Oral Themed Presentation
The General Pediatrics residency programs across Canada will launch Competence By Design training in July 2020. In this reform, the Royal College has established a list of 23 procedures residents must master by the end of their training. Currently, procedural exposure is limited and simulation is used as a complementary training tool.
Literature describes an educational bootcamp as a course designed for learners entering a new clinical role. Educational methods such as Deliberate Practice and Formative Feedback have been integrated into bootcamps. A decline in skills in performing procedures appears over time following simulation-based teaching sessions. Clinical refreshers may be of value to consolidate skills previously learned. However, because of the limited clinical exposure, simulation-based refreshers may be of benefit.
Primary: To compare two educational approaches (simulation-based bootcamp + refreshers in simulation and clinically at bedside vs simulation based bootcamp + clinical refreshers at bedside only) for maintenance of procedural skills competence for bag-mask ventilation (BVM), endotracheal intubation(ETI) and lumbar puncture (LP) during the first year of General Pediatrics residency program.
Secondary: To document the impact of a bootcamp in acquiring mastery level in performing procedures at the beginning of Pediatrics training and clinical exposure to the three procedures.
PROPOSED APPROACH TO ADDRESSING THE GOALS
This multicentric, randomized, prospective study will recruit first-year residents of the General Pediatrics program attending the universities of Montreal, Ottawa, Quebec and Sherbrooke between July 2019 and July 2020. The study was approved by IRB. Participant consent will be obtained prior to the start of the study.
We identified three procedures to be taught early in the course of residency: BVM, ETI and LP. Checklists have been validated for each procedure.
In the university-based simulation centers, residents will participate in a bootcamp, during their first two months of residency (time zero), where procedures will be taught based on the first steps of the LSPPDM method (Learn, See, Practice, Prove, Do, Maintain) (Figure 1). Each session will end when residents reach Mastery Level. Prior to and after attending the bootcamp, participants competency will be assessed for BVM, ETI and LP (pre and post-test). Video performances will be reviewed by external blinded experts using the checklists.
Simulation refreshers, based on a restricted LSPPDM method, will occur quarterly over the 12-month study period. Before each refresher session and at the end of the study year, residents procedural competency will be reassessed as described above.
In addition, , a “Just-in-Time” refresher will be directed by a senior supervisor for procedures performed in the clinical environment. Following the procedure, residents will be evaluated by a checklist and will receive direct feedback. Clinical procedures will also be documented in a logbook.
QUESTIONS FOR DISCUSSION
1) Is there a plus-value for videotaping during clinical procedures for competency assessment?
2) Could this educational intervention have a positive effect on more experienced residents?
3) If clinical exposure is significantly different between residents, how can we account for this in the analysis?