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Procedures

Procedures. Curriculum overview. Underpinning knowledge. Procedures. Learning to competently and compassionately perform procedures is one of the hardest skills in paediatrics. Acquisition of skills is a continuum from novice to expert.

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Procedures

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  1. Procedures

  2. Curriculum overview

  3. Underpinning knowledge

  4. Procedures • Learning to competently and compassionately perform procedures is one of the hardest skills in paediatrics. • Acquisition of skills is a continuum from novice to expert. • Developing the skills to competently teach as well as perform procedural skills is an important part of training.

  5. Dreyfus Model of Skill Acquisition Adapted from Dreyfus and Dreyfus,1980

  6. Things to consider for every procedure • Right procedure, place, time and patient. • Right people – Supervision, Senior help if required, play specialist, assistant. • Consent – is it needed? Have you informed the parents / patient of the procedure. • Check equipment • Analgesia/Distraction aids • Important blood results – e.g. LP – check platelets.

  7. How to evidence • Directly observed procedures – Best done at the time with contemporaneous feedback • Skills log –Keep a contemporaneous log of skills competence including supervising others • Reflective log – Part-task simulation and Resuscitation courses • Mini-CEX – Demonstrating clinical examination of a baby, child or young person or basic resuscitation skills • ACAT– Observed leading resuscitation in ED/Labour Ward • Mini-CEX/CBD – For the senior supervising or teaching the procedure

  8. Steps for learning a new procedure • Revise relevant clinical knowledge • Safe use of equipment • Learn the procedural steps • Practice outside clinical environment – e.g. part task simulation/mannequins • Perform supervised procedures with feedback • Practice in a variety of different contexts/ situations/age groups • Maintain capability

  9. Example – Advanced Airway Management • Revise the relevant clinical knowledge Paediatric airway anatomy, watch some videos to understand clinical anatomy – before you pick up a laryngoscope! • Understand the steps of the procedure and be able to safely use the relevant equipment.

  10. Pre-patient training • Before you do your first intubation get someone to supervise you using a mannequin and give you feedback on positioning and laryngoscopy technique.

  11. Further practice • Preparation, preparation, preparation – if your department has an intubation checklist use it. • Another great way to get experience is to arrange to shadow an anesthetic colleague. • For more advanced airway management you can attend a difficult airway course in your region.

  12. Procedural top-tips • Identify what you need to practice - Put yourself forward for procedures to the clinical team coordinator and the procedures you would like to gain competence in • Be proactive with learning opportunities e.g. organizing anesthetic room experience for airway management • Ask for feedback when leading resuscitation scenarios in ED

  13. Teaching procedural skills Peyton’s 4 Stage Approach Adapted from Peyton 1998

  14. Teaching Procedural Skills Kolb’s Experiential Learning Adapted from Kolb 1984

  15. Useful training and resources • RCPCH Progressing Paediatrics course: Paediatric Emergency Medicine • RCPCH How to Manage courses - a sample of forthcoming events shown below https://www.rcpch.ac.uk/education-careers/courses/rcpch-course?keywords=how+to+manage

  16. Useful Websites Resuscitation Council https://www.resus.org.uk Spotting the Sick Child https://spottingthesickchild.com Paediatric Emergencies – Great resource with lots of resources and videos for intubation https://www.paediatricemergencies.com The Difficult Airway Society - https://das.uk.com

  17. Useful Websites Paediatric FOAM website – useful resources for ventilation management https://www.paediatricfoam.com Cranial Ultrasound Standard Views http://www.adhb.govt.nz/newborn/TeachingResources/Radiology/HUSS/NeonatalHUSSViews.htm MRCPCH Clinical Examination Website https://mrcpch.paediatrics.co.uk

  18. Useful Videos Great videos and lectures for intubation and management of the sick child https://www.youtube.com/channel/UCULr4Ved30fymSHoxeweJHg Percutaneous Long line insertion from Evelina Children's Hospital Central Line insertion from PICU at GOSH https://www.youtube.com/watch?v=7KjjJVFdbC0 Neonatal Procedures from MPROve https://www.youtube.com/channel/UC22LMIG5Bwqhreic_DFHATw Paediatric Anaestheisa and Airway Management https://www.youtube.com/channel/UC4B28Tt4K6hc4tJ239CLS_Q

  19. Useful Apps • Neomate– useful measurements for Endotracheal tube size and length and Umbilical lines • https://itunes.apple.com/us/app/neomate-for-nicu-staff/id944319462?mt=8

  20. References • Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in directed skill acquisition. California Univ Berkeley Operations Research Center; 1980. • Walker M, Peyton JW.  Teaching and Learning in Medical Practice. Heronsgate Rickmansworth, Herts: Manticore Europe Ltd; 1998. Teaching in the Theatre; p. 171–180. • Kolb D. Experiential education: Experience as the source of learning and development. Englewood Cliffs, NJ. 1984. • Harden RM, Laidlaw JM. Essential skills for a medical teacher: an introduction to teaching and learning in medicine: Elsevier Health Sciences; 2016.(3)

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