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

– There’s no TRIK TRIK to it!

Natalie Yanchar1, Adam Cheng2,3, Fayez Al- Harthi4, Amina Lalani5, Sanjay Mehta5, Farhan Bhanji6, Sonny Dhanani7, Angelo Mikrogianakis2

1Division of Surgery, IWK Health Centre,2KidSim-ASPIRE Simulation

Research Program, Alberta Children’s Hospital, 3Royal College of Physicians and Surgeons of Canada, 4Prince Sultan Military Medical City, Riyadh, 5Division of Emergency Medicine, The Hospital for Sick Children,

6Division of Emergency Medicine, Montreal Children’s Hospital,, 7Division 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

• f Major Pediatric Trauma

Physician Comfort with Management

• f 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

• 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.

Course Development

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 Content

Day 1 Day 2

I n-course Lectures: Primary and Secondary Survey Airway Management and Shock Head Trauma Thoracic, Abdominal and Pelvic Trauma Child Abuse Introduction / Orientation in Simulation (1 hour) Introduction (15 min) Lecture: Primary & Secondary Survey (20 min) Lecture: Thoracic, Abdominal and Pelvic Trauma (30 min) Sim ulation: Primary & Secondary Survey (1 hour) Sim ulation (2 scenarios) – Blunt Thoracic/ Abdominal/ Pelvic trauma Skill – Chest tube insertion Sm all Group Discussion – Radiology

(3 hours)

Additional Content: Environmental Injuries Orthopedic Injuries Trauma Radiology FAST Spinal Cord Injuries Pediatric Transport Pain Management and Sedation Lecture: Airway Management and Shock

(30 min)

Lecture: Child Abuse (20 min) Sim ulation (2 scenarios) - Difficult airway; Hemorrhagic Shock Skills (2 stations) - C-Spine stabilization, Vascular access (3 hours) Sim ulation (3 scenarios) – Burn with upper airway obstruction and CO poisoning; Child Abuse with

• rthopedic injuries; Electrical injury

with shock Sm all Group Discussion – Transport

(2 hours)

Lecture: Head Trauma (20 min) Discussion, Feedback and Course 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

Trauma Tasks

1. Conduct an appropriate 1⁰ and 2⁰ survey 2. Manage pediatric airway issues 3. Manage pediatric circulation issues 4. Manage pediatric with traumatic brain injury 5. Manage pediatric patients with blunt torso trauma 6. Manage pediatric burns 7. Interpret pediatric trauma related xrays 8. Identify and manage suspected child abuse 9. Lead a trauma team caring for a pediatric patient

• 10. Manage a pediatric trauma resuscitation (overall)

5

1 2 3 4 5 6 7 8 9 10

Before After

• Partnership with the

Course Growth

Future Directions

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

• Completion of e-textbook

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

Future Directions

Future Directions

• Completion of e-textbook
• Integration of videos into online content
• Development of Instructor training materials

→ increase in instructor capacity

• Completion of e-textbook
• Integration of videos into online content
• Development of Instructor training materials

→ increase in instructor capacity

• Markeng! → 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

• Markeng! → Increase in course delivery
• National → Internaonal course exposure

Future Directions

Thank you!

http://www.royalcollege.ca/portal/page/portal/rc/resources/ppi/trik_course

Adam Cheng Angelo Mikrogianakis Fayez Al-Harthi Amina Lalani Sanjay Mehta Farhan Bhanji Sonny Dhanani Natalie Yanchar

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