P3.237: Rehearse, Reflect, Repeat: A Pediatric Emergency Medicine Fellow–Driven Approach to Critical Care Mastery

Background: Pediatric Emergency Medicine (PEM) fellowships lean on robust didactic conferences to achieve content necessary for skill development in high-acuity, low-frequency emergencies. Fellowship sizes are small, with limited inter-fellow interactions. A national survey of program directors in 2023 demonstrated most feel unable to achieve desired amounts of bedside teaching. Furthermore, the ability to leverage the cognitive congruence produced by near peer interactions elevates fellow learning experience. Didactics within PEM fellowship are content rich, however links to learner-centric needs and the ability to transfer such content to tangible clinical milestones are less well-defined. We seeked to identify methods for delivery of a critical care curriculum that emphasizes a fellow-driven end result,grounded in cognitive load theory. This endeavor captured the development of a learner-centric curriculum, leveraging near peer learning and linking relational skill sets with learned content, optimal for translation to bedside care.

Methods: A multi-factorial needs assessment was conducted including a focus group of current PEM fellows, review of the program's in-training examination reports, discussion with leadership faculty, and review of the American Board of Pediatric (ABP) content specifications. The findings were utilized in a backwards design using the Understanding by Design (UbD) model to innately encourage intentionality during the educational design process. The curricular goal was to foster critical thinking, mental rehearsal of high acuity care scenarios, and knowledge-transfer to and among peers. This informed the implementation of a learner-centric critical care curriculum for PEM fellows designed to activate skills needed to complete critical action items for structured clinical cases. These cases were supported by near peer learning with peer facilitation. A debriefing immediately followed, which harbored reflective practice and development of future action planning. After a pilot session, a template was developed for facilitator implementation. Fellows then facilitated future curricular sessions. A process map is depicted in Figure 1.

Results: A competency-driven assessment based in the American College of Graduate Medical Education (ACGME) PEM milestones was created for evaluation, and included core domains. Milestone domains were intentionally paired with curricular features as depicted in Table 1. These provided a well-rounded base outside of content delivery with identifiable links for transferability to clinical practice and components simulating on-shift experiences. After completion of the pilot phase, fellows independently facilitated one session yearly with faculty feedback.

Conclusion: The UBD model allowed fellows to reach predetermined end points simply by engaging in the facilitated activity. Each course allowed participants to engage in a discussion of thought processes, mental rehearsal of implemented steps, and a facilitated expansion of the topic to engage peer learners. Clinical examples were provided by co-fellows and faculty for consideration of alternatives and the development of reflective practice. The concluding debriefing process prompted deeper exploration, providing an individualized action plan for clinical use.