176 - Learning outcomes using a nursemaid’s elbow reduction task-trainer during Pediatric Intern Bootcamp

Publication Number: 4173.176

Erica C. Scott, University of Texas Southwestern Medical School, Dallas, TX, United States; Dana Chatila, University of Texas Southwestern Medical Center, Dallas, TX, United States; Khawar Nawaz, University of Texas Southwestern Medical School, Dallas, Texas, TX, United States; Ngoc Van Horn, University of Texas-Southwestern Medical Center, Dallas, TX, United States; Kimberly Laird, University of Texas at Southwestern, Dallas, TX, United States; Harriet Leahy, University of Texas Southwestern Medical School, Dallas, TX, United States; Jacquelynn Matthews, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Radial head subluxation are a common presentation to a pediatric ED. Nursemaid’s elbow is a common pediatric elbow injury in young children requiring a clinical diagnosis, effective reduction treatment, and caregiver counseling. Simulation-based education in residency programs utilizes task trainers to obtain repeated practice and proficiency in procedural skills in a psychologically safe environment prior to clinical implementation.

Objective: To design and implement a low-cost, high-yield task trainer for teaching reduction techniques for radial head subluxation to pediatric residents. We aimed to assess the impact of this simulation-based intervention on learners’ self-reported competence across five key domains that reflect Entrustable Professional Activity (EPA) 9: Diagnosis, Indications and Contraindications, Consent, Critical Actions for the Procedure, Troubleshooting.

Design/Methods: A low-cost task trainer was designed using artificial skeletons and nylon tourniquet material to simulate the ligaments of the elbow joint. Pediatric residents will have the opportunity to fill out a one-minute pre-station survey during pediatric intern bootcamp. A script addressing the task trainer learning objectives will be used for an initial didactic session, and residents will participate in active recall of indications, contraindications, counselling and procedural steps.

Results: A total of 38 Pediatric residents completed pre- and post-intervention assessments targeting five skill domains of nursemaid’s elbow reduction. The composite mean scores for the five targeted skill domains were calculated for each participant before and after the educational session. The post-intervention composite mean was significantly higher than the pre-intervention mean based on the Wilcoxon signed-rank test (statistics =7.15, P=2.3 x10-5). The median self-reported overall ability to perform all components of nursemaid’s elbow reduction (EPA 9) rose to 3.5 (IQR 3-4, range 2-5) after the intervention.

Conclusion(s): This low-cost radial head head subluxation task trainer allows residents to practice reduction techniques in a safe, controlled environment. Aligned with current EPA 9, the findings of this study suggest significant educational gains in all key procedural domains and an improvement in residents’ perceived procedural competency related to nursemaid’s elbow reduction. Given the accessibility of this task trainer, as well as the simplicity of the reduction techniques, this study is broadly applicable to learners of all levels including medical students, residents and fellows.