Virtual Objective Structured Clinical Examination (OSCE) Training in the Pandemic Era: Feasibility, Satisfaction, and the Road Ahead.

INTRODUCTION: Objective Structured Clinical Examinations (OSCEs) are essential assessments for evaluating the clinical competencies of medical students. The COVID-19 pandemic caused a significant disruption in medical education, prompting institutions to adopt virtual formats for academic activities. This study analyzes the feasibility, satisfaction, and experiences of pediatric board candidates and faculty during virtual or electronic OSCE (e-OSCE) training sessions using Zoom video communication (Zoom Video Communications, Inc., San Jose, USA). METHODS: This is a post-event survey assessing the perceptions of faculty and candidates and the perceived advantages and obstacles of e-OSCE. RESULTS: A total of 142 participants were invited to complete a post-event survey, and 105 (73.9%) completed the survey. There was equal gender representation. More than half of the participants were examiners. The overall satisfaction with the virtual e-OSCE was high, with a mean score of 4.7±0.67 out of 5. Most participants were likely to recommend e-OSCE to a friend or colleague (mean score 8.84±1.51/10). More faculty (66.1%) than candidates (40.8%) preferred e-OSCE (P=0.006). CONCLUSION: Transitioning to virtual OSCE training during the pandemic proved feasible, with high satisfaction rates. Further research on virtual training for OSCE in medical education is recommended to optimize its implementation and outcomes.

The Development of Bilateral Mastoiditis Following Acute Otitis Media in a Pediatric Patient with Limited Access to Health Care.

Infection of the mastoid cells, known as mastoiditis, can develop due to untreated otitis media, in which bacteria colonize the mastoid air cells that line the inner and middle ear. Antibiotic therapy for otitis media has made the development of mastoiditis a very rare occurrence. However, despite its low prevalence, it is important to keep this complication in mind when treating otitis media in the pediatric population due to the increased susceptibility of mastoiditis in this demographic. Furthermore, pediatric patients of lower socioeconomic status who have limited access to health care may be at an even greater risk for the development of mastoiditis. We report a case of a pediatric patient with significant barriers to health care who developed bilateral mastoiditis as a complication of otitis media, requiring hospitalization and intravenous antibiotic therapy. The patient also experienced hearing loss as a sequela of the infection. Improved access to medical care, parent or guardian education on how to recognize primary otitis media infections, and the use of adequate antibiotic therapy when indicated can effectively prevent the development of mastoiditis following otitis media infections among patients.

Benign Acute Childhood Myositis in a Pediatric Patient Post Influenza B Infection.

Benign acute childhood myositis (BACM) is a mild and self-limited sudden onset of lower extremity pain during or following recovery from a viral illness. It is characterized by difficulty walking due to severe bilateral calf pain, which usually resolves in three days. It is typically appreciated during times of large influenza outbreaks and epidemics. The most severe complication can be rhabdomyolysis without proper treatment and can lead to renal damage and potential renal failure. There are limited reported cases of BACM and therefore no clear guidelines in the treatment or management of the condition. This case is unique in the sense that the patient had leg pain the entire month prior to presentation in the absence of trauma or injury, and it is believed that the pre-existing myalgia may have been exacerbated by an upper respiratory infection (URI) that started a few weeks after the leg pain onset. In addition, this patient's creatine kinase peaked at over 13,000 U/L, which is three to five times higher than the average of other reported children with this condition. The patient is a five-year-old male who presented to the emergency department with bilateral leg pain and difficulty ambulating. His guardian reported that the leg pain began one month prior to presentation and worsened to the point where he could no longer ambulate, following a fever and cough that began one week prior to presentation. A respiratory viral panel was positive for influenza B, and initial creatine kinase (CK) levels were greater than 10,000. A diagnosis of BACM was made, and supportive care was initiated. BACM is an infrequent complication following a viral infection that is typically treatable with hydration management and routine CK monitoring. Symptoms of BACM are usually limited to muscle pain and weakness, but it can progress to rhabdomyolysis and renal failure if not managed properly. It is therefore crucial that physicians monitor CK values daily until a downtrend is noticed and symptoms begin to resolve.

A Simulation Workshop for Pediatric Residents Using Team-Based Reflective Practice to Communicate Life-Altering News.

Introduction Guiding patients and their families through threat and tragedy is an essential skill for physicians. Educational opportunities to acquire this crucial expertise during medical training are limited. We describe a workshop design employing simulation and team-based reflection to enhance pediatric residents' confidence in delivering life-altering news. Methods Three hundred and seventy-six pediatric residents participated in an annual 2.75-hour workshop from 2011 to 2018. For each session, 24 to 28 residents were randomly assigned to learning teams of 6-7 trainees and two faculty. Each team had four different simulated parent encounters to convey life-altering news. Briefing and debriefing of encounters utilized team-based reflection. The impact of this educational intervention was evaluated using retrospective pre-post self-report questionnaires. Results Participants indicated that the learning experience was realistic, useful, and was provided in a safe learning environment. Residents reported increased confidence in their ability to communicate various types of life-altering news. A one-year follow-up survey indicated most respondents found the experience useful in actual practice subsequent to the workshop. The design also appears to be an efficient use of resources. Conclusion A workshop combining team-based reflection and simulation improves the confidence of pediatric residents in communicating life-altering news.

Integrating Cultural Humility Into Infant Safe Sleep Counseling: A Pediatric Resident Simulation.

INTRODUCTION: Co-sleeping with infants is a common practice across cultures, but pediatricians may struggle to engage in patient-centered conversations about infant sleep practices with non-native English- speaking families. Cultural humility is a critical skill to utilize when engaging in cross-cultural conversations. We designed a simulation for pediatric residents to counsel on safe sleep and enhance skills in self-perceived cultural humility and preparedness when caring for diverse patient populations. METHODS: We created a simulation for the second year and senior pediatric residents at a large academic institution focused on a co-sleeping parent and infant from the Burmese community. The Multidimensional Cultural Humility Scale (MCHS) was administered prior to and after the simulation. We also included additional questions regarding changes in knowledge and preparation in engaging in co-sleeping conversations across cultures. RESULTS: Fifty-seven residents participated. Overall, the mean score of the MCHS significantly increased after the simulation, indicating an increase in self-perceived cultural humility. All participants felt more prepared to have conversations about co-sleeping and to engage in difficult conversations with diverse patient populations, and all learned valuable skills to improve care for future patients. Comments regarding the scenario noted an appreciation for learning more about the Burmese population and understanding new approaches to safe sleep counseling. DISCUSSION: After this simulated scenario, residents reported increased self-perceived cultural humility, preparedness in counseling on co-sleeping, and skills to engage in difficult conversations with diverse patient populations. Topics such as cultural humility can be incorporated into simulation-based medical education to help improve the care of diverse patient populations.

Undergraduate Teaching in Geriatrics and Pediatrics in Portuguese Medical Schools: An Observational Study.

INTRODUCTION: Motivated by the contracting nature of the Portuguese age pyramid, and thereby the ever increasing geriatric population, the aim of this study was to compare the number of European Credit Transfer and Accumulation System Credits dedicated to Geriatrics with Pediatrics in Portuguese Medical Schools. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study was conducted and included six Portuguese Medical Schools that have six years of training and a total of 360 credits. The study plans were obtained from the medical schools' websites or requested. Schools were grouped in modular/classic teaching methodology and the courses were categorized in mandatory/optional and specific/related. The credits of Geriatrics and Pediatrics were compared. RESULTS: Four schools had classical methodology and two had a modular one. Overall, they had more credits dedicated to Pediatrics than Geriatrics. Three schools offered mandatory courses specifically oriented to Geriatrics (1.5 - 8 credits) compared to all schools mandatory courses courses on Pediatrics (5.7 - 26.5 credits). The ratio of averages of mandatory specific courses (Pediatrics/Geriatrics) was 12.4 in the classical and 1.5 in the modular group. DISCUSSION: Pediatrics teaching has revealed to be superior to Geriatrics in all categories. Based on our results, we consider the Portuguese Geriatrics' undergraduate teaching sub-optimal. CONCLUSION: Nowadays, geriatric population is quantitatively similar to pediatric population. Efforts should be made to adequate Geriatrics teaching to our reality in order to provide a more adequate health care to this age group.

Introdução: Motivados pelo aumento do número de idosos em Portugal, propusemo-nos a comparar o número de créditos atribuídos a Geriatria e a Pediatria pelo Sistema Europeu de Transferência de Créditos nas Escolas Médicas Portuguesas. Material e Métodos: Estudo observacional, descritivo e transversal incluindo seis Escolas Médicas com seis anos de formação e um total de 360 créditos. Os dados foram colhidos em março e abril de 2016, dos sítios da Internet das faculdades ou pedidos quando não disponibilizados. As Escolas foram divididas pela metodologia de ensino (clássica/modular) e as disciplinas por categorias (obrigatória/ opcional e específica/relacionada). Os créditos obtidos para a Geriatria e Pediatria foram comparados. Resultados: Das Escolas Médicas incluídas, duas tinham metodologia modular e as restantes clássica, dedicando globalmente mais créditos ao ensino de Pediatria que Geriatria. Três ofereciam cadeiras obrigatórias específicas para Geriatria (1,5 - 8 créditos), enquanto que todas ofereciam cadeiras obrigatórias específicas para Pediatria (5,7 - 26,5 créditos). O rácio das médias de créditos obrigatórios e específicos (Pediatria/Geriatria) foi de 12,4 nas clássicas e 1,5 nas modulares. Discussão: Globalmente, o ensino da Pediatria é superior ao da Geriatria em todas as categorias. Através dos resultados obtidos, consideramos que o ensino pré-graduado de Geriatria em Portugal não é adequado. Conclusão: Apesar da população geriátrica ser epidemiologicamente semelhante à pediátrica, as Escolas Médicas Portuguesas dedicam mais tempo ao ensino da Pediatria. São necessários ajustes aos planos de estudo para melhorar os cuidados de saúde prestados a este grupo populacional.

Impact of Just-in-Time and Just-in-Place Simulation on Intern Success With Infant Lumbar Puncture.

BACKGROUND AND OBJECTIVE: Simulation-based skill trainings are common; however, optimal instructional designs that improve outcomes are not well specified. We explored the impact of just-in-time and just-in-place training (JIPT) on interns' infant lumbar puncture (LP) success. METHODS: This prospective study enrolled pediatric and emergency medicine interns from 2009 to 2012 at 34 centers. Two distinct instructional design strategies were compared. Cohort A (2009-2010) completed simulation-based training at commencement of internship, receiving individually coached practice on the LP simulator until achieving a predefined mastery performance standard. Cohort B (2010-2012) had the same training plus JIPT sessions immediately before their first clinical LP. Main outcome was LP success, defined as obtaining fluid with first needle insertion and <1000 red blood cells per high-power field. Process measures included use of analgesia, early stylet removal, and overall attempts. RESULTS: A total of 436 first infant LPs were analyzed. The LP success rate in cohort A was 35% (13/37), compared with 38% (152/399) in cohort B (95% confidence interval for difference [CI diff], -15% to +18%). Cohort B exhibited greater analgesia use (68% vs 19%; 95% CI diff, 33% to 59%), early stylet removal (69% vs 54%; 95% CI diff, 0% to 32%), and lower mean number of attempts (1.4 ± 0.6 vs 2.1 ± 1.6, P < .01) compared with cohort A. CONCLUSIONS: Across multiple institutions, intern success rates with infant LP are poor. Despite improving process measures, adding JIPT to training bundles did not improve success rate. More research is needed on optimal instructional design strategies for infant LP.

Residency exposures and anticipated future involvement in community settings.

OBJECTIVE: To assess how exposures to community activities in residency impact anticipated future involvement in community child health settings. METHODS: Prospective cohort study of pediatric residents from 10 programs (12 sites) who completed training between 2003 and 2009. Residents reported annual participation for ≥ 8 days in each of 7 community activities (eg, community settings, child health advocacy) in the prior year. At the start and end of residency, residents reported anticipated involvement in 10 years in 8 community settings (eg, school, shelter). Anticipated involvement was dichotomized: moderate/substantial ("high") versus none/limited ("low"). Logistic regression modeled whether residency exposures independently influenced anticipated future involvement at the end of residency. RESULTS: A total of 683 residents completed surveys at the start and end of residency (66.8% participation). More than half of trainees reported ≥ 8 days' of involvement in community settings (65.6%) or child health advocacy (53.6%) in residency. Fewer anticipated high involvement in at least 1 community setting at the end of residency than at the start (65.5% vs 85.6%, P < .001). Participation in each community activity mediated but did not moderate relations between anticipated involvement at the start and end of residency. In multivariate models, exposure to community settings in residency was associated with anticipated involvement at end of residency (adjusted odds ratio 1.5; 95% confidence interval 1.2, 2.0). No other residency exposures were associated. CONCLUSIONS: Residents who anticipate high involvement in community pediatrics at the start of residency participate in related opportunities in training. Exposure to community settings during residency may encourage community involvement after training.

Primórdios da pediatria brasileira / Early times of brazilian pediatrics

Carlos Arthur Moncorvo de Figueiredo é considerado o ?Pai da Pediatria Brasileira?, pois empreendeu várias ações na implantação da pediatria no país, em 1882. Participou ativamente da fundação da Policlínica Geral do Rio de Janeiro, com o primeiro serviço de moléstias da infância. Foi ainda responsável pela formação dos primeiros pediatras no país, por meio de seu Curso Livre, e pela implantação do ensino oficial da Pediatria no país, em decorrência de seu Memorial enviado às autoridades do Império.

Carlos Arthur Moncorvo de Figueiredo is considered the leader of the Brazilian pediatrics, because of his several actions aiming to introduce the discipline in the country in 1882. He participated actively in the foundation of Policlínica Geral do Rio de Janeiro, an institution which provided the first children-oriented care service in Brazil. He was responsible for training the first Brazilian pediatricians through his ?Free Course? and for implanting the official teaching of pediatrics in the country as a result of his petitionary letter sent to the imperial authorities.

Incorporating CanMEDS and subspecialty training into paediatric residency programs: Why are we still deficient?

BACKGROUND: The Royal College of Physician and Surgeons of Canada mandates that paediatric training programs in Canada incorporate subspecialty training and the teaching and evaluation of the seven CanMEDS roles into their curriculum. The literature suggests that newly practicing paediatricians feel inadequately prepared in many subspecialties and CanMEDS roles. HYPOTHESIS: That either current training programs underestimate the importance of these areas for future practice, or that residents themselves feel that these areas are less important. METHOD: An online survey of Canadian paediatric residents and paediatric residency program directors was conducted to determine their views on various subspecialty areas and CanMEDS roles. RESULTS: Fourteen of 16 Canadian paediatric programs participated, and 127 of 486 (26%) paediatric residents completed the survey. Overall, trainees were satisfied with their current training (86%), and 90% believed they would be adequately prepared for independent practice. Forty-six residents (40%) believed training programs place less importance on 10 of the subspecialties that newly practicing paediatricians felt less comfortable with (from a previous study conducted in 2006). However, at least 25% of residents themselves placed less importance on nine of these 10 areas. Residents also place less importance on two CanMEDS competencies which practicing paediatricians felt less comfortable with, including the medical aspects of palliative care (medical expert) and managing an efficient office practice (manager). CONCLUSIONS: Residents and programs place less importance on specific areas of paediatric training, thus creating potential deficiencies in graduating paediatricians. Promotion of these topics during training may better prepare residents for future practice.

Pediatric Resuscitation: Evaluation of a Clinical Curriculum.

OBJECTIVE: To assess the impact of a 6-hour pediatric resuscitation curriculum on the comfort levels of resident physicians' evaluation and treatment of critically ill pediatric patients. METHODS: An evaluation instrument assessed resident comfort levels, measured on a seven digit Likert scale ranging from significantly uncomfortable to significantly comfortable, in 13 areas of pediatric resuscitation. To complete the curriculum, residents had to demonstrate proficiency in knowledge and procedural skills during mock resuscitation scenarios and on both written and oral examinations. RESULTS: Thirty-one residents participated in the study: 51.6% were pediatric, 12.9% were medicine/pediatric and 35.5% were emergency medicine residents. Participants in the curriculum had little previous experience with pediatric resuscitation (83% had been involved in five or fewer pediatric resuscitations). In all 13 areas of pediatric resuscitation tested, residents reported improvement in comfort levels following the course (p<0.002; Wilcoxon Signed Rank Tests). The most significant changes were observed for the following items: resuscitation of pulseless arrest, performance of cardioversion and defibrillation, performance of intraosseous needle insertion, and drug selection and dosing for rapid sequence intubation. Fewer than 48% of learners rated themselves as comfortable in these areas prior to training, but after completion, more than 80% rated themselves in the comfortable range. All residents but one received passing scores on their written examinations (97%). During the mock resuscitation scenarios and oral examination, 100% of the residents were assessed to have 'completely' met the learning objectives and critical actions Conclusion: Implementation of a pediatric resuscitation curriculum improves pediatric and emergency medicine residents' comfort with the evaluation and treatment of critically ill pediatric patients. This curriculum can be used in residency training to document the acquisition of core competencies, knowledge and procedural skills needed for the evaluation and treatment of the critically ill child. The results reported in this study support using this model of instructional design to implement educational strategies, which will meet the requirements of graduate education.