2013

residents on how to develop a Quality Improvement (QI)

project during their one-month rotation at the clinic. Using the

Plan, Do, Study, Act (PDSA) model, residents implemented

multiple interventions to improve the rate of standardized

developmental screenings at well-child visits for children aged 9

months to 36 months (N¼ 1061) between January 2009 and

June 2010. The rate of standardized developmental screening

increased from 7% to 56% after residents initiated QI

interventions.

Barriers were encountered during the project, such as

limited education and socioeconomic resources of the patient

population, scarce time in the clinic setting, and suboptimal

resident/staff knowledge of developmental screening tools

and recommendations. By familiarizing themselves with the

barriers that existed, and taking advantage of the AAP’s

mission for health promotion and connection to community-

based resources, the residents were able to positively impact

the developmental screening rates in the clinic.

The residents’ successful outcomes suggest that combining

resident education and AAP mentorship in QI interventions

can lead to substantial gains in the quality of patient care

(Akins & Handel 2009). In this case, the rate of developmental

screening at a general pediatric clinic improved as a result of

this collaborative effort.

Aline Wong, Rebecca Hicks, Marc Lerner, Sabrina Middleton,

Dian Milton & Khanh-Van Le-Bucklin, Department of

Pediatrics, University of California Irvine, 505 S. Main St., Ste.

525, Orange, CA 92868, USA. E-mail: hicksreb@gmail.com

References

Akins R, Handel G. 2009. Utilizing quality improvement methods

to improve patient care outcomes in a pediatric residency program.

J Grad Med Educ 1(2):299–303.

Council on Children with Disabilities. 2006. Identifying infants and young

children with developmental disorders in the medical home: An

algorithm for developmental surveillance and screening. Pediatrics

118(1):405–420.

Procedural certification

program: Enhancing resident

procedural teaching skills

Dear Sir

In the clinical arena, residents frequently supervise their peers

in performing procedures, often prior to being comfortable

doing the procedures themselves (Mourad et al. 2010). To help

residents acquire skills in the teaching and supervision of

procedures, we designed and implemented the Procedural

Certification Program at the University of Calgary. Expanding

upon the concept of a procedural teaching tree whereby

senior residents are trained to teach procedures to junior

residents using simulators (Ma et al. 2010), the Procedural

Certification Program includes a more structured longitudinal

curriculum for the resident teachers.

Twelve resident-teachers taught seven procedures to

82 learners in a longitudinal fashion using simulation in

65 training sessions. Procedural skills covered include: lumbar

puncture, knee arthrocentesis, intubation, arterial blood gas

sampling, cardiac auscultation, and ultrasound-guided central

venous catheterization, thoracentesis and paracentesis.

Resident-teachers taught a minimum of two sessions super-

vised by faculty and once deemed competent to teach

independently, did so for a minimum of two additional

sessions. Sessions were rated out of five by learners and

faculty using a 10-item teaching effectiveness assessment tool.

Resident-teachers’ self-reported comfort in performing

and teaching the procedure increased (from 3.64� 1.21 to

4.80� 0.42, p¼ 0.01; from 3.36� 1.36 to 4.80� 0.42; p¼ 0.005,

respectively). Overall teaching effectiveness rated by learners

also increased (from 4.73� 0.24 to 4.93� 0.11, p¼ 0.01).

Ten of the 11 resident-teachers (91%) reported that the

program was valuable for him/her as a proceduralist, while

all reported it was valuable for him/her as a teacher.

Comments from the resident-teachers included: ‘‘Procedural

teaching as an [PGY-]2 would be especially valuable as you

learn about both the skill and effective teaching strategies . . .’’

and ‘‘This was an excellent experience. I learned a lot about

procedural teaching, and I think the residents I taught had an

enjoyable experience as well’’.

In summary, a longitudinal structured training program

such as the Procedural Certification Program is both feasible

and well-received. Further, it is associated with improved

teaching skills for the resident-teachers and may help prepare

them for their supervisory role in performing procedures on

the wards.

Irene Wai Yan Ma, Sarah Chapelsky, Sankalp Bhavsar, William

Connors, Michael Fisher, Jeffrey Schaefer & Maria Bacchus,

Department of Medicine, University of Calgary, 3330 Hospital

Dr NW, Calgary, AB T2N4N1, Canada. E-mail: ima@ucalgary.ca

References

Ma IW, Roberts JM, Wong RY, Nair P. 2010. A procedural teaching tree

to aid resident doctor peer-teachers. Med Educ 44:1134–1135.

Mourad M, Kohlwes J, Maselli J, Auerbach AD. 2010. Supervising the

supervisors – Procedural training and supervision in internal medicine

residency. J Gen Intern Med 25:351–356.

Does training on placing

rescuer’s hands on victim’s

chest have an impact on the

depth and frequency of chest

compressions?

Dear Sir

During five Basic Life Support – Automatic External

Defibrillator (BLS – AED) seminars a survey comprising 102

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