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BackgroundWhy did you do this work?Paediatric major incidents are rare events but when they occur they cause devastating morbidity and mortality. A well-tested major incident plan allows for optimal management and improved outcomes for the maximum number of patients. Staff training is vital for preparedness for what you hope will be a never event at your hospital.Aimsdevelop a translational major incident in-situ simulation 6-monthly programmeidentify strengths and challenges in our plan and develop changes to strengthen itbuild on staff confidence in their roleutilise the simulation exercises as a form of staff training (non-technical skills, technical skills and system responses)ensure ongoing benefits to the above as the programme progressesMethodsWhat did you do?Through a major incident small working group at a paediatric major trauma centre, we identified an experienced faculty to plan, write and facilitate simulation. We have run 6-monthly major incident in-situ simulation for 3 years whilst maintaining the business continuity of the hospital. In the latest simulation we had 70 participants taking part plus faculty. Each time different areas within the plan have been tested or identified as an area for repeated testing following system and plan changes. Following each simulation, we run both a hot and organisational debrief in order to build staff confidence and ensure psychological safety whilst identifying areas of the plan to be strengthened. Participants complete a questionnaire to detail any changes in their knowledge and confidence. In view of the large scale of this simulation we have also had experienced external simulation educators as observers for feedback.ResultsWhat did you find?Consistently we have demonstrated an increase in confidence on the likert scale comparing before and after the simulation: sim 1 – 7.3 to 8.36, sim 2 – 6.3 to 7.1, sim 3 – 5.6 to 7.8, (sim 4 – break from feedback) and sim 5 5.2 to 7.5.In the 6th simulation using a likert scale staff confidence had increased from 6.73 (range 1 – 10) to 7.51 (range 4 -10) after the sim and staff knowledge from 6.74 (range 1-10) to 7.49 (range 3- 10) after the sim.The simulations have resulted in significant system changes each time for example the implementation of a major incident specific clinical proforma, additions to the major haemorrhage response and new action cards for new roles identified. There have been subsequent updates to the major incident plan.ConclusionsWhat does it mean?Translational major incident in-situ simulation facilitates strengthening your major incident plan and is an excellent addition to staff training for major incident management. It’s impact on strengthening systems also translates to daily practices outwith major incident.

IntroductionThe skill of critical appraisal is essential in informing clinical decision-making. This is an area that is all too often overlooked within teaching programmes. Incorporating Evidence- Based Medicine into trainees’ educational programmes not only enhances trainee knowledge but also patient outcomes. We launched a series of peer-to-peer teaching sessions aimed at improving the integration of Evidence-Based Medicine skills into local paediatric training, enhancing engagement with the RCPCH e- portfolio and improving trainee confidence in their critical appraisal skills.MethodsWe designed and delivered an 8-session peer-to-peer teaching program focused on key aspects of Evidence-Based Medicine (EBM) for trainees at Lister Hospital. Foundation doctors, resident doctors, and clinical fellows participated, with each session incorporating teaching slides and peer-led group discussions. Self-rated confidence in critical appraisal skills was assessed using pre- and post-session questionnaire responses on a 5-point Likert scale.ResultsWe collected 38 trainee responses over the 8- session programme. 39% were from Paediatric Resident doctors; the remainder from foundation trainees, GP trainees and clinical fellows. Post-programme, the proportion of trainees performing formal evidence searches ‘sometimes’ rose from 32% to 50%. Those doing so ‘often’ or ‘daily’ increased from 14% to 25%. Prior to our programme, only one paediatric trainee had logged a clinical question onto the RCPCH e-Portfolio. Six paediatric trainees had logged clinical questions onto the RCPCH e- Portfolio post- programme. Average self-rated confidence levels (assessed using a Likert scale) across all domains of critical appraisal improved from 3.0 pre- programme to 3.45 post- programme. Trainees’ most popular suggestions for continued inclusion of EBM into training included incorporation of EBM into the departmental grand round teaching programme (suggested by 91% of participants), use of the RCPCH e- portfolio to regularly log clinical questions (suggested by 27%) and participating in Shared Learning Events (SLEs, suggested by 73%).ConclusionOur project highlighted strong trainee interest in improving knowledge of EBM alongside a notable increase in trainees’ confidence in application of critical appraisal skills. As a result of our programme, engagement with the RCPCH e- Portfolio also increased, with more trainees aware of capabilities such as logging clinical questions. Moving forward, we plan to integrate EBM teaching into the departmental curriculum, making it a key feature of both paediatric and neonatal grand round sessions.

IntroductionThe skill of critical appraisal is essential in informing clinical decision-making. This is an area that is all too often overlooked within teaching programmes. Incorporating Evidence- Based Medicine into trainees’ educational programmes not only enhances trainee knowledge but also patient outcomes. We launched a series of peer-to-peer teaching sessions aimed at improving the integration of Evidence-Based Medicine skills into local paediatric training, enhancing engagement with the RCPCH e- portfolio and improving trainee confidence in their critical appraisal skills.MethodsWe designed and delivered an 8-session peer-to-peer teaching program focused on key aspects of Evidence-Based Medicine (EBM) for trainees at Lister Hospital. Foundation doctors, resident doctors, and clinical fellows participated, with each session incorporating teaching slides and peer-led group discussions. Self-rated confidence in critical appraisal skills was assessed using pre- and post-session questionnaire responses on a 5-point Likert scale.ResultsWe collected 38 trainee responses over the 8- session programme. 39% were from Paediatric Resident doctors; the remainder from foundation trainees, GP trainees and clinical fellows. Post-programme, the proportion of trainees performing formal evidence searches ‘sometimes’ rose from 32% to 50%. Those doing so ‘often’ or ‘daily’ increased from 14% to 25%. Prior to our programme, only one paediatric trainee had logged a clinical question onto the RCPCH e-Portfolio. Six paediatric trainees had logged clinical questions onto the RCPCH e- Portfolio post- programme. Average self-rated confidence levels (assessed using a Likert scale) across all domains of critical appraisal improved from 3.0 pre- programme to 3.45 post- programme. Trainees’ most popular suggestions for continued inclusion of EBM into training included incorporation of EBM into the departmental grand round teaching programme (suggested by 91% of participants), use of the RCPCH e- portfolio to regularly log clinical questions (suggested by 27%) and participating in Shared Learning Events (SLEs, suggested by 73%).ConclusionOur project highlighted strong trainee interest in improving knowledge of EBM alongside a notable increase in trainees’ confidence in application of critical appraisal skills. As a result of our programme, engagement with the RCPCH e- Portfolio also increased, with more trainees aware of capabilities such as logging clinical questions. Moving forward, we plan to integrate EBM teaching into the departmental curriculum, making it a key feature of both paediatric and neonatal grand round sessions.

A single, widely accepted definition of sport specialization does not exist. A consensus definition is necessary to guide youth sport stakeholders on issues associated with sport specialization. The aim of this study was to develop a consensus definition of youth sport specialization and to identify elements that support the construct of specialization. Delphi Study Setting: Directed Surveys Patients or Other Participants: A consensus panel of 17 experts was created to provide a broad multidisciplinary perspective on sport specialization in youth athletes. The final definition was developed per an iterative process that involved four rounds of review. A comprehensive review of literature and expert input supported our initial proposed umbrella definition that included six additional elements. The study team reviewed the results after each round and changes were made to the definition based on panel feedback. Panel members were provided with the definition and six elements and then asked to rate each specific to importance, relevance, and clarity using a 4-point Likert scale. In four Delphi consensus rounds, 17 experts reviewed the umbrella definition and six elements before consensus was reached. The umbrella definition and three of the initial six elements achieved >80% agreement for importance, relevance, and clarity after the fourth round of review. The remaining 3 components did not reach >80% agreement even after iterative edits and were removed. The process resulted in a final consensus definition: Sport specialization is intentional and focused participation in a single sport for a majority of the year that restricts opportunities for engagement in other sports and activities. A consensus-based conceptual definition for sport specialization has been developed using a Delphi method. This definition has important implications for clinicians and sports medicine professionals who support youth athletes.

ObjectivesPost-graduate doctors typically apply for speciality training during, or soon after, their Foundation Two Year; however, many of them have very limited exposure to Paediatrics.We therefore provided an ‘Introduction to Paediatrics’ course, aimed at foundation doctors with an interest in Paediatrics training. The aims of the course were to: experience a range of common Paediatric presentations and procedural skills; learn about applying for Paediatrics; and learn about a career in Paediatrics.MethodsThe one-day programme consisted of mixed-methods teaching, designed to expose learners to a broad range of Paediatric-relevant experiences, whilst stimulating enthusiasm for the specialty.The course consisted of: four simulation scenarios of common Paediatric presentations, planned to be challenging but accessible to doctors without any previous Paediatric experience; two procedural skills stations (neonatal life support and umbilical venous catheterisation); and a series of short talks on Paediatric training and the application process. There was a large faculty of Paediatric trainees and consultants, with ample time for learners to ask questions. The course was offered at a minimal cost of £20, to limit financial discrimination.The participants were asked to feedback via online surveys, both immediately after the course, and a year following the course.ResultsThirty-nine doctors have attended the course, over three iterations; 20% of them had previous formal postgraduate experience in Paediatrics, and all of them were considering applying to Paediatric training.Immediately after the day, all the participants stated that they would recommend the course to someone who was considering Paediatric training, and that the day was useful in deciding whether to do Paediatrics training. Using a Likert scale, they rated all the teaching sessions as ‘Good’ or ‘Very good’. When asked to give a star rating out of 5, the mean was 4.9.Seven participants replied to a survey sent 12–18 months after the course. Using a Likert scale, they ranked how much attending the course had influenced (in either direction) how likely they were to apply for Paediatrics, and all chose ‘A lot’ or ‘Quite a lot’. Three of them have applied successfully, and the remaining 4 intend to apply in the future.ConclusionThis one-day low-cost course is an effective way of providing foundation doctors with a ‘taster’ of Paediatrics. Although not a substitute for a foundation programme placement in Paediatrics or a clinical taster day, it provides another opportunity for interested foundation doctors to learn about a specialty.

Objectives‘Milestones To Go: Accessibility and Development within Paediatrics’, was a 2023 National Undergraduate Paediatric conference, organised by undergraduate students from King’s College London (KCL) Paediatric Society. The conference aimed to highlight the general training pathway, alongside offering insight into the field of paediatrics for medical students and sixth-formers.MethodsA survey was emailed to participants pre and post-conference, which included questions assessed by the ten-point Likert scale.RStudio was used to conduct a Mann-Whitney U test comparing the mean rank Likert scale scores of students’ interest and understanding in paediatrics pre and post- conference and p <0.05 was considered statistically significant.Results111 students attended the conference. 105 students completed the pre-conference survey (n=65 university; n=40 sixth-form), and 90 students completed the post- conference survey (n=38 university; n=52 sixth-form).The results yielded by the Mann-Whitney U-Test demonstrated a statistically significant increase in the students’ understanding of what a paediatric career involves with the mean score being 6.12 pre-conference and 7.88 post-conference (U = 1810.5, p <0.001). Similarly, the students’ understanding of what is required to pursue a paediatric career has increased from a mean score of 5.12 pre-conference and 7.71 post-conference (U = 1318, p < 0.001).Comparatively, interest in paediatrics exhibited no statistically significant change (p = 0.1864).ConclusionThere were statistically significant changes in the understanding of student delegates of a paediatric career and the application process. Reasons for this could include:Limited paediatric placements during earlier years in medical school.Inviting a speaker from the Royal College of Paediatrics and Child Health, providing clarity regarding the paediatric application process.A range of subspecialties, demonstrating the breath of paediatrics.However, this association between student conferences and understanding in paediatrics may be confounded by both medical students and sixth formers filling out the feedback forms. Sixth formers would have had less exposure to paediatrics and therefore show a greater increase in understanding, hence positively skewing the results.This conference introduced the paediatric specialty pathway and opportunities available to aspiring paediatricians to fill the gap in the medical curriculum. Our statistically significant results demonstrate the value of student paediatric conferences to develop undergraduate understanding of a paediatric career. Undergraduate medical curricula should aim to introduce the specialty pathway at an earlier stage to aid a better foundation towards specialty application.

The central tendency bias is a robust finding in data from experiments using Likert scales to elicit responses. The present paper offers a Bayesian perspective on this bias, explaining it as a natural outcome of how participants provide point estimates of probability distributions over the items on a Likert scale. Two studies are reported that support this Bayesian explanation.

BackgroundThere has been an increasing focus on staff wellbeing in recent years with emphasis on safeguarding the health and mental wellbeing of our workforce. The NHS workforce face many challenges and around 40% of respondents in the 2023 NHS Staff survey reported feeling unwell as a result of work-related stress in the preceding 12 months (National Results across the NHS in England | NHS Staff Survey., 2024). Staff within the PICU or NICU setting have been found to be at high risk of burnout (Butcher et al., 2023). There is increasing evidence that mindfulness-based activities can have positive impact in the workplace with studies reporting increased collaboration, improved decision making and a more productive and compassionate workplace (Hilton et al., 2019; Johnson et al., 2020; Kersemaekers et al., 2018).ObjectivesThis project aimed to introduce short mindfulness exercises during morning handovers in the neonatal unit. The 1-2 minute activities were conducted 2-3 times a week over five weeks in July and August 2024. The impact was assessed through pre- and post-activity questionnaires, with overall programme evaluation conducted at the end.MethodsPrior to the sessions, a leaflet explained the project. Five mindfulness activities were planned, supported by short video resources:Week 1 – Mindful EatingWeek 2 – Progressive Muscle RelaxationWeek 3 – Mini MeditationWeek 4 – Box BreathingWeek 5 – Desk YogaSessions began at 8:15 before handover. A session leader introduced the activity, followed by a brief video-guided exercise. Participants completed anonymous pre- and post-activity surveys, answering questions on focus, calmness, handover readiness, and preparedness for the shift ahead (or leaving the shift behind). Responses were rated on a 1 (strongly disagree) to 5 (strongly agree) Likert scale, with higher scores indicating more favourable responses. Post-activity surveys included a free-text option for comments.ResultsAverage scores for the pre- and post-exercise surveys were calculated, with a total average of 16.8 participants (pre) and 14.8 (post) per session. All surveys showed an increase in scores after the activities (see figure 1). Weeks 4 (Box Breathing) and 5 (Desk Yoga) had the highest impact, though initial scores were lower, possibly due to a busier workload.Abstract 8076 Figure 1Average Likert Scale Scores pre and post across all activities[Figure omitted. See PDF]ConclusionThe mindfulness activities were well received and increased staff feelings of calm and focus. Feedback suggested that longer activities would be preferred, though this could conflict with handover time. This pilot project demonstrated the potential for mindfulness exercises in intensive care settings and could inform future staff wellbeing programmes in the Neonatal Unit and beyond.ReferencesButcher, I., Morrison, R., Balogun, O., Duncan, H., St Louis, K., Webb, S., & Shaw, R. (2024). Burnout and coping strategies in pediatric and neonatal intensive care staff.Clinical Practice in Pediatric Psychology, 12(1), 16–30. https://doi.org/10.1037/cpp0000474Hilton, L. G., Marshall, N. J., Motala, A., Taylor, S. L., Miake-Lye, I. M., Baxi, S., Shanman, R. M., Solloway, M. R., Beroesand, J. M., & Hempel, S. (2019). Mindfulness meditation for workplace wellness: An evidence map. Work (Reading, Mass.), 63(2), 205–218. https://doi.org/10.3233/WOR-192922Johnson, K. R., Park, S., & Chaudhuri, S. (2020). Mindfulness training in the workplace: exploring its scope and outcomes. European Journal of Training and Development, 44(4–5), 341–354. https://doi.org/10.1108/EJTD-09-2019-0156/FULL/XMLKersemaekers, W., Rupprecht, S., Wittmann, M., Tamdjidi, C., Falke, P., Donders, R., Speckens, A., & Kohls, N. (2018). A Workplace Mindfulness Intervention May Be Associated With Improved Psychological Well-Being and Productivity. A Preliminary Field Study in a Company Setting. Frontiers in psychology, 9, 195. https://doi.org/10.3389/fpsyg.2018.001955. National results across the NHS in England | NHS Staff Survey. (2024). Retrieved August 22, 2024, from https://www.nhsstaffsurveys.com/results/national-results/

Why did you do this work?A need for simulation training in our level 2 local neonatal unit (LNU) was identified following review of recent emergency cases. A neonatal multidisciplinary team (MDT) simulation programme was subsequently developed. The simulations aimed to enhance MDT confidence managing common neonatal emergencies, therefore improving patient safety. Simulation increases neonatal MDT competence and confidence and should be routinely undertaken.1 Emerging evidence shows simulation improves patient safety and team performance, with resultant improved patient outcomes in neonatal care.2 Additionally, with appropriate planning, team-based simulation training is feasible in busy neonatal units.3What did you do?Four neonatal MDT simulations ran on the LNU, labour or postnatal ward between September 2023 and March 2024. Multiple neonatal MDT practitioners participated (figure 1). Simulations were created with input from the STAR App4 and MPROvE Academy.5 The simulations included prematurity, meconium/hypoxic ischaemic injury, postnatal collapse (neonatal seizure) and difficult airway management. A post-simulation questionnaire was created for each, using paper and electronic forms. These contained short answer questions and a 5-point-Likert scale for rating confidence (0 no confidence to 4 very confident) before and after the simulation. Anonymised results were analysed.Abstract 8232 Figure 1What did you find?17 practitioners completed the post-simulation questionnaires from across the neonatal MDT. Relevant team leads supported practitioner attendance. Following the neonatal MDT simulations, all practitioners rated their confidence on the 5-point-Likert scale more highly than before, with mean self-reported confidence increasing after simulation participation (figure 2). In the prematurity simulation, mean confidence increased from 2.7 to a post-simulation confidence of 3.7. In the meconium/hypoxic ischaemic injury simulation, mean confidence increased from 2.3 to 3.3. The management of postnatal collapse (neonatal seizure) simulation saw mean confidence increase from 1.3 to 2.5; as did the difficult airway simulation, with mean increase from 1.8 to 2.4.Qualitative feedback suggested simulations used appropriate teams with varying experience. Participants expressed gaining confidence and knowledge; ‘helped build confidence in my decision making’ and ‘very interesting learning...’ Additionally, effective teamwork was highlighted, such as ‘problem solving as a team.’ One participant suggested simulations could be more challenging by starting in theatre.Abstract 8232 Figure 2What does it mean?Implementation of the neonatal MDT simulation programme showed the simulations increased practitioner confidence in neonatal emergency management. Qualitative analysis showed the simulations created a more confident and effective MDT, ultimately improving patient safety. The programme demonstrates feasibility of implementing simulation programmes in busy LNUs. Future intentions include expanding the MDT to involve midwifery colleagues and setting simulations in theatre. Furthermore, the programme is now established in departmental teaching and will be repeated as new practitioners rotate through the LNU. These plans aim to further enable a confident neonatal MDT, subsequently enhancing patient care.ReferencesFelton A, Cheshire K. Using Simulation-Based Training to Improve Neonatal Resuscitation Clinical Competency, Confidence, and Comfort Level of NICU Caregivers. The Journal of Continuing Education in Nursing 2024 Apr.Yousef N, Moreau R, Soghier L. Simulation in neonatal care: towards a change in traditional training? European Journal of Pediatrics. 2022 Apr.Reed DJW, Hermelin RL, Kennedy CS, Sharma J. Interdisciplinary onsite team-based simulation training in the neonatal intensive care unit: a pilot report. Journal of Perinatology. 2017 Apr.STAR. Simulation Tools and Resources (version 3.0). [Mobile application]. [Last accessed: June 2024].MPROvE MultiPROfessional neonatal Education. Available at: https://www.mproveacademy.com/. [Last accessed: June 2024].

Background Emerging artificial intelligence (AI) technologies have diverse applications in medicine. As AI tools advance towards clinical implementation, skills in how to use and interpret AI in a healthcare setting could become integral for physicians. This study examines undergraduate medical students’ perceptions of AI, educational opportunities about of AI in medicine, and the desired medium for AI curriculum delivery. Methods A 32 question survey for undergraduate medical students was distributed from May–October 2021 to students to all 17 Canadian medical schools. The survey assessed the currently available learning opportunities about AI, the perceived need for learning opportunities about AI, and barriers to educating about AI in medicine. Interviews were conducted with participants to provide narrative context to survey responses. Likert scale survey questions were scored from 1 (disagree) to 5 (agree). Interview transcripts were analyzed using qualitative thematic analysis. Results We received 486 responses from 17 of 17 medical schools (roughly 5% of Canadian undergraduate medical students). The mean age of respondents was 25.34, with 45% being in their first year of medical school, 27% in their 2nd year, 15% in their 3rd year, and 10% in their 4th year. Respondents agreed that AI applications in medicine would become common in the future (94% agree) and would improve medicine (84% agree Further, respondents agreed that they would need to use and understand AI during their medical careers (73% agree; 68% agree), and that AI should be formally taught in medical education (67% agree). In contrast, a significant number of participants indicated that they did not have any formal educational opportunities about AI (85% disagree) and that AI-related learning opportunities were inadequate (74% disagree). Interviews with 18 students were conducted. Emerging themes from the interviews were a lack of formal education opportunities and non-AI content taking priority in the curriculum. Conclusion A lack of educational opportunities about AI in medicine were identified across Canada in the participating students. As AI tools are currently progressing towards clinical implementation and there is currently a lack of educational opportunities about AI in medicine, AI should be considered for inclusion in formal medical curriculum.