Implementation of a Pediatric Subspecialty Boot Camp Is Feasible and Increases Resident Confidence in Managing Hematologic and Oncologic Emergencies
Authors: Graff Zachary , Demedis Jenna , Garrington Tim , Lind Katherine 
Published: December 2024

Background: Pediatric resident education consists of frequent transitions between hospital units to allow for a breadth of exposure to different pathology. While orientation at the start of residency is common, few programs allow protected time to orient residents between rotations. This creates an opportunity for medical errors, particularly for the high-risk patients encountered in pediatric hematology/oncology (PHO), and creates an opportunity to target learning that better serves residents while improving patient care. To date, there is limited data describing the benefits of just-in-time learning prior to subspecialty rotations, and none to our knowledge in PHO. This study describes our experience developing and implementing a Pediatric Resident Boot Camp (PRBC) on the PHO rotation.

Objective: 1) To determine the feasibility of implementing a boot camp orientation. 2) To examine the impact of a boot camp on resident confidence in management of PHO emergencies.

Design/Method: This study was conducted at Children's Hospital Colorado, an. academic pediatric institution with approximately 120 categorical/combined pediatric residents in total. Residents spent one month on the PHO unit during their post-graduate year two, with 3 residents on the PHO rotation each month. Graduate medical education evaluations provided the initial problem identification identifying the desire of residents for a formal PHO orientation. We conducted two focus groups (involving 5 residents per group) in line with the Kern's Model of Curriculum Development for a needs assessment, defining the objectives and educational strategies used in designing the orientation. The PRBC orientation occurred on the first day of each monthly rotation from 8am-1pm, with patient coverage provided by advanced practice providers and PHO fellows. Curriculum focused on addressing common PHO emergencies that residents may encounter. Sessions included an orientation to the rotation, case-based discussion on oncology, hematology, and transfusion medicine emergencies, interactive Jeopardy game, and chemotherapy & supportive care.

Eligible participants in this study included residents at Children's Hospital Colorado who had completed their PHO rotation. Quantitative data was collected via de-identified end-of-rotation REDCap surveys sent to all residents before and after the implementation of the PRBC orientation. Resident satisfaction and confidence were measured using a 5-point Likert scale (with 1-unsatisfactory/no confidence to 5-superior/very confident). All Likert scale values are reported as the mean.

Results: REDCap surveys were completed by 21 residents prior to PRBC implementation from September 2018 to June 2020, and 60 residents after PRBC implementation from July 2020 to July 2024. Survey completion rate was 84% before (21 of 25 surveys completed) and 67% after (60 of 90 surveys completed) the implementation of the PRBC.

Overall satisfaction on the hematology/oncology rotation was unchanged before and after the PRBC (4.0 vs 3.9, respectively). Residents felt more prepared starting the PHO rotation following the implementation of the PRBC orientation (2.4 vs 3.6). Specifically, residents felt more confident in the management of common PHO emergencies after the implementation of the PRBC including tumor lysis syndrome (2.1 vs 3.8), fever and neutropenia (2.2 vs 4.0), acute chest syndrome (1.6 vs 3.2), and transfusion reactions (2.0 vs 2.9). Overall satisfaction with the PRBC was 4.3.

The individual sessions of the PRBC were well received, with 92% residents rating the sessions useful/very useful for the orientation to the rotation, case-based discussion on oncology, hematology, and transfusion medicine emergencies, and the interactive Jeopardy game. Fewer residents (73%) found the more traditional lecture-based session on chemotherapy and supportive care useful.

Conclusion: Pediatric residents desire protected time for orientation when transitioning to subspecialty rotations. The monthly pediatric resident boot camp was logistically feasible and enhanced pediatric resident confidence in the management of critical hematology/oncology emergencies encountered in this high-risk patient population. These findings may inform future rotation design in pediatric subspecialties.