Boston Children's Hospital (K Huth), Boston, Mass.
Children's Hospital of Eastern Ontario, University of Ottawa (T Audcent, N Major, and K Issa), Ottawa, Ontario, Canada.
Acad Pediatr. 2020 Mar;20(2):282-289. doi: 10.1016/j.acap.2019.09.002. Epub 2019 Sep 12.
Children with medical complexity (CMC) are a growing population, yet training in complex care varies across pediatric residency programs. The purpose of this study was 1) to evaluate the effectiveness of a curriculum for pediatric residents in improving performance in a simulated clinical scenario, and 2) to explore residents' perceived self-efficacy in caring for CMC.
A randomized controlled trial was conducted supplemented by qualitative inquiry. Pediatric residents from 2 residency programs were randomly assigned to participate in interactive modules on: 1) clinical assessment, care planning, and technological dependency or 2) noncomplex care topics. The primary outcome was mean score on an Observed Structured Clinical Examination (OSCE) of tracheostomy care. Semistructured interviews were conducted postintervention and analyzed using qualitative content analysis.
Ninety-four eligible residents were randomized. Residents who attended all modules and the OSCE and consented to participate (intervention [n = 20] and control [n=24]) were included in the final analysis. At baseline, few (9%) reported being comfortable caring for CMC. There was no significant difference in mean OSCE score between intervention and control groups (39.0 ± 1.1 vs 38.0 ± 1.0, P = .48). Qualitative analysis revealed 3 emerging themes related to resident self-efficacy: building a system of care, navigating uncertainty, and professional identity formation.
A standardized complex care curriculum delivered in a classroom setting did not lead to improved performance in an OSCE station despite increased resident-reported self-efficacy in approaching care for CMC. These findings highlight the need for multidimensional educational interventions and assessments in complex care.
患有复杂疾病的儿童（CMC）的数量在不断增加，但儿科住院医师培训计划中的复杂护理培训却各不相同。本研究的目的是：1）评估儿科住院医师复杂护理课程对提高模拟临床情景下表现的有效性；2）探讨住院医师照顾 CMC 的自我效能感。
一项随机对照试验，辅以定性研究。从 2 个住院医师培训计划中随机抽取儿科住院医师，参加以下 2 个互动模块的培训：1）临床评估、护理计划和技术依赖性；或 2）非复杂护理主题。主要结局指标为气管切开护理的观察结构化临床考试（OSCE）的平均得分。干预后进行半结构化访谈，并采用定性内容分析法进行分析。
94 名符合条件的住院医师被随机分组。参加了所有模块和 OSCE 并同意参与的住院医师（干预组[n=20]和对照组[n=24]）被纳入最终分析。基线时，很少（9%）报告对照顾 CMC 感到舒适。干预组和对照组的 OSCE 平均得分无显著差异（39.0±1.1 vs 38.0±1.0，P=0.48）。定性分析揭示了与住院医师自我效能感相关的 3 个主题：建立护理系统、应对不确定性和职业身份形成。
尽管住院医师对照顾 CMC 的自我效能感有所提高，但在课堂环境中提供的标准化复杂护理课程并未导致 OSCE 成绩提高。这些发现突出了在复杂护理中需要多维教育干预和评估。
