Pediatric Resuscitation: Evaluation of a Clinical Curriculum

Objective: To assess the impact of a 6-hour pediatric resuscitation curriculum on the comfort levels of resident physicians’ evaluation and treatment of critically ill pediatric patients. Methods: An evaluation instrument assessed resident comfort levels, measured on a seven digit Likert scale ranging from significantly uncomfortable to significantly comfortable, in 13 areas of pediatric resuscitation. To complete the curriculum, residents had to demonstrate proficiency in knowledge and procedural skills during mock resuscitation scenarios and on both written and oral examinations. Results: Thirty-one residents participated in the study: 51.6% were pediatric, 12.9% were medicine/pediatric and 35.5% were emergency medicine residents. Participants in the curriculum had little previous experience with pediatric resuscitation (83% had been involved in five or fewer pediatric resuscitations). In all 13 areas of pediatric resuscitation tested, residents reported improvement in comfort levels following the course (p<0.002; Wilcoxon Signed Rank Tests). The most significant changes were observed for the following items: resuscitation of pulseless arrest, performance of cardioversion and defibrillation, performance of intraosseous needle insertion, and drug selection and dosing for rapid sequence intubation. Fewer than 48% of learners rated themselves as comfortable in these areas prior to training, but after completion, more than 80% rated themselves in the comfortable range. All residents but one received passing scores on their written examinations (97%). During the mock resuscitation scenarios and oral examination, 100% of the residents were assessed to have ‘completely’ met the learning objectives and critical actions Conclusion: Implementation of a pediatric resuscitation curriculum improves pediatric and emergency medicine residents’ comfort with the evaluation and treatment of critically ill pediatric patients. This curriculum can be used in residency training to document the acquisition of core competencies, knowledge and procedural skills needed for the evaluation and treatment of the critically ill child. The results reported in this study support using this model of instructional design to implement educational strategies, which will meet the requirements of graduate education

The First Five Minutes: Enhancing Simulation Education for First-Year Pediatric Residents

We are looking at the feasibility of redesigning the existing simulation education for first-year residents within the Children’s Hospital of Richmond at VCU’s pediatric residency program to increase learning opportunities and to enhance exposure to pediatric medical emergencies. Novel simulation scenarios were designed to provide an introduction to managing the first five minutes of commonly encountered emergencies on the inpatient wards. These shortened simulations allow for educational objectives to be tailored to the expected knowledge and responsibilities of first-year residents

Improving Emergency Response in the Outpatient Clinic Setting

Background: Effective triage, assessment, and activation of necessary systems in emergent situations of clinical instability is vital in reducing morbidity and mortality of patients in any clinical setting. When medical emergencies occur outside of the hospital, organized and expedited transfer to a higher level of care reduces the potential for adverse events, lasting deficits, and patient death. Aim: The aim of this project was to identify weaknesses in the emergency response system in the community-based outpatient clinic setting and to propose solutions. Methods: The “Swiss Cheese” theoretical framework was used to do a root cause analysis of two clinical scenarios. Weaknesses in the emergency response system in the community-based outpatient clinic setting were identified. Results: Several tools were utilized including a fish bone diagram and the 5-Whys tool. Two root causes were identified. The first is that clinic staff does not have a working knowledge with specifics regarding the emergency response process. The second is that the existing emergency response checklist document is visually confusing and duties are not in sequence. Discussion and Implications for the CNL: Weaknesses in the emergency response system will be discussed. Knowledge and experience from inpatient care will be translated to the outpatient clinic setting. The role of the CNL in designing an effective emergency response system will be discussed with the proposal of several plans of action

Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrest.

IntroductionIn-hospital cardiac arrest (IHCA) is a particularly vexing entity from the perspective of preparedness, as it is neither common nor truly rare. Survival from IHCA requires the coordinated efforts of multiple providers with different skill sets who may have little prior experience working together. Survival rates have remained low despite advances in therapy, suggesting that human factors may be at play.Methods and analysisThis qualitative study uses a quasiethnographic data collection approach combining focus group interviews with providers involved in IHCA resuscitation as well as analysis of video recordings from in situ-simulated cardiac arrest events. Using grounded theory-based analysis, we intend to understand the organisational, interpersonal, cognitive and behavioural dimensions of IHCA resuscitation, and to build a descriptive model of code team functioning.Ethics and disseminationThis ongoing study has been approved by the IRB at UC Davis Medical Center.ResultsThe results will be disseminated in a subsequent manuscript

Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach

© 2015 Zimmermann et al.Background: Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. Methods: We designed and implemented a team and resuscitation training program according to Kerns six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleutens conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. Results: The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Childrens Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. Conclusions: The programmatic approach of Kerns six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program

Learning to Associate Words and Images Using a Large-scale Graph

We develop an approach for unsupervised learning of associations between co-occurring perceptual events using a large graph. We applied this approach to successfully solve the image captcha of China's railroad system. The approach is based on the principle of suspicious coincidence. In this particular problem, a user is presented with a deformed picture of a Chinese phrase and eight low-resolution images. They must quickly select the relevant images in order to purchase their train tickets. This problem presents several challenges: (1) the teaching labels for both the Chinese phrases and the images were not available for supervised learning, (2) no pre-trained deep convolutional neural networks are available for recognizing these Chinese phrases or the presented images, and (3) each captcha must be solved within a few seconds. We collected 2.6 million captchas, with 2.6 million deformed Chinese phrases and over 21 million images. From these data, we constructed an association graph, composed of over 6 million vertices, and linked these vertices based on co-occurrence information and feature similarity between pairs of images. We then trained a deep convolutional neural network to learn a projection of the Chinese phrases onto a 230-dimensional latent space. Using label propagation, we computed the likelihood of each of the eight images conditioned on the latent space projection of the deformed phrase for each captcha. The resulting system solved captchas with 77% accuracy in 2 seconds on average. Our work, in answering this practical challenge, illustrates the power of this class of unsupervised association learning techniques, which may be related to the brain's general strategy for associating language stimuli with visual objects on the principle of suspicious coincidence.Comment: 8 pages, 7 figures, 14th Conference on Computer and Robot Vision 201

Effects of Mock Code Blue Simulations on Interdisciplinary Team Response and Confidence

Objective: To identify the relationship between performing mock code blue simulations and overall interdisciplinary response time and confidence. Design: Quasi-Experimental, Descriptive Setting: Hays Medical Center Participants: Health Care Providers Methods: During a three-month period, Hays Medical Center healthcare providers will undergo mock code blue simulations to improve response times and increase interdisciplinary team confidence levels. This study will identify the relationship both before and after implementation of mock code blue simulations. The same 100 health care providers will be observed for response times before implementation of the mock code blue simulation, and then will be observed again following a three-month training period with mock code blue simulations. In addition, the sample will voluntarily participate in a pre- and post-survey to identify self-perception of confidence levels in responding to mock code blue simulations using a visual analogue scale (VAS). Results/Conclusion: Pending results and data collection

Evaluation of a web-based portal to improve resident education by neonatology fellows

Background: Integration of web-based educational tools into medical training has been shown to increase accessibility of resources and optimize teaching. We developed a web-based educational portal (WBEP) to support teaching of pediatric residents about newborn medicine by neonatology fellows. Objectives: 1) To compare residents’ attitudes about their fellow-led education in the NICU pre- and post-WBEP; including assessment of factors that impact their education and usefulness of teaching tools. 2) To compare fellow utilization of various teaching modalities pre- and post-WBEP. Design/methods We queried residents about their attitudes regarding fellow-led education efforts and various teaching modalities in the NICU and logistics potentially impacting effectiveness. Based on these data, we introduced the WBEP – a repository of teaching tools (e.g., mock code cases, board review questions, journal articles, case-based discussion scenarios) for use by fellows to supplement didactic sessions in a faculty-based curriculum. We surveyed residents about the effectiveness of fellow teaching pre- and post-WBEP implementation and the type of fellow-led teaching modalities that were used. Results: After analysis of survey responses, we identified that residents cited fellow level of interest as the most important factor impacting their education. Post-implementation, residents described greater utilization of various teaching modalities by fellows, including an increase in use of mock codes (14% to 76%, p<0.0001) and journal articles (33% to 59%, p=0.02). Conclusions: A web-based resource that supplements traditional curricula led to greater utilization of various teaching modalities by fellows and may encourage fellow involvement in resident teaching

Orchestrating the future of clinical care

2005 Annual report of Thomas Jefferson University

Announcements

Announcements include congratulations to JCIPE\u27s Fall 2010 Interprofessional Education and Care Practicum Pilot Award Recipients, 2011 International Essay Contest on Interprofessionalism and upcoming Faculty and Staff Development Programs