Traditional Poster Round
Background: : Pediatric traumas are less common than in adult medicine, and therefore pediatric residents often do not receive adequate opportunities to practice cardiopulmonary resuscitation skills1. This can result in resident hesitancy to participate in resuscitation events of critically-ill children.
Research Question: : Primary objectives of this study were to develop and implement a novel 2 hour simulation-based trauma orientation for residents on their pediatric emergency medicine (PEM) rotation and (2) determine if this orientation increases attendance of pediatric residents at resuscitation events. We hypothesized this orientation would increase confidence in resuscitation skills, thus increasing resident attendance at trauma resuscitations.
Methodology: : Residents were surveyed before and after the orientation to determine perceived barrier to participation and if there was a change in self reported confidence in trauma resuscitation skills. Residents rated confidence on a 0-100 scale, and p values were calculated from these numeric responses. A retrospective review of the electronic medical record was completed to determine the frequency of pediatric resident attendance at Level I/II traumas over a 6 month period before and after implementation of the orientation. All of the 100 pediatric residents in our program (including categorical, child neurology, and combined medicine-pediatrics residents) were eligible for inclusion in this study.
Results: : Initial chart review showed that pediatric residents were present for only 22.7% of traumas despite staffing 59.5% of resident shifts. The most common reported barriers to participation were ‘I am unsure of my exact role during resuscitations’ (76%) and ‘I feel uncomfortable calling out the primary or secondary survey in front of others’ (57%). Comparison of pre- and post-orientation surveys showed significant increases in confidence in performing the primary (p < 0.01) and secondary surveys (p <0.01), understanding the role of a pediatric resident in a trauma (p < 0.01), and deciding between various common medications used in resuscitations (p < 0.04). All residents who completed the post-intervention survey indicated they either agreed or strongly agreed that they felt more confident actively participating in both trauma and medical resuscitations after the orientation. Despite these quantitative survey results, there was no significant difference in the percentage of pediatric residents present for trauma bay activations post-orientation (22.4%, p = 1.0).
Discussion/Conclusions: : We have successfully established a trauma simulation-based orientation for pediatric residents to attend before their PEM rotation. Results of pre- and post-intervention surveys showed increased confidence in basic skills required in trauma resuscitation and improved understanding of the resident role in these situations, however this did not translate into a significant increase in percentage of pediatric residents attending trauma resuscitations.