Deborah Hsu, MD, MEd

All Publications

• Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. Pediatrics Marin, J. R., Lyons, T. W., Claudius, I., Fallat, M. E., Aquino, M., Ruttan, T., Daugherty, R. J. 2024; 154 (1)

  Abstract

  Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging, are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.

  View details for DOI 10.1542/peds.2024-066855

  View details for PubMedID 38932719

• Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement. Pediatrics Marin, J. R., Lyons, T. W., Claudius, I., Fallat, M. E., Aquino, M., Ruttan, T., Daugherty, R. J. 2024; 154 (1)

  Abstract

  Advanced imaging, including ultrasonography, computed tomography, and magnetic resonance imaging, is an integral component to the evaluation and management of ill and injured children in the emergency department. As with any test or intervention, the benefits and potential impacts on management must be weighed against the risks to ensure that high-value care is being delivered. There are important considerations specific to the pediatric patient related to the ordering and interpretation of advanced imaging. This policy statement provides guidelines for institutions and those who care for children to optimize the use of advanced imaging in the emergency department setting and was coauthored by experts in pediatric and general emergency medicine, pediatric radiology, and pediatric surgery. The intent is to guide decision-making where children may access care.

  View details for DOI 10.1542/peds.2024-066854

  View details for PubMedID 38932710

• Competency based medical education and trust in the learning environment. Current problems in pediatric and adolescent health care Hsu, D., Rassbach, C., Leaming-Van Zandt, K., Morrow, A., Rubenstein, J., Tatem, A., Turner, D. A., Poitevien, P., Barone, M. A. 2024: 101640

  View details for DOI 10.1016/j.cppeds.2024.101640

  View details for PubMedID 38876832

• Implementing Entrustable Professional Activities in Pediatric Fellowships: Facilitating the Process. Pediatrics Langhan, M. L., Boyer, D. L., Hsu, D., Moffatt, M. E., Pitts, S. A., Atlas, M. P., Aye, T., Chess, P., Curran, M. L., Czaja, A. S., Dammann, C. E., Fussell, J., George, R. P., Herman, B. E., High, P., James, S. H., Kamin, D. S., Karnik, R., Kesselheim, J., Lopez, M. A., Mahan, J. D., McFadden, V., McGann, K. A., Mehta, J. J., Rama, J., Robinson, B. W., Sauer, C., Stafford, D. E., Turner, D. A., Weiss, P., Yussman, S. M., Schwartz, A., Mink, R. 2024

  Abstract

  Entrustable professional activities (EPAs) will be used for initial certification by the American Board of Pediatrics by 2028. Less than half of pediatric fellowships currently use EPAs for assessment, yet all will need to adopt them. Our objectives were to identify facilitators and barriers to the implementation of EPAs to assess pediatric fellows and to determine fellowship program directors' (FPD) perceptions of EPAs and Milestones.We conducted a survey of FPDs from 15 pediatric subspecialties. EPA users were asked about their implementation of EPAs, barriers encountered, and perceptions of EPAs. Nonusers were queried about deterrents to using EPAs. Both groups were asked about potential facilitators of implementation and their perceptions of Milestones.The response rate was 65% (575/883). Of these, 344 (59.8%) were EPA users and 231 (40.2%) were nonusers. Both groups indicated work burden as a barrier to implementation. Nonusers reported more barriers than users (mean [SD]: 7 [3.8] vs 5.8 [3.4], P < .001). Both groups identified training materials and premade assessment forms as facilitators to implementation. Users felt that EPAs were easier to understand than Milestones (89%) and better reflected what it meant to be a practicing subspecialty physician (90%). In contrast, nonusers felt that Milestones were easy to understand (57%) and reflected what it meant to be a practicing subspecialist (58%).Implementing EPA-based assessment will require a substantial investment by FPDs, facilitated by guidance and easily accessible resources provided by multiple organizations. Perceived barriers to be addressed include FPD time constraints, a need for additional assessment tools, and outcomes data.

  View details for DOI 10.1542/peds.2023-065024

  View details for PubMedID 38757175

• Level of Supervision for the Entrustable Professional Activities Common to General Pediatrics and the Subspecialties Decreases from Residency to Fellowship. Academic pediatrics Mink, R. B., Schwartz, A., Mahan, J. D., Fussell, J. J., George, R., Schumacher, D. J., McFadden, V., Turner, D. A., Atlas, M. P. 2024

  Abstract

  To compare level of supervision (LOS) ratings of graduating pediatric residents with their assessments as fellows for the five Entrustable Professional Activities (EPAs) common to general pediatrics and the subspecialties and to determine if the difference between ratings from residency to fellowship is less for the QI and Practice Management EPAs, since the skills needed to perform these may be less context-dependent.We compared ratings of graduating residents with their assessments as fellows using LOS data from two sequential EPA studies.There were 65 ratings from 41 residents at the first fellow assessment. At graduation, most residents needed little to no supervision for all EPAs with 94% (61/65) of ratings level four or five. In contrast, only 5/65 (8%) of the first fellow assessments were level four or five. The ratings difference for the QI and Practice Management EPAs was similar to the others.LOS ratings for the EPAs common to generalists and subspecialists reset as residents become fellows. There was no evidence that the QI and Practice Management EPAs are less context-dependent. This study provides additional validity evidence for using these LOS scales to assess trainees in pediatric residency and fellowship.

  View details for DOI 10.1016/j.acap.2024.04.004

  View details for PubMedID 38631477

• Clinical use of topical anesthetics in children UpToDate Hsu, D. Wolters Kluwer. 2024
• Subcutaneous infiltration of local anesthetics UpToDate Hsu, D. Wolters Kluwer. 2024
• Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment. BMC medical education Mink, R. B., Carraccio, C. L., Herman, B. E., Weiss, P., Turner, D. A., Stafford, D. E., McGann, K. A., Kesselheim, J., Hsu, D. C., High, P. C., Fussell, J. J., Curran, M. L., Chess, P. R., Sauer, C., Pitts, S., Myers, A. L., Mahan, J. D., Dammann, C. E., Aye, T., Schwartz, A. 2023; 23 (1): 720

  Abstract

  Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment.We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME).In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale.One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05).We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.

  View details for DOI 10.1186/s12909-023-04689-0

  View details for PubMedID 37789289

  View details for PubMedCentralID PMC10548580

• Pediatric Emergency Medicine Fellowship Program Directors' Viewpoint: Minimum Levels of Entrustment for Graduating Fellows and Practicing Physicians to Perform the Subspecialty's Professional Activities. Pediatric emergency care Hsu, D. C., Baghdassarian, A., Caglar, D., Rose, J. A., Herman, B. E., Schwartz, A., Mink, R., Langhan, M. L. 2023; 39 (8): 574-579

  Abstract

  Entrustable Professional Activities (EPAs) are essential tasks physicians perform within their professions. Entrustment levels that pediatric emergency medicine (PEM) fellowship program directors (FPDs) expect graduating fellows to achieve for PEM-specific and common pediatric subspecialty EPAs remain unreported. This study aims to determine minimum entrustment levels FPDs require fellows to achieve to graduate from fellowship and to compare FPD expectations for fellows versus practicing PEM physicians.Secondary analysis of PEM-specific data from a national multispecialty cross-sectional survey of pediatric subspecialty FPDs. For 6 PEM-specific and 7 common pediatric subspecialty EPAs, PEM FPDs indicated (1) minimum entrustment levels fellows should achieve by training completion, (2) whether they would allow a fellow to graduate below these minimum levels, and (3) minimum levels for safe and effective practice by PEM physicians. Minimum levels were defined as the level that more than 80% of FPDs would not drop below.Sixty of 77 PEM FPDs (78%) completed the survey. Most respondents did not require fellows to achieve the highest level (level 5-no supervision) by graduation for any PEM-specific EPAs. The median level FPDs expected for practicing PEM physicians was 5 (trusted to perform without supervision) for EPAs 1 and 4 and level 4 (indirect supervision for complex cases) for the remaining PEM-specific EPAs. Minimum levels expected by FPDs for common subspecialty pediatric EPAs were lower for both groups.Most PEM FPDs indicated that they would graduate fellows before their achievement of the highest entrustment level for all EPAs. Most also indicated that they do not expect practicing PEM physicians to perform all EPAs without supervision. These findings indicate need for stakeholders to evaluate current structure and outcomes of PEM fellowship programs and for institutions and organizations to ensure adequate support in time and resources for ongoing learning for practicing PEM physicians.

  View details for DOI 10.1097/PEC.0000000000002817

  View details for PubMedID 35947053

• Spanish-Speaking Caregivers' Perception of Emergency Physicians' Interpersonal and Communication Skills in a Pediatric Emergency Department. Pediatric emergency care Russell, E. A., Hsu, D., Camp, E. A., Soto-Ruiz, K., Leaming-Van Zandt, K. 2023; 39 (4): 253-258

  Abstract

  Medical communication is more than just the delivery of information; language differences between physicians and patients/caregivers create a challenge to providing effective care in the pediatric emergency department (ED). Overcoming this barrier is vital to providing high-quality care. We evaluated Spanish- versus English-speaking caregivers' perception of their pediatric ED physicians' interpersonal and communication skills. We also compared perceptions of Spanish- versus English-speaking caregivers who self-identified as Hispanic.This study is a retrospective analysis of data from surveys administered in an urban, free-standing children's hospital ED. Surveys were administered in English and Spanish to pediatric patient caregivers. In person, video, and telephonic interpretations were available during patient encounters.There were 2542 (82.4%) surveys completed in English and 543 (17.6%) in Spanish. There were significant differences in demographic data of English versus Spanish survey respondents, including level of education, insurance status, and rates of nonpublic insurance. Spanish survey respondents rated their physicians' interpersonal skills lower than English survey respondents. There were 1455 (47%) surveys completed by the respondents who self-identified as Hispanic. Within this group, 928 (63.8%) respondents completed the survey in English and 527 (36.2%) in Spanish. Among this Hispanic population, the Spanish survey respondents rated their physicians' interpersonal and communication skills lower than English survey respondents. After adjusting for education level and insurance type, these differences persisted.Language barriers have a meaningful impact on physician ability to communicate effectively in the pediatric ED. Improving physicians' ability to overcome this barrier is essential toward enriching patient outcomes and experience in the ED.

  View details for DOI 10.1097/PEC.0000000000002681

  View details for PubMedID 36999987

• CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions. The British journal of surgery Batt, A. M., Tavares, W., Horsley, T., Rich, J. V., Williams, B. 2023; 110 (2): 233-241

  Abstract

  Competency frameworks outline the perceived knowledge, skills, attitudes, and other attributes required for professional practice. These frameworks have gained in popularity, in part for their ability to inform health professions education, assessment, professional mobility, and other activities. Previous research has highlighted inadequate reporting related to their development which may then jeopardize their defensibility and utility.This study aimed to develop a set of minimum reporting criteria for developers and authors of competency frameworks in an effort to improve transparency, clarity, interpretability and appraisal of the developmental process, and its outputs. Following guidance from the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network, an expert panel was assembled, and a knowledge synthesis, a Delphi study, and workshops were conducted using individuals with experience developing competency frameworks, to identify and achieve consensus on the essential items for a competency framework development reporting guideline.An initial checklist was developed by the 35-member expert panel and the research team. Following the steps listed above, a final reporting guideline including 20 essential items across five sections (title and abstract; framework development; development process; testing; and funding/conflicts of interest) was developed.The COmpeteNcy FramEwoRk Development in Health Professions (CONFERD-HP) reporting guideline permits a greater understanding of relevant terminology, core concepts, and key items to report for competency framework development in the health professions.

  View details for DOI 10.1093/bjs/znac394

  View details for PubMedID 36413510

  View details for PubMedCentralID PMC10364529

• Career Development in Pediatric Emergency Medicine: What Do We Need? Pediatric emergency care Chumpitazi, C. E., Allister, L., Cho, C., Hoffmann, J. A., Hsu, D., Iyer, M., Mangold, K., Marino, M., Randell, K. A., Ponce, H., Hariharan, S. 2022; 38 (9): e1552-e1556

  Abstract

  The Women in Pediatric Emergency Medicine (PEM) subcommittee of the American Academy of Pediatrics Section on Emergency Medicine identified 2 top priorities for 2021: career development and mentorship/sponsorship. The objective of this study was to catalog and delineate the career development domains for women physicians in PEM.After a review of the literature to identify the key areas for gaps for women in PEM, we used Q sort methodology to elicit domains for this subcommittee to address by survey of a national sample.One hundred fourteen discrete potential areas of interest for career development were identified by the working group based on salient themes from the literature and personal experiences. Forty-one Women in PEM subcommittee members (27%) completed the survey. The career development topics were sorted into the domains of personal (40.4%; n = 46), administrative (28.1%; n = 32), research (10.5%; n = 12), teaching (10.5%; n = 12), service (7.0%; n = 8), and clinical (3.5%; n = 4).This study demonstrates that the career development needs of women in PEM include a range of personal, teaching, research, administrative, clinical, and service domains. However, more than two-thirds of the career development topics were categorized into just 2 domains, administrative and personal.

  View details for DOI 10.1097/PEC.0000000000002720

  View details for PubMedID 35470318

  View details for PubMedCentralID PMC9912171

• Fellow Entrustment for the Common Pediatric Subspecialty Entrustable Professional Activities Across Subspecialties. Academic pediatrics Pitts, S., Schwartz, A., Carraccio, C. L., Herman, B. E., Mahan, J. D., Sauer, C. G., Dammann, C. E., Aye, T., Myers, A. L., Weiss, P. G., Turner, D. A., Hsu, D. C., Stafford, D. E., Chess, P. R., Fussell, J. J., McGann, K. A., High, P., Curran, M. L., Mink, R. B. 1800

  Abstract

  OBJECTIVE: To determine the relationship between level of supervision (LOS) ratings for the Common Pediatric Subspecialty Entrustable Professional Activities (EPAs) with their associated subcompetency milestones across subspecialties and by fellowship training year.METHODS: Clinical Competency Committees (CCCs) in 14 pediatric subspecialties submitted LOS ratings for 6 Common Subspecialty EPAs and subcompetency milestone levels mapped to these EPAs. We examined associations between these subcompetency milestone levels and LOS ratings across subspecialty training year by fitting per-EPA linear mixed effects models, regressing LOS rating on milestone level and on training year.RESULTS: CCCs from 211 pediatric fellowship programs provided data for 369 first, 336 second, and 331 third year fellows. Mean subcompetency milestone levels increased similarly among subspecialties for most EPAs compared with the reference, Adolescent Medicine. Mean subcompetency milestones mapped to each EPA and mean EPA LOS ratings generally increased by training year across all subspecialties.CONCLUSIONS: Subcompetency milestones levels mapped to each Common Subspecialty EPA and the EPA LOS ratings increase similarly across subspecialties and by training year, providing validity evidence for using EPA LOS to assess pediatric subspecialty trainee performance. This study supports the development of tools to facilitated the CCC evaluation process across all pediatric subspecialties.

  View details for DOI 10.1016/j.acap.2021.12.019

  View details for PubMedID 34936942

• Impact of a Pediatric-Focused Communication Course on Patient/Caregiver-Perceived Physician Communication Skills in a Pediatric Emergency Department. Pediatric emergency care Leaming-Van Zandt, K. J., Zhu, H., Banuelos, R. C., Lopez, M. A., Hsu, D. C. 2021; 37 (12): e1173-e1180

  Abstract

  To evaluate the impact of a pediatric-focused, relationship-centered communication course on patient/caregiver assessment of emergency department (ED) physician communication skills.This was a prospective study; a previously validated assessment tool (Pediatric Physician Interpersonal Communication Skills Assessment [P-PICSA]) was used to collect pediatric patient/caregiver evaluation of ED physician communication skills. Emergency department physicians were required to attend a 5.5-hour communication course. Differences in precourse/postcourse P-PICSA and top-box scores were analyzed to determine course impact on ED physician communication skills.From July 2016 to August 2017, 49 pediatric ED physicians participated in the course, and 24 physicians (49%) had 6-month precourse/postcourse P-PICSA data. Postcourse scores were higher for all 13 items, with 3 items achieving statistical significance: (1) the doctor used words I could understand; (2) the way the doctor involved me in making decisions about my child's care in the ED; (3) how the doctor discussed next steps and/or follow-up plans for my child's care after we leave the ED (P < 0.05). Additionally, postcourse, top-box score percentages were higher for 12 items, with 1 item achieving statistical significance (P = 0.0386).An organization-wide, pediatric-focused, relationship-centered communication course improved patient/caregiver-perceived ED physician communication. Further research is necessary to assess long-term sustainability.

  View details for DOI 10.1097/PEC.0000000000001950

  View details for PubMedID 31851077

• Achieving Entrustable Professional Activities During Fellowship PEDIATRICS Weiss, P. G., Schwartz, A., Carraccio, C. L., Herman, B. E., Turner, D. A., Aye, T., Fussell, J. J., Kesselheim, J., Mahan, J. D., McGann, K. A., Myers, A., Stafford, D. J., Chess, P. R., Curran, M. L., Dammann, C. L., High, P., Hsu, D. C., Pitts, S., Sauer, C., Srivastava, S., Mink, R. B. 2021; 148 (5)

  View details for DOI 10.1542/2021-053258

  View details for Web of Science ID 000754891900017

• Achieving Entrustable Professional Activities During Fellowship. Pediatrics Weiss, P. G., Schwartz, A., Carraccio, C. L., Herman, B. E., Turner, D. A., Aye, T., Fussell, J. J., Kesselheim, J., Mahan, J. D., McGann, K. A., Myers, A., Stafford, D. E., Chess, P. R., Curran, M. L., Dammann, C. E., High, P., Hsu, D. C., Pitts, S., Sauer, C., Srivastava, S., Mink, R. B. 2021

  Abstract

  BACKGROUND AND OBJECTIVES: Entrustable Professional Activities (EPAs) were developed to assess pediatric fellows. We previously showed that fellowship program directors (FPDs) may graduate fellows who still require supervision. How this compares with their expectations for entrustment of practicing subspecialists is unknown.METHODS: We surveyed US FPDs in 14 pediatric subspecialties through the Subspecialty Pediatrics Investigator Network between April and August 2017. For each of 7 common pediatric subspecialty EPAs, we compared the minimum level of supervision that FPDs required for graduation with the level they expected of subspecialists for safe and effective practice using the Friedman rank sum test and paired t test. We compared differences between subspecialties using linear regression.RESULTS: We collected data from 660 FPDs (response rate 82%). For all EPAs, FPDs did not require fellows to reach the level of entrustment for graduation that they expected of subspecialists to practice (P < .001). FPDs expected the least amount of supervision for the EPAs consultation and handovers. Mean differences between supervision levels for graduation and practice were smaller for clinical EPAs (consultation, handovers, lead a team) when compared with nonclinical EPAs (quality improvement, management, lead the profession and scholarship; P = .001) and were similar across nearly all subspecialties.CONCLUSIONS: Fellowship graduates may need continued development of clinical and nonclinical skills in their early practice period, underscoring a need for continued assessment and mentoring. Graduation readiness must be based on clear requirements, with alignment of FPD expectations and regulatory standards, to ensure quality care for patients.

  View details for DOI 10.1542/peds.2021-050196

  View details for PubMedID 34667096

• Design of a point-of-care ultrasound curriculum for pediatric emergency medicine fellows: A Delphi study. AEM education and training Gold, D., Levine, M., Hsu, D., Way, D. P., Shefrin, A. E., Lam, S. H., Lewiss, R., Marin, J. R. 2021; 5 (4): e10700

  Abstract

  There has been a steady increase in the growth and utilization of point-of-care ultrasound (POCUS) in pediatric emergency medicine (PEM). POCUS has been established as an Accreditation Council for Graduate Medical Education (ACGME) core requirement for accreditation of PEM fellowship programs. Despite this requirement, training guidelines regarding POCUS knowledge and skills have yet to be developed. The purpose of this project was to develop a curriculum and a competency checklist for PEM fellow POCUS education.We formed a core leadership group based on expertise in one or more key areas: PEM, POCUS, curriculum development, or Delphi methods. We recruited 29 PEM POCUS or ultrasound education experts from North America to participate in a three-round electronic Delphi project. The first Delphi round asked experts to generate a list of the core POCUS knowledge and skills that a PEM fellow would need during training to function as an autonomous practitioner. Subsequent rounds prioritized the list of knowledge and skills, and the core leadership group organized knowledge and skills into global competencies and subcompetencies.The first Delphi round yielded 61 POCUS areas of knowledge and skills considered important for PEM fellow learning. After two subsequent Delphi rounds, the list of POCUS knowledge and skills was narrowed to 38 items that addressed elements of six global competencies. The core leadership group then revised items into subcompetencies and categorized them under global competencies, developing a curriculum that defined the scope (depth of content) and sequence (order of teaching) of these POCUS knowledge and skill items.This expert, consensus-generated POCUS curriculum provides detailed guidance for PEM fellowships to incorporate POCUS education into their programs. Our curriculum also identifies core ultrasound knowledge and skills needed by PEM fellows to perform the specific POCUS applications recommended in prior publications.

  View details for DOI 10.1002/aet2.10700

  View details for PubMedID 34901685

  View details for PubMedCentralID PMC8637871

• Development of a novel pediatric point-of-care ultrasound question bank using a modified Delphi process. AEM education and training Alade, K. H., Marin, J. R., Constantine, E., Ekpenyong, A., Farrell, S. E., Horowitz, R., Hsu, D., Kwan, C. W., Ng, L., Leonard, P. J., Lewiss, R. E. 2021; 5 (4): e10651

  Abstract

  Measuring pediatric emergency medicine (PEM) fellow competency in point-of-care ultrasound (POCUS) is important for ensuring adequate training and performance. Assessment may include direct observation, image review, quality assessment, and written examination. The purpose of this study was to develop a pediatric POCUS question bank that could subsequently be used as a POCUS assessment for graduating PEM fellows.We organized a 10-person question writing group (QWG). Eight hold expertise in POCUS and two hold expertise in medical education. Members of the QWG created questions within four domains: interpretation/diagnosis (50% of questions), anatomy (30%), physics (10%), and pitfalls (10%). POCUS faculty ascertained content validity and the medical education faculty revised questions for syntax and readability. In 2016, we recruited 31 pediatric POCUS experts. The majority were members of the P2 Network, an international group of experts and leaders in PEM POCUS, to participate in three iterative rounds of a modified Delphi process to review, revise, and establish consensus on the question bank.Thirty-one pediatric POCUS experts participated in the three rounds of the modified Delphi process and evaluated 437 questions developed by the expert panel. Forty-nine percent (n = 216) of the questions were accepted in round 1, 30% (n = 130) in round 2, and 11% (n = 47) in the final round. The final question bank included 393 questions covering 17 pediatric POCUS applications.We developed a 393-question bank to aid in the assessment of PEM POCUS competency. Future work includes piloting the questions with PEM fellows to evaluate the response process and implementing the assessment tool to establish a minimum passing score.

  View details for DOI 10.1002/aet2.10651

  View details for PubMedID 34527846

  View details for PubMedCentralID PMC8427181

• Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation. Academic medicine : journal of the Association of American Medical Colleges Turner, D. A., Schwartz, A., Carraccio, C., Herman, B., Weiss, P., Baffa, J. M., Chess, P., Curran, M., Dammann, C., High, P., Hsu, D., Pitts, S., Sauer, C., Aye, T., Fussell, J., Kesselheim, J., Mahan, J., McGann, K., Myers, A., Mink, R., Subspecialty Pediatrics Investigator Network (SPIN) 2021; 96 (7S): S22-S28

  Abstract

  PURPOSE: Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate.METHOD: In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level.RESULTS: The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001).CONCLUSIONS: Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.

  View details for DOI 10.1097/ACM.0000000000004091

  View details for PubMedID 34183598

• Maintenance of Certification Pediatrics: Pediatric Emergency Medicine (PEM): The New Part 3 Maintenance of Certification Assessment Option. Pediatric emergency care Iyer, M. S., Bachur, R., Wang, V., Hsu, D., Mistry, R. D., Nagler, J., Mick, N., Althouse, L., Du, Y., Leslie, L. K. 2021; 37 (6): 329-333

  Abstract

  Starting in 2022, the American Board of Pediatrics will launch the Maintenance of Certification Assessment for Pediatrics: Pediatric Emergency Medicine (MOCA-Peds: PEM) longitudinal assessment, which will provide an at-home alternative to the point-in-time examination. This longitudinal assessment will help engage PEM physicians participating in continuing certification in a more flexible and continuous lifelong, self-directed learning process while still providing a summative assessment of their knowledge. This commentary provides background information on MOCA-Peds and an introduction to MOCA-Peds: PEM and how it gives the PEM physician another option to participate in continuing certification.

  View details for DOI 10.1097/PEC.0000000000002451

  View details for PubMedID 34009897

• Development and Validation of the Pediatric Physician Interpersonal Communication Skills Assessment of Emergency Physicians by Pediatric Patients and Their Caregivers Hsu, D. C., Kumar, S., Russell, E. A., Soto-Ruiz, K., Leaming-Van Zandt, K. J. WILEY. 2021

  View details for DOI 10.1002/aet2.10458

  View details for Web of Science ID 000705246500005

• Emergency Medicine Providers' Knowledge and Management of Pediatric Tropical Diseases: A Needs Assessment. Pediatric emergency care Thomas, V. A., Crouse, H. L., Murray, K. O., Hsu, D. C., Camp, E. A., Cruz, A. T. 2020; 36 (11): e622-e625

  Abstract

  The aim of this study was to perform a needs assessment of pediatric (PEM) and general emergency medicine (EM) provider knowledge, comfort, and current practice patterns in the evaluation of pediatric tropical infectious diseases.An online survey was developed based on educational priorities identified by an expert panel via modified Delphi methodology. The survey included assessment of providers' typical evaluation, diagnosis, and treatment of tropical diseases and was distributed to PEM and EM providers in 2 large professional organizations.A total of 333 physicians (285 PEM, 32 EM, 8 combined PEM/EM, and 8 general pediatricians in emergency department) participated. Fifty-five percent of vignettes were answered correctly. Those who trained outside the United States or Canada (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.0) and PEM-trained providers (OR, 2.6; 95% CI, 1.2-5.9) were more likely to answer questions correctly. Providers answered more questions correctly about dengue (76%) and tuberculosis (77%) than typhoid (53%) and malaria (39%) (OR, 3.8; 95% CI, 3.0-4.9). Diagnostic evaluation for tropical diseases was variable with greater than 75% agreement for only 2 tests: blood smears in febrile patients from Africa (86%) and bacterial stool cultures in patients with bloody stools from Africa, Asia, or Latin America (94%). Providers had low (62%) or medium (35%) comfort level with pediatric tropical diseases, and 93% were interested in accessing emergency department-specific resources.Pediatric EM and EM providers' knowledge and evaluation for pediatric tropical diseases are variable. Providers recognized their knowledge gaps and expressed interest in gaining access to resources and guidelines to standardize and improve evaluation and treatment of these diseases.

  View details for DOI 10.1097/PEC.0000000000001426

  View details for PubMedID 29538263

• Focused Research Infrastructure for Postgraduate Pediatric Emergency Medicine Fellows Increases Dissemination of Scholarly Work. AEM education and training Cruz, A. T., Doughty, C. B., Hsu, D. C., Chumpitazi, C. E., Sampayo, E. M., Meskill, S. D., Shah, M. I. 2020; 4 (3): 231-238

  Abstract

  Many fellows in clinically driven subspecialties may have difficulty completing and publishing their scholarly projects due to lack of prior experience in research, selection of projects that are difficult to complete during fellowship, or mentorship challenges. This may be particularly true in pediatric emergency medicine (PEM) because research time may be longitudinally integrated with clinical rotations, rather than blocked as is common in other subspecialties. We describe the creation and outcomes of a structured program to increase academic productivity of PEM fellows.This was a retrospective cohort study of scholarly productivity (publications in peer-reviewed journals, presentation at national meetings) for PEM fellows over 17 years in one fellowship program, before and after the implementation of a structured program. We reviewed obstacles to publication for prior fellow projects when developing the curriculum. Our multifaceted program consisted of milestone development, four in-person committee meetings, and abstract and manuscript development workshops. We utilized existing faculty members, most of whom were junior faculty, as committee members. Our primary outcome was the percentage of fellows who were first authors for peer-reviewed publications for their fellowship projects. National conference presentations were the secondary outcome.Data for 76 PEM fellows were eligible for analysis: 44 (58%) before and 32 after programmatic implementation. There was a statistically significant increase in the percentage of fellows who published their studies (32% vs. 63%; odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.4 to 9.3) after programmatic implementation. There were no differences in conference presentations (45% vs. 63%; OR = 2.0, 95% CI = 0.8-5.1) after implementation.Utilizing a small group of existing, predominantly junior faculty members, we created a structured program that enhanced PEM fellows' scholarly productivity and increased publications. We believe that this model is sustainable for and generalizable to other PEM fellowship programs.

  View details for DOI 10.1002/aet2.10402

  View details for PubMedID 32704592

  View details for PubMedCentralID PMC7369492

• Diarrhea Fleisher and Ludwig Textbook of Pediatric Emergency Medicine Pereira, F., Hsu, D. Wolters Kluwer. 2020; 8th
• Agreement of Program Directors With Clinical Competency Committees for Fellow Entrustment. Journal of medical education and curricular development Mink, R., Herman, B. E., Carraccio, C., Aye, T., Baffa, J. M., Chess, P. R., Fussell, J. J., Sauer, C. G., Stafford, D. E., Weiss, P., Curran, M. L., Dammann, C. E., High, P. C., Hsu, D., Kesselheim, J. C., Mahan, J. D., McGann, K. A., Myers, A. L., Pitts, S., Turner, D. A., Schwartz, A. 2020; 7: 2382120520936613

  Abstract

  Objectives: Fellowship program directors (FPD) and Clinical Competency Committees (CCCs) both assess fellow performance. We examined the association of entrustment levels determined by the FPD with those of the CCC for 6 common pediatric subspecialty entrustable professional activities (EPAs), hypothesizing there would be strong correlation and minimal bias between these raters.Methods: The FPDs and CCCs separately assigned a level of supervision to each of their fellows for 6 common pediatric subspecialty EPAs. For each EPA, we determined the correlation between FPD and CCC assessments and calculated bias as CCC minus FPD values for when the FPD was or was not a member of the CCC. In addition, we examined the effect of program size, FPD understanding of EPAs, and subspecialty on the correlations. Data were obtained in fall 2014 and spring 2015.Results: A total of 1040 fellows were assessed in the fall and 1048 in the spring. In both periods and for each EPA, there was a strong correlation between FPD and CCC supervision levels (P<.001). The correlation was somewhat lower when the FPD was not a CCC member (P<.001). Overall bias in both periods was small.Conclusions: The correlation between FPD and CCC assignment of EPA supervision levels is strong. Although slightly weaker when the FPD is not a CCC member, bias is small, so this is likely unimportant in determining fellow entrustment level. The similar performance ratings of FPDs and CCCs support the validity argument for EPAs as competency-based assessment tools.

  View details for DOI 10.1177/2382120520936613

  View details for PubMedID 32844115

• Improved Team Performance During Pediatric Resuscitations After Rapid Cycle Deliberate Practice Compared With Traditional Debriefing: A Pilot Study. Pediatric emergency care Lemke, D. S., Fielder, E. K., Hsu, D. C., Doughty, C. B. 2019; 35 (7): 480-486

  Abstract

  Simulation-based medical education (SBME) improves medical knowledge compared with no intervention. In traditional SBME, more time is spent debriefing than practicing skills. Rapid cycle deliberate practice (RCDP) simulation allows learners to practice skills repetitively, receive brief interspersed feedback, and has been shown to improve individual performance of resuscitation skills in simulation; it has not been compared with traditional simulation methods.The aim of the study was to compare traditional and RCDP SBME.Four pediatric resuscitation cases (3 for teaching and 1 for testing) were developed. For the RCDP arm, traditional cases were deconstructed into sequences of progressively difficult rounds. The last RCDP round served as the traditional arm scenario.Learners received 1 type of instruction on 2 separate days. Pretest and posttest performance during simulation were video recorded and scored using the Simulation Team Assessment Tool; satisfaction surveys were collected.Pretest team performance was similar in both groups. Simulation Team Assessment Tool score improvement for RCDP was 7.2% (95% confidence interval, 3.4% to 11%) and traditional was 0.8% (95% confidence interval, -11% to 13%). The difference in improvement of the human factors subscore was statistically significant; RCDP improved 10.2% and traditional improved 1.7% (P = 0.013). The RCDP technique was well received by learners but caused fatigue.This pilot study showed a trend toward greater improvement in team performance and significantly greater improvement for human factors with RCDP compared with traditional simulation. Future studies comparing RCDP with other methods are needed to identify best practices and applications of RCDP, including which learners and learning objectives are best suited to RCDP.

  View details for DOI 10.1097/PEC.0000000000000940

  View details for PubMedID 27741071

• Creating the Subspecialty Pediatrics Investigator Network (vol 192, pg 3, 2018) JOURNAL OF PEDIATRICS Mink, R., Schwartz, A., Carraccio, C., High, P., Dammann, C., McGann, K. A., Kesselheim, J., Aye, T., Baffa, J., Chess, P., Curran, M., Fussell, J., Hsu, D., Mahan, J., Myers, A., Pitts, S., Sauer, C. G., Stafford, D., Turner, D. A., Weiss, P., Herman, B. 2019; 207: 269

  View details for Web of Science ID 000462161200064

• Validity of Level of Supervision Scales for Assessing Pediatric Fellows on the Common Pediatric Subspecialty Entrustable Professional Activities. Academic medicine : journal of the Association of American Medical Colleges Mink, R. B., Schwartz, A., Herman, B. E., Turner, D. A., Curran, M. L., Myers, A., Hsu, D. C., Kesselheim, J. C., Carraccio, C. L. 2018; 93 (2): 283-291

  Abstract

  Entrustable professional activities (EPAs) represent the routine and essential activities that physicians perform in practice. Although some level of supervision scales have been proposed, they have not been validated. In this study, the investigators created level of supervision scales for EPAs common to the pediatric subspecialties and then examined their validity in a study conducted by the Subspecialty Pediatrics Investigator Network (SPIN).SPIN Steering Committee members used a modified Delphi process to develop unique scales for six of the seven common EPAs. The investigators sought validity evidence in a multisubspecialty study in which pediatric fellowship program directors and Clinical Competency Committees used the scales to evaluate fellows in fall 2014 and spring 2015.Separate scales for the six EPAs, each with five levels of progressive entrustment, were created. In both fall and spring, more than 300 fellows in each year of training from over 200 programs were assessed. In both periods and for each EPA, there was a progressive increase in entrustment levels, with second-year fellows rated higher than first-year fellows (P < .001) and third-year fellows rated higher than second-year fellows (P < .001). For each EPA, spring ratings were higher (P < .001) than those in the fall. Interrater reliability was high (Janson and Olsson's iota = 0.73).The supervision scales developed for these six common pediatric subspecialty EPAs demonstrated strong validity evidence for use in EPA-based assessment of pediatric fellows. They may also inform the development of scales in other specialties.

  View details for DOI 10.1097/ACM.0000000000001820

  View details for PubMedID 28700462

• Pediatric Emergency Medicine Online Curriculum Improves Resident Knowledge Scores, But Will They Use It? Pediatric emergency care Little-Wienert, K., Hsu, D., Torrey, S., Lemke, D., Patel, B., Turner, T., Doughty, C. 2017; 33 (11): 713-717

  Abstract

  Shift work on a pediatric emergency medicine (PEM) rotation makes didactic scheduling difficult, thereby limiting teaching opportunities. These constraints make this rotation an ideal setting to supplement resident education with an online curriculum. We aimed to determine if implementation of an online curriculum during a resident PEM rotation improves posttest performance and increases satisfaction with resident educational experience.This was a prospective before/after study of pediatric and emergency medicine residents on a 1-month rotation in a tertiary care pediatric emergency department. A curriculum was developed consisting of 17 online modules. In the first 5 months of the study, 42 control residents received traditional bedside teaching. In the last 12 months, 80 intervention residents completed at least 8 modules during their rotation. Both groups completed a pretest at rotation start and a posttest and end-of-rotation survey at rotation end.Control group pretest and posttest scores were not significantly different. In the intervention group, posttest scores were significantly increased compared with pretest scores (68 vs 59, P < 0.01). A low percentage of residents completed the study. Only 42% of the 189 residents enrolled in the intervention group completed the posttest and 28% completed the survey.Implementing an online PEM curriculum significantly improved knowledge. As residency programs face new duty hour requirements, online curricula may provide an effective way to supplement teaching. However, to capitalize on this self-directed curriculum, the low participation rates in this study suggest we must first determine and establish ways to overcome barriers to online learning.

  View details for DOI 10.1097/PEC.0000000000000679

  View details for PubMedID 27077995

• Essentials of Pediatric Emergency Medicine Fellowship Part 7: Careers in PEM. Pediatric emergency care Allen, C. H., Anders, J., Ishimine, P., Roskind, C., Shook, J. 2016; 32 (11): 807-811

  Abstract

  This article is the last in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated on program completion. This article focuses on the many career paths as educators, researchers, advocates, innovators, consultants, administrators, and leaders available to pediatric emergency medicine physicians, in both clinical and nonclinical realms, and how fellows and junior faculty can enrich and prolong their careers through diversification.

  View details for DOI 10.1097/PEC.0000000000000944

  View details for PubMedID 27811537

• Essentials of Pediatric Emergency Medicine Fellowship: Part 6: Program Administration. Pediatric emergency care Kim, I. K., Zuckerbraun, N., Kou, M., Vu, T., Levasseur, K., Yen, K., Chapman, J., Doughty, C., McAneney, C., Zaveri, P., Hsu, D. 2016; 32 (10): 726-730

  Abstract

  This article is the sixth in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine (PEM) fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article provides a broad overview of administering and supervising a PEM fellowship program. It explores 3 topics: the principles of program administration, committee management, and recommendations for minimum time allocated for PEM fellowship program directors to administer their programs.

  View details for DOI 10.1097/PEC.0000000000000929

  View details for PubMedID 27749673

• Essentials of PEM Fellowship: Part 5: Scholarship Prepares Fellows to Lead as Pediatric Emergency Specialists. Pediatric emergency care Reynolds, S., Chang, T., Iyer, S., Mann, C., Wilkinson, M., Yen, K., Schnadower, D. 2016; 32 (9): 645-7

  Abstract

  The aim of this article was to discuss the current landscape in pediatric emergency medicine fellowship training for scholarship training and provide an overview of the resources and general strategies required to prepare fellows for their careers.This article is the fifth in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on scholarship training.

  View details for DOI 10.1097/PEC.0000000000000896

  View details for PubMedID 27585128

• Essentials of Pediatric Emergency Medicine Fellowship: Part 4: Beyond Clinical Education. Pediatric emergency care Wolff, M., Carney, M., Eldridge, C., Zaveri, P., Kou, M. 2016; 32 (8): 551-4

  Abstract

  This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the skills beyond clinical training required of pediatric emergency medicine physicians including teaching, leadership, teamwork, and communication.

  View details for DOI 10.1097/PEC.0000000000000872

  View details for PubMedID 27490731

• Essentials of Pediatric Emergency Medicine Fellowship: Part 3: Clinical Education and Experience. Pediatric emergency care Mittiga, M. R., Nagler, J., Eldridge, C. D., Ishimine, P., Zuckerbraun, N. S., McAneney, C. M. 2016; 32 (7): 479-85

  Abstract

  This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the clinical aspects of fellowship training including the impact of the clinical environment, modalities for teaching and evaluation, and threats and opportunities in clinical education.

  View details for DOI 10.1097/PEC.0000000000000841

  View details for PubMedID 27380607

• Essentials of PEM Fellowship Part 2: The Profession in Entrustable Professional Activities PEDIATRIC EMERGENCY CARE Hsu, D., Nypaver, M., Fein, D. M., McAneney, C., Santen, S., Nagler, J., Zuckerbraun, N., Roskind, C. G., Reynolds, S., Zaveri, P., Stankovic, C., House, J. B., Langhan, M., Titus, M. O., Dahl-Grove, D., Klasner, A. E., Ramirez, J., Chang, T., Jacobs, E., Chapman, J., Lumba-Brown, A., Thompson, T., Mittiga, M., Eldridge, C., Heffner, V., Herman, B. E., Kennedy, C., Madhok, M., Kou, M. 2016; 32 (6): 410-418

  Abstract

  This article is the second in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine (PEM) fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article describes the development of PEM entrustable professional activities (EPAs) and the relationship of these EPAs with existing taxonomies of assessment and learning within PEM fellowship. It summarizes the field in concepts that can be taught and assessed, packaging the PEM subspecialty into EPAs.

  View details for DOI 10.1097/PEC.0000000000000827

  View details for PubMedID 27253361

• Essentials of Pediatric Emergency Medicine Fellowship: Part 1: An Overview. Pediatric emergency care Zaveri, P. P., Hsu, D., Mittiga, M. R., Wolff, M., Reynolds, S., Kim, I., Allen, C., McAneney, C. M., Kou, M. 2016; 32 (5): 337-9

  Abstract

  This article is the first in a 7-part series (Table 1) that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated on program completion. This overview article provides a framework for the series.

  View details for DOI 10.1097/PEC.0000000000000802

  View details for PubMedID 27139296

• Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows. Cureus Chumpitazi, C. E., Rees, C. A., Chumpitazi, B. P., Hsu, D. C., Doughty, C. B., Lorin, M. I. 2016; 8 (5): e595

  Abstract

  Background  Bad news in the context of health care has been broadly defined as significant information that negatively alters people's perceptions of the present or future. Effectively delivering bad news (DBN) in the setting of the emergency department requires excellent communication skills. Evidence shows that bad news is frequently given inadequately. Studies show that trainees need to devote more time to developing this skill through formalized training. This program's objectives were to utilize trained standardized patients in a simulation setting to assist pediatric emergency medicine (PEM) fellows in the development of effective, sensitive, and compassionate communication with patients and family members when conveying bad news, and to recognize and respond to the patient/parent's reaction to such news. Methods PEM fellows participated in a novel curriculum utilizing simulated patients (SPs) acting as the patient's parent and immersive techniques in a realistic and supportive environment. A baseline survey was conducted to ascertain participant demographics and previous experience with simulation and DBN. Experienced, multi-disciplinary faculty participated in a training workshop with the SPs one week prior to course delivery. Three scenarios were developed for bad news delivery. Instructors watched via remote video feed while the fellows individually interacted with the SPs and then participated in a confidential debriefing. Fellows later joined for group debriefing. Fellow characteristics, experience, and self-perceived comfort pre/post-course were collected.   Results Baseline data demonstrated that 78% of fellows reported DBN two or more times per month. Ninety-three percent of fellows in this study were present during the delivery of news about the death of a child to a parent or family member in the six-month period preceding this course. Fellows' self-reported comfort level in DBN to a patient/family and dealing with patient and parent emotions improved significantly (p=0.034 and p=0.046, respectively). Conclusions Pediatric emergency medicine fellows frequently deliver bad news. A course using SPs was well received by trainees and resulted in improvement in self-assessed skills and comfort. This curriculum provides the opportunity for fellows to receive patient/parent feedback of their communication skills and observations from skilled instructors. This methodology should be considered when creating training curricula for bad news delivery skills.

  View details for DOI 10.7759/cureus.595

  View details for PubMedID 27335708

  View details for PubMedCentralID PMC4914065

• A Novel Approach to Combining Pediatric Emergency Medicine and Global Health Fellowships. Pediatric emergency care Crouse, H. L., Mullan, P. C., Macias, C. G., Hsu, D. C., Shook, J. E., Sirbaugh, P. E., Schutze, G. E., Torrey, S. B. 2016; 32 (3): 157-62

  Abstract

  To describe the creation of the first known combined Pediatric Emergency Medicine-Global Health (PEM-GH) fellowship for graduates of pediatric or emergency medicine residency programs.We detail the necessary infrastructure for a successfully combined PEM-GH fellowship including goals, objectives, curriculum, timeline, and funding. The fellowship is jointly supported by the department of pediatrics, section of pediatric emergency medicine (PEM), and the hospital. Fellows complete all requirements for the PEM fellowship and Global Health, the latter requiring an additional 12 months of training. Components of the Global Health fellowship include international fieldwork, scholarly activity abroad, advanced degree coursework, disaster training, and didactic curricula.Since 2005, 9 fellows (8 pediatric-trained and 1 emergency medicine-trained) have completed or are enrolled in the PEM-GH fellowship; 3 have graduated. All fellows have completed or are working toward advanced degrees and have or will participate in the disaster management course. Fellows have had 7 presentations at national or international meetings and have published 6 articles in peer-reviewed journals. Of the three graduates, all are working in academic PEM-GH programs and work internationally in Africa and/or Latin America.Our response to a global trend toward improvement in PEM care was the development of the first combined PEM-GH fellowship program. Recognizing the value of this program within our own institution, we now offer it as a model for building such programs in the future. This fellowship program promises to be a paradigm that can be used nationally and internationally, and it establishes a foundation for a full-fledged accredited and certified subspecialty.

  View details for DOI 10.1097/PEC.0000000000000247

  View details for PubMedID 25285392

• Continuing Medical Education for Air Medical Providers: The Successes and Challenges. Pediatric emergency care Miller, J. O., Thammasitboon, S., Hsu, D. C., Shah, M. I., Minard, C. G., Graf, J. M. 2016; 32 (2): 87-92

  Abstract

  Research has shown that patients transported by nonpediatric teams have higher rates of morbidity and mortality. There is currently a paucity of pediatric standardized ongoing medical education for emergency medical service providers, thus we aimed to develop a model curriculum to increase their knowledge regarding pediatric respiratory distress and failure.The curriculum was based on the Kolb Learning Cycle to optimize learning. Target learners were flight nurses (registered nurse) and emergency medical technicians of a private helicopter emergency transport team. The topics included were pediatric stridor, wheezing, and respiratory failure. Online modules were developed for continued spaced education. Knowledge gained from the interventions was measured by precurricular and postcurricular testing and compared with paired t tests. A linear mixed regression model was used to investigate covariates of interest.Sixty-two learners attended the workshop. Fifty-nine learners completed both precurricular and postcurricular testing. The mean increase between pretest and posttest scores was 12.1% (95% confidence interval, 9.4, 14.8; P < 0.001). Type of licensure (private emergency medical technician vs registered nurse) and number of years experience had no association with the level of knowledge gained. Learners who had greater than 1 year of pediatric transport experience scored higher on their pretests. There was no significant retention shown by those who participated in spaced education.The curriculum was associated with a short term increased knowledge regarding pediatric respiratory distress and failure for emergency helicopter transport providers and could be used as an alternative model to develop standardized ongoing medical education in pediatrics. Further work is needed to achieve knowledge retention in this learner population.

  View details for DOI 10.1097/PEC.0000000000000416

  View details for PubMedID 26841111

• Development and assessment of a pediatric emergency medicine simulation and skills rotation: meeting the demands of a large pediatric clerkship. Medical education online Fielder, E. K., Lemke, D. S., Doughty, C. B., Hsu, D. C., Middleman, A. B. 2015; 20: 29618

  Abstract

  To implement a curriculum using simulation and skills training to augment a Pediatric Emergency Medicine (PEM) rotation within a pediatric clerkship.PEM faculty are often challenged with a high learner to teacher ratio in a chaotic clinical setting. This challenge was heightened when our pediatric clerkship's traditional 1-week PEM rotation (consisting of 4 students completing four 8-hour ED shifts/week) expanded to 8 students every 2 weeks. We sought to meet this challenge by integrating simulation-based education into the rotation.Clerkship students from March to June 2012 completed our traditional rotation. Students between July and October 2012 completed the new PEM-SIM curriculum with 19 hours ED shifts/week and 16 hours/week of simulation/skills training. Pre/post-tests evaluated 1) medical management/procedural comfort (five-point Likert scale); and 2) PEM knowledge (15 multiple-choice questions).One hundred and nine students completed the study (48 traditional, 61 PEM-SIM). Improvement in comfort was significantly higher for the PEM-SIM group than the traditional group for 6 of 8 (75%) medical management items (p<0.05) and 3 of 7 (43%) procedures, including fracture splinting, lumbar puncture, and abscess incision/drainage (p<0.05). PEM-SIM students had significantly more improvement in mean knowledge compared to the traditional group (p<0.001).We have successfully integrated 16 hours/week of faculty-facilitated simulation-based education into a PEM rotation within our clerkship. This curriculum is beneficial in clinical settings with high learner to teacher ratios and when patient care experiences alone are insufficient for all students to meet rotation objectives.

  View details for DOI 10.3402/meo.v20.29618

  View details for PubMedID 26626927

  View details for PubMedCentralID PMC4666893

• Investing in future pediatric subspecialists: a fellowship curriculum that prepares for the transition to academic careers. Medical education online Rama, J. A., Campbell, J. R., Balmer, D. F., Turner, T. L., Hsu, D. C. 2015; 20: 26714

  Abstract

  The experience of transitioning to an academic faculty position can be improved with standardized educational interventions. Although a number of such interventions have been described, few utilize an evaluation framework, describe a robust evaluation process, and address why their interventions were successful. In this article, the authors apply a logic model to describe their efforts to develop, implement, evaluate, and revise a comprehensive academic career development curriculum among pediatric subspecialty fellows. They describe inputs, activities, outputs, and outcomes using quantitative data from fellow evaluations and qualitative data from faculty interviews.Methods are described under the input and activities sections. The curriculum started with collaboration among educational leadership and conducting a needs assessment. Using the needs assessment results and targeted learning objectives, we piloted the curriculum and then implemented the full curriculum 1 year later.Results are described under the outputs and outcomes sections. We present immediate, short-term, and 6-month evaluation data. Cumulative data over 3 years reveal that fellows consistently acquired knowledge relevant to transitioning and that they applied acquired knowledge to prepare for finding jobs and career advancement. The curriculum also benefits faculty instructors who gain a sense of reward by filling a critical knowledge gap and fostering fellows' professional growth.The authors relate the success and effectiveness of the curriculum to principles of adult learning, and share lessons learned, including the importance of buy-in from junior and senior fellows and faculty, collaboration, and designating the time to teach and learn.

  View details for DOI 10.3402/meo.v20.26714

  View details for PubMedID 25861876

  View details for PubMedCentralID PMC4393422

• A novel briefing checklist at shift handoff in an emergency department improves situational awareness and safety event identification. Pediatric emergency care Mullan, P. C., Macias, C. G., Hsu, D., Alam, S., Patel, B. 2015; 31 (4): 231-8

  Abstract

  Emergency department (ED) shift handoffs are sources of potential medical error, delays in care, and medicolegal liabilities. Few handoff studies exist in the ED literature. We aimed to describe the implementation of a standardized checklist for improving situational awareness during physician handoffs in a pediatric ED.This is a descriptive observational study in a large academic pediatric ED. Checklists were evaluated for rates of use, completion, and identification of potential safety events. We defined a complete checklist as 80% or more of items checked.  A user perception survey was used. After 1 year, all checklist users (residents, fellows, faculty, and charge nurses with ED experience before and after checklist implementation) were anonymously surveyed to assess the checklist's usability, perceived contributions to Institute of Medicine quality domains, and situational awareness. The electronically administered survey used Likert frequency scales.Of 732 handoffs, 98% used the checklist, and 89% were complete. A mean of 1.7 potential safety events were identified per handoff. The most frequent potential safety events were identification of intensive care unit-level patients in the ED (48%), equipment problems (46%), staffing issues (21%), and intensive care unit-level patients in transport (16%). Eighty-one subjects (88%) responded to the survey. The users agreed that the checklist promoted better communication, safety, efficiency, effective care, and situational awareness.The Physician Active Shift Signout in the Emergency Department briefing checklist was used often and at a high completion rate, frequently identifying potential safety events. The users found that it improved the quality of care and team communication. Future studies on outcomes and processes are needed.

  View details for DOI 10.1097/PEC.0000000000000194

  View details for PubMedID 25198767

• Pediatric Emergency Medicine Fellowship Programs PEDIATRIC EMERGENCY CARE Hsu, D. 2013; 29 (4): 541-547

  View details for DOI 10.1097/PEC.0b013e31828c0beb

  View details for Web of Science ID 000317103300028

• Pediatric emergency medicine fellow training in ultrasound: consensus educational guidelines. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Vieira, R. L., Hsu, D., Nagler, J., Chen, L., Gallagher, R., Levy, J. A. 2013; 20 (3): 300-6

  Abstract

  The importance of point-of-care emergency ultrasound (EUS) to the practice of emergency medicine (EM) is well established, and mounting research continues to demonstrate how EUS can benefit pediatric emergency department (ED) patients. As members of the EM community, pediatric EM (PEM) physicians should understand the potential value of EUS and seek opportunities to incorporate EUS into their daily practice. Currently, EUS education and training is at an early developmental stage for PEM fellows and varies greatly between programs. The goal of this article is to provide consensus education guidelines and to describe a sample curriculum that can be used by PEM fellowship programs when developing or revising their US training curricula. The authors recognize that programs may be at different stages of EUS development and will consequently need to tailor curricula to individual institutional needs and capabilities. This guideline was developed through a collaborative process between EUS educators and members of the American Academy of Pediatrics Section of EM Fellowship Directors Subcommittee. The guideline includes the following topics: important considerations regarding EUS in PEM, PEM US program framework, PEM US curriculum, PEM US education program, and competency assessment.

  View details for DOI 10.1111/acem.12087

  View details for PubMedID 23517263

• Pediatric emergency medicine fellowship programs. Pediatric emergency care Hsu, D. 2012; 28 (4): 395-401

  View details for DOI 10.1097/PEC.0b013e31824dd4dc

  View details for PubMedID 22472662

• Mobile pediatric emergency response team: patient satisfaction during the novel H1N1 influenza outbreak. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Laos, C. M., DiStefano, M. C., Cruz, A. T., Caviness, A. C., Hsu, D. C., Patel, B. 2012; 19 (3): 274-9

  Abstract

  The objective was to determine child caregiver satisfaction with a nontraditional pediatric emergency department (ED) venue during the 2009 novel H1N1 influenza outbreak.Between May 1 and 7, 2009, the Texas Children's Hospital (TCH) ED used a six-bed outdoor facility, the Mobile Pediatric Emergency Response Team (MPERT), to evaluate patients with suspected novel H1N1 influenza. Parents and caregivers of patients evaluated in the MPERT were surveyed by telephone using a validated questionnaire to evaluate satisfaction with the facility.Of 353 patients, 155 caregivers (44%) completed questionnaires; 127 had wrong numbers, 71 did not answer, and 15 were on a no-call list. Survey responders felt that nurses and doctors explained concepts well (nurses 92%, doctors 94%), 91% felt TCH prepared them well for taking care of their children at home, 94% were satisfied with the medical care received, and 88% were not bothered by the outdoor setting. When asked to rate their MPERT experience on a scale of 0 (worst possible) to 10 (best possible), the median score was 9 (range 1 to 10).The MPERT facility alleviated patient volume surge and potentially prevented transmission during H1N1 outbreak. While these were health care provider goals, caregiver expectations were also met. Caregivers perceived MPERT as an acceptable alternative to receiving care in the regular ED, felt that physicians and nurses communicated well, and felt that medical care was good to excellent. Use of the MPERT did not negatively affect overall caregiver satisfaction with TCH. These findings suggest that families of pediatric patients are amenable to nontraditional ED venues during periods of ED crowding.

  View details for DOI 10.1111/j.1553-2712.2012.01289.x

  View details for PubMedID 22435859

• Pediatric Emergency Medicine Fellowship Programs PEDIATRIC EMERGENCY CARE Hsu, D. 2011; 27 (5): 455-467

  View details for DOI 10.1097/PEC.0b013e31821b74d0

  View details for Web of Science ID 000290297200028

• Efficacy of a near-infrared light device in pediatric intravenous cannulation: a randomized controlled trial. Pediatric emergency care Perry, A. M., Caviness, A. C., Hsu, D. C. 2011; 27 (1): 5-10

  Abstract

  To determine whether the use of a near-infrared light venipuncture aid (VeinViewer; Luminetx Corporation, Memphis, Tenn) would improve the rate of successful first-attempt placement of intravenous (IV) catheters in a high-volume pediatric emergency department (ED).Patients younger than 20 years with standard clinical indications for IV access were randomized to have IV placement by ED nurses (in 3 groups stratified by 5-year blocks of nursing experience) using traditional methods (standard group) or with the aid of the near-infrared light source (device group). If a vein could not be cannulated after 3 attempts, patients crossed over from one study arm to the other, and study nurses attempted placement with the alternative technique. The primary end point was first-attempt success rate for IV catheter placement. After completion of patient enrollment, a questionnaire was completed by study nurses as a qualitative assessment of the device.A total of 123 patients (median age, 3 years) were included in the study: 62 in the standard group and 61 in the device group. There was no significant difference in first-attempt success rate between the standard (79.0%, 95% confidence interval [CI], 66.8%-88.3%) and device (72.1%, 95% CI, 59.2%-82.9%) groups. Of the 19 study nurses, 14 completed the questionnaire of whom 70% expressed neutral or unfavorable assessments of the device in nondehydrated patients without chronic underlying medical conditions and 90% found the device a helpful tool for patients in whom IV access was difficult.First-attempt success rate for IV placement was nonsignificantly higher without than with the assistance of a near-infrared light device in a high-volume pediatric ED. Nurses placing IVs did report several benefits to use of the device with specific patient groups, and future research should be conducted to demonstrate the role of the device in these patients.

  View details for DOI 10.1097/PEC.0b013e3182037caf

  View details for PubMedID 21178814

• Rubric evaluation of pediatric emergency medicine fellows. Journal of graduate medical education Hsu, D. C., Macias, C. G. 2010; 2 (4): 523-9

  Abstract

  To develop and validate a rubric assessment instrument for use by pediatric emergency medicine (PEM) faculty to evaluate PEM fellows and for fellows to use to self-assess.This is a prospective study at a PEM fellowship program. The assessment instrument was developed through a multistep process: (1) development of rubric format items, scaled on the modified Dreyfus model proficiency levels, corresponding to the 6 Accreditation Council for Graduate Medical Education core competencies; (2) determination of content and construct validity of the items through structured input and item refinement by subject matter experts and focus group review; (3) collection of data using a 61-item form; (4) evaluation of psychometrics; (5) selection of items for use in the final instrument.A total of 261 evaluations were collected from 2006 to 2007; exploratory factor analysis yielded 5 factors with Eigenvalues >1.0; each contained ≥4 items, with factor loadings >0.4 corresponding with the following competencies: (1) medical knowledge and practice-based learning and improvement, (2) patient care and systems-based practice, (3) interpersonal skills, (4) communication skills, and (5) professionalism. Cronbach α for the final 53-item instrument was 0.989. There was also significant responsiveness of the tool to the year of training.A substantively and statistically validated rubric evaluation of PEM fellows is a reliable tool for formative and summative evaluation.

  View details for DOI 10.4300/JGME-D-10-00083.1

  View details for PubMedID 22132272

  View details for PubMedCentralID PMC3010934