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Emerg Med J. 2018 Oct 16. pii: emermed-2017-207384. doi: 10.1136/emermed-2017-207384. [Epub ahead of print]

Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians.

Craig SS1,2,3, Auerbach M4,5, Cheek JA3,6,7,8, Babl FE3,6,7,8, Oakley E3,6,7,8, Nguyen L9, Rao A3,10,11,12, Dalton S3,13, Lyttle MD14,15,16, Mintegi S17,18,19, Nagler J20,21,22, Mistry RD5,23, Dixon A24,25,26,27, Rino P28,29,30, Kohn-Loncarica G28,29,30, Dalziel SR3,31,32; Pediatric Emergency Research Networks (PERN).

Author information

1
Paediatric Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
2
School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
3
Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia.
4
Yale University School of Medicine, New Haven, Connecticut, USA.
5
Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), Itasca, Illinois, USA.
6
Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
7
Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
8
Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.
9
Peninsula Health, Frankston, Victoria, Australia.
10
Sydney Children's Hospital, Randwick, New South Wales, Australia.
11
Department of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.
12
Health Education Training Institute (HETI), Gladesville, New South Wales, Australia.
13
The Children's Hospital at Westmead, Westmead, NSW, Australia.
14
Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
15
Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
16
Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI), UK.
17
Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain.
18
Department of Pediatrics, University of the Basque Country, Lejona, Spain.
19
Research in European Pediatric Emergency Medicine (REPEM), Brussels, Belgium.
20
Boston Children's Hospital, Boston, Massachusetts, USA.
21
Harvard Medical School, Boston, Massachusetts, USA.
22
Pediatric Emergency Care Applied Research Network (PECARN), USA.
23
Children's Hospital of Colorado, Aurora, Colorado, USA.
24
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
25
Stollery Children's Hospital, Edmonton, Alberta, Canada.
26
Women's and Children's Health Research Institute, Edmonton, Alberta, Canada.
27
Pediatric Emergency Research Canada (PERC), Calgary, Alberta, Canada.
28
Department of Pediatrics, Universidad de Buenos Aires, Pcia de Buenos Aires, Argentina.
29
Hospital de Pediatría 'Profesor Dr Juan P Garrahan', Buenos Aires, Argentina.
30
Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA), Buenos Aires, Argentina.
31
Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
32
Starship Children's Hospital, Auckland, New Zealand.

Abstract

OBJECTIVE:

To describe senior paediatric emergency clinician perspectives on the optimal frequency of and preferred modalities for practising critical paediatric procedures.

METHODS:

Multicentre multicountry cross-sectional survey of senior paediatric emergency clinicians working in 96 EDs affiliated with the Pediatric Emergency Research Network.

RESULTS:

1332/2446 (54%) clinicians provided information on suggested frequency of practice and preferred learning modalities for 18 critical procedures. Yearly practice was recommended for six procedures (bag valve mask ventilation, cardiopulmonary resuscitation (CPR), endotracheal intubation, laryngeal mask airway insertion, defibrillation/direct current (DC) cardioversion and intraosseous needle insertion) by at least 80% of respondents. 16 procedures were recommended for yearly practice by at least 50% of respondents. Two procedures (venous cutdown and ED thoracotomy) had yearly practice recommended by <40% of respondents. Simulation was the preferred learning modality for CPR, bag valve mask ventilation, DC cardioversion and transcutaneous pacing. Practice in alternative clinical settings (eg, the operating room) was the preferred learning modality for endotracheal intubation and laryngeal mask insertion. Use of models/mannequins for isolated procedural training was the preferred learning modality for all other invasive procedures. Free-text responses suggested the utility of cadaver labs and animal labs for more invasive procedures (thoracotomy, intercostal catheter insertion, open surgical airways, venous cutdown and pericardiocentesis).

CONCLUSIONS:

Paediatric ED clinicians suggest that most paediatric critical procedures should be practised at least annually. The preferred learning modality depends on the skill practised; alternative clinical settings are thought to be most useful for standard airway manoeuvres, while simulation-based experiential learning is applicable for most other procedures.

KEYWORDS:

education; paediatric resuscitation; paediatrics, paediatric emergency medicine

Conflict of interest statement

Competing interests: None declared.

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