■程序培训是儿科住院医师及其老师普遍关注的问题。我们开发并实施了形成性评估,以产生直接和间接的程序反馈。我们分析了居民感知的程序知识的变化,技能,信心,和委托。
■儿科急诊科的高级儿科住院医师参加了视频记录的知情同意OSCEs形成性评估,以及模拟幼儿前额裂伤修复和婴儿腰椎穿刺。居民反映了他们感知的程序知识,技能,信心,通过李克特和委托尺度进行委托。形成性评估完成率和由儿科住院医师执行的手术比例的次要结果跟踪可行性和潜在的临床影响,分别。
■包括导频周期,89%的居民(35人中有31人)收到了直接和间接的程序反馈。对于裂伤修复(能力:从3.1到3.9,p<.001;委托:从4.0到5.1,p<.001)和腰椎穿刺(能力:从3.5到4.0,p<.001;委托:从4.6到5.6,p=.001),感知综合能力和委托得到了改善。我们观察到临床裂伤修复的比例增加(11%[885人中的97]与23%[946人中有218人],p<.001)和腰椎穿刺(23%[54个中的12个]与41%[52人中有21人],p=0.05)由儿科住院医师进行。
■将可行的程序形成性评估纳入儿科急诊科轮换对高级儿科居民对其程序知识的看法产生了积极影响,技能,信心,和委托,并与增加的程序参与有关。
Procedural training is a universal concern amongst pediatric residents and their teachers. We developed and implemented formative assessments to generate direct and indirect procedural feedback. We analyzed changes in residents\' perceived procedural knowledge, skills, confidence, and entrustment.
Senior pediatric residents rotating in the pediatric emergency department participated in video-recorded formative assessments of informed consent OSCEs and simulated toddler forehead laceration repair and infant lumbar puncture. Residents reflected on their perceived procedural knowledge, skills, confidence, and entrustment through Likert and entrustment scales. Secondary outcomes of formative assessment completion rates and proportions of procedures performed by pediatric residents tracked feasibility and potential clinical impact, respectively.
Including the pilot period, 89% of residents (31 out of 35) received direct and indirect procedural feedback. Perceived composite competency and entrustment improved for laceration repair (competency: from 3.1 to 3.9, p < .001; entrustment: from 4.0 to 5.1, p < .001) and lumbar puncture (competency: from 3.5 to 4.0, p < .001; entrustment: from 4.6 to 5.6, p = .001). We observed an increase in the proportion of clinical laceration repairs (11% [97 out of 885] vs. 23% [218 out of 946], p < .001) and lumbar punctures (23% [12 out of 54] vs. 41% [21 out of 52], p = .05) performed by pediatric residents.
Integrating feasible procedural formative assessments into the pediatric emergency department rotation had a positive impact on senior pediatric residents\' perceptions of their procedural knowledge, skills, confidence, and entrustment and was associated with increased procedural engagement.