From the Departments of Emergency Medicine.
Pediatr Emerg Care. 2024 Dec 1;40(12):924-930. doi: 10.1097/PEC.0000000000003273.
Pediatric emergency medicine (PEM) fellows are expected to perform high-risk procedures across a wide range of patient age, size, and physiology including procedures that are no longer required during pediatric residency training. Examples include central venous catheter (CVC) placement, endotracheal intubation of children and adolescents, and tube thoracostomy placement. Simulation-based mastery learning has demonstrated decreased patient morbidity. In this study, we describe implementation of a simulation-based mastery learning (SBML) procedural curriculum for PEM fellows.
Our PEM fellows underwent an SBML procedural curriculum for lumbar puncture (LP), CVC placement, endotracheal intubation, and tube thoracostomy placement. These procedures are mandatory for fellows to learn, have known association with potential iatrogenic injury, and are widely available commercial task trainers. Fellows underwent baseline assessments, group demonstration, deliberate practice, and then postassessments. For both pre- and postassessments, we used internally developed checklists with minimum passing scores (MPSs) calculated by the Mastery-Angoff technique.
Nineteen pediatrics residency-trained PEM fellows underwent this curriculum over a 2-year period. Six fellows (31.58%) achieved the MPS on all four procedures during their first posttest attempt. All fellows achieved the MPS on all four procedures by the second posttest attempt. Most fellows (17/19 or 89.47%) did not achieve the MPS on baseline LP assessments, despite inclusion of this procedure as an Accreditation Council of Graduate Medical Education (ACGME) requirement during their pediatric residency training.
All participating PEM fellows demonstrated competency after training on four procedures associated with iatrogenic injuries. Using an SBML framework is a feasible method to teach procedural skills to PEM fellows, allowing them to demonstrate objective measures of competency in the simulation laboratory.
儿科急诊医学（PEM）研究员预计将在广泛的患者年龄、体型和生理范围内执行高风险操作，包括在儿科住院医师培训期间不再需要的操作。例如，包括中心静脉导管（CVC）放置、儿童和青少年的气管插管以及胸腔引流管放置。基于模拟的精通学习已经证明可以降低患者的发病率。在这项研究中，我们描述了为 PEM 研究员实施基于模拟的精通学习（SBML）程序课程的情况。
我们的 PEM 研究员接受了腰椎穿刺（LP）、CVC 放置、气管插管和胸腔引流管放置的 SBML 程序课程。这些操作是研究员必须学习的，与潜在的医源性损伤有明确关联，并且广泛使用商业任务训练器。研究员进行了基线评估、小组示范、刻意练习，然后进行了后续评估。对于前测和后测，我们都使用了内部开发的检查表，最小通过分数（MPS）是通过掌握-安戈夫技术计算得出的。
在两年的时间里，19 名儿科住院医师培训的 PEM 研究员接受了该课程。六名研究员（31.58%）在第一次后测尝试中就达到了所有四项操作的 MPS。所有研究员都在第二次后测尝试中达到了所有四项操作的 MPS。尽管 LP 评估包含在他们的儿科住院医师培训期间作为研究生医学教育认证委员会（ACGME）的要求，但大多数研究员（17/19 或 89.47%）在基线 LP 评估中未达到 MPS。
所有参与的 PEM 研究员在接受四项与医源性损伤相关的操作培训后都表现出了能力。使用基于 SBML 的框架是向 PEM 研究员教授程序技能的一种可行方法，使他们能够在模拟实验室中展示客观的能力衡量标准。
