Pediatric Interfacility Transport Curriculum: Its Impact on the Pediatric Intensive Care and Emergency Medicine Fellows’ Performance and Confidence

Published:August 03, 2022DOI:



      Pediatric interfacility transports are frequent. Despite the absence of a formal pediatric transport curriculum in eastern Canada, directly managing patients during transport and medical direction of the referring center and transport team are part of the pediatric critical care medicine (PCCM) and pediatric emergency medicine (PEM) program requirements. The authors developed a pediatric interfacility transport curriculum and measured its impact on fellows’ confidence and performance.


      This was a pilot interventional prospective study in Montreal, Canada. Postcurriculum surveys were used to measure confidence, and high-fidelity simulations were used to measure performance. A target threshold for confidence was defined before implementation, and pre- and post values were compared. The simulation scenario and assessment checklist were locally developed.


      The participants were 11 PCCM and 3 PEM fellows. The content of the curriculum and educational methods were selected based on the literature and a needs assessment survey. All participants rated themselves as confident at the end of the curriculum. Eighty-three percent of the participants were deemed proficient with a perfect interrater agreement.


      The pediatric transport curriculum had a positive impact on PEM and PCCM fellows’ confidence and performance in transport. Further studies should look at the impact of such a curriculum on participants’ real-life performance and patient care.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gregory CJ
        • Nasrollahzadeh F
        • Dharmar M
        • Parsapour K
        • Marcin JP.
        Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions.
        Pediatrics. 2008; 121: e906-e911
        • Insoft RM
        • Schwartz HP
        • Romito J
        • Alexander SN
        Chapter 2: transport program administration.
        Guidelines for Air and GroundTransport of Neonatal and Pediatric Patients. 4th ed. American Academy of Pediatrics, Media, PA2016
      1. Whyte HEA, Jefferies AL. The interfacility transport of critically ill newborns. February 28, 2018. Available at: Accessed November 10, 2019.

        • Orr RA
        • Felmet KA
        • Han Y
        • et al.
        Pediatric specialized transport teams are associated with improved outcomes.
        Pediatrics. 2009; 124: 40-48
        • Ramnarayan P
        • Thiru K
        • Parslow RC
        • Harrison DA
        • Draper ES
        • Rowan KM.
        Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study.
        Lancet. 2010; 376: 698-704
        • Prabhudesai S
        • Kasala M
        • Manwani N
        • Krupanandan R
        • Ramachandran B.
        Transport-related adverse events in critically-ill children: the role of a dedicated transport team.
        Indian Pediatr. 2017; 54: 942-945
        • Kline-Krammes S
        • Wheeler DS
        • Schwartz HP
        • Forbes M
        • Bigham MT.
        Missed opportunities during pediatric residency training: report of a 10-year follow-up survey in critical care transport medicine.
        Pediatr Emerg Care. 2012; 28: 1-5
      2. Royal College of Physicians and Surgeons of Canada. Objectives of training in pediatrics. 2008. Accessed November 10, 2019.

      3. Royal College of Physicians and Surgeons of Canada. Objectives of training in the subspecialty of pediatric emergency medicine. 2013. Available at: Accessed November 10, 2019.

      4. Royal College of Physicians and Surgeons of Canada. Objectives of training in the subspecialty of pediatric critical care medicine. 2014. Accessed November 10, 2019.

        • Mickells GE
        • Goodman DM
        • Rozenfeld RA.
        Education of pediatric subspecialty fellows in transport medicine: a national survey.
        BMC Pediatr. 2017; 17: 13
        • Rajapreyar P
        • Marcdante K
        • Zhang L
        • Simpson P
        • Meyer MT.
        Decision-making in pediatric transport team dispatch using script concordance testing.
        Pediatr Crit Care Med. 2017; 18: e530-e535
        • Good RJ
        • Zurca AD
        • Turner DA
        • et al.
        Transport medical control education for pediatric critical care fellows: a national needs assessment study.
        Pediatr Crit Care Med. 2022; 23: e55-e59
        • Gee SW
        • Holt PL
        • Stoner MJ.
        Safe interfacility transport of pediatric patients: medical control training, an interdisciplinary approach.
        Air Med J. 2018; 37: 120-123
        • Thomas PA
        • Kern DE
        • Hughes MT
        • Chen BY.
        Curriculum Development for Medical Education: A Six-Step Approach.
        3rd ed. Johns Hopkins University Press, Baltimore, MD2016
        • Fincham JE.
        Response rates and responsiveness for surveys, standards, and the journal.
        Am J Pharm Educ. 2008; 72: 43
      5. Royal College of Physicians and Surgeons of Canada. Access to copyright-protected CBD documents. 2021. Accessed July 22, 2021.

      6. Royal College of Physicians and Surgeons of Canada. CanMEDS Framework. 2015. Accessed November 2, 2019.

        • Bhanji F
        • Gottesman R
        • de Grave W
        • Steinert Y
        • Winer L.
        The retrospective pre–post: a practical method to evaluate learning from an educational program.
        Acad Emerg Med. 2012; 19: 189-194
        • Downing S
        • Haladyna T.
        Validity and its threats.
        Assessment in Health Professions Education. Routledge, London, UK2009: 21-55
        • Yudkowsky R
        • Tumuluru S
        • Casey P
        • Herlich N
        • Ledonne C.
        A patient safety approach to setting pass/fail standards for basic procedural skills checklists.
        Simul Healthc. 2014; 9: 277-282
      7. Royal College of Physicians and Surgeons of Canada. Format of the comprehensive objective examination. 2021. Accessed April 20, 2021.

        • Stead DR.
        A review of the one-minute paper.
        Act Learn High Educ. 2005; 6: 118-131
        • McHugh ML.
        Interrater reliability: the kappa statistic.
        Biochem Med (Zagreb). 2012; 22: 276-282
        • Costabile PM
        • Perretta J
        • Henderson E
        • Duval-Arnould J
        • Klein BL
        • Noje C.
        Development and implementation of a standardized education curriculum for pediatric transport.
        Pediatrics. 2018; 142 (487-487)
        • Yu JH
        • Chang HJ
        • Kim SS
        • et al.
        Effects of high-fidelity simulation education on medical students’ anxiety and confidence.
        PLoS One. 2021; 16e0251078
        • Stefan MS
        • Belforti RK
        • Langlois G
        • Rothberg MB.
        A simulation-based program to train medical residents to lead and perform advanced cardiovascular life support.
        Hosp Pract (1995). 2011; 39: 63-69
        • Bullard MJ
        • Leuck JA
        • Howley LD.
        Unifying interdisciplinary education: designing and implementing an intern simulation educational curriculum to increase confidence in critical care from PGY1 to PGY2.
        BMC Res Notes. 2017; 10: 563
        • Lund-Kordahl I
        • Mathiassen M
        • Melau J
        • Olasveengen TM
        • Sunde K
        • Fredriksen K.
        Relationship between level of CPR training, self-reported skills, and actual manikin test performance—an observational study.
        Int J Emerg Med. 2019; 12: 2
        • Tofil NM
        • Benner KW
        • Zinkan L
        • Alten J
        • Varisco BM
        • White ML.
        Pediatric intensive care simulation course: a new paradigm in teaching.
        J Grad Med Educ. 2011; 3: 81-87
        • Cheng A
        • Auerbach M
        • Hunt EA
        • et al.
        Designing and conducting simulation-based research.
        Pediatrics. 2014; 133: 1091-1101
        • Zakhary BM
        • Kam LM
        • Kaufman BS
        • Felner KJ.
        The utility of high-fidelity simulation for training critical care fellows in the management of extracorporeal membrane oxygenation emergencies: a randomized controlled trial.
        Crit Care Med. 2017; 45: 1367-1373
        • Ansquer R
        • Mesnier T
        • Farampour F
        • Oriot D
        • Ghazali DA.
        Long-term retention assessment after simulation-based-training of pediatric procedural skills among adult emergency physicians: a multicenter observational study.
        BMC Med Educ. 2019; 19: 348
        • Vadnais MA
        • Dodge LE
        • Awtrey CS
        • Ricciotti HA
        • Golen TH
        • Hacker MR.
        Assessment of long-term knowledge retention following single-day simulation training for uncommon but critical obstetrical events.
        J Matern Fetal Neonatal Med. 2012; 25: 1640-1645
        • Lo BM
        • Devine AS
        • Evans DP
        • et al.
        Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge.
        Resuscitation. 2011; 82: 1440-1443