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Background To ascertain if undergraduate medical students attain adequate knowledge to practice in paediatrics, we designed the minimum accepted competency (MAC) examination. This was a set of MCQ’s designed to test the most basic, ‘must know’ knowledge as determined by non-faculty paediatric clinicians. Only two-thirds of undergraduate students passed this exam, despite 96% of the same cohort passing their official university paediatric examination. We aim to describe the psychometric properties of the MAC examination to explore why there was a difference in student performance between these two assessments which should, in theory, be testing the same subject area. We will also investigate if the MAC examination is a potentially reliable method of assessing undergraduate knowledge. Methods The MAC examination was sat by three groups of undergraduate medical students and paediatric trainee doctors. Test item analysis was performed using facility index, discrimination index and Cronbach’s alpha. Results Test item difficulty on the MAC between each group was positively correlated. Correlation of item difficulty with the standard set for each item showed a statistically significant positive relationship. However, for 10 of the items, the mean score achieved by the candidates did not even reach two standard deviations below the standard set by the faculty. Medical students outperformed the trainee doctors on three items. 18 of 30 items achieved a discrimination index > 0.2. Cronbach’s alpha ranged from 0.22–0.59. Conclusion Despite faculty correctly judging that this would be a difficult paper for the candidates, there were a significant number of items on which students performed particularly badly. It is possible that the clinical emphasis in these non-faculty derived questions was juxtaposed with the factual recall often required for university examinations. The MAC examination highlights the difference in the level of knowledge expected of a junior doctor starting work in paediatrics between faculty and non-faculty clinicians and can identify gaps between the current curriculum and the ‘hidden curriculum’ required for real world clinical practice. The faculty comprises physicians in employment by the University whose role it is to design the paediatric curriculum and deliver teaching to undergraduate students. Non-faculty clinicians are paediatric physicians who work soley as clinicians with no affiliation to an educational institution. The concept of a MAC examination to test basic medical knowledge is feasible and the study presented is an encouraging first step towards this method of assessment.

Background It is recognised that newly qualified doctors feel unprepared in many areas of their daily practice and that there is a gap between what students learn during medical school and their clinical responsibilities early in their postgraduate career. This study aimed to assess if undergraduate students and junior paediatric doctors met a Minimum Accepted Competency (MAC) of knowledge. Methods The knowledge of undergraduates and junior paediatric doctors was quantitatively assessed by their performance on a 30-item examination (the MAC examination). The items within this examination were designed by non-academic consultants to test ‘must-know’ knowledge for starting work in paediatrics. The performance of the students was compared with their official university examination results and with the performance of the junior doctors. Results For the undergraduate student cohort ( n  = 366) the mean examination score achieved was 45.9%. For the junior doctor cohort ( n  = 58) the mean examination score achieved was significantly higher, 64.2% ( p  < 0.01). 68% of undergraduate students attained the pass mark for the MAC examination whilst a significantly higher proportion, 97%, passed their official university examination ( p <  0.01). A Spearman’s rank co-efficient showed a moderate but statistically significant positive correlation between students results in their official university examinations and their score in the MAC examination. Conclusion This work demonstrates a disparity between both student and junior doctor levels of knowledge with consultant expectations from an examination based on what front-line paediatricians determined as “must-know” standards. This study demonstrates the importance of involvement of end-users and future supervisors in undergraduate teaching.

Introduction The Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome. Methods A national prospective, observational study was conducted over a 2-year period. All patients under 17 years of age referred to a neurosurgical service following TBI were included. Data on patient demographics, events surrounding injury, injury type and severity, patient management and outcome were collected from ‘on-call’ logbooks and neurosurgical admissions records. Results 342 patients were included. Falls were the leading cause of injury for both sexes. Boys’ injuries tended to involve greater energy transfer and involved more risk-prone behaviour resulting in a higher rate of other (non-brain) injury and a higher mortality rate. Intentional injury occurred only in boys. While injury severity was similar for boys and girls, significant gender differences in injury type were present; extradural haematomas were significantly higher in boys (p=0.014) and subdural haematomas were significantly higher in girls (p=0.011). Mortality was 1.8% for girls and 4.3% for boys. Conclusions Falls were responsible for most TBI, the home is the most common place of injury and non-operable TBI was common. These findings relate to all children. Significant gender differences exist from infancy. Boys sustained injuries associated with a greater energy transfer, were less likely to use protective devices and more likely to be injured deliberately. This results in a different pattern of injury, higher levels of associated injury and a higher mortality rate.

ObjectiveTo establish the incidence of road transport collision (RTC) fatalities in the Irish paediatric population, examining trends in fatality rates over a period of 25 years, during which several national road safety interventions were implemented.Study designRetrospective review of death registration details of children 0–19 years in Ireland between January 1991 and December 2015. Trends in mortality rates were investigated using average annual per cent change and Poisson regression analysis.ResultsProportionate RTC mortality, the majority of which occurred on public roads (94.1%, n=1432) increased with age; <0.3% (<1 year), 8.3% (1–14 years) and 18.4% (15–19 years) (2011–2015 average). Over time, rates declined significantly in all age groups; reductions of 79.0% (4.0 to 0.84/100 000, 1–14 years) and 68.4% (15.5 to 4.9/100 000, 15–19 years) resulted in 537 (95% CI 515 to 566) fewer child deaths (1–19 years) over the period 1996–2015. This reduction was evident for both road user types, the greatest decline (84.8%) among pedestrians 1–14 years (2.1 to 0.32/100 000) and the lowest (66.5%) among occupants 15–19 years, the majority of whom were male (12.4 to 4.2/100 000). The rate of decline was greatest during periods coinciding with introduction of targeted interventions. Risk of death in children 1–14 years was halved in the period after 2002 (incidence rate ratio (IRR) 0.52) while in children 15–19 years old, a significantly lower RTC fatality risk was evident after 2006 and 2010 (IRR 0.68 and IRR 0.50).ConclusionChild and adolescent mortality from RTCs has declined dramatically in Ireland, in excess of reductions in overall paediatric mortality. However, rates remain higher than in other EU countries and further effort is required to reduce the number of deaths further, particularly among adolescent males.

BackgroundTo date, children with hydrocephalus continue to have a considerable long-term outcome. However, current literature on health-related quality of life (HRQOL) among children with hydrocephalus are limited. This serves a call for research to validate a suitable HRQOL for children with hydrocephalus measuring the physical, emotional, social and cognitive well being.ObjectiveTo validate a technology-enhanced quality of life questionnaire (EITVAQ) as an effective assessment tool measuring the current well-being of a child with hydrocephalus (child-centred)To adopt a technology-enhanced quality of life assessment tool (EITVAQ) into a phone/tablet application to gain widespread usageTo explore the use of technology to increase the learning potential and obtaining a new skill among children with hydrocephalusMethodsThis is a prospective study which took place since January 2018 to January 2019.This study received ethical approvalAll data was compiled and analysed using SPSS. The validation process involved: Content Validity, Feasibility and Reliability. A cohort of 70 healthy children from various primary and secondary schools participated as a control. Finally, a small cohort of children with hydrocephalus participated in technology-enhanced learning programme (TELP) to learn a new music skill and created a music video.ResultsThis study reports the result of the validation process. In total there were 132 participants. Content validity was achieved by the nominal group technique. In this study, technology enhanced quality of life questionnaire (EITVAQ) is a feasible tool, having a high satisfaction rate of 78%, a response rate of 76.5% and an average completion time of 4 mins and 26 seconds. EITVAQ had a score of 0.92 (Cronbach Alpha). When comparing with the control, the two lowest scores were the social and emotional aspect. The two major differences in scores among both groups were the physical and cognitive well-being. All participants who participated in the TELP managed to complete the task learning the skills of creating a music video.ConclusionEITVAQ, an interactive and child-friendly tool to assess quality of life is now validated. It aims to be used widely among children with hydrocephalus, providing a baseline assessment to allow us to understand more about a child’s quality of life from their own perspective. This study concludes that technology has a huge potential in helping children with hydrocephalus and various neuro-disability to integrate into society.

Situation Awareness for Everyone (SAFE) is a collaborative programme developed by the Royal College of Paediatrics and Child Health UK to support clinical teams to improve communication, build a safety based culture and deliver better outcomes for children and young people.The programme includes Quality Improvement (QI) theory, situation awareness methodology and planning of safety huddles on the wards. It has been implemented in over 50 teams across the UK and the Quality Improvement Department of the Royal College of Physicians of Ireland are delighted to bring this initiative to Ireland.A National Paediatric Early Warning System (PEWS) was endorsed by the Irish Minister for Health in December 2015. The supporting National Clinical Guideline recommends that hospitals ‘support additional safety practices that enhance the PEWS and lead to greater situation awareness among clinicians and multidisciplinary teams, such as incorporating briefings, safety pause and huddles into practice’. Programmes such as SAFE that use quality improvement methods and patient safety science were specified as appropriate to assist hospitals to collaborate in addressing these challenges.11 consultant-led teams from across Ireland are participating in this SAFE Collaborative. Teams consist mostly of frontline paediatric clinical care providers (Consultants in Paediatric Medicine, Paediatric Nurses, Pharmacists, Dieticians, Hospital Senior Management and Non-Consultant Hospital Doctors). At a series of face-to-face sessions, teams receive mentoring in QI methodology by RCPI QI Faculty, through the IHI Breakthrough Series Collaborative Model, to develop local SAFE improvement projects impacting onReducing avoidable error and harm to acutely unwell childrenImproving communication between all individuals involved in a child’s careImproving working culture for healthcare staff providing care to childrenIncreasing involvement of parents, children and young people in their care.The teaching faculty includes active patient representation through parent involvement. Participating teams are encouraged to engage with children, parents and carers to guide their improvement efforts.Teams collect a concise monthly dataset to facilitate aggregate and comparative measures on paediatric clinical outcomes. Teams are encouraged to use this data, and to collect other necessary data to inform the outcome, process and balancing measures pertinent to the areas upon which they are focusing their improvement efforts.The National SAFE Improvement Collaborative is in its early stages. However, at this point, experience with similar national collaborative projects indicates that QI methodology will be used effectively to generate improvements to positively impact paediatric patient safety outcomes, through site specific changes.

BackgroundThe Irish Paediatric Early Warning System (I-PEWS) and associated National Clinical Guideline No.12 was developed in response to a ministerial mandate as a funded workstream of the National Clinical Programme for Paediatrics. I-PEWS is a multifaceted approach to improving patient safety and clinical outcomes, based upon the implementation of several complementary interventions, including 5 age-specific paediatric observation charts incorporating a PEWS scoring tool and escalation guide, promotion of effective communication using the national standard (ISBAR communication tool for patient deterioration), timely nursing and medical input, and clear documentation of management plans.ObjectivesI-PEWS was developed to improve prevention, recognition and response to children at risk of inpatient clinical deterioration in Ireland. For a defined period, national implementation was overseen by a Working Group of stakeholders and supported by a National Coordinator.Implementation strategyOver a three-year period, we piloted and refined the PEWS charts and associated education resources and facilitated national implementation of the Irish PEWS in 29 public hospitals. We developed a centrally-delivered, standardised training programme to establish hospital-level PEWS Trainers. Locally nominated PEWS Leads and Trainers were supported by regular communications, site visits and remote support culminating in a paediatric patient safety celebration day to mark the conclusion of the Working Group and Coordinator involvement. National Key Performance Indicators (KPI) were developed to demonstrate adherence to National Clinical Guideline recommendations by the local governance bodies to include development of locally applicable continuous education standards and regular audit to promote frontline ownership of the change.ResultsImplementation of PEWS was challenging due to the number of sites involved and the different specialties, resources and levels of engagement within each. The four quarterly KPI reports from 2018 demonstrate inconsistency in implementation and embedding of PEWS.21 of 29 (72%) hospitals overall report full compliance with the standards set out in the KPI suite. Issues include (ranges indicate variance in reporting across quarters): no local governance group (33%) no provision for continuous education programme for nurses (1–4 hospitals) or doctors (3–5 hospitals) all admitted children are not monitored using PEWS (1–2 hospitals) audit practices are not as recommended (1–3 hospitals) outcome data is not being collected (4–6 hospitals)LearningImplementing a national QI initiative is complex. The flexibility for locally relevant adaptations is essential for applicability and buy-in. The KPI data demonstrates a deficit in implementation standards and should be addressed by the Irish health service.

BackgroundInjury is a leading cause of childhood death throughout the EU. For every fatality many more children are seriously injured and a large proportion left permanently disabled. Age specific, population based data is required to enable accurate assessment of the magnitude and characteristics of the injury problem.ObjectiveTo determine the burden of accident and injury related childhood mortality in Ireland by determining the prevalence and characteristics of intentional and unintentional injury related deaths over a twelve year period from 2006 to 2017.DesignRetrospective review of cause of death information on all deaths <15yrs, registered in Ireland from 2006–2017, with additional detailed information retrieved from autopsy reports reviewed by paediatric pathologists.ResultsA total of 4,443 paediatric deaths (<15yrs) were registered in Ireland during 2006–2017, 49% of which were aged >28 days. Beyond infancy the leading cause of childhood death during this period (26.5%) was accident and injury. Most were unintentional accidents, children 1–4yrs being most susceptible (3.9/100,000 vs. 2.8/100,000 1–14yrs). Proportionate injury mortality increased gradually with age ranging from <1% of neonatal deaths to 36% of deaths in children 10–14yrs. Road traffic accidents (RTA) accounted for the greatest proportion of accidental injury deaths across all ages (33%). Other important causes of injury death in younger children 1–4yrs were drowning (8%) fires/burns (7.2%), high falls (6.4%) and accidental strangulation (5.6%), while fires/burns (12.7%) and drowning (8.9%) accounted for a greater proportion of deaths in children 5–9yrs. Interpersonal violence accounted for at least 9.5% of all injury deaths and 1.6% of child mortality overall. The rate of injury fatalities in children 1–14yrs has declined by 40% over the period from 2007 to 2016; from an average of 4.2 deaths/100,000 in 2007–2011 to 2.4 per 100,000 in 2012–2016, due largely to a significant decline in RTA fatalities during this period. A male preponderance of deaths was apparent for all categories of injury particularly drowning (88%), accidental strangulation (75%) and falls (69%).ConclusionsAlthough welcome reductions in childhood mortality rates have been observed in Ireland in recent years, 26.5% of child deaths, attributable to accident and intentional injury are potentially avoidable and warrant further attention. National, age-specific data relating to the nature and circumstances of such deaths will assist in providing evidence based information with which to inform effective intervention strategies.