MedEdPORTAL, Journal Year: 2023, Volume and Issue: unknown

Published: July 11, 2023

OPEN ACCESSJuly 11, 2023Get SMART: Teaching Pediatric Residents the 2020 Focused Asthma Updates' Recommendations for Symptom-Based Medication Increases Karen L. Warman, MD, MS, Ellen Johnson Silver, PhD MS https://orcid.org/0000-0002-5586-3992 Associate Professor, Division of Academic General Pediatrics, Department Children's Hospital at Montefiore, Albert Einstein College Medicine E-mail Address: [email protected] Google Scholar More articles by this author , https://orcid.org/0000-0002-8970-9838 https://doi.org/10.15766/mep_2374-8265.11320 SectionsAboutPDF ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: The Updates introduced a paradigm shift in treatment asthma that includes symptom-based adjustments to outpatient vary age and severity. length complexity updates have made them challenging adopt. Methods: We implemented an educational session among pediatric residents increase their familiarity with, comprehension of, plans adopt two evidence-based recommendations therapy. Facilitators led groups four six cased-based discussions during 30-minute, ambulatory care–based session. One week prior, participants facilitators received synopses 2007 Guidelines Diagnosis Management Updates. also guide scripts explaining new concepts, providing supporting data, highlighting learning objectives. Retrospective pre/post surveys assessed participants’ planned adoption intermittent steroids single maintenance reliever therapy (SMART) before after conference. prior exposure reflections on Results: There were 26 participants. Ratings familiarity, comprehension, regarding significantly improved (ps < .001, Wilcoxon signed rank test). case-based approach was well received, material deemed relevant. Discussion: This increased residents’ treatments. Dissemination may improve management. Educational Objectives By end activity, learners will be able to: 1.Categorize severity applying impairment risk criteria, as specified National Education Prevention Program Asthma.2.Recommend use inhaled beta-agonists start respiratory tract infections children 0–4 years old with viral-induced asthma, described Updates.3.Recommend adolescents moderate persistent SMART (single therapy) corticosteroid formoterol combination pump, Introduction is most common chronic lung disease childhood, affecting approximately 5 million United States. US prevalence (age <18 years) 6% 2020, accounted 790,478 emergency department visits 64,525 hospital inpatient stays 2019.1 Even who do not severe exacerbations requiring acute care, can poorly controlled, impacting quality life. In multistate, community-based sample patients presenting routine 35% had controlled asthma.2 recent version Program's released 2007.3 Since publication 16 ago, evidence has accumulated approaches management, including moving away from standard practice using short-acting beta-agonist alone rescue instead giving concomitant steroids.4 Some these changes reflected 2019 Global Initiative (GINA),5 but only recently release December 2020.6 These important recommended management reduce morbidity; however, they added additional guidelines already proven difficult disseminate into practice.7–10 A variety barriers guideline adherence exist, lack awareness, agreement, self-efficacy, outcome expectancy, inertia previous readiness change, external barriers.11,12 Two include (1) starting steroids, addition beta-agonists, upper under wheeze (2) pump (inhaled steroid rapid-onset, long-acting formoterol) both medicine controller. coined term START former. latter recommendation referred therapy). preponderance falls general pediatricians, receive care specialists, particularly underresourced settings.13 Therefore, target audience pediatricians primary asthma. formal local needs assessment undertaken; practicing it clear many found overwhelming digest. Didactic sessions trying cover aspects hard absorb. For reason, decision limit focus examples illustrating chose study effectiveness residents, there structure place resident education evaluation weekly continuity clinic conferences. faculty participated could benefit well; did complete postsession evaluations. are very limited materials available guidelines, we encounter any topic literature. no medical evaluations literature introducing either recommendations. search concerning PubMed between 2009 2022 revealed eight publications; one provided guidance implementation SMART,14 none included interventions. publications discussing six, specifically focused relevant and/or adolescents.15,16 MedEdPORTAL 64 results. Of these, Updates, SMART, or albuterol 4 younger. While our focuses lessons learned applied teaching future used other disciplines complex goal strategies delivering steroids. young delivers formoterol, beta-agonist, uses methodologies, delivered regularly scheduled clinics, help comprehend apply selected components active learning. faculty, lead approach. follow prescribed script introduce problem-based adult methodology keeping Carnegie Foundation Advancement Teaching's implements pedagogy encourage integration curricular content application knowledge clinical practice.17 Methods conferences training urban center November 2021. case held separate afternoons same week, participating each Sessions person different campuses. conference, campuses PowerPoint presentation (Appendix A). It objectives rationale changes. orientation overview B). brief synopsis At-a-Glance Guide,18 Care Quick Reference,19 which charts classifying identifying step categories based upon Guidelines. given previously mentioned resources review expected facilitators’ slides leading trainees small-group, interactive discussion. presenters all except one, attending presented None experts field, required. learning; familiar small-group discussions. met around conference table, projected onto screen. followed instructions guide, posing questions participants, facilitating discussions, specific After completed retrospective survey C) 5-point Likert scales assessing comfort in, Updates: Learners answered multiple-choice level offered open-ended value developed authors (Karen Warman). supported work McLeod, Steinert, Snell,20 helped avoid response bias inherent traditional self-assessments. survey's formation informed Lang Savageau describing measuring evaluations.21 questionnaires administered linking scanned QR code presentation. Likert-scale anchors adopted Vagias.22 test, statistical test determining whether measurements group different, compare scores Results (five attending) (nine interns, 11 second-year five third-year student). transfer, understanding, making overall results shown Table. Only On scale (1 = familiar, extremely familiar), learner (2.4 vs. 4.1, p .001). Familiarity (2.2 3.8, poor, excellent), ratings understanding (1.9 3.5, .001), (2.0 never, always), learners’ own 3.6, Mean Differences Paired Pre/Post Scores Among All Participants (N 26)Table. 26) proportion reported least moderately corticosteroids (ICSs) 8% 96% participation Before 31% having good ICS use, whereas, 42% 50% excellent understanding. Prior 38% occasionally following wheeze, more frequent 93% (27% occasionally, 58% almost every time, frequently). feeling 4% 77% greater 96%, reporting recommending frequently, recommend 95% (48% 12% occasionally). Most became aware informally physicians (62%). few read (8%), attended lecture about (4%), journal article (12%). unfamiliar Reflections positive, “incredibly relevant” appreciation asked question “What, if anything, you find valuable training?” Respondents focusing major updates: older old. highly They liked helpful how material. largely expand scope Suggestions cases, further discussion insurance coverage, setting. Discussion strategy better understand scenarios would likely As defined Thistlewaite et al.,23 “is prepare students practice, through authentic cases. links theory inquiry-based methods.” fellow serve believe signal appropriate master validate resident, expertise, effectively efficiently facilitate working patient care. analysis suggested effective achieving its increasing self-reported significant increases measured adopting teenagers increased, still 26% respondents occasionally. know why, because concerns dosing ICSs growth suppression. nebulized budesonide solution demonstrate suppression.24 However, another high-dose, metered-dose inhaler did.25 Additional studies safety regimens inhalers physicians’ Similarly, chart showing doses medications often administer doses, such Reddel al.,14 addition, support make easier terms implementation. Using smart phrases—built-in text within electronic records import prewritten medication plans—can clinicians prescribe communicate families. subsequently created START. limited, word-of-mouth exposure. challenge reading even though focused, 322 pages long. Interpretating predicated past guidelines’ classification. contain abbreviations terms, SABA (short-acting beta-agonist), LABA (long-acting beta-2 agonist), ICSs, reader send existing 1 time frame chosen ongoing curriculum topics week. measure much any, spent reviewing sent body benefits flipped classroom approaches, session, promote higher-order thinking.26 Given programs helping assimilate materials, effort needed ensure session.27,28 required synthesize information suggest tremendous need sessions, session's design useful educators aiming move towards plans. Satisfaction high. enjoyed raised areas pursue, thorough limitations. Ideally, reviewed best prepared participate learn higher level. query observe closely delivery script. 30 minutes so easily incorporated clinic. cases might gain concepts. conduct assessment. strengthened gaps scores. surveys. awareness faculties’ suggestions Finally, resurvey several months later assess retention constitutes first them, require work. current infrastructure yet changed example, printed share concept wheezing colds. Likewise, action incorporate readily available. US, ICS-formoterol approval Federal Drug Administration; Europe GINA guidelines. insurances give extra above medication. al.14 practical implementation, some actions plan, iteration when COVID pandemic health system's main focus. Due surge Bronx early pandemic, assisted took year later, person, masked. competing priorities unusually low rate symptoms period.29 Reductions corresponded decrease viral infections.30 finding appear key driver exacerbations30 gives impetus us train titration exacerbations, residency program institution low-income, environment high written without geographic sociodemographic references. therefore region US. family teach facilitator presumes updates, stay allotted 30-minute interval. digital, therefore, replicated throughout training, experienced digest References1. national data. Centers Disease Control Prevention. Updated 12, 2022. Accessed April 13, 2023. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htmGoogle Scholar2. Liu AH, Gilsenan AW, Stanford RH, Lincourt W, Ziemiecki R, Ortega H. Status control care: Characteristics Prevalence Survey Study (ACCESS). J Pediatr. 2010;157(2):276–281.E3. https://doi.org/10.1016/j.jpeds.2010.02.017Medline, Scholar3. Heart, Lung, Blood Institute. Expert Panel Report 3: Asthma. Institutes Health; 2007. NIH 08-5846. https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthsumm.pdfGoogle Scholar4. HK, FitzGerald JM, Bateman ED, al. 2019: fundamental change Eur Respir J. 2019;53(6):1901046. https://doi.org/10.1183/13993003.01046-2019Medline, Scholar5. Bacharier LB, Strategy 2021: executive summary 2022;59(1):2102730. https://doi.org/10.1183/13993003.02730-2021Medline, Scholar6. Working Group Lung Guidelines: report Coordinating Committee Group. Allergy Clin Immunol. 2020;146(6):1217–1270. https://doi.org/10.1016/j.jaci.2020.10.003Medline, Scholar7. Finkelstein JA, Lozano P, Shulruff Self-reported physician practices asthma: followed?Pediatrics. 2000;106(suppl 3):886–896. https://doi.org/10.1542/peds.106.S3.886Medline, Scholar8. Legorreta AP, Christian-Herman J, O'Connor RD, Hasan MM, Evans Leung KM. Compliance specialty organization experience. Arch Intern Med. 1998;158(5):457–464. https://doi.org/10.1001/archinte.158.5.457Medline, Scholar9. Doerschug KC, Peterson MW, Dayton CS, Kline JN. guidelines: practice. Am Crit 1999;159(6):1735–1741. https://doi.org/10.1164/ajrccm.159.6.9809051Medline, Scholar10. Cloutier Salo PM, Akinbami LJ, Clinician Immunol Pract. 2018;6(3):886–894.E4. https://doi.org/10.1016/j.jaip.2018.01.018Medline, Scholar11. Cabana Rand Becher OJ, Rubin HR. Reasons pediatrician nonadherence Pediatr Adolesc 2001;155(9):1057–1062. https://doi.org/10.1001/archpedi.155.9.1057Medline, Scholar12. Powe NR, Why don't guidelines? framework improvement. JAMA. 1999;282(15):1458–1465. https://doi.org/10.1001/jama.282.15.1458Medline, Scholar13. Warman KL, Silver EJ. Are inner-city receiving guidelines?J 2018;55(5):517–524. https://doi.org/10.1080/02770903.2017.1350966Medline, Scholar14. Schatz M, Krishnan MM. implementing 2022;10(1)(suppl):S31–S38. https://doi.org/10.1016/j.jaip.2021.10.011Medline, Scholar15. Teach SJ, Lemanske RF, Blake KV. points pediatricians. Pediatrics. 2021;147(6):e2021050286. https://doi.org/10.1542/peds.2021-050286Medline, Scholar16. Dixon AE, Pace M. Managing adults: Guideline Update Program. 2020;324(22):2301–2317. https://doi.org/10.1001/jama.2020.21974Medline, Scholar17. O'Brien BC, Irby DM. Enacting call reform school residency. Learn 2013;25(suppl 1):S1–S8. https://doi.org/10.1080/10401334.2013.842915Medline, Scholar18. Guide. 2020. 20-HL-8142. https://www.nhlbi.nih.gov/sites/default/files/publications/Asthma%20Clinicians%20At-a-Glance%20508_02-03-21.pdfGoogle Scholar19. Reference: Diagnosing 2012. 12-5075. https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdfGoogle Scholar20. McLeod PJ, Steinert Y, Snell Use assessments development. Med Educ. 2008;42(5):543. https://doi.org/10.1111/j.1365-2923.2008.03060.xMedline, Scholar21. D, Starting end: pre-post AEA365 blog. July 31, 2017. http://aea365.org/blog/starting-at-the-end-measuring-learning-using-retrospective-pre-post-evaluations-by-debi-lang-and-judy-savageau/Google Scholar22. Vagias WM. Likert-Type Scale Response Anchors. Clemson University; 2006. http://media.clemson.edu/cbshs/prtm/research/resources-for-research-page-2/Vagias-Likert-Type-Scale-Response-Anchors.pdfGoogle Scholar23. JE, Davies Ekeocha S, professional education. BEME systematic review: Guide no. 23. Teach. 2012;34(6):e421–e444. https://doi.org/10.3109/0142159X.2012.680939Medline, Scholar24. Phillips BR, Zeiger RS, al; Childhood Research Network. Episodic leukotriene receptor antagonist preschool moderate-to-severe wheezing. 2008;122(6):1127–1135.E8. https://doi.org/10.1016/j.jaci.2008.09.029Medline, Scholar25. Ducharme FM, Lemire C, Noya FJD, Preemptive high-dose fluticasone virus-induced children. N Engl 2009;360(4):339–353. https://doi.org/10.1056/NEJMoa0808907Medline, Scholar26. Hwang GJ, Yin Chu HC. era learning: promoting order thinking innovative systems. Interact Environ. 2019;27(8):991–994. https://doi.org/10.1080/10494820.2019.1667150Google Scholar27. Brame CJ. Flipping classroom. Vanderbilt University Center Teaching. 2013. http://cft.vanderbilt.edu/guides-sub-pages/flipping-the-classroom/Google Scholar28. Wolff Wagner MJ, Poznanski Schiller Santen S. Not boring lecture: engaging techniques. Emerg 2015;48(1):85–93. https://doi.org/10.1016/j.jemermed.2014.09.010Medline, Scholar29. Hurst JH, Zhao Fitzpatrick NS, Goldstein BA, JE. Reduced urgent utilization COVID-19 pandemic. Pulmonol. 2021;56(10):3166–3173. https://doi.org/10.1002/ppul.25578Medline, Scholar30. Sayed Diwadkar AR, Dudley JW, pandemic–related reductions infections. 2022;10(1):91–99.E12. https://doi.org/10.1016/j.jaip.2021.10.067Medline, ScholarPDF download Sign up latest Add your email below APPENDICESReferencesRelatedDetailsAppendices Get Selected Updates.pptx Facilitator Orientation Guide.docx Session Evaluation.docx Download CitationWarman Increases. MedEdPORTAL. 2023;19:11320. Copyright & Permissions© 2023 Silver. open-access distributed Creative Commons Attribution-NonCommercial license.KeywordsAsthmaPediatricsCase-Based LearningDisclosures report. Funding/Support Presentations Presented at: Societies (PAS) Meeting; 24, 2022; Denver, CO. Ethical Approval Reported applicable. tabs.loading

Language: Английский