Introduction: Children with tracheostomies are high risk for morbidity and mortality. Pediatric resident physicians are not routinely taught skills to care for this vulnerable patient population. Few reports link educational interventions to improved patient outcomes. This study evaluates the impact of an intensive educational training program on pediatric residents’ observed skills and tracheostomy-dependent patient outcomes. Methods: Pediatric post-graduate year 2 (PGY2) resident physicians rotating through the inpatient pediatric pulmonology month at Children’s Hospital Colorado July 2018-2019 participated in the Pediatric Resident Education in Pulmonary (PREP) Boot Camp, an intensive educational program with an interactive lecture and simulation experience on patients with tracheostomy-dependence. PGY2s who partook in PREP and PGY3s who rotated prior to PREP initiation were invited to be studied. Primary outcomes included: 1) resident skills assessed by direct observation during simulation encounters and 2) rates of intensive care unit (ICU) transfers in tracheostomy-dependent patients following acute events before and after introduction of PREP. We hypothesized that increased education would enhance resident skills and improve patient outcomes by decreasing the rate of ICU transfers. Results: PGY2 residents retained skills learned during PREP up to 11 months following initial participation, and significantly outperformed their PGY3 counterparts. There was a significant decrease in ICU transfer rate in patients with tracheostomies admitted to the pulmonary team during the 19 months following initiation of PREP. Conclusions: Enhanced early education improves resident physicians’ ability to care for complex patients with tracheostomies and improves outcomes in this high-risk population.

Beginning in the early 2010s, an increased incidence of interstitial lung disease in systemic juvenile idiopathic arthritis (sJIA-LD) in pediatric patients has been identified. Despite the increase in prevalence of sJIA-LD, little is known about this disease process and effective therapeutic management. In this single-center, retrospective case series of 9 patients, we analyze demographic, clinical, radiographic, and laboratory data to corroborate common clinical characteristics and describe an approach for diagnosis and monitoring of interstitial lung disease in children with sJIA. Our results were similar to other described cases of sJIA-LD as patients in our cohort were more likely to be younger, have a history of macrophage activation syndrome and prior use of biologic therapies. In contrast to prior studies, they did not present with lymphadenopathy and hepatosplenomegaly. We discuss our management of this rare disease process. More research is necessary to understand the increased incidence and treatment of sJIA-LD in pediatric population.