A Novel Simulation-Based Ultrasound Curriculum (Descriptive Abstract)

ACADEMIC PEDIATRICS scheduling and organizational issues. Promoters of ownership include faculty who provide an optimal balance of space and support, scheduling that permits continuity with patients and supervisors, and overnight call. Both groups agree that ownership can be taught, primarily through role modeling, and is best assessed by peers. CONCLUSIONS: Residents and faculty consistently define ownership as a cornerstone of patient care and value additional training and feedback on this skill. These findings will be used to develop a novel assessment instrument to measure ownership of clinical care in multiple settings. 6. INTERPRETER USE TRAINING THROUGH SIMULATION (DESCRIPTIVE ABSTRACT) Kathryn Diamond-Falk, MD, Brian Youth, MD, Maine Medical Center, Portland, ME Portland, Maine where Maine Medical Center trains Pediatric and Med-Peds residents is home to a large immigrant, refugee and asylee community. Portland Public Schools estimates that there are at least 59 languages represented and that 36% of the students’ primary language at home is not English. The resident clinics at Maine Medical Center care for many of the children and families that represent those numbers. Given the need to use interpreters regularly and variable training and use of interpreters prior to residency we developed training for our interns. Via the use of interpreters trained as standardized patients, all of our residents participate in a simulation session within the first 2 months of their training. Goals of this session are to learn about the importance of using interpreters during clinical visits, and practice their skills working with interpreters and “patients” through typical scenarios they will encounter. A liaison from Interpreter Services gives an introduction that includes some basics of cultural sensitivity as well as the requirements for offering and using interpreters with patients and families. Scenarios were developed that focus on recognizing when an interpreter is needed, the importance of room set-up, using short sentences, recognizing when interpreting needs are not being met and how to ask for a new interpreter, how to address sensitive topics through interpreters and with family/friends, and how to address cultural norms that may affect use of interpreters. We have aligned scenarios with milestones to focus on intrapersonal skills and communication, professionalism and systems based practice. Each resident participates in one scenario with standardized patients (interpreters serve the role given need for native speakers of a foreign language). The residents observe one another; then with faculty oversight all residents participate in feedback after each scenario. Residents complete a survey after the simulation session and feedback has been very positive. We feel that this type of training is something that many other programs who serve large refugee or any non-English speaking population would benefit from. 7. OUTCOMES OF A NOVEL CURRICULUM ON DE-ESCALATING ANGRY CAREGIVERS FOR PEDIATRIC RESIDENTS (DESCRIPTIVE ABSTRACT) Sarah L. Hilgenberg, MD, Stanford University, Stanford, CA, Alyssa Bogetz, MSW, Collin Leibold, BS, David Gaba, MD, Rebecca Blankenburg, MD, MPH, Stanford University, Palo Alto, CA BACKGROUND: Physicians identify 1 in 6 outpatient encounters as difficult, including those involving angry patients and care-

ABSTRACTS

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givers. As such, communication with angry caregivers has emerged nationally as an area of need for trainee and faculty development. In the pediatrics literature to date, only one article describes approaches physicians can take with “difficult parents;” no research describes how to approach angry caregivers or how to teach this skill to physician trainees. OBJECTIVES 1. Create a novel communication curriculum to teach pediatric residents de-escalation techniques to use with angry caregivers 2. Conduct a randomized-controlled trial to evaluate the efficacy of the curriculum. METHODS: We created an interactive 90-minute curriculum on de-escalation skills after a thorough literature review. The curriculum includes instruction on a 9-step de-escalation framework, specific language to use, and 3 role plays to apply skills. Content experts reviewed all materials prior to implementation. All pediatric residents (n¼87) were randomized to participate in the curriculum (intervention) or to read and discuss an article on approaches to difficult patient/parent encounters (control). Descriptive statistics compare their pre/post self-efficacy and attitudinal data. Research in process will compare resident vs. standardized patient vs. faculty ratings of resident performance. RESULTS: 84 (97%) of residents participated. 43 (51%) participated in the intervention, 41 (49%) participated in the control. Of those in the intervention, 41 (95%) agreed or strongly agreed that the content was “helpful for my clinical practice,” compared with 38 (93%) of the controls, and that they would “apply the skills learned to my clinical practice,” compared with 33 (80%) of the controls. Forty (93%) reported that their ability to de-escalate angry caregivers would improve as a result of their participation, compared with 32 (78%) of the controls. CONCLUSIONS: We developed a curriculum on de-escalating angry caregivers that was feasible, well-received, and directly applicable to residents’’ clinical practice. 8. A NOVEL SIMULATION-BASED ULTRASOUND CURRICULUM (DESCRIPTIVE ABSTRACT) Vinod Havalad, MD, Joanne Claveria, MD, William Tsai, MD, Advocate Lutheran General Hospital, Park Ridge, IL Ultrasound (US) imaging technology has moved out of the realm of radiologists and technicians and into the hands of bedside clinicians. US is useful for guiding specific procedures such as central, arterial, and peripheral vascular access, thoracentesis, and paracentesis with dramatic improvements in patient safety. In addition, bedside US is consistently used in emergency departments to evaluate trauma patients in realtime and is increasingly being used across ICUs to evaluate unstable patients. US is non-invasive and can give useful, immediate information regarding cardiac function, lung function, and intra-abdominal processes, and the information gleaned often guides therapeutic and resuscitation decisions. Despite these benefits, US training is currently only a standard element in emergency medicine training and has not been required in other medical training specialties. In addition, it can sometimes be difficult to find enough willing patient participants for practice in a busy ICU and this methodology does not allow for consistent standardized practice. Our goal was to develop an ultrasound curriculum for Pediatric Critical Care Medicine fellows using simulation to augment live patient encounters. At the beginning of training, each fellow was assigned a SonoSimÒ handheld device and a registered ultrasound training account. The device allowed the fellow to practice how to hold the probe and obtain proper views for each study

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ABSTRACTS

before approaching a patient. In addition, program leaders were able to track progress by overseeing their accounts for performance on knowledge assessments and practical training. The fellows then began performing supervised studies on live patients, with the goal of acquiring 25 cardiac, 25 lung, 25 FAST and 25 procedural exams, which were then all qualitycontrolled by a physician certified in bedside ultrasound. This was accomplished during their primary service months but also during three dedicated one-month long imaging rotations spread over the three years of fellowship. At any time during this process, fellows would return to the simulator technology to refresh skills or to potentially acquire new skills not required by the curriculum. By the end of this three-year curriculum, each fellow will have enough imaging experience, as demonstrated by their verified acquired images, that they will be able to be certified in critical care ultrasound. This will have been made possible by the use of a hybrid training curriculum that leverages simulator technology. 9. PEDIATRIC CARDIOLOGY BOOT CAMP PROMOTES FELLOWSHIP READINESS AND ENABLES RETENTION OF KNOWLEDGE (RESEARCH ABSTRACT) Scott R. Ceresnak, MD, David M. Axelrod, MD, Loren D. Sacks, MD, Kara S. Motonaga, MD, Emily R. Johnson, Catherine D. Krawczeski, MD, Stanford University, Palo Alto, CA BACKGROUND: We have previously demonstrated that a pediatric cardiology boot camp can improve knowledge acquisition and decrease anxiety for trainees. We sought to determine if participants in pediatric cardiology boot camp entered fellowship with a knowledge advantage over fellows who did not attend and if there was moderate-term retention of that knowledge. METHODS: A two-day intensive training program was provided for incoming pediatric cardiology fellows from 8 pediatric cardiology fellowship programs in April 2016. Hands-on, immersive experiences and simulations were provided in all major areas of pediatric cardiology. Knowledge-based examinations were completed by each participant prior to boot camp (PRE), immediately post-training (POST), and prior to the start of fellowship in June 2016 (F/U). A control group of fellows at the same level of training who did not attend boot camp also completed an examination prior to fellowship (CTRL). Comparisons of scores were made for individual participants and between participants and controls. RESULTS: A total of 16 participants and 16 control subjects were included. Baseline exam scores were similar between participants and controls (PRE 47  11% vs. CTRL 52  10%; p ¼ 0.22). Participants’ knowledge improved with boot-camp training (PRE 47  11% vs. POST 70  8%; p<0.001) and there was excellent moderate-term retention of the information taught at boot-camp (PRE 47  11% vs. F/U 71  8%; p<0.001). Testing done at the beginning of fellowship demonstrated significantly better scores in participants versus controls (F/U 71  8% vs. CTRL 52  10%; p<0.001), suggesting that boot camp participants began fellowship with a deeper fund of knowledge compared to those that did not attend. CONCLUSIONS: Boot camp participants demonstrated a significant improvement in basic cardiology knowledge after the training program and had excellent moderate-term retention of that knowledge. Participants began fellowship with a larger fund of knowledge than those fellows who did not attend and may be better prepared for the rigors of cardiology fellowship.

ACADEMIC PEDIATRICS

Figure. Comparison of Test Scores Immediately Prior to the Start of Fellowship for Boot Camp Participants and Controls.

10. SIM ONE, TEACH ONE - SENIOR RESIDENT-LED PEDIATRIC INTERN PROCEDURAL TRAINING (RESEARCH ABSTRACT) Svetlana Melamed, MD, Beverley Robin, MD, Rush University Medical Center, Chicago, IL OBJECTIVE: Assess whether senior pediatric resident-led simulation-based procedural training (SBPT) for pediatric interns improves: 1) intern procedural skill, confidence and knowledge, 2) senior resident procedural and teaching confidence. Introduction: The ACGME requires graduating pediatric resident competence in pediatric procedures1, but graduating residents lack these skills.2 Senior residents teach procedural skills to junior trainees. METHODS: A needs assessment of Rush University Children’s Hospital pediatric residents found gaps in residents’ procedural skill. A SBPT curriculum (lumbar puncture [LP], intravenous [IV], cardiac defibrillation [CD]) was created and delivered to senior residents. Interns received 4, 2-hour, senior resident-led SBPT sessions. Interns’ procedural performance was videotaped and assessed by trained, blinded raters. Skills, confidence and knowledge were compared pre- and post-training. Senior resident confidence performing and teaching procedures were measured pre- and post-training. RESULTS: Twenty-five senior residents completed SBPT. Confidence performing LP and CD improved significantly (p¼0.001; p¼0.002 respectively). Confidence teaching procedures improved significantly (p¼0.03; p¼0.012; 0.00 for IV, LP and CD respectively). Nine interns completed SBPT. IV placement, confidence performing LP, and procedural knowledge improved Intern vs Second Year Resident Results Procedural knowledge IV Skills Confidence LP Skills Confidence CD Skills Confidence

Intern Post-training Mean Score (N)

Second Year Resident Mean Score (N)

0.76 (9)

0.63 (11)

0.03

0.86 (8) 3.25 (8)

0.65 (6) 2.90 (11)

0.008 0.49

0.81 (8) 3.25 (8)

0.69 (5) 2.90 (11)

0.289 0.465

0.90 (7) 2.63 (8)

0.67 (9) 1.70 (11)

0.017 0.108

P Value

IV: intravenous line; LP: lumbar puncture; CD: cardiac defibrillation Confidence scale: 1¼not confident; 2¼somewhat confident; 3¼neutral; 4¼confident 5¼very confident