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2013
residents on how to develop a Quality Improvement (QI)
project during their one-month rotation at the clinic. Using the
Plan, Do, Study, Act (PDSA) model, residents implemented
multiple interventions to improve the rate of standardized
developmental screenings at well-child visits for children aged 9
months to 36 months (N¼ 1061) between January 2009 and
June 2010. The rate of standardized developmental screening
increased from 7% to 56% after residents initiated QI
interventions.
Barriers were encountered during the project, such as
limited education and socioeconomic resources of the patient
population, scarce time in the clinic setting, and suboptimal
resident/staff knowledge of developmental screening tools
and recommendations. By familiarizing themselves with the
barriers that existed, and taking advantage of the AAP’s
mission for health promotion and connection to community-
based resources, the residents were able to positively impact
the developmental screening rates in the clinic.
The residents’ successful outcomes suggest that combining
resident education and AAP mentorship in QI interventions
can lead to substantial gains in the quality of patient care
(Akins & Handel 2009). In this case, the rate of developmental
screening at a general pediatric clinic improved as a result of
this collaborative effort.
Aline Wong, Rebecca Hicks, Marc Lerner, Sabrina Middleton,
Dian Milton & Khanh-Van Le-Bucklin, Department of
Pediatrics, University of California Irvine, 505 S. Main St., Ste.
525, Orange, CA 92868, USA. E-mail: hicksreb@gmail.com
References
Akins R, Handel G. 2009. Utilizing quality improvement methods
to improve patient care outcomes in a pediatric residency program.
J Grad Med Educ 1(2):299–303.
Council on Children with Disabilities. 2006. Identifying infants and young
children with developmental disorders in the medical home: An
algorithm for developmental surveillance and screening. Pediatrics
118(1):405–420.
Procedural certification
program: Enhancing resident
procedural teaching skills
Dear Sir
In the clinical arena, residents frequently supervise their peers
in performing procedures, often prior to being comfortable
doing the procedures themselves (Mourad et al. 2010). To help
residents acquire skills in the teaching and supervision of
procedures, we designed and implemented the Procedural
Certification Program at the University of Calgary. Expanding
upon the concept of a procedural teaching tree whereby
senior residents are trained to teach procedures to junior
residents using simulators (Ma et al. 2010), the Procedural
Certification Program includes a more structured longitudinal
curriculum for the resident teachers.
Twelve resident-teachers taught seven procedures to
82 learners in a longitudinal fashion using simulation in
65 training sessions. Procedural skills covered include: lumbar
puncture, knee arthrocentesis, intubation, arterial blood gas
sampling, cardiac auscultation, and ultrasound-guided central
venous catheterization, thoracentesis and paracentesis.
Resident-teachers taught a minimum of two sessions super-
vised by faculty and once deemed competent to teach
independently, did so for a minimum of two additional
sessions. Sessions were rated out of five by learners and
faculty using a 10-item teaching effectiveness assessment tool.
Resident-teachers’ self-reported comfort in performing
and teaching the procedure increased (from 3.64� 1.21 to
4.80� 0.42, p¼ 0.01; from 3.36� 1.36 to 4.80� 0.42; p¼ 0.005,
respectively). Overall teaching effectiveness rated by learners
also increased (from 4.73� 0.24 to 4.93� 0.11, p¼ 0.01).
Ten of the 11 resident-teachers (91%) reported that the
program was valuable for him/her as a proceduralist, while
all reported it was valuable for him/her as a teacher.
Comments from the resident-teachers included: ‘‘Procedural
teaching as an [PGY-]2 would be especially valuable as you
learn about both the skill and effective teaching strategies . . .’’
and ‘‘This was an excellent experience. I learned a lot about
procedural teaching, and I think the residents I taught had an
enjoyable experience as well’’.
In summary, a longitudinal structured training program
such as the Procedural Certification Program is both feasible
and well-received. Further, it is associated with improved
teaching skills for the resident-teachers and may help prepare
them for their supervisory role in performing procedures on
the wards.
Irene Wai Yan Ma, Sarah Chapelsky, Sankalp Bhavsar, William
Connors, Michael Fisher, Jeffrey Schaefer & Maria Bacchus,
Department of Medicine, University of Calgary, 3330 Hospital
Dr NW, Calgary, AB T2N4N1, Canada. E-mail: ima@ucalgary.ca
References
Ma IW, Roberts JM, Wong RY, Nair P. 2010. A procedural teaching tree
to aid resident doctor peer-teachers. Med Educ 44:1134–1135.
Mourad M, Kohlwes J, Maselli J, Auerbach AD. 2010. Supervising the
supervisors – Procedural training and supervision in internal medicine
residency. J Gen Intern Med 25:351–356.
Does training on placing
rescuer’s hands on victim’s
chest have an impact on the
depth and frequency of chest
compressions?
Dear Sir
During five Basic Life Support – Automatic External
Defibrillator (BLS – AED) seminars a survey comprising 102
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