Traditional Poster Round
The University of Mississippi Medical Center is the only Pediatric Residency program in the state of Mississippi and trains 48 categorical pediatric residents and 16 internal medicine/pediatrics residents each year. We recognized the need for additional simulation based educational activities that stress prompt identification of clinical decompensation and initiation of appropriate interventions as well as the need for training of nontechnical skills to enhance team function.
Faculty from Pediatric Emergency Medicine, Pediatric Critical Care, and the Pediatric Residency Program developed a rotating curriculum of pediatric clinical scenarios from September 2015 to August 2017. A total of 46 sessions were held over the two year time period with the development of 18 unique clinical scenarios. Each session and the debriefing was evaluated by the students and instructors.
Every month the collaborating faculty designed a new scenario and didactic session based on identified educational needs. The content focuses on clinical decompensation of a patient in the emergency center or general floor and rarely includes cardiac arrest. Instead, recognition of decompensation and implementation of appropriate treatment is emphasized.
In order to engage all pediatric residents, 2 sessions are held each month for the general pediatrics wards teams with half of each team attending on a certain day. The session lasts 50 minutes and occurs during morning report. After a quick briefing, the residents participate in a clinical scenario followed by debriefing and a quick didactic session including supplementary PREP® questions.
Student evaluations of the sessions were overwhelmingly positive (97% of responses.) Participants praised the relevance of the material, appreciation for a safe learning environment, and improved knowledge of team skills such as assigning roles and closed loop communication. Most criticisms focused on the timing of their participation with accompanying comments regarding the demands of the general ward rotation. Similarly, participant evaluations of instructors using the DASH tool revealed that the debriefing was very good or excellent 93% of the time.
To overcome the perceived threat of breached content confidentiality, we also paired scenarios of clinical diseases that mimic each other such as asthma and anaphylaxis or viral bronchiolitis and myocarditis. This educational strategy of disease mimicry may be useful for encouraging content discussion and broadening resident knowledge through shared experiences.
The timing of these sessions is challenging as resident education has competing interests of clinical exposure and appropriate duty hours. A potential solution is to encourage the addition of simulation based educational activities during other rotations.