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Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians
  1. Simon S Craig1,2,3,
  2. Marc Auerbach4,5,
  3. John Alexander Cheek3,6,7,8,
  4. Franz E Babl3,6,7,8,
  5. Ed Oakley3,6,7,8,
  6. Lucia Nguyen9,
  7. Arjun Rao3,10,11,12,
  8. Sarah Dalton3,13,
  9. Mark D Lyttle14,15,16,
  10. Santiago Mintegi17,18,19,
  11. Joshua Nagler20,21,22,
  12. Rakesh D Mistry5,23,
  13. Andrew Dixon24,25,26,27,
  14. Pedro Rino28,29,30,
  15. Guillermo Kohn-Loncarica28,29,30,
  16. Stuart R Dalziel3,32,31
  17. for the Pediatric Emergency Research Networks (PERN)
    1. 1 Paediatric Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
    2. 2 School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
    3. 3 Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
    4. 4 Yale University School of Medicine, New Haven, Connecticut, USA
    5. 5 Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), Itasca, Illinois, USA
    6. 6 Emergency Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
    7. 7 Emergency Department, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
    8. 8 Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
    9. 9 Peninsula Health, Frankston, Victoria, Australia
    10. 10 Sydney Children’s Hospital, Randwick, New South Wales, Australia
    11. 11 Department of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia
    12. 12 Health Education Training Institute (HETI), Gladesville, New South Wales, Australia
    13. 13 The Children’s Hospital at Westmead, Westmead, NSW, Australia
    14. 14 Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
    15. 15 Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
    16. 16 Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI), UK
    17. 17 Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain
    18. 18 Department of Pediatrics, University of the Basque Country, Lejona, Spain
    19. 19 Research in European Pediatric Emergency Medicine (REPEM), Brussels, Belgium
    20. 20 Boston Children’s Hospital, Boston, Massachusetts, USA
    21. 21 Harvard Medical School, Boston, Massachusetts, USA
    22. 22 Pediatric Emergency Care Applied Research Network (PECARN), USA
    23. 23 Children’s Hospital of Colorado, Aurora, Colorado, USA
    24. 24 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    25. 25 Stollery Children’s Hospital, Edmonton, Alberta, Canada
    26. 26 Women’s and Children’s Health Research Institute, Edmonton, Alberta, Canada
    27. 27 Pediatric Emergency Research Canada (PERC), Calgary, Alberta, Canada
    28. 28 Department of Pediatrics, Universidad de Buenos Aires, Pcia de Buenos Aires, Argentina
    29. 29 Hospital de Pediatría ’Profesor Dr Juan P Garrahan', Buenos Aires, Argentina
    30. 30 Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA), Buenos Aires, Argentina
    31. 31 Starship Children’s Hospital, Auckland, New Zealand
    32. 32 Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
    1. Correspondence to Dr Simon S Craig, Paediatric Research in Emergency Departments International Collaborative (PREDICT). 246 Clayton Rd, Clayton VIC 3168, Australia; simon.craig{at}


    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.

    • paediatrics, paediatric emergency medicine
    • paediatric resuscitation
    • education

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    • Contributors SSC and MA conceptualised and designed the study, collected data, drafted the initial manuscript and reviewed and revised the manuscript. All other authors (JAC, FB, EO, LN, AR, SD, MDL, SM, JN, RDM, AD, PR, GKL and SRD) designed the study, collected data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding SRD’s time was part funded by the Health Research Council of New Zealand (HRC13/556). FB and EO are funded by the National Health and Medical Research Council project grant GNT1046727, Centre of Research Excellence for Paediatric Emergency Medicine GNT1058560), Canberra, Australia; and supported by the Victorian Government’s Infrastructure Support Program, Melbourne, Australia. FB’s time was part funded by a grant from the Royal Children’s Hospital Foundation, Melbourne, Australia, a Melbourne Children’s Clinician Scientist Fellowship, Melbourne, Australia and an NHMRC Practitioner Fellowship, Canberra, Australia.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The survey was approved by the Monash Health Human Research Ethics Committee (and other committees/institutional review boards in participating countries).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There is no additional unpublished data from the study available.

    • Collaborators Participating networks include: the Pediatric Emergency Care Applied Research Network (PECARN), USA: University of California, Davis, California: Leah Tzimenatos, Children’s Hospital of Colorado (Denver): Rakesh Mistry, Children’s National Medical Center, District of Columbia: Kathleen Brown, Lurie Children’s Hospital (Chicago), Illinois: Elizabeth Powell, Boston Children’s Hospital, Massachusetts: Joshua Nagler, Children’s Hospital of Michigan (Detroit), Michigan: Amy Cortis, University of Michigan (Ann Arbor), Michigan: Angela Zamarripa, Alexander Rogers, Washington University/St. Louis Children’s, Missouri: David Schnadower, Morgan Stanley Children’s Hospital (NYC), New York: Nazreen Jamal, Cincinnati Children’s Hospital, Ohio: Matt Mittiga, Nationwide Children’s Hospital (Columbus), Ohio: Rachel Stanley, Children’s Hospital of Philadelphia, Pennsylvania: Anna Weiss, Pittsburgh Children’s Hospital, Pennsylvania: Robert W. Hickey, Baylor Children’s Hospital (Houston), Texas: Cara Doughty, Primary Children’s Hospital (Salt Lake City), Utah: Douglas Nelson, Children’s Hospital of Wisconsin (Milwaukee), Wisconsin: Jean Pearce. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (PEMCRC), USA: University of Alabama-Birmingham, Alabama: Chris Pruitt, Phoenix Children’s, Arizona: Blake Bulloch, Rady Children’s (San Diego), California: Keri Carstairs, Yale-New Haven Children’s, Connecticut: Paul Aronson, Kosair Children’s (Louisville), Kentucky: Michelle Stevenson, John’s Hopkins University (Baltimore), Maryland: Jennifer Fishe, Children’s Hospital and Clinics (Minneapolis-St. Paul), Minnesota: Ernest Krause, University of Minnesota Children’s (Minneapolis), Minnesota: Jeff Louie, Children’s Mercy (Kansas City), Missouri: Kim Randell, Newark-Beth Israel, New Jersey: Adam Sivitz, Children’s Hospital of Montefiore (NYC), New York: Daniel Fein, Cohen Children’s Hospital, New York: William Krief, Lincoln Medical Center (NYC), New York: Muhammad Waseem, Maimonodes Medical Centre (NYC), New York: Hector Vazquez, Vanderbilt University (Nashville), Tennessee: Don Arnold, Children’s Medical Center/UT-Southwestern (Dallas), Texas: Halim Hennes, Dell Children’s Hospital (Austin), Texas: Matthew Wilkinson, Seattle Children’s, Washington: Eileen Klein. Pediatric Emergency Research Canada (PERC): Alberta Children’s Hospital: Kelly Millar, British Columbia Children’s Hospital: Sim Grewal, Children’s Hospital of Eastern Ontario: Sarah Reid, CHU-Sainte Justine: Jocelyn Gravel, IWK Health Centre: Eleanor Fitzpatrick, McMaster Children’s Hospital: Mohamed Eltorki, Sick Kids: Tania Principi, Stollery Children’s Hospital: Andrew Dixon, Winnipeg Children’s Hospital: Scott Sawyer. Paediatric Emergency Research in the UK and Ireland (PERUKI): England: Addenbrooke’s Hospital, Cambridge: Lisa Mackenzie, Alder Hey Children’s Hospital, Liverpool: Shrouk Messahel, Barts & the London, London: Ami Parikh, Birmingham Children’s Hospital, Birmingham: Stuart Hartshorn, Bristol Royal Hospital for Children, Bristol: Holly Lavigne-Smith, Chelsea and Westminster Hospital, London: Felicity Taylor, County Durham and Darlington NHS Foundation Trust: Amanda Cowton, Derriford Hospital, Plymouth: Tom Dougherty, Evelina London Children’s Hospital, London: John Criddle King’s College Hospital, London: Fleur Cantle, Darren Darby, Leeds General Infirmary, Leeds: Abi Hoyle, Leicester Royal Infirmary, Leicester: Damian Roland, Northumbria Specialist Emergency Care Hospital: Stephen Owens, Nottingham Children’s Hospital, Nottingham: Chris Gough, Royal Alexandra Children’s Hospital, Brighton: Catherine Bevan, Royal Derby Hospital, Derby: Gisela Robinson, Royal Devon and Exeter Hospital, Exeter: Elizabeth Florey, Royal Manchester Children’s Hospital, Manchester: Katherine Potier, Sheffield Children’s Hospital, Sheffield: Derek Burke, Sunderland Royal Hospital, Sunderland: Niall Mullen, University Hospital, Southampton, Southampton: Jane Bayreuther, Watford General Hospital (West Herts NHS Trust), Watford: Michelle Jacobs, Royal Victoria Infirmary, Newcastle upon Tyne: Mark Anderson. Ireland: Our Lady’s Children’s Hospital, Crumlin, Dublin: Carol Blackburn, Tallaght Children’s Hospital, Tallaght, Dublin: Turlough Bolger, Temple Street Children’s University Hospital, Dublin: Roisin Mc Namara. Northern Ireland: Royal Belfast Hospital for Sick Children, Belfast: Julie-Ann Maney, Scotland: Royal Aberdeen Children’s Hospital, Aberdeen: Gareth Patton, Crosshouse Hospital, Kilmarnock: Joanne Mulligan, Forth Valley Royal Hospital, Larbert: Roger Alcock, Royal Hospital for Children, Glasgow: Steven Foster, Royal Hospital for Sick Children, Edinburgh: Jen Browning, Wales: Children’s Hospital for Wales, Cardiff: Colin Powell, Zoe Roberts, Morriston Hospital, Swansea: Kirsty Dickson-Jardine. Pediatric Research in Emergency Departments International Collaborative (PREDICT): New Zealand: Kidz First Children’s Hospital: Jocelyn Neutze, Starship Children’s Hospital: Stuart Dalziel, Australia: John Hunter Hospital, Newcastle: Michael Zhang, Sydney Children’s Hospital: Arjun Rao, The Children’s Hospital at Westmead: Sarah Dalton, Mary McCaskill, Lady Cilento Children’s Hospital: Natalie Phillips, The Gold Coast Hospital and Health Service: Shane George, The Townsville Hospital: Jeremy Furyk, Women & Children’s Hospital, Adelaide: Amit Kochar, Monash Children’s Hospital: Simon Craig, Royal Children’s Hospital, Melbourne: Franz Babl, Princess Margaret Hospital, Perth: Meredith Borland. Research in European Pediatric Emergency Medicine (REPEM): Belgium: University Hospital Ghent: Patrick Van de Voorde France: Necker Enfants, Malades H, Paris: Gérard Cheron, Spain: Cruces University Hospital, Bilbao, Basque Country: Santiago Mintegi, Jimena de Pedro, Rio Hortega’s Hospital, Valladolid: Roberto Velasco, Gregorio Maranon University Hospital, Madrid: Rafael Marañón and Red de Investigación y Desarrollo de la Emergencia Pediatrica de Latinoamérica (RIDEPLA): Argentina: Hospital de Pediatría Professor Dr Juan P Garrahan, Buenos Aires: Guillermo Kohn Loncarica and Pedro Rino, Paraguay: Hospital Pediátrico Niños de Acosta Ñu, San Lorenzo: Viviana Pavlicich.

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