Oral Themed Presentation
Oral Themed
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Lindsay Nadkarni, MD
Pediatric Resident
Columbia University Medical Center
Aaron Donoghue, MD, MSCE
Assistant Professor of Pediatrics
Children's Hospital of Philadelphia
Sage Meyers, MD, MSCE
Assistant Professor of Pediatrics
Children's Hospital of Philadelphia
Benjamin Kerrey, MD
Assistant Professor of Pediatrics
Cincinnati Children's Hospital Medical Center
Mary Frey, MSN, RN, CNL, CPN, CPEN
Medical Resuscitation Program Specialist
Cincinnati Children's Hospital Medical Center
Stephanie Boyd, PhD
Research Associate
Cincinnati Children's Hospital Medical Center
Karen O'Connell, MD
Assistant Professor of Pediatrics
Children's National Medical Center
Tara Neubrand, MD
Critical Care Liaison
Children's Hospital Colorado
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David Kessler, MD, MSc
Medical Director of Pediatric Simulation Center
Columbia University College of Physicians and Surgeons
Kate McCloskey, MBBS FRACP GDipEd, GCertSim PhD
Medical Director of Simulation, Geelong Clinical School
Deakin University; University Hospital Geelong
Discussant: Lindsay Nadkarni, MD
Background: Pediatric resuscitations are infrequent but high-stakes events providing scarce opportunities for trainees to achieve proficiency in leading these scenarios (1-4). The Concise Assessment of Leader Management (CALM) instrument is designed to provide formative feedback to resuscitation leaders after simulated pediatric resuscitations. The initial validation study of the CALM instrument supported content and internal structure (reliability) validity (5).
Research Question: Do higher CALM scores of leaders of pediatric resuscitation scenarios correlate with improved clinical outcomes, supporting consequence validity of the CALM instrument?
Methodology: This is a prospective validation study to assess consequence validity using Messick’s framework of validity (6). The CALM instrument will be used to score leaders of resuscitations in videos from the VIPER (Videography In Pediatric Emergency Resuscitation) Collaborative. Identified clinical outcomes as well as time to certain care processes (e.g. primary survey, epinephrine, shock delivery) will be abstracted from each video. Analysis will compare if better CALM scores correlate with better clinical outcomes and shorter time to certain care processes.
Results: We are currently in the study design and pilot data abstraction phase. Continuous data will be described as means with standard deviations, or as medians and interquartile ranges, and will be compared using Unpaired T-tests or Wilcoxon-Rank-Sum tests, as appropriate. Categorical data will be described as counts (frequencies), and will be compared using Chi-Squared analysis or Fisher’s exact test, if needed.
Discussion/Conclusions: Pediatric trainees often do not become proficient in leading resuscitation scenarios due to infrequent opportunities to lead these high-stakes events as well as lack of tools to provide immediate formative feedback. The CALM tool is designed to provide feedback to leaders of pediatric resuscitation scenarios, and initial validation studies have supported content and internal structure (reliability) validity. This study will evaluate consequence validity of the CALM instrument.
References:
1. Nadel FM, Lavelle JM, Fein JA, Giardino AP, Decker JM, Durbin DR: Assessing pediatric senior residents’ training in resuscitation: fund of knowledge, technical skills, and perception of confidence. Pediatr Emerg Care 2000 Apr;16(2):73-6.
2. Chen EH, Cho CS, Shofer FS, Mills AM, Baren JM: Resident exposure to critical patients in a pediatric emergency department. Pediatr Emerg Care 2007 Nov;23(11):774-8.
3. Guilfoyle FJ, Milner R, Kissoon N. Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of skills. CJEM. 2011 Mar;13(2):90-5.
4. Chen EH, Shofer FS, Baren JM: Emergency medicine resident rotation in pediatric emergency medicine: what kind of experience are we providing? Acad Emerg Med 2004 Jul;11(7):771-773.
5. Nadkarni LD, Roskind CG, Auerbach MA, Calhoun AW, Adler MD, Kessler DO: The development and validation of a concise instrument for formative assessment of team leader performance during simulated pediatric resuscitations. Simul Healthc 2018 Apr;13(2):77-82.
6. Messick S: Validity. In: Linn RL, editor. Educational Measurement, 3rd Ed. New York: American Council on Education and Macmillan; 1989.