Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review.

BACKGROUND: Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers. OBJECTIVE: This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings. METHODS: This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness. RESULTS: Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs. CONCLUSIONS: There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions.

Paediatric trainees’ training experiences during the COVID-19 pandemic: a national survey

BackgroundThere is a paucity of published data exploring the opinions of UK paediatric trainees as to the impact of COVID-19 on their training and education.ObjectivesThis study aims to explore paediatric trainees’ education and training experiences during this period.MethodsAn online survey open to all UK paediatric trainees between May and August 2020 captured quantitative data alongside qualitative data by critical incident technique open questioning. Positive and negative training experiences related to COVID-19 were thematically analysed by dual coding utilising grounded theory.Results365 UK trainees responded with equal distribution across deaneries and training grades.Although the majority of trainees remained in their specialties, there was significant disruption to training events, teaching and learning opportunities. Changes to work pattern were common (87%), including rota amendments (57%), redeployment within paediatrics (18%) or adult services (4%), or requirement to shield (6%). Trainees reported cancelled teaching events (88%) or examination(s) (25%), with the greatest impact to simulation and deanery-based teaching (75% less). Only 82% of trainees anticipated completion of ARCP requirements.Despite this, for many, novel opportunities presented themselves that may not have otherwise been accessible. 68% reported new opportunities for learning. 93% of respondents attended virtual teaching, commonly in-house (67%), predominantly initiated by middle-grades (67%) or consultants (68%). 71% participated in e-learning. Trainees reported increased opportunities for reflection (28%) and leadership and management (23%). No significant differences were seen between the ST1–3 and ST4+ groups (p >0.05). A breadth of trainee-identified web-based paediatric training resources were also highlighted.Four positive impact themes were identified: Changed Practice, New Skills, Extra Time and Teamworking. Furthermore, four negative impact themes were delineated: Training, Clinical Exposure, Safety and Wellbeing.ConclusionsThis national survey captured candid paediatric trainee perspectives independent of regulatory bodies such as the GMC/RCPCH. As the COVID-19 pandemic persists, these trainee experiences inform educators to adopt helpful training practices from other regions, including sharing of virtual learning regionally and acting-up opportunities. Positive themes enable wider dissemination of good training practice, for example the sharing of virtual learning regionally, integrating trainees into virtual consultations and remote working, acting-up opportunities and developing leadership and management skills. Negative themes highlight previously under-recognised areas of concern with important potential for further governance and research. Examples include enhancing patient safety through tackling reported trainee fatigue, or combating the reported reduced clinical experience consequent to redeployment or shielding, or instituting protected supporting professional activity time.

Paediatric trainees' training experiences during the COVID-19 pandemic: a national survey.

This study examines trainees' experiences of paediatric education and training during the COVID-19 pandemic. Paediatric trainees across the UK undertook an online survey. 368 of approximately 4000 trainees responded; quantitative and qualitative data were collected. Although the majority of trainees remained in their specialties, there was significant disruption to training events, teaching and learning opportunities. Despite this, for many, novel opportunities presented themselves that may not have otherwise been accessible. Trainees reported increased virtual learning, reflection, leadership and management opportunities. A breadth of trainee-identified web-based paediatric training resources were also highlighted. As the COVID-19 pandemic persists, these trainee experiences inform educators to adopt helpful training practices from other regions, including sharing of virtual learning regionally and acting-up opportunities. Trainees highlighted previously under-recognised areas of concern that can inform quality improvement initiatives, such as enhancing patient safety through tackling trainee fatigue, combating reduced clinical experience or instituting protected supporting professional activity time.