Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Division of Pediatric Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.
PLoS One. 2024 Aug 30;19(8):e0306721. doi: 10.1371/journal.pone.0306721. eCollection 2024.
Acute procedural skill competence is expected by the end of pediatric residency training; however, the extent to which residents are actually competent is not clear. Therefore, a cross-sectional observational study was performed to examine the competency of pediatric residents in acute care procedures in emergency medicine.
Pediatric residents underwent didactic/hands-on "Acute Procedure Day" where they performed procedures with direct supervision and received entrustable professional activity (EPA) assessments (scores from 1-5) for each attempt. Procedures included: bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR) with defibrillation. Demographic information, perceived comfort level, and EPA data were collected. Descriptive statistics and Pearson correlation for postgraduate year (PGY) versus EPA scores were performed.
Thirty-six residents participated (24 PGY 1-2, and 12 PGY 3-4). Self-reported prior clinical exposure was lowest for chest tube placement (n = 3, 8.3%), followed by IOs (n = 19, 52.8%). During the sessions, residents showed the highest levels of first attempt proficiency with IO placement (EPA 4-5 in 28 residents/33 who participated) and BVM (EPA 4-5 in 27/33), and the lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). There was a strong correlation between PGY level and EPA score for intubation, but not for other skills.
Entrustability in acute care skills is not achieved with current pediatrics training. Research is needed to explore learning curves for skill acquisition and their relative importance.
儿科住院医师培训结束时应具备急性程序技能，但不清楚住院医师实际具备的能力程度。因此，进行了一项横断面观察性研究，以检查急诊医学中儿科住院医师在急性护理程序方面的能力。
儿科住院医师接受了理论/实践“急性程序日”的培训，他们在直接监督下进行了程序操作，并对每次尝试进行了可委托的专业活动（EPA）评估（评分从 1-5 分）。程序包括：球囊面罩通气（BVM）、插管、骨髓内（IO）线插入、胸腔管插入和心肺复苏（CPR）与除颤。收集人口统计学信息、感知舒适度和 EPA 数据。进行了与住院医师年级（PGY）与 EPA 评分相关的描述性统计和 Pearson 相关性分析。
共有 36 名住院医师参与（PGY 1-2 组 24 名，PGY 3-4 组 12 名）。自我报告的先前临床暴露最低的是胸腔管放置（n = 3，8.3%），其次是 IO（n = 19，52.8%）。在会议期间，住院医师在 IO 放置（28 名/33 名参与者中 EPA 4-5 分）和 BVM（27/33 名 EPA 4-5 分）方面的首次尝试能力最高，而在胸腔管放置（35 名中 EPA 4-5 分）、除颤（31 名居民中 EPA 4-5 分）和插管（31 名居民中 EPA 4-5 分）方面的能力最低。在插管方面，PGY 水平与 EPA 评分之间存在很强的相关性，但在其他技能方面则没有。
目前的儿科培训并未达到急性护理技能的可委托性。需要研究探索技能获取的学习曲线及其相对重要性。
