Aisha Davis

A 6-year-old girl with extensive bullous skin lesions.

6-year-old previously healthy girl presented with extensive bullous skin lesions involving approximately 25% of her total body surface area (TBSA). She initially presented 9 days earlier with low-grade fever, bilateral non-exudative conjunctival injection, cough, and rash. Her rash appeared as raised, erythematous target lesions that began behind her ears and then progressed to involve her face and body. Her symptoms at first presentation were attributed to erythema multiforme and she was treated with hydroxyzine and olopatadine eye drops. Five days later, fluid-filled bullae developed at the centers of the target lesions and increased in number and size up to the time of admission. Physical examination on admission revealed a nontoxic-appearing girl with extensive fluid-filled bullous lesions of varying sizes behind her ears, around her eyes and mouth, and on her neck, trunk, back, axillae, and perineum (Figures 1 and 2). Mucous membrane involvement included small bullae in her nares, hard palate, and perianal region. She had scattered bullae on her wrists and ankles, although her extremities were relatively spared. The skin at the base of the bullae was erythematous, slightly raised, and pruritic. Initial work-up included a normal complete blood count and electrolytes, clear chest radiograph, and negative herpes simplex virus antigen swab from one of her lesions. She was admitted to the hospital for wound care, pain control, nutritional support, and diagnostic evaluation. She continued to develop bullae during her initial hospital days until approximately 60% of her TBSA was affected (Figure 3, see page 230). Her palms and soles also developed lesions. Further testing and a skin biopsy revealed the diagnosis.

Virtual Reality for Pediatric Sedation: A Randomized Controlled Trial Using Simulation.

Introduction: Team training for procedural sedation for pediatric residents has traditionally consisted of didactic presentations and simulated scenarios using high-fidelity mannequins. We assessed the effectiveness of a virtual reality module in teaching preparation for and management of sedation for procedures. Methods: After developing a virtual reality environment in Second Life® (Linden Lab, San Francisco, CA) where providers perform and recover patients from procedural sedation, we conducted a randomized controlled trial to assess the effectiveness of the virtual reality module versus a traditional web-based educational module. A 20 question pre- and post-test was administered to assess knowledge change. All subjects participated in a simulated pediatric procedural sedation scenario that was video recorded for review and assessed using a 32-point checklist. A brief survey elicited feedback on the virtual reality module and the simulation scenario. Results: The median score on the assessment checklist was 75% for the intervention group and 70% for the control group (P = 0.32). For the knowledge tests, there was no statistically significant difference between the groups (P = 0.14). Users had excellent reviews of the virtual reality module and reported that the module added to their education. Conclusions: Pediatric residents performed similarly in simulation and on a knowledge test after a virtual reality module compared with a traditional web-based module on procedural sedation. Although users enjoyed the virtual reality experience, these results question the value virtual reality adds in improving the performance of trainees. Further inquiry is needed into how virtual reality provides true value in simulation-based education.

Development of a Curriculum on the Child With Medical Complexity: Filling a Gap When Few Practice Guidelines Exist.

Background: Pediatric hospitalists are increasingly involved in the clinical management of children with medical complexity (CMC), specifically those with neurologic impairment and technology dependence. Clinical care guidelines and educational resources on management of the diseases and devices prevalent in CMC are scarce. The objective of this study was to develop and evaluate a web-based curriculum on care of CMC for hospitalists at our institution using a novel approach to validate educational content. Methods: Junior faculty collaborated with senior hospitalist peer mentors to create multimedia learning modules on highly-desired topics as determined by needs assessment. Module authors were encouraged to work with subspecialty experts from within the institution and to submit their modules for external peer review. Pilot study participants were asked to complete all modules, associated knowledge tests, and evaluations over a 4-month period. Results: Sixteen of 33 eligible hospitalists completed the curriculum and associated assessments. High scores with respect to satisfaction were seen across all modules. There was a significant increase in posttest knowledge scores (P < 0.001) with sustained retention at 6 months posttest (P < 0.013). Participants were most likely to make changes to their teaching and clinical practice based on participation in this curriculum. Conclusions: We used a novel approach for content development in this curriculum that incorporated consultation with experts and external peer review, resulting in improved knowledge, high satisfaction, and behavior change. Our approach may be a useful method to improve content validity for educational resources on topics that do not have established clinical care guidelines.