Children's Hospital of Boston
Boston, MA
Debra Boyer, MD
The pediatric pulmonary fellowship program at Children’s hospital, Boston has been training fellows for over thirty years. However, limitations in direct patient contact due to duty hour restrictions and increasing societal expectations for attending level involvement, has led to wide and unpredictable variation in the educational experiences of pediatric pulmonary fellows with regard to clinical exposure, teaching, procedural training, as well as formative/summative feedback. We sought to develop a unique simulation-based training “boot camp” for pulmonary fellows to improve consistency and quality of education across expertise gradients.
In April of 2010 a needs assessment was performed throughout the Children’s hospital Boston (ChB) pediatric pulmonary fellowship and included data from current ChB fellows, attendings, recent program graduates as well as national pediatric pulmonary fellowship directors. The e-administered survey identified gaps in subspecialty training and responses were categorized by theme. Training gaps included inconsistencies in clinical exposure, teaching experience and procedural training. We then derived the Boot Camp course content from these and divided these items among three general teaching modalities (i.e. didactics, simulation, task training.)
The pediatric pulmonary boot camp curriculum was devised as three 4 hour sessions including mixed-modalities tailored to specific learning objectives (e.g. skills training such as chest tube placement, flexible bronchoscopy complication management, respiratory failure in the cystic fibrosis patient, and team responses to acute medical crises). Each course includes introductions, icebreakers, didactics, partial task training and full-scale high fidelity simulation. Importantly, grant funding was obtained so that scenarios could include professional actors to provide patient and family interactions. This provides much needed practice and feedback around difficult conversations with patients and families.
We performed a pilot session last year and have now implemented our first full year running all of our fellows through the program. The feedback has been uniformly positive with fellows appreciating the opportunity to work through simulated medical complications and difficult conversations in safe environments. Our goals are to further enhance and develop this Boot Camp by developing further sessions for more senior fellows over the next few years. Learning objectives of these more advanced sessions might include experience with teaching/supervision, providing feedback and crisis resource management. In addition, we hope to be able to make this Boot Camp available for pediatric pulmonary fellows around the country.
Our approach is concordant with the American Board of Pediatrics efforts to ensure competent training in critical elements known as “entrustable professional activities” (ePAs). (o ten Cate 2007) We are quite proud of our Pediatric Pulmonary Fellows Boot Camp as it offers on demand opportunities for practice/preparation in numerous ePAs and therefore may offer a new paradigm to standardizing effective fellowship training curricula across programs.
