Trauma Skills Training Curriculum Development: Understanding the perspectives and performances of pediatric emergency medicine trainees in pediatric trauma cases, a convergent mixed methods study

Abstract

High-acuity, low occurrence events such as pediatric traumas present unique challenges not only for the physicians who provide these patients care, but for Pediatric Emergency Medicine (PEM) fellowship programs who strive to train expert pediatric trauma providers. Currently, individual PEM fellowship training programs are responsible for designing pediatric trauma curriculum, assessing competency in trauma care, and providing feedback to trainees. This project aimed to explore the current clinical practice environments of PEM fellowship trainees, self-confidence and perceived competency in various aspects of trauma management, exposure to trauma management of real patients and perspectives of current training practices regarding trauma management skills.

We conducted a convergent mixed methods study amongst PEM providers, both fellowship trainees and staff physicians, in Canada. PEM providers were recruited to complete a quantitative survey and participate in semi-structured interviews (42 providers completed the survey and 8 participated in interviews). Amongst those surveyed, current trainees and staff physicians who completed training within the past 3 years indicated very little exposure to performing the role of Trauma Team Leader (TTL) in real life (86% and 58%, respectively). Self-confidence ratings in the TTL role were lower for both groups as well as for skills used infrequently such as finger thoracostomy, thoracotomy, and traumatic cardiac arrest. Perceived trauma competency of fellow trainees was also lower for experienced staff physicians, 41% of whom still felt the need to be in the room for fellows acting as TTL at the end of their training. Similar themes of lack of confidence and exposure to the TTL role, as well as barriers regarding useful feedback and simulation-based training were observed in interviews with Recent Graduates and Program Directors.

This study highlighted various areas for improvement with respect to training of PEM fellows in pediatric trauma care and the need for continued curriculum development in pediatric trauma education.