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OBJECTIVES: To describe the current approach to initial training, ongoing skill maintenance, and assessment of competence in central venous catheter placement by pediatric critical care medicine fellows, a subset of trainees in whom this skill is required. DESIGN: Cross-sectional internet-based survey with deliberate sampling. SETTING: United States pediatric critical care medicine fellowship programs. SUBJECTS: Pediatric critical care medicine program directors of Accreditation Council for Graduate Medical Education-accredited fellowship programs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A working group of the Education in Pediatric Intensive Care Investigators research collaborative conducted a national study to assess the degree of standardization of training and competence assessment of central venous catheter placement across pediatric critical care medicine fellowship programs. After piloting, the survey was sent to all program directors (n = 67) of Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine programs between July 2017 and September 2017. The response rate was 85% (57/67). Although 98% of programs provide formalized central venous catheter placement training for first-year fellows, only 42% of programs provide ongoing maintenance training as part of fellowship. Over half (55%) of programs use a global assessment tool and 33% use a checklist-based tool when evaluating fellow central venous catheter placement competence under direct supervision. Only two programs (4%) currently use an assessment tool previously published and validated by the Education in Pediatric Intensive Care group. A majority (82%) of responding program directors believe that a standardized approach to assessment of central venous catheter competency across programs is important. CONCLUSIONS: Despite national mandates for skill competence by many accrediting bodies, no standardized system currently exists across programs for assessing central venous catheter placement. Most pediatric critical care medicine programs use a global assessment and decisions around the ability of a fellow to place a central venous catheter under indirect supervision are largely based upon subjective assessment of performance. Further investigation is needed to determine if this finding is consistent in other specialties/subspecialties, if utilization of standardized assessment methods can improve program directors' abilities to ensure trainee competence in central venous catheter insertion in the setting of variable training approaches, and if these findings are consistent with other procedures across critical care medicine training programs, adult and pediatric.

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BACKGROUND: A need for improved patient safety, quality of care, and accountability has prompted the development of competency-based educational processes. Assessment tools related to bronchoscopy training, however, have not yet been developed or validated. PURPOSES: To determine whether 25 multiple-choice questions (MCQs) extracted from the free, Web-based Essential Bronchoscopist (EB) learning guide qualify in their original form as a preliminary pool of questions for a low-stakes assessment of bronchoscopic knowledge. MATERIALS AND METHODS: Twenty-five randomly selected MCQs from among the top 70 question-answer sets of the EB were administered to 40 self-declared novice bronchoscopists (n = 13), experienced bronchoscopists (n = 21), and expert bronchoscopists (n = 6). A difficulty index and a discrimination index (DI) were calculated for each item. Internal consistency reliability was calculated using item-total correlation and Cronbach alpha. Content validity was determined by five independent experts. Ideal test items based on a difficulty index and item-total correlation were administered to a different group of 24 bronchoscopists to prospectively reassess internal consistency reliability. RESULTS: The mean (+/- SD) score for the 40 participants was 16.47 +/- 3.72 (median score, 17; score range, 7 to 22). The mean difficulty index was 0.65 +/- 0.22, and the mean DI was 0.52 +/- 0.28. Item total-correlations ranged from - 0.01 to + 0.71. Test content was unanimously validated. The Cronbach alpha was 0.69. There was no significant correlation between scores and the number of bronchoscopies performed or self-declared expertise. Eleven ideal test MCQs were identified. The internal consistency of these items remained satisfactory (Cronbach alpha = 0.75) when assessed prospectively in a different cohort. CONCLUSION: Reliable and valid MCQs were identified to initiate a preliminary pool of questions for a low-stakes assessment of bronchoscopic knowledge.

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OBJECTIVE: 1) To develop and validate an instrument to evaluate the clinical pathology correlation aptitude in pneumopathology (CPCAP). 2) Compare two groups of students: those who had already taken the respiratory pathology course and students that hadn't. METHODS: An instrument with real anatomopathology respiratory cases was developed. The measurement instrument was validated through expert rounds. It included 116 items of the "true", "false", or "don't know" type, with an agreement of 80 % or more in the answerers between the judges. The internal consistency was determined with Spearman Brown proficiency, reaching a value of 0.78. The sample studied was all the groups of each hospital of an organic pathology undergraduate universitary course. Two sampled were taken, students who had already been through respiratory pathology (Group A), and students who hadn't (Group B). RESULTS: The sample studied was of 485 applicants, from 64 different universitary groups. These were divided in two groups, with 245 (A) and 240 (B) students each. Its global medians were 51 and 36 for groups A and B respectively (p < 0.001). In the 55 % of the subgroups when compared individually taking into account each one of the hospital where they study the test results were significantly better in group A. DISCUSSION: In a general way, students in group A show a major development into CPCAP than students in B. However, development is not enough to reach the expected by the educative program. The results suggest that the teachers put greater effort in the correlation between anatomopathological changes and the clinical and paraclinical manifestations of the patients.

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Objective. 1) To develop and validate an instrument to evaluate the clinical pathology correlation aptitude in pneumopathology (CPCAP). 2) Compare two groups of students: those who had already taken the respiratory pathology course and students that hadn 't. Methods. An instrument with real anatomopathology respiratory cases was developed. The measurement instrument was validated through expert rounds. It included 116 items of the "true", "false", or "don't know" type, with an agreement of 80 % or more in the answerers between the judges. The internal consistency was determined with Spearman Brown proficiency, reaching a value of 0.78. The sample studied was all the groups of each hospital of an organic pathology undergraduate universitary course. Two sampled were taken, students who had already been through respiratory pathology (Group A), and students who hadn't (Group B) Results.The sample studied was of 485 applicants, from 64 different universitary groups. These were divided in two groups, with 245 (A) and 240 (B) students each. Its global medians were 51 and 36 for groups A and B respectively (p < 0.001). In the 55 % of the subgroups when compared individually taking into account each one of the hospital where they study the test results were significantly better in group A. Discussion.In a general way, students in group A show a major development into CPCAP than students in B. However, development is not enough to reach the expected by the educative program. The results suggest that the teachers put greater effort in the correlation between anatomopathological changes and the clinical and paraclinical manifestations of the patients.

Objetivos. 1) Construir y validar un instrumento de medición de la aptitud para la correlación anatomoclínica en neumopatología (ACACN). 2) Comparar la ACACN de alumnos que ya tomaron el curso de patología y quiénes no. Métodos. Se elaboró un cuestionario con base en nueve casos anatomopatológicos con sus correspondientes estudios clínicos. Se estimó su validez conceptual por un grupo de expertos y la confiabilidad mediante correlación de mitades equivalentes. El instrumento quedó conformado por 116 ítems, que obtuvieron un porcentaje de acuerdo con 80 o mayor en las respuestas de los jueces y un coeficiente de .78 de confiabilidad (Spearman-Brown). Se aplicó un diseño ex post facto y las unidades de análisis fueron los grupos de cada hospital sede de un curso universitario de patología orgánica. Mediante un muestreo por cuota se seleccionaron dos muestras de alumnos de pregrado de la carrera de medicina para realizar las mediciones: quienes ya habían cursado la asignatura de patología (A) y quienes no (B). Resultados. Se incluyeron 485 alumnos, 245 de la muestra A y 240 de la muestra B, correspondientes a 64 grupos universitarios. Las medianas globales de ambas muestras fueron 51 y 36, respectivamente (p < 0.001). En la comparación entre muestras de una misma sede hubo diferencia significativa a favor de A en 39% de los grupos. Discusión. Los resultados muestran que la ACACN fue mayor en los alumnos que ya habían cursado la materia, en comparación con los que aún no lo habían hecho, sin embargo, el grado de desarrollo de la misma está lejos de las expectativas del programa educativo y refleja la necesidad de implementar modificaciones en la manera de cómo se imparte la materia.

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BACKGROUND: Private and non-private specialist practitioners are often considered an obstacle to the performance of the National Tuberculosis Control Programme (NTP). OBJECTIVE: To evaluate the impact of an intensive refresher course directed at specialist physicians in El Salvador, a questionnaire was sent to all course participants on their basic knowledge of tuberculosis (TB) control. RESULTS: Of 64 participants, 55 were assessed (86%); 33 were chest physicians and 22 belonged to other related specialities. The evaluation showed a considerable improvement in both groups in their ability to suspect the disease, in their tendency to avoid hospitalising patients and instead refer them to out-patient clinics, and in their adherence to the recommendations of the NTP manual (diagnostic procedures, treatment guidelines, case notification and cohort studies). Improvements were more noticeable, in all the parameters evaluated, among the non-chest physicians. CONCLUSION: The intervention model succeeded in improving the collaboration of private and non-private specialist practitioners with the NTP.

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En la práctica hospitalaria cardio-respiratoria, se presentan con mucha frecuencia emergencias que requieren conocimientos y habilidades que el médico recién egresado deberia resolverlos cotidianamente. El presente trabajo pretende demostrar las falencias de actitud de los internos (estudiantes del 6to año de la carrera de Medicina), de las diferentes facultades de Medicina dependiente del Estado, para la solución de las emergencias cardiopulmonares que se presentan a diario enlos diferentes hospitales. Para ello se tomará como universo, todos los internos que actualmente rotan por los diferentes servicios del Hospital Obrero y del Hospital General de la ciudad de oruro. A cAda uno de ellos se les pasara un cuestionario. donde se les preguntará sobre todo, la actitud que tomarian ante pacientes que presentan emergencias cardiorespiratorias desde el punto de vista netamente práctico, se valorará los conocimientos teorico-práctico, ante las vicisitudes, y lo que pretenderán para mejorar sus habilidades en el campo del tratamiento de las emergencias cardio-pulmonares...

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