills. Communication skills were assessed by two pre- and post- Objective Structured Clinical Examination encounters of patients with syncope, with an SP evaluation using a 20-item checklist. Analysis was performed with Sign test and McNemar\u27s test. Trainees provided feedback on a Critical Incident Questionnaire, which was analyzed qualitatively. RESULTS: Sixty-four residents participated. There was an overall improvement in communication skills based on SP scores (82.7 ± 10.9% to 91.7 ± 5.0%, p \u3c 0.001), and 13/20 items demonstrated significant improvement post-intervention. Residents\u27 improved performance enabled them to address patient/family emotions, explain referral logistics, and clarify concerns to agree on a plan. CONCLUSIONS: By participating in this curriculum, residents\u27 communication skills improved immediately post-intervention. Further research is needed to assess if this intervention improves patient care by providing residents with enduring skills to judiciously manage the referral process

An educational intervention to facilitate appropriate subspecialty referrals: a study assessing resident communication skills

BACKGROUND: Our goal was to improve pediatric residents\u27 advanced communication skills in the setting of referral to address the entrustable professional activity of subspecialty referral identified by the American Board of Pediatrics. To accomplish this aim, we created a referral and consultation curriculum to teach and assess core communication skills in subspecialty referral involving an adolescent with syncope, an anxiety-provoking symptom that is rarely associated with serious pathology. METHODS: We utilized blended multimodal educational interventions to improve resident communication skills in referral of patients. Trainees participated in 1) an interactive online module on syncope focusing on red-flag symptoms that would warrant a subspecialty cardiology referral and 2) a 4-h intervention with Standardized Parents (SPs), focusing on the case-based application of communication skills. Communication skills were assessed by two pre- and post- Objective Structured Clinical Examination encounters of patients with syncope, with an SP evaluation using a 20-item checklist. Analysis was performed with Sign test and McNemar\u27s test. Trainees provided feedback on a Critical Incident Questionnaire, which was analyzed qualitatively. RESULTS: Sixty-four residents participated. There was an overall improvement in communication skills based on SP scores (82.7 ± 10.9% to 91.7 ± 5.0%, p \u3c 0.001), and 13/20 items demonstrated significant improvement post-intervention. Residents\u27 improved performance enabled them to address patient/family emotions, explain referral logistics, and clarify concerns to agree on a plan. CONCLUSIONS: By participating in this curriculum, residents\u27 communication skills improved immediately post-intervention. Further research is needed to assess if this intervention improves patient care by providing residents with enduring skills to judiciously manage the referral process