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
There were similarities between reservations about participating in a TM rotation among fellows and barriers identified by graduates and PDs (Table). However, no graduates cited lack of relevance to a career in PHM as a barrier to participation in a TM rotation. Fellows, graduates, and PDs reported concordant responses regarding the prioritization of learning objectives for a TM rotation (Table). Both graduates and PDs ranked active learning strategies, such as direct patient care and simulation, as the most effective methods for teaching TM.
Discordance was noted between how frequently fellows participated in aspects of TM during fellowship and graduates’ current practice of PHM (Figure). With regard to select TM-related PHM core competencies, such as respiratory failure, shock, and leading a healthcare team, most (63%–90%, depending on the competency) fellows perceived themselves as “competent” prior to the start of the fellowship. Nevertheless, more than 70% of fellows remained very or extremely interested in gaining additional experience in each competency during fellowship.
DISCUSSION
Survey respondents demonstrate variable levels of interest and engagement in TM training; in particular, fellows and graduates often reported greater interest and value in a TM rotation than PDs. Similar to fellows in related fields,10 PHM fellows and graduates selected clinical topics as the most essential elements of TM training. In accordance with the literature, our findings suggest that direct patient care, one-on-one instruction, and simulation would be appropriate and popular methods for delivering this type of educational content.10,11
Curriculum design for a TM rotation should reinforce clinical PHM competencies related to TM while focusing on topics that are specific to the transport environment, such as methods of interfacility transport, handoffs, transitions of care, and team leadership.2,7,12 Trainee comfort level with different forms of transport (eg, fear of flying, motion sickness) and local and state policies regarding interfacility transfer should also be considered. In addition, fellows could engage in clinical research and quality improvement projects related to TM given the overall paucity of literature in the field.13
Several reasons can explain why fellows and graduates place a greater value on a TM rotation than PDs. Fellows and graduates may perceive inherent value in gaining particular knowledge and skills, such as greater understanding of the logistics and personnel involved in transferring patients and experience working with a healthcare team in a unique and dynamic setting.3,10,14
PDs may not be aware of the extent of participation in elements of transport among graduates. A recent workforce survey of pediatric interfacility transport systems indicated that although medical directors are from the fields of emergency, critical care, and neonatal medicine, 20% of medical control physicians are pediatric hospitalists.4 Given that the majority of PHM fellowships are based at children’s hospitals and transport teams are often associated with intensive care or emergency medicine units, PDs may have limited exposure to transport systems that incorporate hospitalists.
Pediatric hospitalists at all practice sites must have clinical and systems skills related to TM. However, the scope of practice for those working at community sites may be more likely to include distinct elements of TM.6 Currently, most fellowship graduates work at free-standing children’s or university-affiliated hospitals and have pursued careers in academic medicine.15 As the field evolves, the number of fellowship-trained pediatric hospitalists working at community sites may increase, making the acquisition of skills relevant to TM during fellowship training more crucial.
This study has several limitations. We attempted to identify all recent PHM fellowship graduates, but sampling bias may exist. Response bias may have been introduced by the self-reporting of skill and proficiency as well as by the small sample size and response rate for some stakeholder groups. The latter may be exacerbated by the fact that we do not have data on the degree or distribution of program representation among the fellow and graduate groups, given the lack of identifying information collected. Finally, we did not collect specific information about existing TM curricula in PHM fellowships.
We report a variable level of interest and engagement in TM among fellowship stakeholders, even though “Transport of the Critically Ill Child” is a PHM Core Competency. Fellows are interested in TM but unsure of its relevance to a PHM career. Graduates support the acquisition of transport skills during fellowship training.
