Improving pediatric procedural skills and EPA assessments through an acute care procedural skills curriculum.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Clinical Competence* ; Internship and Residency* ; Pediatrics*/education ; Curriculum*; Humans ; Cross-Sectional Studies ; Female ; Male ; Educational Measurement ; Emergency Medicine/education ; Adult

Introduction: Acute procedural skill competence is expected by the end of pediatric residency training; however, the extent to which residents are actually competent is not clear. Therefore, a cross-sectional observational study was performed to examine the competency of pediatric residents in acute care procedures in emergency medicine.
Materials and Methods: Pediatric residents underwent didactic/hands-on "Acute Procedure Day" where they performed procedures with direct supervision and received entrustable professional activity (EPA) assessments (scores from 1-5) for each attempt. Procedures included: bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR) with defibrillation. Demographic information, perceived comfort level, and EPA data were collected. Descriptive statistics and Pearson correlation for postgraduate year (PGY) versus EPA scores were performed.
Results: Thirty-six residents participated (24 PGY 1-2, and 12 PGY 3-4). Self-reported prior clinical exposure was lowest for chest tube placement (n = 3, 8.3%), followed by IOs (n = 19, 52.8%). During the sessions, residents showed the highest levels of first attempt proficiency with IO placement (EPA 4-5 in 28 residents/33 who participated) and BVM (EPA 4-5 in 27/33), and the lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). There was a strong correlation between PGY level and EPA score for intubation, but not for other skills.
Discussion: Entrustability in acute care skills is not achieved with current pediatrics training. Research is needed to explore learning curves for skill acquisition and their relative importance.
Competing Interests: The authors received no financial support for this project. This project was a quality improvement initiative of the Department of Pediatrics at McMaster University, which the authors are affiliated with. All authors report no relevant conflicts of interest. EB reports grant money from the Social Sciences and Humanities Research Council (SSHRC) Insight Development Grant, the SSHRC Partnership Engage Grants (PEG), the Royal College of Physicians and Surgeons of Canada Medical Education Research Grant (RC MERG), the eCampus Ontario grant, and Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship Award. QN and KF reports grant money from the SSHRC PEG. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2024 Mirza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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Date Created: 20240830 Date Completed: 20240830 Latest Revision: 20240905

20240906

PMC11364283

10.1371/journal.pone.0306721

39213371