1. Michele M. Nypaver, MD
Associate Professor
William G. Barsan
Dept. of EM Research Forum
April 27,
2016

2. A Less Conventional Research Journey
We’re gonna be program directors!
Survival Guide for PD’s
Curriculum Development for Dummies
Learning 101
A girls guide to simulators
FINDING COLLABORATORS!
•AAP/Section on EM Program
Directors Subcommittee
•UM Educators (MERG),
Residents and PEM Fellow

3. Nypaver 101
• Clinical (Educator) Track
•Associate Professor
•Scholarly Interests
•Education
•Simulation
•Assessment
•Quality Improvement
•Children with Cancer
& Fever

4. How do we evaluate (and measure) performance?
Build your own or steal someone else’s tools!
What are we trying to assess?
Formative?
Summative?
Cognitive?
Technical?
What tools are available to measure the
learner?
Are they valid?
Are they reliable?
Are the evaluators trained to use
the tool?
Will the tool discriminate levels of
learners?
OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILLS
(OSATS)
GLOBAL RATING SCALE OF PERFORMANCE:
Pediatric Emergency Endotracheal Intubation
Please circle the number corresponding to the candidate's performance in each category.
Time/Situational awareness 1 2 3 4 5
Does not know
Dependent on instruction
Independent with
minor error(s)
Independent and efficient
with no errors
Preparation 1 2 3 4 5
Does not know
Dependent on instruction
Independent with
minor error(s)
Independent and efficient
with no errors
Medication 1 2 3 4 5
Does not know
Dependent on instruction
Independent with
minor error(s)
Independent and efficient
with no errors
Pre- Intubation Processes 1 2 3 4 5
Does not know
Dependent on instruction
Independent with
minor error(s)
Independent and efficient
with no errors
Intubation Technique 1 2 3 4 5
Does not know
Dependant on instruction
Independent with
minor error(s)
Independent and efficient
with no errors
ETT Placement 1 2 3 4 5
Does not know
Dependent on instruction
>90 seconds Between 60 and 90
seconds
Between 60 and
30 seconds
<30 seconds
Confirmation of Tube Place 1 2 3 4 5
Does not know
Dependent on instruction
Independent with
minor error(s)
Independent and efficient
with no errors
Recognizes Complication:
Right main stem
☐ Not applicable
1 2 3 4 5
Does not know
Dependent on instruction
Recognize and correct
>2 min
Recognize and
correct <2 min,
but >1 min
Recognize and correct
<1 min
Would you let this Trainee perform this procedure on your next patient unsupervised?: YES NO
OVERALL
PERFORMANCE
1 2 3 4 5
Very poor Competent Clearly superior

5. Assessment of learning (is hard)
Prospective comparison of live evaluation and video review in the evaluation of operator
performance in a pediatric emergency airway simulation.
House JB, Dooley-Hash S, Kowalenko T, Sikavitsas A, Seeyave DM, Younger JG, Hamstra SJ, Nypaver
MM.
J Grad Med Educ. 2012 Sep;4(3):312-6

6. Cloutier RL, Walthall JD, Mull CC, Nypaver MM, Baren JM: Best educational practices in pediatric emergency medicine during emergency
medicine residency training: guiding principles and expert recommendations. Academic emergency medicine : official journal of the Society for
Academic Emergency Medicine 17 Suppl 2: S104-13, 2010. PM21199076
House JB, Dooley-Hash S, Kowalenko T, Sikavitsas A, Seeyave DM, Younger JG, Hamstra SJ, Nypaver
MM: Prospective comparison of live evaluation and video review in the evaluation of operator performance in a pediatric emergency airway
simulation. Journal of graduate medical education 4(3): 312-6, 2012.
Eppich WJ, Nypaver MM, Mahajan P, Denmark KT, Kennedy C, Joseph MM, Kim I: The Role of High-Fidelity Simulation in Training Pediatric
Emergency Medicine Fellows in the United States and Canada. Pediatric emergency care 29(1): 1-7, 2013. PM23283253
Iyer MS, Santen SA, Nypaver M, Warrier K, Bradin S, Chapman R, McAllister J, Vredeveld J, House JB: Assessing the validity evidence of an
objective structured assessment tool of technical skills for neonatal lumbar punctures. Academic emergency medicine : official journal of the
Society for Academic Emergency Medicine 20(3): 321-4, 2013.
House J, Iyer M, Santen S, Warrier K, Bradin S, Chapman R, Vredeveld J, Nypaver, M: OSATS Assessment Instrument for Neonatal Lumbar
Puncture. MedEdPortal www.mededportal.org/publication/9758, 2014.
House, J, Nypaver M, Dooley Hash S, Hamstra S.: OSATS Tool for Pediatric Rapid Sequence Intubation AAMC MedEdPORTAL Feb 2014
Doughty, Cara; Kessler, David; Zuckerbraun, Noel; Stone, Kimberly; Reid, Jennifer; Kennedy, Chris; Nypaver, Michele; Auerbach, Marc:
Simulation in Pediatric Emergency Medicine Fellowships Pediatrics 136(1): 152-158, 2015. 26055850
House J, Santen SA, Carney M, Nypaver M, Fischer JP, Hopson LR.: Implementation of an Education Value Unit (EVU) System to Recognize
Faculty Contributions Western Journal of Emergency Medicine16(6): 952-6, 2015. 26594298
Perry M, Hopson L, House JB, Fischer JP, Dooley-Hash S, Hauff S, Wolff MS, Sozener C, Nypaver M, Moll J, Losman ED, Carney M, Santen
SA.: Model for Developing Educational Research Productivity Western Journal of Emergency Medicine 16(6): 457-451, 2015. 26594297
Hsu D, Nypaver M, Fein DM, McAneney C, Santen S, Nagler J, Zuckerbraun N, Roskind C, Reynolds S,Zaveri P, Stankovic C, House J,
Langhan M, Titus MO, Dahl-Grove D, Klasner A, Ramirez J, Chang TP, Jacobs E, Chapman J, Lumba-Brown A, Thompson T, Mittiga M,
Eldridge C, Heffner V, Herman B, Kennedy C, Madhok M, and Kou M on behalf of the PEM Fellowship Directors' Writing Group: Essentials
of PEM Fellowship Part 2: The Profession in EPAs Pediatric Emergency Care Journal accepted Feb 2016

7. The Pediatric Emergency Medicine
Milestone Project
A Joint Initiative of
The Accreditation Council for Graduate Medical Education,
The American Board of Pediatrics,
and,
The American Board of Emergency Medicine
July 2015
Emergency Medicine Advisory Group
Wallace Carter, MD
Deborah Hsu, MD, MEd
Maybelle Kou, MD
Michele Nypaver, MD
Earl Reisdorff, MD

8. Thou Shalt:
Learn & Teach
Quality
Improvement
to residents &
fellows
Thou Shalt:
Participate in
QI for
Maintenance
of Certification
for your board.
ACGME
ABP
ABEM
2010
Pediatric Emergency
Medicine Leadership
Conference
Enhancing Leadership to Improve Quality
of Care in Emergency Settings for Children
Sponsored by the American Academy of Pediatrics
and the AAP Section on Emergency Medicine

9. Benner C, Nypaver, M, Mora E, Mueller E, Seagull FJ, Walkovich K, Johnson K, Halverson S, Rothman E,
Hucks G, Younger JG.: Making improvements in the ED: Does ED busyness affect time to antibiotics in
febrile pediatric oncology patients presenting to the emergency department? Pediatric Emergency
Care
Journal (accepted for publication 11/2015).
Improving clinical processes (and publishing)

10. Successful emergency department interventions that reduce time to
antibiotics in febrile pediatric cancer patients.
Michele M. Nypaver MD1
, Sandra Spencer MD2
, Katherine Hebert MD3
,
Christopher Benner MD4,5
, Rachel Stanley MD, MHSA1,2
, Daniel M. Cohen MD2
,
Alexander Rogers MD1
, Jason Goldstick PhD, MA1
, & Prashant Mahajan MD, MPH,
MBA3

11. Center 1 Center 2 Center 3
Education Interventions
1. Patient/Family information for ED experience during fever with neutropenia (FN)
episodes X X X
2. Staff/faculty on consensus guidelines for FN care
(Time to Antibiotic goal < 60 minutes and Antibiotic type) X X X
3. Staff/faculty initial education & update on project progress X X X
4. Standardized RN central line education/training X X
Process Change
5. Topical anesthetic to central line site in triage X X X
6. Rapid rooming for all cancer patients with fever X X X
7. Ill appearing or severe triage category placed in resuscitation room X X X
8. Central line equipment more accessible X X X
9. Antibiotic delivery prior to absolute neutrophil count (ANC) result X X X
10. Rapid ANC testing X**
11. Electronic order entry modifications/order set development X X
12. Pharmacy assistance for antibiotic readiness/availability X X
13. MD notified upon patient arrival X X
14.Direct phone communication (Oncology MD to Emergency MD) of incoming patient
prior to arrival (when possible) X
15. All febrile cancer pts triage level 1(highest acuity) X
TEAM Composition
Emergency Physicians X X X
Emergency Nurses X X X
Pharmacy Representative X X X
Oncology Physicians X X X
Computer Order Entry Representative X X
Infectious Disease Physician X X
Quality Improvement Representative X X
Table 2: Quality Improvement Project Interventions & Team Composition*
* Bold type = Interventions adopted at all sites
**Rapid ANC testing at Site 2 was abandoned during the project period

12. ED Improvement is for kids too!
Keith Kocher, MD Director
Michele Nypaver, MD Co Director Pediatrics
Joining general & pediatric ED provider data to improve
pediatric emergency practice
Pediatric Initiatives:
CT use in minor traumatic brain injury (adult & children)
CXR utilization in asthma, croup and bronchiolitis
MEDIC-Program for alternatives to hospitalization (adult & children)