Implementing Entrustable Professional Activities in Pediatric Fellowships: Facilitating the Process.

Background And Objectives: 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.

Development of an Approach to Assessing Pediatric Fellows' Transport Medical Control Skills.

Background And Objective: Pediatric interfacility transport teams facilitate access to subspecialty care, and physicians often guide management remotely as transport medical control (TMC). Pediatric subspecialty fellows frequently perform TMC duties, but tools assessing competency are lacking. Our objective was to develop content validity for the items required to assess pediatric subspecialty fellows' TMC skills.

Into the Unknown: Characterizing Fellow Uncertainty During the Transition to Unsupervised Practice.

Background: Helping fellows confront and manage uncertainty in the course of diagnosis and treatment of patients has been a growing focus of medical education. How these same fellows confront uncertainty as they make a transition in their professional development is less commonly a focus of training programs. Better understanding of how fellows experience these transitions will allow fellows, training programs, and hiring institutions to navigate transitions more easily.

Variations in Demonstrated Emotional Intelligence: Trainee to Experienced Faculty Member.

Objectives: To identify differences in emotional intelligence (EI)-related competencies between fellows and faculty in a cohort of pediatric critical care physicians.

Design: Single-center, cross-sectional observation study.

Setting: Seventy-two-bed multidisciplinary pediatric critical care unit at a quaternary children's hospital (Children's Hospital of Philadelphia, Philadelphia, PA).

Benefits and Limitations of Virtual Recruitment: Perspectives From Subspeciality Directors.

Background And Objectives: Because of the coronavirus disease 2019 pandemic and recommendations from a range of leaders and organizations, the pediatrics subspecialty 2020 recruitment season was entirely virtual. Minimal data exist on the effect of this change to guide future strategies. The aim of this study was to understand the effects of virtual recruitment on pediatric subspecialty programs as perceived by program leaders.

Best Practices in Medical Documentation: A Curricular Module.

Objective: To create and validate a checklist for high-quality documentation and pilot a multi-modal, immersive educational module across multiple institutions. We hypothesized that this module would improve knowledge, skills, and attitudes in medical documentation.

Methods: Module design was grounded in an established curriculum design framework.

Validity Evidence for a Novel, Comprehensive Bag-Mask Ventilation Assessment Tool.

Objective: To develop a comprehensive competency assessment tool for pediatric bag-mask ventilation (pBMV) and demonstrate multidimensional validity evidence for this tool.

Study Design: A novel pBMV assessment tool was developed consisting of 3 components: a 22-item-based checklist (trichotomized response), global rating scale (GRS, 5-point), and entrustment assessment (4-point). Participants' performance in a realistic simulation scenario was video-recorded and assessed by blinded raters.

Transport Medical Control Education for Pediatric Critical Care Fellows: A National Needs Assessment Study.

Objectives: Characterize transport medical control education in Pediatric Critical Care Medicine fellowship.

Design: Cross-sectional survey study.

Setting: Pediatric Critical Care Medicine fellowship programs in the United States.

Navigating landscapes of practice: A longitudinal qualitative study of physicians in medical education.

Introduction: Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physician-educators. Knowing how physician-educators find their way among different communities of practice (ie their landscape of practice) has implications for professional development but the limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice.

Creating a "Culture of Triage": A Dual-Perspective Study of Interruptions During ICU Rounds.

Objectives: To explore interrupters' and interruptees' experiences of interruptions occurring during morning rounds in a PICU in an attempt to understand better how to limit interruptions that threaten patient safety.

Design: Qualitative ethnographic study including observations, field interviews, and in-depth interviews.

Setting: A 55-bed PICU in a free-standing, quaternary-care children's hospital.

Just-in-Time Simulation to Guide Workflow Design for Coronavirus Disease 2019 Difficult Airway Management.

Objectives: The coronavirus disease 2019 pandemic has required that hospitals rapidly adapt workflows and processes to limit disease spread and optimize the care of critically ill children.

Design And Setting: As part of our institution's coronavirus disease 2019 critical care workflow design process, we developed and conducted a number of simulation exercises, increasing in complexity, progressing to intubation wearing personal protective equipment, and culminating in activation of our difficult airway team for an airway emergency.

Patients And Interventions: In situ simulations were used to identify and rework potential failure points to generate guidance for optimal airway management in coronavirus disease 2019 suspected or positive children.

Establishing the Knowledge and Skills Necessary in Pediatric Critical Care Medicine: A Systematic Approach to Practice Analysis.

Objectives: To describe the practice analysis undertaken by a task force convened by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to create a comprehensive document to guide learning and assessment within Pediatric Critical Care Medicine.

Design: An in-depth practice analysis with a mixed-methods design involving a descriptive review of practice, a modified Delphi process, and a survey.

Setting: Not applicable.

Vecuronium- and Esmolol-Induced Pseudohypernatremia Due to Drug Interference With Ion-Selective Electrodes.

Objectives: We observed that patients treated with continuous vecuronium or esmolol infusions showed elevated plasma sodium measurements when measured by the routine chemistry analyzer as part of the basic metabolic panel (Vitros 5600; Ortho Clinical Diagnostics, Raritan, NJ), but not by blood gas analyzers (RAPIDLab 1265; Siemens, Tarrytown, NY). Both instruments use direct ion-selective electrode technology, albeit with different sodium ionophores (basic metabolic panel: methyl monensin, blood gas: glass). We questioned if the basic metabolic panel hypernatremia represents artefactual pseudohypernatremia.

Burnout in Pediatric Critical Care Medicine Fellows.

Objectives: Assess the overall level of burnout in pediatric critical care medicine fellows and examine factors that may contribute to or protect against its development.

Design: Cross-sectional observational study.

Setting: Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs across the United States.

Online Learning and Residents' Acquisition of Mechanical Ventilation Knowledge: Sequencing Matters.

Objective: Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents' knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains.

Design: A prospective, interventional crossover study conducted from October 2015 to December 2017.

Assessing Competence in Central Venous Catheter Placement by Pediatric Critical Care Fellows: A National Survey Study.

Objectives: To describe the current approach to initial training, ongoing skill maintenance, and assessment of competence in central venous catheter placement by pediatric critical care medicine fellows, a subset of trainees in whom this skill is required.

Design: Cross-sectional internet-based survey with deliberate sampling.

Setting: United States pediatric critical care medicine fellowship programs.

Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey.

Objectives: To assess current diagnostic bedside ultrasound program core element (training, credentialing, image storage, documentation, and quality assurance) implementation across pediatric critical care medicine divisions in the United States.

Design: Cross-sectional questionnaire-based needs assessment survey.

Setting: Pediatric critical care medicine divisions with an Accreditation Council of Graduate Medical Education-accredited fellowship.

Characterization of Thoracic Pathophysiologic Conditions in Patients Receiving High-Frequency Oscillatory Ventilation: Pediatric Experience.

High-frequency oscillatory ventilation (HFOV) is a mode of mechanical ventilation used in severe pediatric respiratory failure. Thoracic ultrasound (US) is a powerful tool for diagnosing acute pathophysiologic conditions during spontaneous respiration and conventional noninvasive and invasive mechanical ventilation. High-frequency oscillatory ventilation differs from conventional modes of ventilation in that it does not primarily use bulk flow delivery for gas exchange but, rather, a number of alternative mechanisms as the result of pressure variations oscillating around a constant distending pressure.