Current Perspectives on Transport Medicine in Pediatric Hospital Medicine Fellowships
Transport medicine (TM) is a Pediatric Hospital Medicine (PHM) Core Competency and part of the proposed PHM fellowship curricular framework. No published TM curricula are available. This cross-sectional study was designed to determine attitudes toward TM training among PHM fellowship stakeholders and conduct a TM curriculum needs assessment. Unique, web-based, anonymous surveys for PHM fellows, graduates, and program directors (PDs) were administered, with response rates of 57%, 37%, and 44%, respectively. Fellows’ interest in completing a TM rotation is greater than their perceived interest by PDs (P = .06). Graduates who completed a TM rotation were more likely to recommend a TM rotation than those who did not (P = .001). Perceived barriers included lack of a formal TM curriculum and time constraints. Stabilizing patients and triage of referrals were deemed important learning objectives, and active learning strategies were prioritized. Curriculum design should focus on topics specific to the transport process and environment.
© 2018 Society of Hospital Medicine
Transport medicine (TM) involves the provision of care to patients who require transfer to a healthcare facility that can deliver definitive treatment.1 Pediatric interfacility transport occurs in approximately 10% of nonneonatal, nonpregnancy pediatric hospitalizations in the United States.2 Studies document a decline in resident participation in pediatric transports and variability in curricular content.3,4
The Pediatric Hospital Medicine (PHM) Core Competencies include “Transport of the Critically Ill Child.”7 Additionally, the Curriculum Committee of the PHM Fellowship Directors Council proposed a curricular framework that includes a required clinical experience in “Care and Stabilization of the Critically Ill Child,”8 which can occur in a variety of practice settings, including TM. TM is also listed as a potential elective rotation.
In 2014, 60% of PHM fellowships included a required or optional TM rotation.9 A recent study of pediatric emergency, critical care, and neonatal medicine fellowships revealed a paucity of formal or published TM curricula in these programs.10 Furthermore, no standard or published TM curricula have been established for PHM fellowships. The primary objective of our study is to determine attitudes regarding TM training among PHM fellows, recent PHM fellowship graduates, and PHM fellowship program directors (PDs). The secondary objective is to identify how the perspectives of these fellowship stakeholders could influence the design of a TM curriculum.
METHODS
This cross-sectional study focused on 3 stakeholder groups related to PHM fellowships. The subjects included in the study were physicians enrolled in a PHM fellowship (fellow) during the 2015-2016 academic year, graduates of fellowship (graduate) between 2010 and 2015, and fellowship program directors (PD). Unique web-based, anonymous surveys for each group were developed, reviewed by content and methodology experts, and piloted with local pediatric hospitalists. Surveys consisted of unfolding multiple-choice questions and ranking items along Likert scales and the Dreyfus model.
Questions were designed to elicit demographic data, perspectives, and experience related to TM education in PHM fellowships across all respondent groups. Depending on the context, identical or similar questions were asked among the groups. For example, all groups were asked to prioritize learning objectives for a TM rotation. Graduates and PDs reported the most effective teaching methods for use during a TM rotation. Fellows rated their own interest in a TM elective, and PDs were asked to rate the level of interest among their fellows.
Participant contact information was obtained from a website (phmfellows.org) and databases of fellows and graduates, which are maintained by the PHM Fellowship Directors Council (personal communication, Jayne Truckenbrod, DO; February 2, 2017). Between February and April 2016, the participants were individually emailed a link to their respective surveys, and 3 reminder e-mails were sent to nonresponders. The survey was administered through SurveyMonkey (www.surveymonkey.com).
SPSS (IBM SPSS Statistics, IBM Corporation, Armonk, New York) was used for statistical analysis. Descriptive data were presented using mean and standard deviation. Comparisons among fellows, graduates, and PDs were conducted using one-way analyses of variance or Mann-Whitney U test. Frequency of application and self-evaluation of core competency skills before and after the rotation were evaluated using paired sample t-tests. The study protocol was deemed exempt from review by our local Institutional Review Board.
RESULTS
Forty of 70 (57%) fellows, 32 of 87 graduates (37%), and 14 of 32 PDs (44%) responded to the survey. The majority of the participants described their respective programs as 2 years in duration (59% for fellows, 56% for graduates, and 85% for PDs). Most programs (85%) were based at children’s hospitals. Most graduates (84%) practiced in a children’s hospital, and 12% of them practiced in a community site or a combination of sites.
Both fellows and graduates reported limited involvement in several aspects of TM prior to fellowship. Fellows’ interest in completing a TM rotation during fellowship is greater than the interest as perceived by PDs (3.03+1.00 vs. 2.38+1.19, P = .061). Prior TM exposure in residency or perceived proficiency in TM was not associated with lack of interest. Twenty-five percent of graduates completed a TM rotation during PHM fellowship. Many graduates agreed (41%) or strongly agreed (16%) with the statement “I recommend participating in a TM rotation during PHM fellowship.” Graduates who had completed a TM rotation were more likely to agree with this statement (P = .001).
