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Original article
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. 1Paediatric Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
    2. 2School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
    3. 3Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
    4. 4Yale University School of Medicine, New Haven, Connecticut, USA
    5. 5Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), Itasca, Illinois, USA
    6. 6Emergency Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
    7. 7Emergency Department, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
    8. 8Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
    9. 9Peninsula Health, Frankston, Victoria, Australia
    10. 10Sydney Children’s Hospital, Randwick, New South Wales, Australia
    11. 11Department of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia
    12. 12Health Education Training Institute (HETI), Gladesville, New South Wales, Australia
    13. 13The Children’s Hospital at Westmead, Westmead, NSW, Australia
    14. 14Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
    15. 15Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
    16. 16Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI), UK
    17. 17Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain
    18. 18Department of Pediatrics, University of the Basque Country, Lejona, Spain
    19. 19Research in European Pediatric Emergency Medicine (REPEM), Brussels, Belgium
    20. 20Boston Children’s Hospital, Boston, Massachusetts, USA
    21. 21Harvard Medical School, Boston, Massachusetts, USA
    22. 22Pediatric Emergency Care Applied Research Network (PECARN), USA
    23. 23Children’s Hospital of Colorado, Aurora, Colorado, USA
    24. 24Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
    25. 25Stollery Children’s Hospital, Edmonton, Alberta, Canada
    26. 26Women’s and Children’s Health Research Institute, Edmonton, Alberta, Canada
    27. 27Pediatric Emergency Research Canada (PERC), Calgary, Alberta, Canada
    28. 28Department of Pediatrics, Universidad de Buenos Aires, Pcia de Buenos Aires, Argentina
    29. 29Hospital de Pediatría ’Profesor Dr Juan P Garrahan', Buenos Aires, Argentina
    30. 30Red de Investigación y Desarrollo de la Emergencia Pediátrica de Latinoamérica (RIDEPLA), Buenos Aires, Argentina
    31. 31Starship Children’s Hospital, Auckland, New Zealand
    32. 32Departments 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}monashhealth.org

    Abstract

    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

    https://doi.org/10.1136/emermed-2017-207384

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      Footnotes

      • 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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