Assessment Of Need For Trauma Education For Pediatric Residents In The Emergency Department, And Creation Of A Video Module In Response

Abstract

Introduction: Over 200 learners rotate through our pediatric emergency department yearly, and roughly 130 of them are residents in a pediatrics (categorical or combined) residency program. For many of these residents, the pediatric emergency medicine rotation is one of the only opportunities for experience with pediatric trauma resuscitation. Consistently, residents have identified pediatric trauma as an area of discomfort within their practice. Trauma resuscitations in the emergency department are relatively infrequent, and high stakes, so are not ideal opportunities for novice learners. Simulation exists as part of the curriculum, but scheduling challenges make increasing this portion of the curriculum impractical. We sought to further explore resident experience with trauma resuscitation education, and to create a new approach to trauma education that would supplement the existing curriculum. Methods: We distributed 2 different surveys to all pediatric residents on their pediatric emergency medicine rotation: one prior to the start of the rotation, and one after completion. Survey data were collected anonymously and voluntarily, over the course of 1 year. Based on preliminary survey data and informal discussions with residents and education leadership, we conceived of the idea of a video as a novel educational tool to supplement our existing pediatric trauma curriculum. This would be viewed online, asynchronously, circumventing many of the practical challenges associated with increasing simulation or patient care time. We developed a script with an emphasis on a practical approach to running a pediatric trauma resuscitation. Results: Our survey data found that residents started their pediatric emergency medicine rotations with low confidence in leading trauma resuscitation, rating their confidence an average of 25.1 on a visual analog scale (VAS) from 1 to 100. There was a modest improvement after the rotation to 43.7. Anxiety about trauma resuscitation, however, remained high with a rating of 63.2 on a VAS of 1 to 100 before the rotation, and 62.5 after. At the end of their rotations, residents reported that patient care and simulation sessions both contributed a moderate amount (63.2 and 56.5 respectively on a VAS from 1 to 100), while self study only contributed a little (33.1). In response to these data, we created a trauma education video for residents rotating through the pediatric emergency department. The video was filmed in one of our own trauma resuscitation rooms in the Riley Pediatric Emergency Department with our own nurses and Emergency Medicine/Pediatrics residents, with technical support from IU Collaboration Technologies and Classroom Support.

Conclusions: Our survey data confirmed the need for improvement in education on pediatric trauma resuscitation. Results suggest residents find that more “hands on” opportunities contribute more to their education, but there remain significant challenges to increasing these opportunities. We are hopeful that the practical emphasis of our pediatric trauma education video will improve the effectiveness over other self-study modalities already in existence. In the coming months, we intend to incorporate the video into the online education modules and investigate its impact on resident confidence and comfort with pediatric trauma resuscitation.