JournalTOCs

Academic Pediatrics
Journal Prestige (SJR): 1.655

Citation Impact (citeScore): 2
Number of Followers: 37

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1876-2859
Published by Elsevier

[3184 journals]

Evaluating curricular modules in the care of children with medical
complexity: A mixed-methods randomized controlled trial
- Abstract: Publication date: Available online 12 September 2019Source: Academic PediatricsAuthor(s): Kathleen Huth, Tobey Audcent, Sara Long-Gagne, Anne Marie Sbrocchi, Natalie Weiser, Doug Miller, Danielle Arje, Derek Stephens, Nathalie Major, Kheirie Issa, Eyal Cohen, Julia OrkinABSTRACTObjectiveChildren with medical complexity (CMC) are a growing population, yet training in complex care varies across pediatric residency programs. The purpose of this study was 1) to evaluate the effectiveness of a curriculum for pediatric residents in improving performance in a simulated clinical scenario; and 2) to explore residents’ perceived self-efficacy in caring for CMC.MethodsA randomized controlled trial was conducted supplemented by qualitative inquiry. Pediatric residents from two residency programs were randomly assigned to participate in interactive modules on: (a) clinical assessment, care planning and technological dependency or (b) non-complex care topics. The primary outcome was mean score on an Observed Structured Clinical Examination (OSCE) of tracheostomy care. Semi-structured interviews were conducted post-intervention and analyzed using qualitative content analysis.ResultsNinety-four eligible residents were randomized. Residents who attended all modules and the OSCE and consented to participate [intervention (n=20) and control (n=24)] were included in the final analysis. At baseline, few (9%) reported being comfortable caring for CMC. There was no significant difference in mean OSCE score between intervention and control groups (39.0±1.1 vs. 38.0±1.0, p=0.48). Qualitative analysis revealed three emerging themes related to resident self-efficacy: building a system of care, navigating uncertainty and professional identity formation.ConclusionA standardized complex care curriculum delivered in a classroom setting did not lead to improved performance in an OSCE station despite increased resident-reported self-efficacy in approaching care for CMC. These findings highlight the need for multidimensional educational interventions and assessments in complex care.
Public Charge: An Expanding Challenge to Child Health Care Policy
- Abstract: Publication date: Available online 12 September 2019Source: Academic PediatricsAuthor(s): Jean L. Raphael, Lee S. Beers, James M. Perrin, Arvin Garg
My Magic Wand
- Abstract: Publication date: Available online 3 September 2019Source: Academic PediatricsAuthor(s): Moira Szilagyi
Grace amid turmoil: Death in the delivery room
- Abstract: Publication date: Available online 3 September 2019Source: Academic PediatricsAuthor(s): Sarah Mongiello Bernstein
Self-Confidence in Endotracheal Intubation Among Pediatric Interns:
Associations With Gender, Experience, and Performance
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Kelsey A. Miller, Michael C. Monuteaux, Christopher Roussin, Joshua Nagler Background and ObjectiveSupervisors’ decisions regarding procedural readiness are influenced by resident confidence. Confidence is a valuable metric if we understand how it correlates with trainee characteristics and procedural competence. Our objective was to evaluate the relationship between self-reported confidence in endotracheal intubation (ETI) and pediatric interns’ characteristics (gender, prior intubation experience) and performance (airway management knowledge, demonstrated skills on airway trainers).MethodsThis was a secondary analysis of a randomized, controlled trial of an airway management curriculum. Gender and prior intubation experience were reported on a preparticipation questionnaire. Interns’ performance was measured 1) using a 14-item knowledge-based assessment of airway management and 2) as time to successful intubation across 4 simulated intubation scenarios. After completing the curriculum and assessment, interns reported retrospective precurriculum and current postcurriculum confidence with ETI using a 10-point Likert scale.ResultsForty-nine interns participated, of whom 16 (33%) were male. Eleven (22%) had ≥1 previous successful intubation. Median [interquartile range] pre- and postcurriculum confidence scores were 3 [2, 5] and 6 [5, 8], respectively. Male interns reported higher precurriculum confidence than females (median difference: 2.0; 95% confidence interval: 0.1, 3.9); postcurriculum confidence among males was also higher but not statistically significant. There was no correlation between self-reported precurriculum confidence and prior experience. There was no correlation between pre- or postcurriculum self-reported confidence and performance on the knowledge-based assessment or time to successful intubation on airway trainers.ConclusionsMale pediatric interns self-report higher initial confidence in ETI compared to females. Self-reported confidence did not correlate with prior experience, airway management knowledge, or intubation performance on airway trainers.
Impact of a Baby-Friendly–Aligned Pacifier Policy on Pacifier Use at
1 Month of Age
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Maheswari Ekambaram, Matilde M. Irigoyen, Andrew Paoletti, Iqra Siddiqui ObjectivePacifier use decreases the risk of sudden infant death syndrome, but its impact on breastfeeding remains controversial. We evaluated the impact of a pacifier policy aligned with the World Health Organization and United Nations Children's Fund Baby-Friendly Hospital Initiative on subsequent pacifier use and breastfeeding at 1 month of age.MethodsWe conducted a prospective 2-stage (pre- and post-implementation) cohort study of newborns at a birth hospital before and after implementation of a Baby-Friendly–aligned pacifier policy. Consecutive mothers of newborns admitted to the nursery participated in a telephone survey when the infants were 1 month of age.ResultsIn total, 342 mothers participated (190 before and 152 after implementation of the policy). Pacifier adoption was delayed in the post-implementation group, but pacifier use by 1 month of age was comparable (78.9% pre-implementation vs 77.6% post-implementation; P = .793). In the pre-implementation group, female and male infants used pacifiers at comparable rates; however, in the post-implementation group, females were significantly less likely to use a pacifier compared to males after controlling for insurance, race, parity, and delivery mode (adjusted odds ratio, 0.35; 95% confidence interval, 0.15–0.83; P = .02). In the post-implementation group, exclusive breastfeeding rates at discharge increased significantly (from 40% to 51.3%; P = .04), but rates were not different at 1 month (23.7% pre-implementation vs 24.3% post-implementation; P = .89).ConclusionA Baby-Friendly–aligned pacifier policy delayed pacifier adoption but did not impact overall pacifier use or breastfeeding rates at 1 month of age. The finding of lower pacifier use rates among female infants post-intervention requires verification in other populations before evaluating public heath relevance.
Refusal of Vitamin K by Parents of Newborns: A Qualitative Study
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Jaspreet Loyal, Theresa R. Weiss, Jessica H. Cheng, Laura R. Kair, Eve Colson ObjectiveDespite American Academy of Pediatrics recommendations, some parents refuse intramuscular (IM) vitamin K as prophylaxis against vitamin K deficiency bleeding for their newborns. The purpose of our study was to describe attitudes and perceptions of parents who choose to defer IM vitamin K for their newborns.MethodsUsing qualitative methodology, we conducted in-depth semi-structured interviews with parents of newborns in 3 hospitals in Connecticut and California. We used the grounded theory approach and the constant comparative method until saturation was reached.ResultsNineteen participants (17 mothers and 2 fathers) of 17 newborns were interviewed; 14 newborns did not receive IM vitamin K due to refusal by the parents, and for 3 newborns IM vitamin K administration was delayed due to initial hesitation by the parents. Four major themes emerged: 1) risk-to-benefit ratio, where parents refused IM vitamin K due to a perceived risk to their newborn from preservatives, for example; 2) “natural” approaches, which led to seeking oral vitamin K or increasing the mother's own prenatal dietary vitamin K intake; 3) placement of trust and mistrust, which involved mistrust of the medical and pharmaceutical community with overlapping concerns about vaccines and trust of self, like-minded allopathic and non-allopathic health care providers, the social circle, the internet, and social media; and 4) informed by experiences, reflecting hospital experiences with prior pregnancies and communication with health care providers.ConclusionsParents’ perception of risk, preference for alternative options, trust, and communication with health care providers were pivotal factors when making decisions about IM vitamin K.
Mothers’ Perceptions of the Cardboard Box as a Potential Sleep Space
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Nisha Dalvie, Victoria Nguyen, Eve Colson, Jaspreet Loyal ObjectiveDue to increasing popularity, our hospital began considering distributing cardboard boxes combined with safe sleep education to new mothers. As a first step in studying the impact of this intervention on bedsharing in our community, we sought to understand mothers’ perceptions of the cardboard box.MethodsWe recruited primarily low-income, English- or Spanish-speaking mothers of infants aged 2 to 16 weeks during routine primary care visits. Participants responding to a cross-sectional survey about infant sleep practices were invited to participate in in-depth interviews about the cardboard box. We used a grounded theory approach and the constant comparative method until saturation was reached.ResultsOf 120 participants in the survey, 50 (42%) participated in the qualitative study. Participants were mothers of infants aged ≤4 weeks (46%), 4 to 8 weeks (32%), and 16 weeks (22%). Of 50 participants, 52% said they would use the cardboard box for their infant to sleep in, if provided, compared with 42% who said they would not and 6% were unsure. Three themes emerged from the data: (1) safety of the cardboard box; (2) appearance, and (3) variation in planned use. Some participants planned to place the cardboard box in their bed.ConclusionsParticipants in our study were divided about whether they would use the cardboard box for their infant to sleep in. If distributed, hospital staff should advise families to not place the cardboard box in their bed. Next steps include determining bedsharing frequency among parents who choose to use the cardboard box for their infant.
Weight Bias in Pediatric Inpatient Care
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Elizabeth E. Halvorson, Thomas Curley, Mariah Wright, Joseph A. Skelton ObjectiveWeight bias can influence medical care but has not been studied in the pediatric inpatient setting. We will quantify implicit and explicit weight bias of pediatric inpatient providers and qualitatively explore providers’ attitudes toward children with obesity and patient/family perceptions of weight bias in the hospital.MethodsWe performed a mixed-methods study including semistructured key informant interviews and validated tests for implicit (Implicit Association Test) and explicit (Crandall's Anti-Fat Attitudes Questionnaire) bias with pediatric hospitalists, residents, and acute care nurses. We performed semistructured key informant interviews with pediatric inpatients aged 7 to 17 years and the patient's parent(s) or guardian(s). Interviews were coded using an inductive approach to identify recurrent themes.ResultsWe enrolled 28 pediatric providers, 12 patients, and 12 parents/guardians. In total, 71% of providers exhibited moderate or strong implicit weight bias, with generally lower scores for explicit bias. Qualitative analysis identified seven themes: the existence of weight bias, shared responsibility for a child's obesity, a potential for provider bias toward the parents of pediatric patients with obesity, possible effects of patient weight on inpatient care, importance of terminology in addressing obesity, and the possibility of addressing obesity inpatient but a preference for obesity to be addressed in the outpatient setting.ConclusionsHealth care providers, patients, and families in the pediatric inpatient setting identified multiple ways that obesity could impact care, including provider weight bias.
Parents’ Willingness to Pay for Pediatric Weight Management Programs
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Olivier Drouin, Mona Sharifi, Monica Gerber, Christine Horan, E. John Orav, Richard Marshall, Elsie M. Taveras ObjectiveTo examine parents’ interest in continuing and willingness to pay (WTP) for 2 pediatric weight management programs following their participation.MethodsParticipants were parents of 2- to 12-year-old children with body mass index ≥ 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other received EPC plus individualized coaching (EPC+C). At 1 year, we assessed parents’ self-reported WTP for a similar program and the maximum amount ($/month) they would pay. We used multivariable regression to examine differences in WTP and WTP amount by intervention arm and by individual and family-level factors.ResultsOf 638 parents who completed the survey, 85% were interested in continuing and 38% of those parents were willing to pay (31% in the EPC group and 45% in the EPC+C group). The median amount parents were willing to pay was $25/month (interquartile range, $15–$50). In multivariable models, the EPC+C parents were more likely to endorse WTP than the EPC parents (odds ratio, 1.53; 95% confidence interval, 1.05–2.22). Parents of children with Hispanic/Latino versus white ethnicity and those reporting higher satisfaction with the program were also more likely to endorse WTP.ConclusionsMost parents of children in a weight management program were interested in continuing it after it ended, but fewer were willing to pay out of pocket for it. A greater proportion of parents were willing to pay if the program included individualized health coaching.
Talking About Childhood Obesity: A Survey of What Parents Want
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Ruth S. Faircloth, Daniel I. Brooks, Karen S. Vogt, Jill E. Emerick ObjectiveDetermine parent preferences when discussing their child's weight with regard to weight-based terms, terms that are the most motivating, preferred setting, and whether or not awareness of their child's weight status impact these preferences.MethodsParents of children ages 3 to 17 years (N = 349) presenting for health supervision visits completed a survey to assess the degree of offensiveness and motivation for change of commonly used weight-based terminology, as well as the preferred setting for discussion of weight. Parents were asked to assess their child's weight status using recommended terminology (“obese,” “overweight,” “healthy weight,” “underweight”), and their responses were compared to the children's objective body mass index (BMI) percentile.ResultsThe children had a median age of 10.3 years; 47.3% were female, 15.8% had overweight (85th–94th percentile BMI), and 11.5% had obesity (≥95th percentile BMI). Of children with overweight/obesity, 84.2% of parents underestimated their child's weight status. The least offensive terms were “at-risk weight,” “BMI is high,” “BMI is above 95%,” and “unhealthy weight.” The more offensive terms (P < .001) were “overweight” and “obese.” The parent's perception of their child's weight did not affect offensiveness ratings. “Obese” was the strongest motivator for change (P < .001), and “unhealthy weight” was next. Well visits were preferred for discussing weight (P < .001). Most parents preferred to have the child remain in the room (P
Parental and Provider Perceptions of Sugar-Sweetened Beverage
Interventions in the First 1000 Days: A Qualitative Study
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Kayla Morel, Kelsey Nichols, Yvonne Nong, Nalini Charles, Sarah Price, Elsie Taveras, Roberta Goldman, Jennifer A. Woo BaidalABSTRACTBackgroundNovel approaches to reduce sugar-sweetened beverage (SSB) consumption during the first 1000 days—pregnancy through age 2 years—are urgently needed.ObjectiveTo examine perceptions of SSB consumption and acceptability of potential intervention strategies to promote SSB avoidance in low-income families in the first 1000 days.MethodsIn this qualitative research, we performed semistructured, in-depth interviews of 25 women and 7 nutrition/health care providers. Eligible women were Women, Infants, and Children program-enrolled and pregnant or had an infant younger than age 2 years. Eligible providers cared for families during the first 1000 days. Using immersion-crystallization techniques, we examined perceptions, barriers, and facilitators related to avoidance of SSB consumption; acceptability of messages framed as positive gains or negative losses; and perceived influence on SSB consumption of various intervention modalities.ResultsThemes related to SSB consumption included parental confusion about healthy beverage recommendations and maternal feelings of lack of control over beverage choices due to pregnancy cravings and infant tastes. Themes surrounding message frames included negative health consequences of sugary drink consumption are strong motivators for behavior change; and savings and cost count, but are not top priority. Highly acceptable intervention strategies included use of images showing health consequences of SSB consumption, illustrations of sugar content at the point of purchase, and multimodal delivery of messages.ConclusionsMessages focused on infant health consequences and parental empowerment to evaluate and select healthier beverages based on sugar content should be tested in interventions to reduce SSB consumption in the first 1000 days.
The Development of a Pediatric Osteopathic Recognition Track
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Alexander Rakowsky, Carl Backes, John D. Mahan, Kimberly Wolf, Elizabeth Zmuda It is clear that graduates of osteopathic medical schools desire to maintain their Osteopathic Manipulative Medicine (OMM) and Osteopathic Principles and Practice (OPP) skills and mindset of their professional identity. In a recent survey, 68% of 1,523 third year osteopathic medical students indicated that it would be more appealing to attend a residency with osteopathic recognition, with more than half indicating this would play an important role in how they made their rank list. There are currently few options available to DO students that would like to maintain their OMM and OPP skills during pediatric residency programs, and with an increasing number of DO graduates each year, there may be a need to provide more opportunities for them. In this article we describe our pediatric Osteopathic Recognition Track, which has the goal of providing an appropriate level of osteopathic focused training to our small number of residents in the track (4 annually) while incorporating them fully into a large and very busy pediatric program. We use Bloom's taxonomy as the framework upon which to provide details about our approach.
Secondhand Smoke Exposure and Sleep-Related Breathing Problems in Toddlers
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Judith A. Groner, Lisa Nicholson, Hong Huang, John Anthony Bauer BackgroundAdequate sleep during childhood is an important component of overall health and wellbeing for children. Secondhand smoke (SHS) exposure has been linked to a greater risk of sleep-disordered breathing.ObjectiveOur objective was to investigate relationships between SHS exposure and sleep-related breathing problems in healthy toddlers aged 2 to 5 years. We hypothesized that there is an independent relationship between objectively measured SHS exposure and presence of sleep-related breathing problems by parental report.MethodsA convenience sample of 149 healthy children ages 2 to 5 years was recruited from an academic pediatric primary care center for this cross-sectional study; 138 had complete data that were analyzed. Current SHS exposure was determined by hair nicotine level. Presence of sleep-related breathing problems was assessed by 1 survey item. Inflammation was determined by serum C-reactive protein (CRP) level. Analysis in Stata 15 included a series of multivariate logistic regression models, controlling for individual-level demographics and body mass index z scores according to mediation analysis procedures for dichotomous outcomes.ResultsApproximately 24% of parents reported their child snored, gasped, or had difficulty breathing at night sometimes, most of the time, or almost always. Regression models with mediation analysis indicate that SHS exposure significantly increased the odds of reporting the child had sleep-related breathing problems, and 18% of this relationship is explained by log serum CRP levels.ConclusionsAlthough the cross-sectional nature of this study limits causality, evidence suggests a relationship exists between SHS exposure, as measured by log hair nicotine and sleep-related breathing problems at night.
Medical Student Perspectives on the Use of Immersive Virtual Reality for
Clinical Assessment Training
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Matthew W. Zackoff, Francis J. Real, Bradley Cruse, David Davis, Melissa Klein
Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline
Adherence and Mental Workload
- Abstract: Publication date: September–October 2019Source: Academic Pediatrics, Volume 19, Issue 7Author(s): Katherine M. Richardson, Sarah D. Fouquet, Ellen Kerns, Russell J. McCulloh ObjectiveTo evaluate the individual-level impact of an electronic clinical decision support (ECDS) tool, PedsGuide, on febrile infant clinical decision making and cognitive load.MethodsA counterbalanced, prospective, crossover simulation study was performed among attending and trainee physicians. Participants performed simulated febrile infant cases with use of PedsGuide and with standard reference text. Cognitive load was assessed using the NASA-Task Load Index (NASA-TLX), which determines mental, physical, temporal demand, effort, frustration, and performance. Usability was assessed with the System Usability Scale (SUS). Scores on cases and NASA-TLX scores were compared between condition states.ResultsA total of 32 participants completed the study. Scores on febrile infant cases using PedsGuide were greater compared with standard reference text (89% vs 72%, P = .001). NASA-TLX scores were lower (ie, more optimal) with use of PedsGuide versus control (mental 6.34 vs 11.8, P < .001; physical 2.6 vs 6.1, P = .001; temporal demand 4.6 vs 8.0, P = .003; performance 4.5 vs 8.3, P < .001; effort 5.8 vs 10.7, P < .001; frustration 3.9 vs 10, P < .001). The SUS had an overall score of 88 of 100 with rating of acceptable on the acceptability scale.ConclusionsUse of PedsGuide led to increased adherence to guidelines and decreased cognitive load in febrile infant management when compared with the use of a standard reference tool. This study employs a rarely used method of assessing ECDS tools using a multifaceted approach (medical decision-making, assessing usability, and cognitive workload,) that may be used to assess other ECDS tools in the future.
Spanish Interpreter Services for the Hospitalized Pediatric Patient:
Provider and Interpreter Perceptions
- Abstract: Publication date: Available online 22 August 2019Source: Academic PediatricsAuthor(s): Ivy Tam, Maria Huang, Aarti Patel, Kyung Rhee, Erin FisherABSTRACTBackgroundMany Americans have limited English proficiency (LEP) and difficulty communicating with healthcare providers, creating inequitable healthcare delivery. Despite widespread interpreter availability in hospitals, perceptions of interpreter services in the pediatric inpatient setting are largely unknown.ObjectiveTo investigate staff perspectives regarding: 1) roles of the interpreter and provider (attending, resident, nurse) during an encounter, 2) modalities of interpretation, and 3) barriers to services.MethodsFocus groups were conducted with: 1) hospital-employed Spanish interpreters, 2) Pediatric Hospital Medicine attendings, 3) pediatric and internal medicine-pediatric residents, and 4) medical unit nurses. Sessions were audio-recorded and transcribed. Using Atlas.ti©, two investigators created the coding scheme, independently coded the data, and achieved consensus. Qualitative methods were used for thematic analysis.ResultsFourteen groups (n=59 participants) were held: 3 interpreter groups (n=10), 3 attending groups (n=14), 2 resident groups (n=17), and 6 nurse groups (n=18). Most believed the interpreter's role was to serve as a conduit (provide word-for-word interpretation), act as a cultural broker, and maintain transparency (not withhold information). All groups felt providers should interact with families as they would with English-speaking families. In-person interpreters were preferred over telephone and video for being more accurate, efficient, and personable. Barriers to accessing services included time needed for interpretation, overconfidence in language skills, variable family dynamics, and identification of LEP families.ConclusionsIn-person interpreters are highly valued, fulfilling complex roles. However, operational and human factors limit access to services in the hospital. These findings, along with family perspectives, can be used to optimize interpretation experiences.
The Evolving Educational Challenge: Balancing Patient Numbers, Conference
Attendance, Sleep and Resident Wellness
- Abstract: Publication date: Available online 22 August 2019Source: Academic PediatricsAuthor(s): Irene Kocolas, Wendy Hobson, Ameet Daftary, Marta King, James F. Bale
Improving hypertension recognition in adolescents, a small but important
first step in cardiovascular disease prevention
- Abstract: Publication date: Available online 21 August 2019Source: Academic PediatricsAuthor(s): Elyse Olshen Kharbanda, Stephen E. Asche, Alan Sinaiko, James D. Nordin, Heidi L. Ekstrom, Steven P. Dehmer, Dani Bredeson, Patrick J. O'Connor
Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A
qualitative exploration of mothers’ experiences
- Abstract: Publication date: Available online 16 August 2019Source: Academic PediatricsAuthor(s): Chelsea Anne Young, Honora Burnett, Alexandra Ballinger, Gloria Castro, Shay Steinberg, Melissa Nau, E. Hayes Bakken, Melanie Thomas, Amy L. Beck ObjectiveThe American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic.MethodsSemi-structured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach.Results20 women participated. Five major themes emerged: (1) Barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; (2) Benefits of embedded care, including convenience, low barrier to entry and trust; (3) Motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) Focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; (5) Treatment modality preferences, including concerns about medications and a preference for psychotherapy.ConclusionsPostpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers.
Uncomfortable Comfort Care
- Abstract: Publication date: Available online 14 August 2019Source: Academic PediatricsAuthor(s): Shabih Manzar
Pediatric Career Choice: Insights from a Novel, Medical School Pathway
Program
- Abstract: Publication date: Available online 9 August 2019Source: Academic PediatricsAuthor(s): Dorene F. Balmer, Rachel J. Gottlieb-Smith, Patricia M. Hobday, Michele Long, Carol Carraccio, James F. Bale, J Lindsey Lane, the EPAC Study Group ObjectiveResearch on how medical students choose a career in pediatrics is either dated or conflated with primary care career choice. Capitalizing on student participation in an innovative, time-variable, competency based pathway program, Education in Pediatrics Across the Continuum (EPAC), the authors explored the process of career decision-making in students at five medical schools (including 4 EPAC sites) who begin medical school with an interest in pediatrics.MethodsIndividual, semi-structured interviews were conducted with students in five groups: Group 1: accepted into EPAC, n=8; Group 2: accepted into EPAC, opted-out, n=4; Group 3 applied to EPAC, not accepted, pursued pediatrics, n=4; Group 4: applied to EPAC, not accepted, did not pursue pediatrics, n=3; Group 5: pursued pediatrics at a non-EPAC site, n=6. Data collection and analysis occurred iteratively, with inductive coding of data revealing patterns in data explored in subsequent interviews and refined in the final analysis.ResultsAll students described intrinsic guiding principles, i.e., “doing what you love”, that attracted them to pediatrics. They described extrinsic, phase-specific experiences before medical school, before clerkship, and in clerkship that shaped their perceptions of a career in pediatrics and shed light on collective values of different specialties. Student's assessment of how their guiding principles aligned with the collective values of pediatrics, which students encountered in the clerkship phase, was key to making career decisions.ConclusionsIntrinsic and extrinsic factors do not act alone but interact in clerkships, and influence career choice of students who enter medical school with an interest in pediatrics.
Inequities in Insurance Coverage and Well-Child Visits Improve, but
Insurance Gains for White and Black Youth Reverse
- Abstract: Publication date: Available online 9 August 2019Source: Academic PediatricsAuthor(s): Alexander N. Ortega, Jessie Kemmick Pintor, Cinthya K. Alberto, Dylan H. Roby
Connected Subspecialty Care: Applying Telehealth Strategies to Specific
Referral Barriers
- Abstract: Publication date: Available online 9 August 2019Source: Academic PediatricsAuthor(s): Kristin N Ray, Jeremy M Kahn Nearly a quarter of families of children with need of subspecialty care report difficulty accessing that care. Telehealth is a method to overcome barriers to subspecialty care. However, improving access to subspecialty care through telehealth requires granular identification of specific subspecialty barriers and recognition of the strengths and limitations of each telehealth strategy for addressing identified barriers. Focusing on each sequential step in subspecialty referrals and potential associated barriers, we summarize specific telehealth and technology-enabled strategies to improve access to subspecialty care, including electronic consultations, live interactive telemedicine, store-and-forward telemedicine, tele-mentoring, patient portals, and remote patient monitoring. Intentionally selecting telehealth strategies to target specific subspecialty referral barriers may avoid risks from misapplication of telehealth, may more clearly elevate equitable access as an essential goal within telehealth initiatives, and may also lead to synergistic use of strategies that overcome sequential barriers.
Using the Modified Delphi Method to Develop a Tool to Assess Pediatric
Residents Supervising on Inpatient Rounds
- Abstract: Publication date: Available online 9 August 2019Source: Academic PediatricsAuthor(s): Kelsey A. Miller, Beatriz Collada, Destiny Tolliver, Zeena Audi, Amy Cohen, Catherine Michelson, Lori R. NewmanABSTRACTBackgroundConsensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking.ObjectiveUse modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, non-specialty teaching rounds and pilot the checklist.Design/Methods141 initial candidate behaviors were identified through literature review and narrowed by local stakeholders. 41 behaviors were submitted to national experts identified through purposive sampling to be refined using the modified Delphi method. Participants indicated agreement with behaviors’ inclusion in the checklist and whether any were non-observable. Measures of central tendency and dispersion were used to identify consensus with a behavior's inclusion in the next cycle. A criterion was eliminated if> 25% of experts felt it was not observable. Cycles continued until consensus was reached on ≤ 20 behaviors. The resulting checklist was piloted at 2 hospitals.ResultsAfter two modified Delphi cycles, consensus was obtained on 18 behaviors for inclusion in the final checklist. These were spread across 3 subcategories: teaching, leadership, and patient safety. In the pilot, the checklist of behaviors discriminated between residents with differing levels of competency in supervising trainees on inpatient rounds. For residents who had the checklist completed by 2 faculty, there was 75% agreement in behaviors observed.Conclusion(s)Based on literature review, local stakeholder input, and consensus of national experts through the modified Delphi method, we created and piloted a checklist of observable behaviors characteristic of effective clinical supervision by pediatric residents leading trainee teams on inpatient, non-ICU, non-specialty rounds.
Internet Alcohol Marketing Recall and Drinking in Underage Adolescents
- Abstract: Publication date: Available online 8 August 2019Source: Academic PediatricsAuthor(s): Auden C. McClure, Joy Gabrielli, Samantha Cukier, Kristina M. Jackson, Zoe L.B. Brennan, Susanne E. TanskiABSTRACTObjectiveEvidence suggests that adolescents are exposed to alcohol marketing in digital media. We aimed to assess recall of Internet alcohol marketing and its association with underage drinking.MethodsNew England adolescents age 12-17 years (N=202) were recruited from a pediatric clinic. Subjects completed an online survey assessing: 1) general simple recall of Internet alcohol marketing and 2) image-prompted recall of specific Internet alcohol marketing channels (display ads, commercials, brand websites, brand social media pages). Cross-sectional associations between recall (simple and image-prompted) and ever-drinking were each assessed in regression analysis adjusting for age, gender, race, parent education, ever-smoking, media use, sensation-seeking, peer/parent drinking, parent monitoring/responsiveness, and parent Internet monitoring.ResultsIn this sample (Mage=14.5 years; 55% female; 89% white; high parent education), 20% reported ever-drinking and 87% recalled Internet alcohol marketing. Of the latter, 67% recalled display ads, 67% Internet commercials, 5% websites, 5% social media pages. In logistic regression, higher Internet alcohol advertising recall was independently associated with higher odds of ever-drinking for simple (AOR: 2.66 [1.04,6.83]) but not for image-prompted recall.ConclusionsDespite controlling for potential confounders, simple recall of Internet alcohol marketing was significantly associated with underage drinking whereas image-prompted recall was significant only in bivariate analysis, likely due to small sample and a more limited range of specific channels assessed than those accessed by adolescents. Further longitudinal studies using image-prompted recall and capturing a broader range of internet platforms could be used to better understand adolescent engagement with alcohol marketing and guide policy and prevention efforts.
Brief Resolved Unexplained Events: analysis of an Apparent Life
Threatening Event database
- Abstract: Publication date: Available online 8 August 2019Source: Academic PediatricsAuthor(s): Sriram Ramgopal, Jane Soung, Raymond D Pitetti ObjectiveTo identify the proportion of patients previously diagnosed with apparent life-threatening events (ALTE) who would meet criteria for brief resolved unexplained events (BRUE) and to identify rates of adverse outcomes in subgroups: ALTE not meeting criteria for BRUE, lower-risk BRUE, and higher-risk ALTE.MethodsWe performed a secondary analysis of a single-center prospective registry of patients diagnosed with ALTE in a tertiary care emergency department from March 1, 1997 to October 31, 2007. We identified the proportion of patients meeting criteria for BRUE, and the proportion of patients with BRUE meeting lower-risk criteria. We assessed outcomes of patients in subgroups.Results762 patients were included. Adverse outcomes included recurrent ALTE (n=49), aspiration (n=9), trauma (n=8), and death (n=4). 326/762 (42.8%) met criteria for BRUE. 70/326 (21.5%) met criteria for lower-risk BRUE. Adverse outcomes occurred in 40/436 (9.2%) with ALTE not meeting criteria for BRUE, 2/70 (2.9%) with lower-risk BRUE, and 23/256 (9.0%) with higher-risk BRUE. Of four patients who died, one had an ALTE not meeting criteria for BRUE and three had non lower-risk BRUE. The BRUE risk criteria identified all BRUE patients that died or had substantial morbidity as higher-risk.ConclusionLess than half of patients with ALTE meet criteria for BRUE. Of those who do, one-fifth are lower-risk. In this series, the risk-stratification in the BRUE criteria identified those patients at highest risk of adverse outcomes. Further research is required to risk-stratify patients with BRUE.
The use and impact of professional interpretation in a pediatric emergency
department
- Abstract: Publication date: Available online 5 August 2019Source: Academic PediatricsAuthor(s): Emily A Hartford, Andrea P Anderson, Eileen J Klein, Derya Caglar, Kristy Carlin, K Casey Lion Background and ObjectivesPatients with limited English proficiency (LEP) experience worse healthcare outcomes compared to English proficient (EP) patients, and professional interpretation is underutilized in clinical settings. The objectives of this study were to describe patterns of interpreter use in a pediatric emergency department (ED), to determine factors associated with its use, and to examine differences in outcomes between EP families and those with LEP.MethodsED encounters for LEP and EP patients were reviewed in a retrospective cohort study design over a 15 month period. Generalized estimating equations were used to compare patient encounters and factors associated with interpreter use.ResultsInterpreter use for families who preferred a non-English language was 45.4%. Use of interpretation was less likely during busier times of day (OR 0.85, CI 0.78-0.93), with a lower triage acuity (OR 0.66, CI 0.62-0.70), and with each increasing year of patient age (OR 0.97, CI 0.96-0.98). LEP patients who did not receive interpretation were less likely to be admitted than EP patients (OR 0.69, 0.62-0.78). Patients of LEP families, with or without interpretation, were more likely to be transferred to the ICU within 24 hours of admission than patients of EP families (OR 1.76, 1.07-2.90; 1.85, 1.08-3.18) suggesting that an aspect of clinical severity may have been missed in the ED.ConclusionProfessional interpretation is currently underutilized in this ED for patients with LEP, and important differences in outcomes exist between LEP and EP patients. Factors associated with interpreter use will inform ongoing improvement efforts.
Scholarly Collaboration, Mentorship, and Friendship: A New Model for
Success in Academic Medicine
- Abstract: Publication date: Available online 2 August 2019Source: Academic PediatricsAuthor(s): Erika L. Abramson, Monique M. Naifeh, Michelle D. Stevenson, Su-Ting T. Li Mentorship can be one of the most important factors in helping faculty members successfully advance academic careers. Finding effective mentorship, however, is extremely challenging and lack of mentorship may negatively impact productivity, promotion, and retention. Women, in particular, identify lack of mentorship as a major factor inhibiting career advancement, which in turn may be one element contributing to the significant gender gaps existing in academic medicine. Here we describe a model of mentoring drawn from our personal experiences as four female faculty that has resulted in a successful collaboration spanning nearly a decade. This model combines different elements of mentoring models previously described in the literature into a single model of network mentoring. Our model aims to promote longitudinal, collaborative scholarship around a broad common research theme, provide long-term mentorship focused on successfully navigating personal and academic hurdles, and create a forum of mentorship for faculty at all academic ranks. Keys to the success of our model, The Accelerate Scholarship through Personal Engagement with a Collaborative Team (ASPECT) Model, are: 1) a shared overarching research goal that allows for multiple projects to be worked on over time; 2) regular, structured meetings; 3) a collaborative yet flexible arrangement with “group accountability;” and 4) a focus on the human connection. Our goal in writing this paper is to describe, in detail, lessons learned from our experiences and reflect on why and how this model may be effective in addressing mentoring gaps many faculty members, particularly women, experience.
Children and Medicaid: Will the Courts be There When They Need Them'
- Abstract: Publication date: Available online 2 August 2019Source: Academic PediatricsAuthor(s): Sara Rosenbaum
88. STUDYING THE PROGRESSION OF RESIDENTS' CULTURAL ATTITUDES DURING
STANDARD PEDIATRIC RESIDENCY
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Bindiya Bagga, Kimberlee V. NorwoodBackgroundDeveloping skills for taking care of patients from a variety of backgrounds is an important aspect in medical education as cultural differences between providers and patients can lead to miscommunication and affect patient outcomes. There is a lack of evidence in the current medical literature on the progression of residents’ cultural attitudes during pediatric residency through clinical experiences alone. The purpose of this study was to perform a cross-sectional survey of pediatric residents at different levels of training in our mid-size residency program. We hypothesized that clinical experiences attained with natural progression through standard pediatric residency training is insufficient to improve the trainees’ cultural attitudes.MethodsAfter obtaining IRB approval, a previously validated Health Belief Attitudes Survey (15 items scored on a 6-point Likert scale) was used to conduct a cross-sectional survey of the cultural attitudes of residents in different levels of training at our pediatric residency program (N=71). Standard descriptive statistics were done. The overall HBAS score was the mean of all 15 questions, Kruskal-Wallis test was used to compare overall median HBAS scores by residency class.Results60/71 residents (84.5%) completed the survey. 55% reported receiving previous training and most (93.4%) wanted additional training on the topic. Despite that, a majority agreed that they were confident in their ability to deliver culturally effective health care. Residents fared especially poorly in the question on the importance of patient perspective in the physician-patient relationship. No statistically significant differences were seen between the median scores of each PGY class (p=0.65).ConclusionsClinical experiences alone did not lead to a progression of cultural attitudes in our cross-sectional study of pediatric residents in different levels of training. Our study demonstrates a need for developing a cultural sensitivity training curriculum at our residency program and identified specific areas where additional training would be most beneficial.
87. TRANSFORMING ADVOCACY CURRICULA INTO ONE THAT PROMOTES TRAINEE
KNOWLEDGE, SKILLS, AND ENGAGEMENT
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Patrice Pryce, Alexandra Kilinsky, Grace Fisler, Jami Zaretsky, Allison Driansky, Stephen BaroneBackgroundResidency programs have addressed advocacy curriculum needs with various degrees of success. Program leadership at Cohen Children's Medical Center recognized the need to enhance curricula to meet the demands of residents and communities.DesignDidactics are structured as a series of conferences, interactive workshops and web-based modules. There is education on the importance of Community Based Organizations (CBOs), health equity, vulnerable populations, legislative advocacy etc. Experiential learning is provided at CBOs, federal program sites, and schools. During this 4-week intern rotation, residents care for vulnerable populations, provide outreach, conduct health assessments, and participate in home visits in a community setting. Each intern develops an advocacy topic/campaign (gun safety, toxic stress, border separation, voter rights) to present at a resident noon conference. To further highlight the importance of this topic, a 3-week advocacy lecture series was incorporated into the core resident education curricula.ResultsEnhanced understanding of advocacy topics and increased interest in engaging in advocacy initiatives was demonstrated. The mean value-added score for the series was 1.52 (CI 1.35 to 1.7). There was improvement in understanding (decrease in score) within multiple topics. Pre-intervention understanding of public health insurance, school-based clinics, healthcare economics, and CBOs was 2.83, 2.67, 2.89, and 2.25 respectively. Post-intervention understanding of public health insurance, school-based clinics, healthcare economics, and CBOs was 1.61, 1.80, 2.00, and 1.55 respectively (p
81. COMFORT AND PERCEIVED VALUE: PARENT VIEWS OF TRAINEE PARTICIPATION IN
PEDIATRIC CARE
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Jessica C. Babal, Daniel J. Sklansky, Megan A. MorenoIntroTrainees require progressive autonomy to prepare for unsupervised practice as physicians. Studies show that patients largely accept trainee participation in their own medical care, but little is known about parental perceptions of medical student and resident engagement in pediatric care.MethodsWe conducted a national cross-sectional online survey of parents with at least one child under 18 years. The survey used 5-point Likert scale to explore acceptability, desirability, and perceived value of medical student and resident involvement in pediatric care. The survey also assessed parent comfort with progressive trainee autonomy in the clinical encounter. The Wilcoxon rank sum test was used to compare means for Likert scale responses, p
80. DOES MY TEAM REALLY NEED OUR ATTENDING' PERCEIVED AUTONOMY OF
ATTENDING-LESS ROUNDS
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Rustin A. Meister, Alicia Williams, Travis W. Crook, Alison Herndon, Whitney Browning, Rebecca R. Swan, Patricia A. Hametz, Priya N. JainBackgroundAccording to accreditation guidelines, residents must demonstrate progressive autonomy over the course of training. Although desired, there is little data showing the impact on the perceived sense of autonomy of housestaff when rounding without an attending on an inpatient service.ObjectiveDetermine residents’ and interns’ perception of autonomy with and without the attending present on family centered rounds on a hospitalist general pediatric service in a tertiary children's hospital.MethodsResidents and interns who participated in standard family centered rounds and attending-less family centered rounds were given anonymous surveys asking about their ability to complete tasks autonomously on a Likert-type scale. Attendings completed a similar survey assessing their upper level resident. We averaged the standard rounds responses (pre-forms) and compared them to the attending-less rounds responses (post-forms). Comments were allowed for qualitative data.ResultsWe obtained surveys from 15 interns, 10 upper levels and 7 attendings who participated. Compared to the pre-surveys, residents felt more autonomous in 7/11 areas queried (p
78. APPLICANTS' WE HAVE AN APP FOR THAT!
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): LaGail Green, Andrea DelGiudice, Elise Gross, Marie Pfarr, Kayla B. Phelps, David A. Stewart, Lauren Helms, Thomas Saba, John Schmidt, Shane Quinonez, Heather L. BurrowsBackgroundLarge amounts of information are provided to applicants during the residency interview process. It is important to share this information in an efficient, environmentally sound, and engaging manner. Preparing information packets requires significant administrative time and results in discarded paper or unused flash-drives. OBJECTIVE We sought to eliminate paper documents, minimize administrative effort, and streamline communication during interview season.MethodsWith the assistance of LegitApps Company we designed an app for Android and Apple devices that allows us to communicate in real time with applicants. The app delivers all required documentation prior to the applicant's arrival. It provides interview day schedule details and logistics, maps to their specific pre-interview dinner, and helps with navigating our city (finding hotels, identifying places to eat, highlighting fun things to do, etc). An easy to complete interview day survey is automatically pushed to all applicants at the end of the day. After initial programming, only minimal maintenance was needed by our administrative staff throughout the season.ResultsThe app was downloaded 522 times this season. Based on results from the end-of-the-day survey, almost all 353 applicants downloaded the app. They appreciated the streamlined communication and hub for information. They used it to find Uber rides, book hotels, explore the city, and to prepare for their interview day. By eliminating paper, we saved money and manpower, allowing our staff to dedicate their time to the applicant experience. Survey comments include: “I appreciated the UM Pediatrics App, as it made the resources easy to access and reference throughout the day” and “I liked the App and that you tried to save some trees and not print out all of the information.”ConclusionThe app successfully conveyed information efficiently to applicants and decreasing the administrative workload. We plan to expand the app to include our fellowship programs and are working with other programs at our institution to develop similar apps for their programs.
76. IMPLEMENTATION AND EVALUATION OF A COORDINATOR-LED, PEDIATRIC PROGRAM
COORDINATOR MONTHLY EDUCATIONAL SERIES
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Megan K. Christofferson, Sara L. Salem, Charlene L. RotandiBackgroundWith ever expanding requirements from the Accreditation Council of Graduate Medical Education (ACGME), the role of the program coordinator has grown, necessitating updated onboarding materials for new coordinators and continuing education for experienced coordinators. While the need for coordinator education and professional development is well-established, there remains the question of who should provide such education. A needs assessment at a single institution of coordinators representing 177 programs (111 ACGME accredited residencies and fellowships, 66 non-ACGME accredited fellowships) found that although monthly meetings were provided by the Graduate Medical Education Office, gaps still existed in the knowledge and engagement of coordinators across-the-board. 86% of coordinators surveyed indicated that coordinator professional development is very important and needed.ObjectiveTo create and assess the impact and feasibility of a coordinator-led educational series for pediatric program coordinators.MethodsThe Department of Pediatrics at Stanford University School of Medicine instituted a monthly, coordinator-led educational series. Three coordinators organized the series, with a total of nine coordinators collaborating on presentation of topics. Over a period of 18 months, 20 distinct topics were delivered, with some topics being repeated (Figure 1). Participants were asked to rate the entire series as a whole at the end of the 18-month period. Descriptive statistics were used to analyze the results.ResultsOf 19 pediatric coordinators, 18 completed the final survey (95%). Coordinators reported they were satisfied with the series (94%), likely to recommend to new coordinators (100%), and likely to recommend to experienced coordinators (82%). C-TAGME and opportunities for national participation were identified as topics that would be useful for future sessions. Comments underscored that rolling topics were necessary for new coordinators but would be repetitive for experienced coordinators. The time spent in organization and preparation of the series was estimated at eight hours a month.ConclusionThe implementation of a program coordinator-led educational series was found to be feasible and satisfactory, with coordinators likely to recommend the series to others. More work needs to be done to determine the best format, frequency, and topics for a coordinator-led series.
75. IN PURSUIT OF UNINTERRUPTED EDUCATION: TRANSITION FROM A NOON
CONFERENCE TO AN ACADEMIC HALF DAY
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Morgan H. Khawaja, Mason Walgrave, Mark Siegel, Jordan Newman, Sarah YaleIntroductionThe Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to provide regularly scheduled didactic sessions. The ACGME does not, however, dictate the format of these didactic sessions, and traditionally programs have opted for a daily noon conference (NC). The daily NC format often leads to poor conference attendance for a variety of reasons including resident duty hour restrictions, clinical responsibilities, and increased off-campus rotations. Without clinical coverage, conference attendees are often interrupted to answer pages and phone calls, leading to poor participation in these learning sessions. In response to resident criticism of the NC structure, our institution transitioned to a pager-protected Academic Half Day (AHD) model in which didactic sessions are delivered in a single weekly afternoon learning session.MethodsSecond and third year residents (n=21) were surveyed at the start of the AHD transition and 5 months later using a five point Likert scale. Results were not statistically significant, likely due to lack of power with 21 participants. However, there was an overall trend of improvement between the two survey time intervals. Most notably, the areas showing the greatest improvement were: ability to arrive on time, frequency of interruptions, frequency of leaving early, perception of retention of medical knowledge, and overall satisfaction [Fig 1]. In addition, overall resident attendance increased from 50% with a NC model to approximately 80% with a AHD model.ConclusionTransitioning from a NC to an AHD model improved overall resident satisfaction and provides a better learning environment with uninterrupted time for medical education. Follow-up data will assess the AHD impact on resident wellness and knowledge retention via analysis of in-training exam scores and ultimately Pediatric Board Exam scores.
68. EVALUATING THE PERCEIVED EFFECTIVENESS OF PEDIATRIC INTERN ORIENTATION
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Sabrina Ben-Zion, Ndidi Unaka, Lori Price, Rebecca WallihanBackgroundEffective means of preparing interns for transition to residency remains elusive. Recent studies indicate program directors perceive new interns to be underprepared for residency. While intern orientation is ubiquitous, content can vary greatly and often does not assess trainee competence.ObjectiveTo determine the content of intern orientation across several pediatric residency programs and evaluate intern perceptions of the effectiveness of orientation.MethodsThis cross-sectional study included pediatric residency programs in the Mid-America region. A survey with questions regarding orientation activities including content, allotted time, format, and assessment was sent to 24 program directors. Current interns at these programs were surveyed regarding their perceptions of the effectiveness of activities completed during orientation. Descriptive statistics were used to analyze survey responses.ResultsFifty-eight percent of program directors responded to the initial survey. Median time in orientation was 65.5 hours (range 30-120). Variation was noted across programs in content and format. Only 9 activities were represented among all survey participants. Additionally, 93 interns from 15 programs completed the intern survey. Approximately 80% of interns perceived the overall time spent in orientation was “just right”; however, 37% felt too little time was spent on orientation to intern roles, and 38% perceived that too little time was spent on review of clinical skills. Fifty-four percent of respondents felt electronic health record training was slightly or not at all effective.ConclusionsPediatric intern orientation varied across the institutions surveyed and intern responses indicate that time on clinical skills and intern roles should be increased. This study is the first to characterize the activities included in pediatric orientation and their perceived value to interns. Next steps include expanding the study to additional pediatric programs and utilizing findings to help inform best practices for orientation and onboarding of pediatric residents.
67. YEAR ONE OF A NEW RESIDENCY PROGRAM: REFLECTIONS FROM THE INAUGURAL
INTERN CLASS TO LEADERSHIP
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Benjamin L. Moresco, Adam D. WolfeBackgroundAs the number of graduating medical students is increasing, the number of residency positions is remaining the same. One solution to this problem is the creation and accreditation of new residency programs to help bridge the gap. However, the distinct challenges and opportunities that new training programs present for learners and faculty have not been extensively studied or described.ObjectiveDetermine and understand the distinctive perspective of a group of resident physicians who served as the inaugural interns in a new categorical pediatrics residency program.MethodsWe conducted a modified qualitative analysis of themes to generate resident perspectives. Seven residents (70% of the total class) agreed to answer six initial open-ended questions followed by a analysis of themes. These residents then met as a group and identified three consensus themes in each of the three topic areas: Strengths, Challenges, and Lessons Learned from a new program. In small working groups key areas were investigated and themes were consolidated, reviewed and edited for flow by faculty over a 2-month period and presented in a summarized form.ResultsResidents described strengths of participating in a new residency-training program as the opportunity to shape the program, individualized learning experience, and enthusiastic and available faculty. They identified challenges of training in a new program as lack of upper level residents, diverse faculty expectations, resident morale, and coping with challenges. Lessons learned included themes of resident engagement, standard expectations and feedback, and resident driven wellness.ConclusionsOur inaugural class of residents identified the key challenges and opportunities of training in a new program. These perspectives should prove informative for educators who are planning new programs in graduate medical education.
63. THE NEXT MORNING: MODIFICATIONS MADE ON ROUNDS TO ORDERS PLACED BY
OVERNIGHT ADMITTING RESIDENTS
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Eli Freiman, Laura Chiel, Julia Yarahuan, Chase Parsons, Christopher Landrigan, Ariel WinnBackgroundAn increased focus on quality and safety has resulted in increased resident supervision by attending physicians. At our large pediatric academic medical center, the overnight shift is when residents admit general pediatrics patients without immediate attending supervision. As such, admission orders are not evaluated by an attending until morning rounds. To the authors’ knowledge these orders have not been previously evaluated in the academic literature.ObjectivesTo categorize orders placed by residents overnight that were subsequently discontinued on medical rounds the next morning and to examine the reasons for those changes.MethodsWe utilized our hospital's Enterprise Data Warehouse to generate a report of all orders placed on newly admitted patients by residents on the general pediatrics night shift over a 12-month period that were subsequently discontinued the following morning on rounds. All charts were reviewed by two independent reviewers. Orders were categorized by type of order and perceived reason for discontinuation. Disagreements on categorization were discussed with the research team until consensus was achieved.Results290 discontinued patient orders were included in the analysis. Inter-rater agreement was very good with a kappa of 0.91. 66% of orders were medicines, 11% were diets, 4% were diagnostic testing, and 19% were for patient care. Within medication orders, 29% were antibiotics, 17% were antiasthmatics, and 10% were non-narcotic analgesics. The reason for order discontinuation was due to a change in clinical trajectory in 44% of cases (98% of which was patient improvement), primary attending decision in 11% of cases, and due to medical errors in 8% of cases. The most common medical error was a duplicate order (37.5%).ConclusionsThis study suggests that admission orders placed by pediatrics residents overnight are clinically appropriate. Medical errors were most commonly duplicate orders. This pilot identifies the need for further study to better understand the overnight care delivered by residents and to identify areas for increased resident autonomy.
61. DO PEDIATRIC FELLOWS MEET THE EXPECTED LEVEL OF SUPERVISION AT
GRADUATION'
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Richard Mink, Carol Carraccio, Bruce Herman, Angela Myers, Jill J. Fussell, David A. Turner, Sarah Pitts, Jennifer Kesselheim, Jeanne Baffa, Pnina Weiss, Cary Sauer, Shubhika Srivastava, Mary E. Moffatt, Susan Halbach, Alan SchwartzBackgroundAt the end of training, fellowship program directors (FPD) attest that graduating fellows are competent to practice without supervision, but there are no agreed upon criteria on which to base this decision. Entrustable Professional Activities (EPAs) may provide an approach to determine if fellows are meeting a set standard. We examined whether graduates from the pediatric fellowships are meeting the minimum level of supervision for 6/7 common subspecialty EPAs.MethodsThe Subspecialty Pediatrics Investigator Network (SPIN) recently surveyed FPDs (response rate 82%) asking them to identify the minimum level of supervision expected for a graduating fellow for the common pediatric subspecialty EPAs (table). Consensus for the expected level was set at the 80th percentile. Achievement of these levels was then examined using data from a previous SPIN study in which Clinical Competency Committees assigned a level of supervision for graduating fellows for each EPA using 5-level scales. The number of fellows who met the minimum levels was determined and differences among subspecialties examined.Results331 graduating fellows of ∼1275 graduates (26%) were assessed. 91% (n=302) met minimum levels for all 6 EPAs, 5% (n=16) met 5 and 4% (n=13) met 4 or fewer. For the Consultation and Handover EPAs, 22 (7%) and 10 (3%), respectively, did not meet minimum levels and 23 (7%) did not meet levels for both. There were differences among the subspecialties (p
60. NEEDS ASSESSMENT AND EARLY EXPERIENCE USING PEDIATRIC SUBSPECIALITY
EPAS AS A FORMATIVE ASSESSMENT TOOL
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Eric P. Velazquez, Antoinette Moran, Brandon Nathan, Emily Borman-ShoapBackgroundCompared to semi-annual Milestone-based assessment models of fellowship training, Entrustable Professional Activities (EPAs) may be better at assessing fellow development. EPAs' formative assessment capabilities are unknown, nor have they been adopted as a method for evaluation. The use of EPAs' entrustment scales could allow for more specific, actionable feedback from faculty during training.MethodsIn a pilot study, we created a needs assessment on feedback in pediatric fellowship training and a readily accessible online EPA assessment form. Fellows use the form to ask faculty to choose EPAs to assess following a clinical experience. Fellows from Neonatology, Endocrinology, Adolescent Medicine, and Developmental & Behavioral Pediatrics were recruited. Fellows are asked to obtain a minimum of four EPA assessments monthly. Time spent completing forms and providing feedback is recorded for each encounter.Results20 faculty, 4 program directors and 9 fellows completed the needs assessment. 77% of fellows reported current Milestone-based feedback aided their professional development, but only 60% were satisfied with the quantity and quality of feedback received. 80% of faculty believed fellows were provided adequate feedback using Milestones, but only 50% reported they provided good feedback. Faculty identified many barriers to giving good feedback using Milestones. 85% felt use of a structured EPA template and more frequent opportunities would improve their feedback. In the first 4 months of the pilot, 27 episodes of EPA based feedback occurred. 12 different faculty members have provided feedback using the template. The most often used EPA was Lead Team while Public Health was least used. An average of 9 minutes of feedback per assessment was reported.ConclusionsOur pediatric faculty and fellows feel an opportunity exists to improve the quality and quantity of feedback from our current Milestone approach. An online EPA tool is being used by faculty and fellows to provide more frequent feedback. Future assessments will evaluate the utility and specificity of feedback provided.
59. FELLOW SELF ASSESSMENT USING THE PEDIATRIC SUBSPECIALITY EPAS
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Eric P. Velazquez, Antoinette Moran, Brandon Nathan, Emily Borman-ShoapBackgroundAs an alternative to milestone based evaluations, Entrustable Professional Activities (EPAs) may provide a more specific and useful feedback tool for fellow training. Assigning a level of entrustment on an EPA coupled with qualitative comments, shows promise as a real-time feedback approach. Although the EPAs are being studied as a summative assessment tool in fellowship training, their formative assessment capabilities remain unknown. In addition, fellows self-assessment on EPAs has not been well-studied.MethodsAs part of a pilot study, we created an online EPA assessment form. Pediatric fellows from four divisions (Neonatology, Endocrinology, Adolescent Medicine, and Developmental and Behavioral Pediatrics) were recruited. As part of a needs assessment on feedback in fellowship training, the participating fellows were asked to provide self-assessment via the 6 core pediatric subspecialty EPAs using the established scoring benchmarks.ResultsNine fellows completed the needs assessment survey: 3 first year, 4 second year, and 2 third year fellows. Lead Subspecialty had the lowest average score of 2.78, with Handovers having the highest average score of 3.67. Fellows rated themselves as trusted to practice without supervision for Fiscal Management and Handovers, whereas fellows at all levels of training rated themselves as needing at least indirect supervision for the EPAs related to Consultation, Public Health, and Lead Team.ConclusionsOur pilot establishes preliminary data of where fellows feel their level of entrustment is at the beginning of the academic year. Variability in self-assessment may be related to unfamiliarity with the rating scale, true variation in fellow skillset, or may represent re-appraisal of skills as fellows advance in development. Use of the EPA assessment scale and more frequent assessments we hope will increase familiarity with EPA scale and improve fellows’ ability to reflect on development. Fellows self-reported need for at least indirect supervision on most EPAs highlights the need for ongoing coaching and supervision throughout all three years of training.
55. UTILITY OF RESIDENCY MILESTONES REPORTED TO FELLOWSHIP DIRECTORS: A
NATIONAL SURVEY OF PEDIATRIC FELLOWSHIP PROGRAM DIRECTORS
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Suzanne Reed, Richard Mink, Su-Ting LiBackgroundThe Accreditation Council for Graduate Medical Education (ACGME) requires milestone-based assessments of residents and fellows. The ACGME recently allowed fellowship programs access to the final residency milestones for incoming fellows through the ACGME Accreditation Data System. It is unknown if fellowship programs are downloading residency milestones and if fellowship program directors (FPDs) believe they have value.ObjectiveDetermine how many pediatric FPDs downloaded residency milestones and FPD perspectives on usefulness of residency milestones for first-year fellows.MethodsCross-sectional survey of pediatric FPDs in the US, with assistance from the Subspecialty Pediatrics Investigator Network (SPIN) Steering Committee. Respondents were asked whether they downloaded residency milestones and their programs’ specific use of these milestones for their first-year fellows. FPDs were asked open-ended questions about why residency milestones were or were not useful, how they could be more useful, and if they would be useful in recruitment. Descriptive statistics were used to explore quantitative data and content analysis was used to analyze qualitative data.Results66.5% (532/800) of FPDs responded, representing all 14 pediatric subspecialties. Most programs (60.7%; 323/532) did not download residency milestones for their first-year fellows. Of these, 67.5% (218/323) did not know they could. Of FPDs that downloaded and reviewed residency milestones, only 27% (50/185) used them for individualized education. Only 24% (129/532) of all FPDs thought residency milestones were useful or very useful. 41% (218/532) thought residency milestones would be useful or very useful during recruitment, but some believed this may harm applicants. FPDs felt residency milestones allowed for identification of trainee needs and baseline assessments, but felt that these milestones had limited usefulness during fellowship due to concerns about lack of validity evidence, relevance, and how milestones are assessed and reported (Table).ConclusionsMost pediatric subspecialty programs do not use residency milestones to tailor education for their first-year fellows and most think they have limited usefulness. While more FPDs felt that residency milestones might be useful during recruitment, there was not universal agreement. Further studies to improve validity of residency milestones may make them more useful to fellowship programs.
54. GENDER GAPS IN THE PEDIATRIC EMERGENCY DEPARTMENT: HOW DOES GENDER
AFFECT EVALUATIONS'
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Lydia M. Rabon, Jon F. McGreevy, Lucia MireaBackgroundThe emergency medicine literature reports a gender gap in milestone attainment. While residents receive similar evaluations at the start of residency, throughout training male residents receive milestone attainment at a faster rate across all EM competencies leading to a gender gap that continues until graduation. The field of both pediatrics and pediatric EM data shows that a higher percentage of female trainees and attendings are entering the specialty each year. Our study objectives were to test for gender differences in evaluations from both the learner and the evaluator and examine differences in scores between same and opposite gender evaluator-resident pairings.MethodsPediatric residents were assessed every month that they rotated through the Pediatric Emergency Department. Evaluations assessed 8 different competencies: procedural competency (PC), prioritizing and multitasking (PC2), management plans (PC5), medical knowledge (MK), physician accountability (PROF2), reliability (PROF5), handling uncertainty in medicine (PROF6), and interdisciplinary teamwork (SBP3). Statistical comparisons of each category were performed using the Kruskal-Wallis test at the 5% level.ResultsTotal evaluations included 69 male and 94 female resident rotations performed by 64 male and 99 female evaluators. Female residents scored higher than male residents on PROF5 and SBP3 and PROF6. Female evaluators scored residents higher in the areas of PROF2 and PROF6. Scores from same sex pairings (92) were higher than different sex (71) pairings for PROF2, PROF6 and SBP3. Also, female evaluators scored female residents higher than male residents on PROF2, PROF6 and SBP3 while male evaluators showed no difference.ConclusionBoth the gender of evaluator and gender of resident impact evaluation scores in the areas of PROF2, PROF5, PROF6 and SBP3. This study doesn't address the longitudinal gender gap previously reported but would suggest that, in pediatrics, female residents are evaluated with higher milestone competencies. Additional data collection and analyses will further understanding of the effect gender has on resident evaluations, and drive change towards gender-equal resident competency evaluation.
48. CONTINUITY CLINIC PRACTICE FEEDBACK: WHAT DO RESIDENTS WANT'
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Chad Vercio, Chris Peltier, Lori Price, Dominick DeblasioBackgroundThe Accreditation Council of Graduate Medical Education (ACGME) recommends that residents receive data on quality metrics and benchmarks related to patient care. Continuity clinic (CC) is an ideal setting to obtain practice habit data.ObjectiveTo determine which CC practice habit data residents would find beneficial to receive during feedback.MethodsA multicenter qualitative study was conducted with pediatric continuity clinic residents at 3 academic medical centers in two different phases. During phase 1, small resident focus groups were conducted at each site. The focus groups explored preferred content feedback on CC practice habit data. The qualitative data were reviewed by all investigators to identify major themes. For the second phase of the study, the results obtained from the focus group were used to develop a survey in order to determine how strongly residents felt about the particular areas of feedback that were identified in phase one of the study. This survey, which utilized a 5-point Likert scale to determine the importance of each feedback item, was sent out electronically to all categorical residents at each academic center. Results were analyzed with the mean and standard deviation for each question calculated.ResultsFocus groups were held at 3 sites with 3-10 residents per focus group. Consistent major themes which arose from the focus groups at all sites as desired areas to receive feedback on CC practice included the following categories: patient panel characteristics, quality measures, measures of efficiency in patient care, population management and information on specific patients. For the second phase of the study, 277 residents received the survey with 92 responding (33% response rate). The mean value that residents placed on the importance of each content area is displayed (table 1) with 1 being not important at all and 5 being very important.ConclusionResidents are interested in receiving practice habit data from continuity clinic. Presentation of the feedback described may enhance the resident continuity clinic experience and improve overall performance and enhance patient care.
47. DEVELOPMENT AND IMPLEMENTATION OF THE SCALABLE TOLERATING
AMBIGUITY/UNCERTAINTY TOOL UTILIZING SIMULATION (STATUS) TO ASSESS THE
PROF6 PEDIATRIC MILESTONE SUB-COMPETENCY: A PILOT STUDY
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Charles M. Bergman, Kevin M. ChingBackgroundUncertainty and ambiguity permeate the health care field. The Pediatrics Milestone Project identifies a sub-competency under the “Personal and Professional Development” competency stating residents must, “recognize that ambiguity is part of clinical medicine and respond by utilizing appropriate resources in dealing with uncertainty” (PROF6). A survey of pediatric program directors and simulation experts conducted by Mallory et al., ranked PROF6 as the most difficult sub-competency to assess using traditional methods.ObjectiveProof-of-concept assessment tool pilot to evaluate PROF6 in simulation.MethodsSTATUS is comprised of an “Instructors” assessment focused on direct observation of predefined skills, and a “Learners” self-assessment focused on subjective feelings towards ambiguity in practice. STATUS features items from the “Physician's Reactions to Uncertainty” scale developed by Gerrity et al., the “Pearson Risk Attitue” index developed by Pearson et al., and novel items derived from the Pediatrics Milestone Project Domains. Pediatric interns at an urban tertiary care medical center participated in a simulation scenario where there is substantial practice variation in managing a febrile infant. A trained standardized parent actor utilized scripted lines to elicit the interns’ position on the uncertain outcome of their child's condition.Results36/40 pediatric interns participated in our study. Interrater-reliability between the two instructors was calculated for our initial tool using a 5-point Likert scale (kappa = 0.705 [95% CI, 0.572-0.838]), and for modified versions of our tool using a 3-point scale (kappa=0.982 [95% CI, 0.957-1]).ConclusionSTATUS reliably assessed pediatric resident responses to ambiguity in an uncertain clinical situation. Next steps will be to incorporate the learner and instructor assessments to generate a combined appraisal of a resident's performance in PROF6. A multi-center study is planned to further validate and evaluate these assessments.
46. QUICK RESPONSE (QR) CODES ARE A MORE EFFECTIVE MEANS OF ELICITING
FEEDBACK FROM PATIENTS AND FAMILIES
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Jennifer Fishbein, Kimberly Lau, Stephen BaroneBackgroundMultisource feedback to residents is important for development and evaluation. In addition to traditional feedback from faculty, valuable feedback can be provided by patients and families. Previously, our program obtained family feedback via paper forms distributed on admission. This system resulted in a low response rate. Alternatively, Quick Response (QR) codes are an efficient means of gathering survey responses.ObjectiveTo determine whether QR codes are more effective than paper-based surveys in eliciting feedback for first-year residents from patients and families on inpatient units.MethodsA standardized set of questions, adapted from Child HCAHPS, asked patients and families for feedback on their experience with first-year residents throughout hospitalization. The survey included multiple-choice and free text response. A QR code was created to link directly to the online survey. Survey responses were collected using REDCap, a secure data collection web application. The QR code was introduced onto already existing Family Centered Rounds handouts, which include name, role, and picture of each team member. At the start of each inpatient service month, first-year residents were briefed on project goals and expectations via e-mail and at required unit orientation. Study designers monitored response rate. Number of online survey responses was compared to the number collected using the previous paper-based method.ResultsIn the first few months of the initiative, there were 30 completed feedback surveys. This was already a 7-fold increase from the previous year, during which only 4 surveys were collected via the paper-based method.ConclusionsQR codes are a feasible and more effective method of eliciting feedback for first-year residents from patients and families on inpatient units. The use of a QR code decreases a barrier inherent to paper-based survey collection. Future directions include improving response rate by devising new strategies to involve patients and families and evaluating the effect of receiving feedback on first-year resident engagement with patients.
44. DEVELOPMENT OF A TOOL FOR FACULTY TO ASSESS RESIDENT-LED LARGE GROUP
TEACHING
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Ariel S. Frey-Vogel, Kristina Dzara, Kimberly A. Gifford, Erica Y. ChungBackgroundResidency programs are required to develop residents as teachers. Much of the formal teaching by residents occurs in group settings; the existing published tools did not collect validity evidence for assessment of resident-led large group teaching. We aim to create a tool for faculty to assess resident teaching in this setting.MethodsInitial content for the tool came from literature review and our personal experience leading resident-as-teacher curricula. Resident focus groups provided stakeholder input, informing the first round of tool revisions. A modified Delphi panel of 14 international faculty experts, over 2 rounds of revisions, provided feedback on the tool's elements. Anchors were designed and finalized after a third Delphi round. Study investigators piloted the tool with 10 video recordings of senior residents teaching from the 3 sites. Cronbach's alpha was calculated for internal consistency and intraclass correlation (ICC) for interrater reliability.ResultsThe tool has 6 domains: learning climate, goals and objectives, content, promotion of understanding and retention, session management, and closure. Each domain contains 12 sub-elements which are described by 37 observable behaviors. The Cronbach's alpha was 0.88. The ICC was good or excellent for 13/37 sub-elements (35%), fair or poor for 22/37 sub-elements (59%) and the remaining 2 elements had no ICC score given no variability in rater scores.ConclusionA tool for faculty assessment of resident-led large group teaching was developed using robust methodology. In the pilot study, the assessed behaviors have good internal consistency, but low interrater reliability without rater training. In the next study phase, we will develop tool utilization standards, train faculty raters, and apply the tool to a larger video sample of resident teaching. We will collect validity evidence for the tool including ability to discriminate between novice and advanced teachers and its correlation with teaching milestones.
43. WHAT DO YOU WANT TO LEARN OR WORK ON TODAY': BENEFITS AND BARRIERS
TO ASKING RESIDENTS FOR SELF-IDENTIFIED LEARNING GOALS IN THE PEDIATRIC
EMERGENCY DEPARTMENT
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Pamela Fazzio, Emily Hardy, Meghan Chamberlain, Isabel Genecin, Jill Posner, John Shatzer, Kathy ShawBackgroundIn the clinical setting of the pediatric emergency department (PED), residents and preceptors may have a short-term relationship, such as a single shift. This poses challenges to performing learner assessment, selecting instructional strategies, and providing substantive feedback.ObjectivesWe used the conceptual framework that learner-driven goal-setting would increase engagement in learning and teaching, which would promote reflective feedback and guided discovery learning in the PED. The purpose of this study was to determine how asking residents to self-identify learning goals for their PED shifts affected residents’ and preceptors’ experiences with learning, teaching, and feedback.MethodsThis was a qualitative study with attending physicians and residents from fourteen training programs that rotate through an academic PED. Residents were asked to write a learning goal for their shift and to share it with their attending. Semi-structured interviews were conducted with a convenience sample of residents and a purposive randomized sample of attending physicians about their experience. Interviews were audio-recorded, transcribed, parallel coded, and analyzed until thematic saturation was reached.ResultsDuring the 19-week study period, 358 unique learning goals were collected. Nineteen residents and ten attending physicians were interviewed. Major themes included: (1) Goal-setting facilitated learning. Residents and attendings reported that learning was attending-dependent and identified multiple ways in which attendings facilitated accomplishing residents’ goals, such as prioritizing teaching on shift, doing verbal teaching, and directing residents to patients and resources. (2) Residents’ perceived weaknesses, future practice settings, and available patients informed their goals. (3) Goal identification helped determine residents’ educational needs, as there was often mismatch between resident and attending-identified goals. (4) Ideal goals were specific and achievable. (5) There were multiple barriers and facilitators to goal-setting, accomplishment, and feedback. The most commonly reported barriers to goal-setting, accomplishment, and feedback were the busyness of the ED, available patients, and resident difficulty creating goals.ConclusionsAsking residents to self-identify learning goals for their shifts in the pediatric ED as an instructional strategy facilitated perceived learning, goal accomplishment, and feedback.
42. WHAT DO YOU WANT TO LEARN OR WORK ON TODAY': FEASIBILITY OF ASKING
RESIDENTS FOR SELF-IDENTIFIED LEARNING GOALS IN THE PEDIATRIC EMERGENCY
DEPARTMENT
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Pamela Fazzio, Emily Hardy, Anna Weiss, Jill Posner, John Shatzer, Kathy ShawBackgroundIn the unique clinical setting of the emergency department (ED), residents and preceptors may have only a short-term relationship, such as a single shift. This poses challenges to performing accurate learner assessment, selecting ideal instructional strategies, and providing substantive feedback.ObjectivesThe aims of this study were to determine if implementing a formal process in which residents self-identified learning goals for their ED shifts was feasible and to characterize the goals that residents self-identified. We used the conceptual framework that learner-driven goal-setting would increase engagement in learning and teaching, which would promote reflective feedback and guided discovery learning in the pediatric ED.MethodsIn this prospective cohort study in the ED of an academic children's hospital, residents were prompted to write a learning goal for their shift on a study card. At the end of the shift, residents were asked three yes/no questions to determine if they had identified, accomplished, and received feedback related to their goal. Logistic regression was used to determine if shift time, number of residents on shift, PGY level, and residency program type were predictors of goal identification, accomplishment, and receiving feedback. Goals were categorized by the six ACGME core competencies.ResultsDuring the 19-week study period, residents completed 306 end-of-shift surveys (74% response rate) and identified 358 learning goals. Residents reported that they identified a goal 54% of the time, accomplished 89% of identified goals, and received feedback related to their goal 76% of the time. Residents were less likely to identify goals on evening shifts (odds ratio [OR]=0.62, 95% confidence interval [CI] 0.41-0.94). The odds of receiving feedback were greatest on an overnight shift (OR=3.66, 95% CI 1.87-7.14) and lowest on an evening shift (OR=0.19, 95% CI 0.10-0.37). The number of residents on shift, PGY level, and program type did not influence the odds of goal identification, accomplishment, or receiving feedback. Most learning goals related to Patient Care and Procedural Skills (56%) or Medical Knowledge (41%) competencies.ConclusionsAsking residents to self-identify learning goals for their shifts in the pediatric ED is a feasible instructional strategy. Residents were able to identify, accomplish, and receive feedback related to their goals.
37. NEEDS ASSESSMENT OF BOARD PREPARATION CURRICULA AND CERTIFICATION
RATES AMONG U.S. PEDIATRIC RESIDENCY PROGRAMS
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Miki Nishitani, Nicola OrlovBackgroundThe Accreditation Council for Graduate Medical Education (ACGME) requires pediatric residency programs to achieve an overall 70% pass rate on the American Board of Pediatrics Certification Exam. There is high variability in board preparation curricula among programs and minimal evidence showing which are the most effective in producing the highest certification rates.ObjectiveTo gain an understanding of the current board preparation landscape across pediatric residency programs and to evaluate the need for individualized and/or focused board preparation curricula.MethodsA survey was distributed to all U.S. pediatric residency program directors by the Academic Pediatric Program Directors (n=209; response rate=35%). Programs were anonymously asked about their demographics, average in-training examination (ITE) scores and board pass rates, board preparation styles, and whether they are individualized and/or required for certain residents. Survey results were analyzed using descriptive statistics and Fisher's exact tests.ResultsOverall, board preparation consists of a combination of lectures/didactics (n=68, 100%), completion of board-style questions (n=70, 98.5%), and/or a formalized comprehensive review course (n=68, 26.5%). While almost all programs required didactics (91.2%), only about half (52.2%) of programs required completion of self-directed questions for all residents. ITE scores were the most commonly used means of identifying which residents needed an individualized curriculum. Board pass rates were divided into 80% (above goal). Seven programs (10%) were considered below goal, while 13 (18.6%) were at risk. Table 1 shows that there is a statistically significant association between a requirement for completing self-directed questions and pass rates (p = 0.03). There were no statistically significant associations between other forms of board preparation and certification rates.ConclusionFuture efforts should focus on personalizing each resident's board preparation curriculum, especially based on ITE scores.
36. CHANGE IN RESIDENT KNOWLEDGE AND PERCEPTIONS OF DAILY PROGRESS NOTES
FOLLOWING AN EDUCATIONAL INTERVENTION
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Helen G. Waterman, Nicole L. Bentley, Daniel J. Sklansky, Michelle M. Kelly, Kirstin A. Nackers, Daniel P. Gorski, Kristin A. ShadmanIntroductionPhysicians enter residency with variable proficiency in note writing and knowledge of note purpose. Best practice guidelines give learners some direction, but may not provide adequate explanation about the importance and purposes of progress notes.ObjectiveTest the efficacy of a workshop intervention on changing resident knowledge, attitudes, and beliefs about progress notes.MethodsAn educational workshop was constructed by residents and faculty stakeholders based on review of the literature, institutional best practices, and a previously designed note assessment tool. Residents from a mid-sized pediatric residency program attended a workshop consisting of best practice didactics and small group work using the tool to assess example progress notes. Participants completed a 22-question online survey (Qualtrics) before and after the workshop to evaluate knowledge of progress note components and attitudes regarding note importance. Pre-post analysis was performed with Chi square testing for true/false questions and Mann-Whitney testing for Likert scale questions.ResultsPediatric residents (n=26, 79% response rate) completed the pre-intervention online survey, and 23 (70%) completed the post-intervention survey. Accurate response rate improved in 15/20 of the true/false content questions, with a statistically significant improvement in five of them (p
35. STRENGTHENING SELF-DIRECTED NIGHTTIME LEARNING THROUGH RESIDENT AS
TEACHER CURRICULUM
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Nisha Wadhwa, Sarah GustafsonBackgroundAs in many other residency programs, night rotations comprise a significant portion of the curriculum at Harbor-UCLA. The National Pediatric Nighttime curriculum is a robust educational resource that was created to address the gap in nighttime education and has been provided to our residents through a residency website, though limited data existed about usage after implementation. In our program, there are no in-house hospitalist attendings at night, which requires residents to independently lead learning. Our residents were not formally trained in teaching methods until this year.MethodsResident feedback about the inpatient pediatric night rotation was solicited in the form of an online survey. Respondents were asked to rate agreement with statements on a five-point scale. Prior to the implementation of changes to the nighttime curriculum, residents participated in a Resident as Teacher lecture series.ResultsWe obtained responses from 20 of 30 residents. 90% were not satisfied with the current state of nighttime education, and 95% did not use the nighttime curriculum. However, 80% stated that senior residents were preferred teachers. Based on these results, a strategy to increase accountability was instituted, while the Resident as Teacher intervention was ongoing. At the outset of the night rotation, expectations are now formally reviewed with assigned modules and associated questions which map to board content specifications. Completion will be tracked on the website. Resident satisfaction will be assessed in a follow-up survey at the end of the rotation, the first set of which will be available in February 2019.ConclusionsIn spite of the availability of nighttime curriculum, it is not being used at our program. This may indicate the need for increased mechanisms for accountability with residents, with the strategy of incorporating Resident as Teacher training to build confidence and positively frame teaching experiences. The interventions planned may be useful at other institutions with similar remote supervision from hospitalists.
33. DEVELOPING A BOOTCAMP TO INCREASE PEDIATRIC RESIDENTS’ COMFORT
BEFORE CRITICAL CARE ROTATIONS
- Abstract: Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Anyela Duque Suarez, Manu R. Varma, Jackie Z. Lui, Megha Thakkar, Jon F. Sicat, Sumon K. Das, Ketan KansagraIntroductionPediatric residents have limited exposure to critical care early in training. Orientation programs (“bootcamps”) have been described for graduating medical students and beginning fellows, but not for residents within pediatric training. We developed a bootcamp for rising senior residents beginning critical care rotations and hypothesized that the program would increase participants’ comfort with critical care.MethodsEleven PGY-2 pediatric residents completed the bootcamp prior to their first critical care rotation. Critical care and cardiac surgery attendings led the program and covered respiratory support including ventilation, shock including pressors, postoperative cardiac surgery care, and total parenteral nutrition. Outcomes were measured with a retrospective pre-post survey on a five-point scale, assessing residents’ comfort with initiating treatment, titrating treatment, and seeking assistance in each topic covered. Free text comments were also solicited. Data were analyzed using Wilcoxon signed-rank test with paired scores on each question and pooled data for all topics.ResultsParticipants reported increased comfort with initiating treatment (+1.44, Z = 5.16), titrating treatment (+1.44, Z = 5.23), and seeking assistance (+0.91, Z = 4.57), all p < 0.0001, 100% response rate. In free text comments, they reported that the sessions were valuable but that further training would be needed.ConclusionsA bootcamp for rising senior residents beginning critical care rotations increases comfort with critical care and may create a better experience during pediatric residency.