Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents.

BACKGROUND: Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. OBJECTIVE: We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. METHODS: A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. RESULTS: Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P < .001). CONCLUSIONS: A comprehensive, integrated communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.

When the Mannequin Dies, Creation and Exploration of a Theoretical Framework Using a Mixed Methods Approach.

INTRODUCTION: Controversy exists in the simulation community as to the emotional and educational ramifications of mannequin death due to learner action or inaction. No theoretical framework to guide future investigations of learner actions currently exists. The purpose of our study was to generate a model of the learner experience of mannequin death using a mixed methods approach. METHODS: The study consisted of an initial focus group phase composed of 11 learners who had previously experienced mannequin death due to action or inaction on the part of learners as defined by Leighton (Clin Simul Nurs. 2009;5(2):e59-e62). Transcripts were analyzed using grounded theory to generate a list of relevant themes that were further organized into a theoretical framework. With the use of this framework, a survey was generated and distributed to additional learners who had experienced mannequin death due to action or inaction. Results were analyzed using a mixed methods approach. RESULTS: Forty-one clinicians completed the survey. A correlation was found between the emotional experience of mannequin death and degree of presession anxiety (P < 0.001). Debriefing was found to significantly reduce negative emotion and enhance satisfaction. Sixty-nine percent of respondents indicated that mannequin death enhanced learning. These results were used to modify our framework. CONCLUSIONS: Using the previous approach, we created a model of the effect of mannequin death on the educational and psychological state of learners. We offer the final model as a guide to future research regarding the learner experience of mannequin death.

New professionalism challenges in medical training: an exploration of social networking.

BACKGROUND: Innovative online technology can enhance the practice of medicine, yet it also may be a forum for unprofessional behavior. OBJECTIVE: We surveyed program directors regarding their perceptions and experiences with residents' use of social networking sites (SNS). METHODS: In September 2011, we sent an online survey to program directors and associate program directors of pediatrics residency programs within the United States who are members of the Association of Pediatric Program Directors. RESULTS: A total of 162 program directors or associate program directors (representing 50% of residency programs) responded to the survey. One-third of respondents are "very familiar" with SNS and 23% use them "daily or often." Most respondents (70%) rated "friending" peers as "completely appropriate," whereas only 1% of respondents rated "friending" current or past patients as "completely appropriate." More than one half of respondents believe inappropriate behavior on SNS is "somewhat" or "very" prevalent, and 91% are "somewhat" or "very" concerned that the prevalence of inappropriate behavior on SNS may increase. The most commonly reported problematic online activity was posting inappropriate comments about the workplace. Posting of inappropriate comments about self, patients, and staff also was observed. Residency programs commonly educate trainees about SNS during intern orientation (45%), or using written guidelines (29%) and ad hoc remediation (16%). CONCLUSIONS: As educators teach trainees principles of online professionalism, appropriate use of SNS needs to be included in the training process. Curricular efforts may be hindered by some program directors' lack of familiarity with SNS.

Integrated in-situ simulation using redirected faculty educational time to minimize costs: a feasibility study.

INTRODUCTION: Simulation is an effective teaching tool, but many hospitals do not possess the space or finances to support traditional simulation centers. Our objective is to describe the feasibility of an in situ simulation program model that uses minimal permanent space and "redirected" cost-neutral faculty educational time to address these issues. METHODS: Two pediatric simulators and audiovisual equipment were purchased. Course faculty were derived from a group of physicians and nurses with a percentage work assignment apportioned to education. A portion of this was subsequently redirected toward simulation. After 2 years of operation, faculty were surveyed regarding time devoted to the program. Program growth and quality statistics were examined descriptively. RESULTS: The program supported 786 learner encounters in 166 sessions over 2 years. Simulation hours per month increased over sixfold during that period (P < 0.001). Program initiation cost was $128920.89, with subsequent yearly costs of $11,695. Mean program ratings ranged between 4.5/5 for Crisis Resource Management and 4.4/5 for communication skills training. Resident (2.6 h/y increase, P value <0.001) and nursing (2.2 h/y increase, P < 0.001) simulation hours increased significantly. Faculty involvement averaged between 3% and 32% of total work hours. CONCLUSION: This report demonstrates the feasibility of implementing an in situ simulation program using minimal permanent institutional space and cost-neutral redirected faculty time. This type of programmatic structure is conducive to short- and medium-term growth, is well received by participants, and allows for substantial cost savings. Future work will be needed to determine what growth limitations are inherent in this staffing and structural model.

Comparison of end-tidal CO2 and Paco2 in children receiving mechanical ventilation.

OBJECTIVE: To determine whether end-tidal CO(2) (Petco(2)) measurement provides a reliable estimate of ventilation in critically ill children who are mechanically ventilated. DESIGN: Prospective, nonrandomized, consecutive enrollment study. SETTING: A university-affiliated children's hospital pediatric intensive care unit. PATIENTS: All intubated, mechanically ventilated pediatric patients. INTERVENTIONS: All Petco(2)-Paco(2) pairs were from patients ventilated with a Servo 300 Ventilator (Siemens-Elema AB, Stockholm, Sweden). When a blood gas sample was obtained, Petco(2) as measured by a continuous mainstream Petco(2) capnograph was recorded. Measurements: The results of blood gas measurements and corresponding Petco(2) measurements were recorded. Demographic data and primary diagnosis were noted. Petco(2)-Paco(2) pairs obtained from patients with intracardiac shunts or obtained during high-frequency oscillation or extracorporeal membrane oxygenation at the time of measurement were excluded from analysis. Linear regression was used to analyze Petco(2)-Paco(2) pairs. Repeated measure analysis of variance with the mixed-model algorithm in SAS software (SAS Institute, Carey, NC) was used to analyze the trend in the Petco(2) and Paco(2) relationship. Chi-square was used to analyze categorical data. Statistical significance was considered p <.05. RESULTS: A total of 129 children were enrolled, and 1708 paired Paco(2) and Petco(2) measurements were recorded. The mean age +/- sd was 4.1 +/- 5.6 yrs. Paco(2) positively correlated with Petco(2). The linear equation for the regression analysis was y = 0.71x (95% confidence interval, 0.69-0.73) + 8.93 (95% confidence interval, 7.89-9.97), with r (2) =.716 and p <.001. The Petco(2)-Paco(2) difference was 10 mm Hg (1.33 kPa) difference between the Petco(2) and Paco(2). However, only 111 of 1068 (10%) Petco(2)-Paco(2) pairs had a difference of >10 mm Hg (1.33 kPa) in patients with a Pao(2)/Fio(2) ratio >200. Trend analysis showed the Petco(2)-Paco(2) difference increased with increasing duration of mechanical ventilation. CONCLUSION: In most intubated, mechanically ventilated infants and children, Petco(2) reliably estimates ventilation.