Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA.
Department of Anaesthesia, Harvard Medical School, Boston, MA.
Pediatr Crit Care Med. 2020 Sep;21(9):e769-e775. doi: 10.1097/PCC.0000000000002504.
To assess the current state of nutrition education provided during pediatric critical care medicine fellowship.
Cross-sectional survey.
Program directors and fellows from pediatric critical care medicine fellowship programs in America and Canada.
Seventy current pediatric critical care medicine fellows and twenty-five pediatric critical care medicine fellowship program directors were invited to participate.
Participants were asked demographic questions related to their fellowship programs, currently utilized teaching methods, perceptions regarding adequacy and effectiveness of current nutrition education, and levels of fellow independence, comfort, confidence, and expectations in caring for the nutritional needs of patients.
Surveys were sent to randomly selected program directors and fellows enrolled in pediatric critical care medicine fellowship programs in America and Canada. Twenty program directors (80%) and 60 fellows (86%) responded. Ninety-five percent of programs (19/20) delivered a formal nutrition curriculum; no curriculum was longer than 5 hours per academic year. Self-reported fellow comfort with nutrition topics did not improve over the course of fellowship (p = 0.03), with the exception of nutritional aspects of special diets. Sixty-five percent of programs did not hold fellows responsible for writing daily parenteral nutrition prescriptions. There was an inverse relationship between total number of fellows in a pediatric critical care medicine program and levels of comfort in ability to provide parenteral nutrition support (p = 0.01). Program directors perceived their nutritional curriculum to be more effective than did their fellows (p ≤ 0.001).
Nutrition education was reported as highly underrepresented in pediatric critical care medicine fellowship curricula. The majority of programs rely on allied health care professionals to prescribe parenteral nutrition, which may influence trainee independence in the provision of nutritional therapies. Improving the format of current nutrition curriculums, by relying on more active teaching methods, may improve the delivery and efficacy of nutrition education. The impact of novel training interventions on improving the competency and safety of enteral and parenteral nutrition delivery in the PICU must be further examined.
评估小儿危重病医学 fellowship期间提供的营养教育现状。
横断面调查。
美国和加拿大的小儿危重病医学 fellowship计划的项目主任和研究员。
邀请了 70 名当前的小儿危重病医学研究员和 25 名小儿危重病医学 fellowship项目主任参加。
参与者被问及与他们的 fellowship 项目相关的人口统计学问题、当前使用的教学方法、对当前营养教育的充分性和有效性的看法、以及研究员在照顾患者营养需求方面的独立性、舒适度、信心和期望水平。
向美国和加拿大的小儿危重病医学 fellowship项目中随机选择的项目主任和研究员发送了调查。20 名项目主任（80%）和 60 名研究员（86%）做出了回应。95%的项目（19/20）提供了正式的营养课程；没有课程每年超过 5 小时。随着 fellowship 的进行，研究员对营养主题的舒适度并没有改善（p=0.03），除了特殊饮食的营养方面。65%的项目不要求研究员负责书写每日肠外营养处方。小儿危重病医学计划中的研究员人数与提供肠外营养支持的能力舒适度呈反比关系（p=0.01）。项目主任认为他们的营养课程比他们的研究员更有效（p≤0.001）。
营养教育在小儿危重病医学 fellowship课程中被报告为严重不足。大多数项目依赖于医疗保健专业人员来开处肠外营养处方，这可能会影响学员在提供营养治疗方面的独立性。通过采用更积极的教学方法来改进当前营养课程的形式，可能会提高营养教育的提供和效果。必须进一步研究新的培训干预措施对改善儿科重症监护病房肠内和肠外营养输送的能力和安全性的影响。
