小児救急医療フェローのための多職種外傷シミュレーションカリキュラムの実装

Unintentional injury is a leading cause of morbidity and mortality in children. The Accreditation Council for Graduate Medical Education (ACGME) requires competency in medical and trauma resuscitation in patients from newborn through adulthood. Yet there is a paucity of data regarding best practices for pediatric trauma training. The goal of this study was to evaluate knowledge gaps in pediatric trauma training, implement a trauma simulation curriculum, and evaluate changes in fellows comfort level with trauma skills preimplementation and postimplementation.

We utilized Kern's 6-step approach to design an innovative longitudinal trauma curriculum for Pediatric Emergency Medicine (PEM) fellows. A needs assessment was sent to PEM faculty, PEM fellows, pediatric surgery faculty, pediatric surgery fellows, and pediatric ED nursing. Learning objectives were derived and categorized as technical skills, nontechnical skills, and case-based medical knowledge. This guided a year-long curriculum including 11 simulation cases and 3 didactic sessions. The curriculum was assessed at Kirkpatrick levels 1 and 2 through preimplementation and postimplementation surveys. We assessed fellows' self-reported comfort and faculty perception of the supervision required.

Fellows began with higher overall comfort with nontechnical skills compared with technical skills. Following implementation, there was a statistically significant improvement in fellow comfort in overall technical skills (P < 0.05), traction splint application (P < 0.05), and initiating massive transfusion protocol (P < 0.05). There were positive trends in obtaining access, placing pelvic binders, managing increased intracranial pressure, and leadership skills. There were no statistically significant findings noted in the surveys completed by the faculty.

This study presents a promising foundation for a comprehensive longitudinal pediatric trauma curriculum. Our study, while small, showed overall improvement in fellow comfort with trauma resuscitation at Kirkpatrick level 1, most notably with technical skills. Future areas of research include increased sample size, enhanced skills assessment methods, and expansion to other trauma team stakeholders.