Understanding the Procedural Skills Needed in Rural Pediatric Practices: A Survey of Rural Pediatric Providers in the State of New Mexico
Ontology highlight
ABSTRACT:
SUBMITTER: Chow C
PROVIDER: S-EPMC10848801 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:IntroductionAcute 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 methodsPediatric 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.ResultsThirty-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.DiscussionEntrustability 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.
| S-EPMC11364283 | biostudies-literature
Project description:BackgroundLittle is known about the practice of pediatric procedural sedation in Africa, despite being incredibly useful to the emergency care of children. This study describes the clinical experiences of African medical providers who use pediatric procedural sedation, including clinical indications, medications, adverse events, training, clinical guideline use, and comfort level. The goals of this study are to describe pediatric sedation practices in resource-limited settings in Africa and identify potential barriers to the provision of safe pediatric sedation.MethodsThis mixed methods study describes the pediatric procedural sedation practices of African providers using semi-structured interviews. Purposive sampling was used to identify key informants working in African resource-limited settings across a broad geographic, economic, and professional range. Quantitative data about provider background and sedation practices were collected concurrently with qualitative data about perceived barriers to pediatric procedural sedation and suggestions to improve the practice of pediatric sedation in their settings. All interviews were transcribed, coded, and analyzed for major themes.ResultsThirty-eight key informants participated, representing 19 countries and the specialties of Anesthesia, Surgery, Pediatrics, Critical Care, Emergency Medicine, and General Practice. The most common indication for pediatric sedation was imaging (42%), the most common medication used was ketamine (92%), and hypoxia was the most common adverse event (61%). Despite 92% of key informants stating that pediatric procedural sedation was critical to their practice, only half reported feeling adequately trained. The three major qualitative themes regarding barriers to safe pediatric sedation in their settings were: lack of resources, lack of education, and lack of standardization across sites and providers.ConclusionsThe results of this study suggest that training specialized pediatric sedation teams, creating portable "pediatric sedation kits," and producing locally relevant pediatric sedation guidelines may help reduce current barriers to the provision of safe pediatric sedation in resource-limited African settings.
| S-EPMC10491935 | biostudies-literature
Project description:BackgroundMany pediatric heart transplant (HT) recipients reach adulthood and may be interested in family planning; there is little data regarding safety of pregnancy post HT and clinicians' opinions differ. Pediatric HT clinicians are instrumental in early counseling. Thus, a better understanding of pediatric HT clinicians' practices regarding family planning and how well aligned these practices are with adult transplant centers is essential.MethodsWe conducted a confidential, web-based survey of pediatric HT clinicians in fall 2021. We summarized and compared answers using Fisher's exact test.ResultsThe survey was sent to 53 United States-based HT directors and to the International Society for Heart and Lung Transplantation and Pediatric Heart Transplant Society list serves. There were 69 respondents. The majority (77%) of respondents felt pregnancy was feasible in selected or all female HT recipients. Ten respondents reported that their institution had an established policy regarding pregnancy post HT. A majority (77%) of HT clinicians would either use a shared care model or recommend transition to their adult institution if pregnancy occurred, though 74% of respondents were either unaware of their corresponding adult institution's policy (62%) or had a counterpart adult program with a policy against pregnancy post HT (12%).ConclusionsWhile many clinicians feel pregnancy is feasible in pediatric HT recipients, there remains significant practice variation. Few pediatric programs have a policy regarding pregnancy post HT. Future efforts to provide consistent messaging between adult and pediatric HT programs regarding the feasibility and care of post HT pregnancy are warranted.
| S-EPMC10567538 | biostudies-literature
Project description:BackgroundInfant feeding practices are rapidly changing within rural areas in Mexico, including indigenous communities. The aim of this study was to compare infant feeding recommendations between grandmothers and healthcare providers, to better understand the factors that may influence these practices within these communities. This study builds on research that recognizes the legacy of colonization as an ongoing process that impacts the lives of people through many pathways, including the substandard healthcare systems available to them.MethodsQualitative study based on secondary data analysis from interviews and focus groups guided by a socioecological framework conducted in 2018 in two rural, Indigenous communities in Central Mexico. Participants were purposively selected mothers (n = 25), grandmothers (n = 11), and healthcare providers (n = 24) who offered care to children up to two years of age and/or their mothers. Data were coded and thematically analyzed to contrast the different perspectives of infant feeding recommendations and practices between mother, grandmothers, and healthcare providers.ResultsGrandmothers and healthcare providers differed in their beliefs regarding appropriate timing to introduce non-milk foods and duration of breastfeeding. Compared to grandmothers, healthcare providers tended to believe that their recommendations were superior to those from people in the communities and expressed stereotypes reflected in negative attitudes towards mothers who did not follow their recommendations. Grandmothers often passed down advice from previous generations and their own experiences with infant feeding but were also open to learning from healthcare providers through government programs and sharing their knowledge with their daughters and other women. Given the contradictory recommendations from grandmothers and healthcare providers, mothers often were unsure which advice to follow.ConclusionsThere are important differences between grandmothers and healthcare providers regarding infant feeding recommendations. Healthcare providers may perceive their recommendations as superior given the neocolonial structures of the medical system. Public health policies are needed to address the different recommendations mothers receive from different sources, by harmonizing them and following an evidence-informed approach. Breastfeeding programs need to value and to seek the participation of grandmothers.
| S-EPMC9682729 | biostudies-literature
Project description:While multiple oral medications are used to treat dystonia, limited information exists on current prescribing practices. This study analyzes real-world prescribing practices for pediatric dystonia in the United States, evaluating prescription frequency, dosing, and the impact of comorbidities. Oracle electronic health record real-world data were queried from 2014 to 2019 for encounters of patients under age 18 with a dystonia diagnosis and available medication records. Information was extracted on prescriptions for dystonia medications (baclofen, clonidine, carbidopa-levodopa, gabapentin, tetrabenazine, trihexyphenidyl, and select benzodiazepines), dosing, and comorbid diagnoses of cerebral palsy (CP), epilepsy, or spasticity. A total of 4010 pediatric patients with dystonia were included. Benzodiazepines were most commonly prescribed (midazolam in 53.5% of patients, diazepam 46.7%, lorazepam 41.9%, clonazepam 28.3%). This was followed by baclofen (33.4%), clonidine (26.3%), and gabapentin (19.7%). Dystonia patients with epilepsy were more commonly prescribed benzodiazepines than patients without epilepsy (diazepam 79.1% vs. 29%; clonazepam 50.9% vs. 16%) and baclofen was more often prescribed in patients with CP (59.4%) or spasticity (63.8%) than those without (17%). All medications showed decreased milligram per kilogram dosage as patient weight increased. Benzodiazepines, baclofen, and clonidine were the most common medications prescribed to pediatric patients with dystonia in the United States, although medical comorbidities impact prescribing practices. There was significant variability in weight-based dosing of all medications. There remains a need to determine which dystonia medications are most effective for each patient and the necessary drug exposure to maximize therapeutic efficacy and minimize adverse effects.
| S-EPMC11839397 | biostudies-literature
Project description:We surveyed 323 members of the Pediatric Infectious Diseases Society about their clinical practices for skin abscess management based on the 2011 Infectious Diseases Society of America guidelines and contemporary evidence. Despite this guideline and recent randomized trials, variability exists among pediatric infectious diseases clinicians in current skin and soft tissue infection management practices.
| S-EPMC7864142 | biostudies-literature
Project description:BackgroundParamedic education has evolved in recent times from vocational post-employment to tertiary pre-employment supplemented by clinical placement. Simulation is advocated as a means of transferring learned skills to clinical practice. Sole reliance of simulation learning using mannequin-based models may not be sufficient to prepare students for variance in human anatomy. In 2012, we trialled the use of fresh frozen human cadavers to supplement undergraduate paramedic procedural skill training. The purpose of this study is to evaluate whether cadaveric training is an effective adjunct to mannequin simulation and clinical placement.MethodsA multi-method approach was adopted. The first step involved a Delphi methodology to formulate and validate the evaluation instrument. The instrument comprised of knowledge-based MCQs, Likert for self-evaluation of procedural skills and behaviours, and open answer. The second step involved a pre-post evaluation of the 2013 cadaveric training.ResultsOne hundred and fourteen students attended the workshop and 96 evaluations were included in the analysis, representing a return rate of 84%. There was statistically significant improved anatomical knowledge after the workshop. Students' self-rated confidence in performing procedural skills on real patients improved significantly after the workshop: inserting laryngeal mask (MD 0.667), oropharyngeal (MD 0.198) and nasopharyngeal (MD 0.600) airways, performing Bag-Valve-Mask (MD 0.379), double (MD 0.344) and triple (MD 0.326,) airway manoeuvre, doing 12-lead electrocardiography (MD 0.729), using laryngoscope (MD 0.726), using Magill® forceps to remove foreign body (MD 0.632), attempting thoracocentesis (MD 1.240), and putting on a traction splint (MD 0.865). The students commented that the workshop provided context to their theoretical knowledge and that they gained an appreciation of the differences in normal tissue variation. Following engagement in/ completion of the workshop, students were more aware of their own clinical and non-clinical competencies.ConclusionsThe paramedic profession has evolved beyond patient transport with minimal intervention to providing comprehensive both emergency and non-emergency medical care. With limited availability of clinical placements for undergraduate paramedic training, there is an increasing demand on universities to provide suitable alternatives. Our findings suggested that cadaveric training using fresh frozen cadavers provides an effective adjunct to simulated learning and clinical placements.
| S-EPMC4099026 | biostudies-literature
Project description:Huge amounts of money are spent every year on unlearning programs--in drug-treatment facilities, prisons, psychotherapy clinics, and schools. Yet almost all of these programs fail, since recidivism rates are high in each of these fields. Progress on this problem requires a better understanding of the mechanisms that make unlearning so difficult. Much cognitive neuroscience evidence suggests that an important component of these mechanisms also dictates success on categorization tasks that recruit procedural learning and depend on synaptic plasticity within the striatum. A biologically detailed computational model of this striatal-dependent learning is described (based on Ashby & Crossley, 2011). The model assumes that a key component of striatal-dependent learning is provided by interneurons in the striatum called the tonically active neurons (TANs), which act as a gate for the learning and expression of striatal-dependent behaviors. In their tonically active state, the TANs prevent the expression of any striatal-dependent behavior. However, they learn to pause in rewarding environments and thereby permit the learning and expression of striatal-dependent behaviors. The model predicts that when rewards are no longer contingent on behavior, the TANs cease to pause, which protects striatal learning from decay and prevents unlearning. In addition, the model predicts that when rewards are partially contingent on behavior, the TANs remain partially paused, leaving the striatum available for unlearning. The results from 3 human behavioral studies support the model predictions and suggest a novel unlearning protocol that shows promising initial signs of success.
| S-EPMC3543754 | biostudies-literature
Project description:IntroductionTeaching procedural skills is an essential part of health professions education, yet formal training is often lacking from traditional curricula.MethodsA workshop on teaching procedural skills was developed as part of a clinician educator track at a large health professions university. Participants included medical residents and fellows (postgraduate years 2-6) from various training programs. The 90-minute, interactive training integrated Gagne's model of instructional design with evidence-based teaching practices. Workshop outcomes were evaluated with pre- and postworkshop surveys. Learner reactions (Kirkpatrick level 1) were assessed via course evaluation. Learning and behavior (Kirkpatrick level 2) were evaluated via attitudinal and knowledge-based questions. Data were collected from three cohorts of participants (2022-2024). Responses were analyzed by paired t test.ResultsResidents and fellows from 11 different disciplines participated in the workshops. The survey response rate was 30 out of 35 (86%). Course evaluations were positive for all six questions (mean scores: 4.8-5.0 on a 5-point Likert scale [1 = strongly disagree, 5 = strongly agree]). Postworkshop scores improved significantly for all five attitudinal questions, including "I can apply instructional design theory when teaching procedural skills" (pre: 2.2 vs. post: 4.3 on a 5-point scale, p < .01). The number of participants correctly answering the knowledge-based questions also increased following the workshop.DiscussionA workshop focused on evidence-based teaching of procedural skills was well reviewed and improved participants' attitudes and knowledge. Strengths of the workshop include its appeal to a broad range of medical trainees, integration of educational theory, and interactive design.
| S-EPMC11632081 | biostudies-literature
Project description:BackgroundOne of the primary goals of simulation-based education is to enable long-term retention of training gains. However, medical literature has poorly contributed to understanding the best timing for repetition of simulation sessions. There is heterogeneity in re-training recommendations.ObjectivesThis study assessed, through simulation-based training in different groups, the long-term retention of rare pediatric technical procedures.MethodsThis multicenter observational study included 107 emergency physicians and residents. Eighty-eight were divided into four groups that were specifically trained for pediatric emergency procedures at different points in time between 2010 and 2015 (< 0.5 year prior for G1, between 0.5 and 2 years prior for G2, between 2 and 4 years prior for G3, and ≥ 4 years prior for G4). An untrained control group (C) included 19 emergency physicians. Participants were asked to manage an unconscious infant using a low-fidelity mannequin. Assessment was based on the performance at 6 specific tasks corresponding to airway (A) and ventilation (B) skills. The performance (scored on 100) was evaluated by the TAPAS scale (Team Average Performance Assessment Scale). Correlation between performance and clinical level of experience was studied.ResultsThere was a significant difference in performance between groups (p < 0.0001). For G1, 89% of the expected tasks were completed but resulted in longer delays before initiating actions than for the other groups. There was no difference between G4 and C with less than half of the tasks performed (47 and 43% respectively, p = 0.57). There was no correlation between clinical level of experience and performance (p = 0.39).ConclusionPerformance decreased at 6 months after specific training for pediatric emergency skills, with total loss at 4 years after training, irrespective of experience. Repetition of simulation sessions should be implemented frequently after training to improve long-term retention and the optimal rate of refresher courses requires further research.
| S-EPMC6739955 | biostudies-literature