81 A Snapshot of Entrustability of Acute Care Procedural Skills in Paediatrics Residents

Abstract

Abstract Background General paediatricians are expected to be competent in the resuscitation of children and important to this competency is the ability to perform certain acute care procedural skills. Paediatric residents are expected to be competent in these procedural skills by the end of their training as specified by the Royal College (RCPSC). However, the extent to which residents are actually competent is not fully assessed or understood. There are currently no evidence-supported guidelines suggesting the best path toward procedural skills competency for residents, and they are less likely to receive formal training and or supervision for completing procedural skills than their nursing counterparts. They also report feeling inadequately prepared. To address this gap, the Paediatrics program at McMaster University aimed to conduct a longitudinal cross-sectional study examining the competency of their trainees in specific acute care procedures. Objectives The purpose of this first study was to present a cross-sectional observation of the entrustability of paediatric residents in 6 procedural skills. Design/Methods The procedures were bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR), and defibrillation, which are all requirements of the RCPSC. Paediatric residents attended an “Acute Care Procedure Day” where they performed each procedure with direct observation and feedback. Entrustable professional activity (EPA) scores (from 1 to 5) were recorded for each attempt. Prior, a 1-hour interactive lecture was given that included procedural information and a video demonstration of each procedure. Residents received a copy of the milestones per EPA. Demographic information, self-perceived comfort, and EPA data were collected. Descriptive statistics and Pearson correlation for PGY level versus EPA scores were performed. Results Of the 36 residents who participated, 24(67%) were in postgraduate year (PGY) 1-2, and 12 PGY 3-4(33%). Reported levels of past experience were lowest for placement of chest tubes (n=3, 8.3%), followed by IOs (n=19, 52.8%). During the sessions, residents showed the highest levels of initial entrustment with IO placement (EPA 4-5 in 28/33), BVM skills (EPA 4-5 in 27/33), and CPR (EPA 4-5 in 16/25), and lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). Despite this, self-reported overall confidence after training for these procedures was moderate to high. There was strong correlation between PGY level and EPA score for intubation, and no correlation for the other procedures. Conclusion Our findings show that entrustability of certain acute care skills is not being obtained (i.e., defibrillation, chest tube placement), and that there were large discrepancies between entrustment scores and perceived comfort among the PGY levels. Further research is needed to characterize the learning curves for these skills, and their relative importance in paediatrics training.