Theres no TRIK TRIK to it! Natalie Yanchar 1 , Adam Cheng 2,3 , - PowerPoint PPT Presentation

– There’s no TRIK TRIK to it! Natalie Yanchar 1 , Adam Cheng 2,3 , Fayez Al- Harthi 4 , Amina Lalani 5 , Sanjay Mehta 5 , Farhan Bhanji 6 , Sonny Dhanani 7 , Angelo Mikrogianakis 2 1 Division of Surgery, IWK Health Centre, 2 KidSim-ASPIRE Simulation Research Program, Alberta Children’s Hospital, 3 Royal College of Physicians and Surgeons of Canada, 4 Prince Sultan Military Medical City, Riyadh, 5 Division of Emergency Medicine, The Hospital for Sick Children, 6 Division of Emergency Medicine, Montreal Children’s Hospital,, 7 Division of Critical Care, Children’s Hospital of Eastern Ontario

Objectives • Why? Course need • How? Course Development • Where? Course status • When? Course growth

Major Trauma in Canada – Age Distribution (2010/11)

Physician Comfort with Management of Major Pediatric Trauma

Physician Comfort with Management of Major Pediatric Trauma

Why are Physicians Uncomfortable with Pediatric Trauma? • Variablities with age; Size/weight-based meds, tubes, etc…. • Fear of a “sudden crash” • What’s hidden behind the “OK-looking” child? the crying child? • Evolving knowledge of long-term risks of CT • Knowing when to operate • Changing paradigm of orthopedic care • Caring for families

Survey of Canadian Pediatric & Adult-oriented General Surgeons Li D, et al, J Pediatr Surg 2008 •STABLE pediatric patients with blunt splenic injury •General Surgeons (non-pediatric): –LESS likely to treat injuries non-operatively •5x increased risk of higher CT grade influencing decision to intervene •6x increased risk of intervention when contrast blush visualized –MORE likely to use more resources •20x increased incidence routine admission of all patients to the ICU regardless of CT injury grade •5x increased risk of routine follow-up imaging

Courses on Pediatric Trauma

Other Courses

Other Courses

Other Courses

Other Courses

Medical Teacher, 2010

Medical Teacher, 2010 Table 1. e 1. Domains f Domains for the r the pedia pediatric tr ric trauma auma cur curriculum iculum Domains selected by the initial four expert panels Introduction to pediatric trauma, epidemiology, burden of illness, and trauma prevention Assessment and initial management of pediatric trauma patient Assessment and management of pediatric airway Assessment and management of shock Assessment and management of thoracic injuries Assessment and management of abdominal and pelvic injuries Assessment and management of spinal and neurological injuries Assessment and management of pediatric burns and electrical injuries Assessment and management of pediatric orthopedic injuries

TRIK Course Development • Eight experts, across Canada, representing pediatric emergency medicine, pediatric critical care, pediatric surgery and pediatric transport • Development of the course following Kern’s 6 step model for curriculum design. 1.Problem identification and general needs assessment 2.Targeted learner’s needs assessment 3.Goals and objectives 4.Educational strategies 5.Implementation 6.Evaluation and feedback

Course Development Learning objectives were obtained from a • national needs assessment conducted by second Delphi Method. Individual learning objectives were grouped in • categories (16 knowledge-based; 5 skills based) Highest rated items were selected for in course • delivery, and grouped into one half-day block according to theme Lower rated items were selected for online • content

Course Development • Educational Strategies determined by expert consensus Lectures • Team-based high-fidelity simulation • Procedural skills training • Small group discussion • Online learning modules • • Evaluation with retrospective pre-post survey comprised of 10 different items to assess learner comfort for various trauma tasks.

TRIK Course Two day course • Online content • 4 in-course modules with didactic and simulation-based learning and/or procedural skills training. : 1. Initial management and assessment of Airway and shock 2. Head trauma and neurogenic shock 3. Blunt Torso trauma 4. Burns, Electrical Injuries, Child abuse

Pre-Course Online Day 1 Day 2 Content I n-course Lectures: Introduction / Orientation in Introduction (15 min) Primary and Secondary Simulation (1 hour) Survey Lecture: Lecture : Airway Management Primary & Secondary Survey Thoracic, Abdominal and Pelvic and Shock (20 min) Trauma (30 min) Head Trauma Thoracic, Abdominal Sim ulation : Sim ulation (2 scenarios) – Blunt and Pelvic Trauma Primary & Secondary Survey Thoracic/ Abdominal/ Pelvic trauma Child Abuse (1 hour) Skill – Chest tube insertion Sm all Group Discussion – Radiology (3 hours) Additional Content: Lecture : Lecture : Environmental Injuries Airway Management and Shock Child Abuse (20 min) (30 min) Orthopedic Injuries Trauma Radiology Sim ulation (2 scenarios) - Sim ulation (3 scenarios) – Burn with FAST Difficult airway; Hemorrhagic upper airway obstruction and CO Spinal Cord Injuries Shock poisoning; Child Abuse with Pediatric Transport Skills (2 stations) - C-Spine orthopedic injuries; Electrical injury Pain Management and stabilization, Vascular access with shock Sedation (3 hours) Sm all Group Discussion – Transport (2 hours) Lecture : Discussion, Feedback and Course Head Trauma (20 min) Evaluation Sim ulation (2 scenarios) – Severe Head Trauma; Neurogenic Shock (90 min)

Evaluation – Pilot Course • Wide variety of participants – Rural Family/ED Docs – Pediatric Emergency Physicians • Retrospective pre-post survey. – Ten Trauma tasks

Before Trauma Tasks After 1. Conduct an appropriate 1 ⁰ and 2 ⁰ survey 10 2. Manage pediatric airway issues 9 3. Manage pediatric circulation issues 8 4. Manage pediatric with traumatic brain injury 7 5. Manage pediatric patients with blunt torso trauma 6 6. Manage pediatric burns 5 7. Interpret pediatric trauma related xrays 4 8. Identify and manage suspected child abuse 3 9. Lead a trauma team caring for a pediatric patient 2 10. Manage a pediatric trauma resuscitation (overall) 1 0 5

Course Growth • Partnership with the

Future Directions • Completion of e-textbook TABLE OF CONTENTS Primary and Secondary Surveys Airway Management and Shock Pain and Sedation Head Trauma Spinal Cord Trauma Thoracic, Abdominal and Pelvic Injuries Orthopedic Injuries Environmental Injuries Child Abuse Injuries Patient Transport

Future Directions • Completion of e-textbook • Integration of videos into online content

Future Directions • Completion of e-textbook • Integration of videos into online content • Development of Instructor training materials → increase in instructor capacity

Future Directions • Completion of e-textbook • Integration of videos into online content • Development of Instructor training materials → increase in instructor capacity • Marke � ng! → Increase in course delivery

Future Directions • Completion of e-textbook • Integration of videos into online content • Development of Instructor training materials → increase in instructor capacity • Marke � ng! → Increase in course delivery • National → Interna � onal course exposure

Thank you! Adam Cheng Fayez Al-Harthi Angelo Farhan Bhanji Mikrogianakis Amina Lalani Sanjay Mehta Sonny Dhanani Natalie Yanchar http://www.royalcollege.ca/portal/page/portal/rc/resources/ppi/trik_course

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