Transport in Support of Resident Education

Interfacility transport requires a unique set of skills, distinct from the traditional training of most hospital-based residency training programs. It is essential that personnel used to provide care during interfacility transport be properly trained, familiar with the unique demands of providing care during ground or air transport, and prepared to handle the variety of patient contingencies that might occur during transport.

Providing an educational experience for residents in transport medicine is desirable but may present challenges in the service area. Because patient care must not be compromised, personnel in training who are not trained or capable of fully participating in the care of the patient should not replace experienced transport team members. Practically, space for inclusion of additional personnel in training during the transport process might be an issue with limited space vehicles. The Accreditation Council for Graduate Medical Education (ACGME) states that general pediatrics residency training programs must offer residents a minimum of two 1-month blocks of pediatric emergency and acute care medicine and exposure to emergency medical services. Given these requirements, it would seem that active participation of pediatric residents on transport teams is desirable, but this must be accomplished in a manner that ensures maximal quality and efficiency of the care provided. Furthermore, ACGME work-hour constraints might present programmatic challenges for programs interested in including a transport rotation or transport call to augment the emergency and acute care medicine requirements.

Residency and fellowship training programs that include transport medicine as a rotation should develop specific curricula for physicians in training. To be consistent with ACGME requirements, the syllabus should reflect specific educational goals, expectations, and measurable objectives.

An assessment of the trainee's performance that measures the degree to which educational objectives were met is required at the completion of the rotation. Finally, adherence to resident work rules, which limit the number of continuous hours house staff may work and the cumulative hours of work in a given week, is mandatory.

Because traditional rotations in the pediatric residency are geared toward managing inpatients and ambulatory care patients, pediatric residents might not be specifically educated about the management of critically ill transport patients. If pediatric residents are to be part of a transport team, specific transport, critical care, and neonatal medicine education should be developed and presented before these physicians are included in the transport process. Studies are warranted to determine whether pediatric resident involvement in a transport medicine rotation improves the resident’s level of skill and confidence and adds value to the service.

To ensure the quality of patient care, scopes of practice, policies, and educational guidelines must be developed to outline duties of all personnel, including physicians in training (residents and fellows) who serve on transport teams. A separate training curriculum should be developed that includes instruction in pretransport evaluation, triage, communication, transport safety, and medical management of critically ill patients who require transfer. Specific educational needs can be identified by a thorough practice analysis. These analyses will be required to identify knowledge gaps and steer the development of bridging curricula.

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Source: AAP. Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients. 4th edition. — American Academy of Pediatrics,2015. — 488 p.. 2015

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