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HOUSTON – Training programs for pediatric emergency physicians are facing a difficult challenge: How to give fellowship participants exposure to ED procedures with fewer critical care events, more duty hour limitations, increasing attending presence and little tolerance for medical errors.
The solution, according to an article published online recently by the journal Pediatrics, is greater use of simulation training.
The study, led by pediatric emergency physicians at Baylor College of Medicine in Houston, included a survey sent to the directors and associate directors of 73 different pediatric emergency medicine fellowship programs. Garnering a 95% response rate, the survey was developed in collaboration with American Academy of Pediatrics Section on Emergency Medicine Program Directors Committee to document and analyze the use of simulation training.
Assessed was each program’s use of simulation training, plans for future simulation training, simulation resource availability, and the obstacles associated with getting simulation training implemented.
Nearly all, 97%, of the 69 programs responding said they used simulation training, with the remaining 3% reporting that they planned to begin simulation training within two years. Most of the institutions, 96%, agreed or strongly agreed that more resources would be allocated to simulation training because of the need for more procedural skills preparation. More than a third of the responding programs said their fellows spent more than 20 hours annually in simulation training.
In fact, the use of simulation training increased from only 63% reported in a similar study in 2008.
“Simulation is now ubiquitous … and is being applied to a wide spectrum of training topics,” study authors write. “Shared curricula and assessment tools, increased faculty and financial support, and regionalization for programs with less local resources could further ameliorate barriers to pediatric emergency medicine fellowship simulation.”
Simulation training can employ simple mannequins, high fidelity simulators that can be programmed to respond appropriately or even simulated patients played by actors, according to the article.
According to the survey, most of the simulation programs focus on resuscitation (71%), procedures (63%), and teamwork/communication (38%). Simulation is used to evaluate procedural competency and resuscitation management in 37% of the respondents’ programs.
The programs also reported obstacles to investing more in simulation training, however.
“Current limitations primarily involve faculty and funding, with equipment and dedicated space less significant than previously reported,” the authors report. “Shared curricula and assessment tools, increased faculty and financial support, and regionalization could ameliorate barriers to incorporating simulation into PEM fellowships.”