Building Emergency Medicine Trainee Competency in Pediatric Musculoskeletal Radiograph Interpretation: A Multicenter Prospective Cohort Study

Lee, Michelle Sin; Pusic, Martin; Carrière, Benoit; Dixon, Andrew; Stimec, Jennifer; Boutis, Kathy

doi:10.1002/aet2.10329

Cited by 15 publications

(9 citation statements)

References 36 publications

(70 reference statements)

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“…We used previously established methods to develop the education intervention . Deidentified images in the four POCUS applications acquired using the departmental ultrasound machine (Zonare Medical Systems) were exported from the local POCUS archive (Q‐Path, Telexy Healthcare) in JPEG (still images) or MPEG‐4 (cine‐clips) formats.…”

Section: Methodsmentioning

confidence: 99%

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Kwan

Pusic

Pecaric³

et al. 2019

AEM Education and Training

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Objectives: To complement bedside learning of point-of-care ultrasound (POCUS), we developed an online learning assessment platform for the visual interpretation component of this skill. This study examined the amount and rate of skill acquisition in POCUS image interpretation in a cohort of pediatric emergency medicine (PEM) physician learners.Methods: This was a multicenter prospective cohort study. PEM physicians learned POCUS using a computerbased image repository and learning assessment system that allowed participants to deliberately practice image interpretation of 400 images from four pediatric POCUS applications (soft tissue, lung, cardiac, and focused assessment sonography for trauma [FAST]). Participants completed at least one application (100 cases) over a 4week period.Results: We enrolled 172 PEM physicians (114 attendings, 65 fellows). The increase in accuracy from the initial to final 25 cases was 11.6%, 9.8%, 7.4%, and 8.6% for soft tissue, lung, cardiac, and FAST, respectively. For all applications, the average learners (50th percentile) required 0 to 45, 25 to 97, 66 to 175, and 141 to 290 cases to reach 80, 85, 90, and 95% accuracy, respectively. The least efficient (95th percentile) learners required 60 to 288, 109 to 456, 160 to 666, and 243 to 1040 cases to reach these same accuracy benchmarks. Generally, the soft tissue application required participants to complete the least number of cases to reach a given proficiency level, while the cardiac application required the most.Conclusions: Deliberate practice of pediatric POCUS image cases using an online learning and assessment platform may lead to skill improvement in POCUS image interpretation. Importantly, there was a highly variable rate of achievement across learners and applications. These data inform our understanding of POCUS image interpretation skill development and could complement bedside learning and performance assessments.From the

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Section: Methodsmentioning

confidence: 99%

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Kwan

Pusic

Pecaric³

et al. 2019

AEM Education and Training

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“…19 In 2 other studies in which researchers evaluated family medicine and internal medicine residents, residents who saw more patients scored higher on intraining examinations. 20,[21][22][23] Given this association between exposure and competency, it is, therefore, important for residency programs to consider tracking resident-level patient exposures during the pandemic. It is also important to recognize that concerns about competency may impact intern confidence in medical decision-making, particularly as they gain additional autonomy at the end of intern year.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Intern Clinical Exposure During the COVID-19 Pandemic

Geanacopoulos¹,

Sundheim²,

Greco³

et al. 2021

Hospital Pediatrics

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BACKGROUND AND OBJECTIVES: Pediatric health care encounters declined during the coronavirus disease 2019 (COVID-19) pandemic, and pediatric residency programs have adapted trainee schedules to meet the needs of this changing clinical environment. We sought to evaluate the impact of the pandemic on pediatric interns' clinical exposure. METHODS:In this retrospective cohort study, we quantified patient exposure among pediatric interns from a single large pediatric residency program at a freestanding children's hospital. Patient encounters and shifts per pediatric intern in the inpatient and emergency department settings were evaluated during the COVID-19 pandemic, from March to June 2020, as compared with these 3 months in 2019. Patient encounters by diagnosis were also evaluated. RESULTS:The median number of patient encounters per intern per 2-week block declined on the pediatric hospital medicine service (37.5 vs 27.0; P < .001) and intensive care step-down unit (29.0 vs 18.8; P = .004) during the pandemic. No significant difference in emergency department encounters was observed (63.0 vs 40.5; P = .06). The median number of shifts worked per intern per 2-week block also decreased on the pediatric hospital medicine service (10.5 vs 9.5, P < .001). Across all settings, there were more encounters for screening for infectious disease and fewer encounters for respiratory illnesses.CONCLUSIONS: Pediatric interns at the onset of the COVID-19 pandemic were exposed to fewer patients and had reduced clinical schedules. Careful consideration is needed to track and supplement missed clinical experiences during the pandemic.

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“…Thus, the introduction of effective education strategies that target pediatric MSK radiograph interpretation into residency and continued professional development may be important to reduce errors among practicing ED physicians. An online evidence‐based pediatric MSK radiograph interpretation system has been developed and has demonstrated effective learning outcomes to a competency standard, and this could be integrated into ED residency training . Espinosa and Nolan described an educational process at their site where all staff reviewed all clinically significant discrepancies at monthly meetings and created a teaching file of errors.…”

Section: Discussionmentioning

confidence: 99%

“…Our results have practice implications. The interpretation of pediatric MSK radiographs has been shown to be relatively deficient among graduating pediatric and emergency medicine residents, and therefore it is not surprising that there are interpretation errors among practicing physicians. Thus, the introduction of effective education strategies that target pediatric MSK radiograph interpretation into residency and continued professional development may be important to reduce errors among practicing ED physicians.…”

Section: Discussionmentioning

confidence: 99%

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Adverse Events from Emergency Physician Pediatric Extremity Radiograph Interpretations: A Prospective Cohort Study

Al-Sani

Prasad

Panwar

et al. 2019

Academic Emergency Medicine

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Objectives We determined how often emergency physician pediatric musculoskeletal (MSK) radiograph interpretations were discordant to that of a radiologist and led to an adverse event (AE). We also established the variables independently associated with this outcome. Methods This prospective cohort study was conducted in an urban, tertiary care children's emergency department (ED). We enrolled children who presented to an ED with an extremity injury and received radiographs. ED physicians documented their radiograph interpretation, which was compared to a radiology reference standard. Patients received telephone follow‐up and had institutional medical records reviewed in 3 weeks. An AE occurred if there were clinical sequelae and/or repeat health care visits due to a delay in correct radiograph interpretation. Results We enrolled 2,302 children (mean [±SD] age = 9.0 [4.4] years; 1,288 (56.0%) male]. Of these, 180 (7.8%; 95% confidence interval = 6.8 to 9.0) ED physician discordant interpretations resulted in an AE. Specifically, there were no negative clinical outcomes; however, relative to cases diagnosed correctly at the index ED, patients whose fracture was not initially identified encountered 77.2% more subsequent ED visits, while those falsely diagnosed with a fracture experienced 41.5% additional orthopedic clinic visits. Odds of an ED discrepant interpretation was significantly higher if a physician’s pretest probability of a fracture was ≤ 20% versus> 20% (adjusted odds ratio [aOR] = 1.6), patient’s pain score was ≤ 2 versus> 2 (aOR = 1.6), and injury was located in a joint versus other location (aOR = 1.7). Conclusions Emergency physician discordant pediatric MSK radiograph interpretations that resulted in an AE occurred with regular frequency in a pediatric ED setting. AEs were primarily an increase in subsequent health care visits. Importantly, a low clinical suspicion for a fracture or injury located in the joint were risk factors for ED physician discordant interpretations.

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Building Emergency Medicine Trainee Competency in Pediatric Musculoskeletal Radiograph Interpretation: A Multicenter Prospective Cohort Study

Cited by 15 publications

References 36 publications

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Pediatric Intern Clinical Exposure During the COVID-19 Pandemic

Adverse Events from Emergency Physician Pediatric Extremity Radiograph Interpretations: A Prospective Cohort Study

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