RESULTS: Sixty-nine (95%) fellowship programs responded. Depending on individual needs, additional resources may be provided to learners before beginning the case. The team leader position was filled by whichever team member would potentially fill that role in an emergency setting. PMID: 29535873. Vital sign changes were demonstrated on the monitors. To improve health outcomes and survival for acutely ill and injured infants and children through simulation-based interventions and quality improvement processes. When the learners were ready, they were told that the patient had just been brought to the resuscitation room by emergency medical services and that the team had been called into the room. Three-year track for graduates of Pediatric residency programs; Two-year track for graduates of Emergency Medicine residency programs; Fellowship core educational activities occur on Tuesdays throughout the year. ImPACTS is a multi-centered, simulation-based education and QI program with an overarching goal to enhance preparedness of all hospitals’ emergency departments and provide high-quality pediatric emergency training to all health care practitioners caring for ill and injured children. Thirty-seven percent use simulation to evaluate procedural competency and resuscitation management. BACKGROUND AND OBJECTIVES: Graduate medical education faces challenges as programs transition to the next accreditation system. We also found it helpful to tailor the case to the needs of individual learners (e.g., providing less information to more advanced learners in order to provide a greater diagnostic challenge). It could also be modified to be run in a simulation lab. BACKGROUND AND OBJECTIVES: Graduate medical education faces challenges as programs transition to the next accreditation system. If circulation is impaired due to cardiac arrest or rhythm disturbance, high-quality CPR should be performed along with additional interventions such as epinephrine or electrical defibrillation as appropriate. This simulation case was designed to help learners build a framework for recognizing, managing, and treating the sequelae of electrical injury in the pediatric population. It is critical for providers at all levels to have an appropriate index of suspicion for electrical injury in order to promptly provide necessary interventions. Participants were also asked to assess their confidence with the stated learning objectives. We provided common code references such as Pediatric Advanced Life Support (PALS) cards, Broselow tape, and medication dosing for participants. Pediatric Grand Rounds at 8 a.m. is followed by ED divisional meetings. An early version of the case did not include moulage on the hand and foot, which led to a delay in learners bringing electrical injury into their differential. Pediatric Emergency Medicine Fellowship Director: Dr. Jennifer Chao Established in 2009, the program is led by an energetic and dynamic group of dedicated faculty determined to provide excellent clinical and academic training to our fellows. Of note, when we used this curriculum with pediatric residents and medical students, we tailored the learning objects to focus on high-quality CPR, rapid role assignment, defibrillation, and identification of hyperkalemia. In the case of electrical injury, the extent of the injuries is not always evident from an external exam, a fact that heightens the need to consider the diagnosis when appropriate. Improving Pediatric Acute Care through Simulation Administration of real medications and use of real equipment. Learners or confederates filled any open roles. Current limitations primarily involve faculty and funding, with equipment and dedicated space less significant than previously reported. Shared curricula and assessment tools, increased faculty and financial support, and regionalization could ameliorate barriers to incorporating simulation into PEM fellowships. 2018 January. Low-voltage injuries (< 1000 volts) tend to come from alternating current (AC) sources such as household outlets and electrical cords. If your organization uses OpenAthens, you can log in using your OpenAthens username and password. Operate a defibrillator and deliver the appropriate therapy. This was a pilot, prospective, single cohort, exploratory, observational study utilizing survey methodology and a convenience sample. 14–19 We chose to include attending physicians from various disciplines in the simulation when available in an effort to more effectively emulate reality. Standardized patients and some partial task trainers, such as intubation heads, have been used for decades. When possible, trainees and facilitators transitioned to a debriefing room or area separate from the mannequin after the scenario was complete in order to review the case without the learners being distracted by the equipment. PEDIATRIC SIMULATION IN EMERGENCY MEDICINE RESIDENCY TRAINING. 2014-2017 The PEM program is part of SUNY Downstate Medical Center, a large tertiary medical center. These include the pediatric intern procedure workshop, the pediatric resident case conference, pediatric resident simulation cases, the emergency medicine morning conference, and emergency medicine resident lectures. The patient was unresponsive and being manually ventilated with a bag-mask by the emergency medical technician when the participants arrived. Attribution-NonCommercial-No Derivatives license. It encouraged active learning by providing the opportunity to practice resuscitation, teamwork, and communication skills. Determining content for a simulation-based curriculum in pediatric emergency medicine: results from a national Delphi process - Volume 17 Issue 6 - … Running the case multiple times in different settings was important to guide revisions to the scenario. You will be redirected to aap.org to login or to create your account. Access to this article can also be purchased. Emergency Medicine International. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Pediatric … This study aims to describe the current use of simulation and barriers to its implementation in pediatric emergency medicine (PEM) fellowship programs. The Emergency Medicine Simulation program devotes a great deal of energy and time to educate residents in the management of pediatric emergencies through the use of high fidelity simulation. While rare in the pediatric population, they can present with a variety of complications, including deep burns, indirect trauma, secondary electrolyte abnormalities, cardiac arrhythmia, respiratory failure, and death. This simulation scenario allows the learner to practice recognizing and managing injuries and cardiac/electrolyte abnormalities that may result from exposure to high-voltage electricity. Although the majority of electrical injuries in adults occur from high-voltage exposures in the workplace,1 pediatric patients can present with a mix of low-voltage and high-voltage injuries that range from benign to life-threatening in their severity. PowerPoint slides Appendix H were used to assist the instructor in delivering information about electrical injury and management of the various sequelae that could be encountered. This one-day simulation-based teaching program is a QCHP approved CME activity with category 1 & 3 points. A compendium of 16 peer-reviewed, simulation cases as a standardized national pediatric curriculum for all emergency medicine (EM) residency programs, based on high-priority pediatric … The simulation provides structured education in the management of a critically ill pediatric patient and the development of a differential in real time, while challenging learners to effectively manage an airway and support ventilation and oxygenation, provide high-quality CPR, defibrillate pulseless ventricular tachycardia, and manage fluids and hyperkalemia, skills that are relevant in other circumstances outside of electrical injury. Finally, learners were each asked to fill out the evaluation form Appendix G to provide feedback on the structure and content of the simulation. PECARN is a federally funded pediatric emergency medicine research network conducting multi-institutional research on the prevention and management of acute illness and injuries in children and youth of all ages. The target audiences are the groups most likely to encounter this type of emergency: pediatric and emergency medicine residents, pediatric emergency medicine fellows and attendings, pediatric nurses, and medical students. The case can be used to supplement other simulation-based curricula from the Pediatric Emergency Medicine Simulation Curriculum5–18 or as a stand-alone unit. CONCLUSIONS: PEM fellowships have rapidly integrated simulation into their curricula over the past 5 years. The Society for Academic Emergency Medicine (SAEM) has a FREE Simulation Case Library for sharing Emergency Medicine based case scenarios available here *Link Updated (March 2017) Some of the cases are AAMC peer reviewed... what a great resource! The evolution of high-fidelity simulators has led to a surge of enhanced medical applications that fit nicely into the core of emergency medicine training. We used a high-fidelity adult mannequin with burn injuries applied to the right hand and left foot. There is a growing need for comprehensive, patient-centred medical services for children in Qatar. We then distributed the simulation session evaluation form Appendix G to obtain learner evaluations and feedback on the session itself. The TeamSTEPPS glossary Appendix E was used to focus on a common vocabulary. BASE Camp brings together an expert multidisciplinary collaborative of pediatric emergency medicine, emergency medicine, critical care, surgery, anesthesia, and child life faculty and nurses to help you practice teamwork behaviors and critical pediatric emergency airway and trauma skills The debriefing guide Appendix F, which focuses on medical management evaluation and teamwork and communication evaluation, was used to provide formative feedback to the learners, as introduced above. We have utilized this curriculum over 3 years with various learners. We have a staff of physicians, biostatisticians and research coordinators to help fellows complete their research requirements. This simulation-based curriculum was designed to provide learners the opportunity to practice recognition and management of a critically ill pediatric electrical injury patient in a realistic setting. The feedback received throughout this process was overwhelmingly positive at all levels of learners, and this case will continue to be used as part of our simulation curriculum moving forward. Debriefing was a critical component of the simulation session that allowed for identification and exploration of lessons learned during the scenario. See Table 1 for results. Monitors were available but not attached to the mannequin, and their screens were blank at the outset of the case. We also challenged the pediatric emergency medicine fellows to manage hyperkalemia as well as establish a disposition plan for the patient. This simulation scenario can be adjusted to accommodate three to seven trainees per session, with a target audience of pediatric emergency medicine health care providers, including pediatric, family medicine, and emergency medicine residents, fellows, attending physicians, respiratory therapists, and … Injuries from these are more common in younger children (< 6 years old).2–4 High-voltage injuries can be the result of AC contact but more often are the result of direct current sources such as batteries, train tracks, or a lightning strike. Finally, a comprehensive set of respiratory supplies was at the bedside, including nasal cannulas, oxygen hook-up, oral/nasal airways, bag-mask system, suction devices, endotracheal tubes, laryngoscope with Miller/Mac blades, and end-tidal CO2 colorimeter. Bedside equipment including monitors, stethoscopes, IV/IO supplies, gauze, syringes, and code equipment such as a crash cart, backboard, and defibrillator was provided. Teenage patients are at higher risk for severe, adult-pattern injuries.2,3 Males are more often affected in all age groups.2. While there are published peer-reviewed cases pertaining to arrhythmias including ventricular tachycardia in pediatric patients, there are no other published cases that specifically address the presentation and sequelae of electrical injury. This study aims to describe the current use of simulation and barriers to its implementation in pediatric emergency medicine (PEM) fellowship programs. Programs receive simulation funding from hospitals (47%), academic institutions (22%), and PEM revenue (17%), with 22% reporting no direct simulation funding.
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