Eibensteiner Fabian, Ritschl Valentin, Valent Isabella, Schaup Rebecca Michaela, Hellmann Axana, Kaltenegger Lukas, Daniel-Fischer Lisa, Oviedo Flores Krystell, Brandstaetter Stefan, Stamm Tanja, Schaden Eva, Aufricht Christoph, Boehm Michael
Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.
Front Pediatr. 2022 May 16;10:851033. doi: 10.3389/fped.2022.851033. eCollection 2022.
Children with medical complexity (CMC) are prone to medical errors and longer hospital stays, while residents do not feel prepared to provide adequate medical care for this vulnerable population. No educational guidance for the training of future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC exists. We investigated pediatric residents past educational needs and challenges to identify key learning content for future training involving care for CMC.
This was a prospective mixed-methods study at a single pediatric tertiary care center. Qualitative semi-structured interviews with residents were conducted, submitted to thematic content analysis, linked to the American Board of Pediatrics (ABP) general pediatrics content outline, and analyzed with importance performance analysis (IPA). Quantitative validation was focused on key themes of pediatric nephrology within the scope of an online survey among pediatric residents and specialists.
A total of 16 interviews, median duration 69 min [interquartile range IQR 35], were conducted. The 280 listed themes of the ABP general pediatrics content outline were reduced to 165 themes, with 86% (theoretical) knowledge, 12% practical skills, and 2% soft skills. IPA identified 23 knowledge themes to be of high importance where improvement is necessary and deemed fruitful. Quantitative validation among 84 residents and specialists (response rate 55%) of key themes in nephrology yielded high agreement among specialists in pediatric nephrology but low interrater agreement among trainees and "trained" non-nephrologists. The occurrence of themes in the qualitative interviews and their calculated importance in the quantitative survey were highly correlated (tau = 0.57, = 0.001). Two clusters of high importance for other pediatric specialties emerged together with a contextual cluster of frequent encounters in both in- and outpatient care.
Regarding patient safety, this study revealed the heterogeneous aspects and the importance of training future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC. Our results may lay the groundwork for future detailed analysis and development of training boot camps that might be able to aid the improvement of patient safety by decreasing preventable harm by medical errors, especially for vulnerable patient groups, such as CMC in tertiary care pediatrics.
患有复杂疾病的儿童（CMC）容易出现医疗差错且住院时间更长，而住院医师认为自己没有准备好为这一弱势群体提供充分的医疗护理。对于未来儿科三级护理专家在其专业领域之外涉及CMC多学科护理的培训，不存在教育指导。我们调查了儿科住院医师过去的教育需求和挑战，以确定未来涉及CMC护理培训的关键学习内容。
这是一项在单一儿科三级护理中心进行的前瞻性混合方法研究。对住院医师进行了定性半结构化访谈，提交给主题内容分析，与美国儿科学会（ABP）普通儿科学内容大纲相关联，并采用重要性-绩效分析（IPA）进行分析。定量验证聚焦于儿科住院医师和专家在线调查范围内儿科肾脏病学的关键主题。
共进行了16次访谈，中位时长69分钟[四分位间距IQR 35]。ABP普通儿科学内容大纲列出的280个主题减少到165个主题，其中86%为（理论）知识、12%为实践技能、2%为软技能。IPA确定了23个知识主题非常重要，需要改进且有望取得成效。对84名住院医师和专家（回复率55%）进行的肾脏病学关键主题定量验证显示，儿科肾脏病学专家之间的一致性较高，但受训人员和“受过培训”的非肾脏病学专家之间的评分者间一致性较低。定性访谈中主题的出现情况及其在定量调查中计算出的重要性高度相关（tau = 0.57，P = 0.001）。出现了对其他儿科专科非常重要的两个类别，以及一个在门诊和住院护理中频繁遇到情况的背景类别。
关于患者安全，本研究揭示了未来儿科三级护理专家在其专业领域之外涉及CMC多学科护理培训的异质性方面及其重要性。我们的结果可能为未来详细分析和开发培训训练营奠定基础，这些训练营可能能够通过减少医疗差错导致的可预防伤害来帮助提高患者安全，特别是对于三级护理儿科中的弱势群体，如CMC。
