Devaluing babies: neonatal implications of proposed changes in pediatric residency training.

Background Over the last twenty years, higher education, par-ticularly pediatric residency training, has changed dramatically. Aquestion arises whether the pediatric residency training conductedin Indonesia today has been set up to meet the changing as wellas the community needs.Objective To evaluate whether the pediatric residency trainingprogram in Indonesia today has met the changing as well as thecommunity needs.Methods Twelve centers with pediatric training program in Indone-sia were involved in this study. Each institution had various numberof respondents, with a total of 42 respondents. A structured ques-tionnaire with open responses was selected to ensure the varietyand flexibility of responses.The questionnaires included statementswhich encompassed areas such as curriculum, training and educa-tional system, and alumni achievement of educational objectives.Continuous content analysis of the responses was made.Results Coverage was considered adequate by 80% of respon-dents and was suggested to be continuously updated to be in linewith existing national problems but not yet considered internationalstandard. Additional knowledge and competence proposed by therespondents are mollecular biology, genetics, generic skills, com-munication skills, and introduction to sophisticated instruments. Thelength of the existing program was appropriate. Graduate knowl-edge was sufficient and fulfilled pediatric standards. Current pro-gram was different from that of the past. The objectives are compre-hensible. The placement of trainees enabled them to follow eachdivision in a spiral fashion (at least three times during the training).Conclusion The curriculum content of the training process wascontinuously updated to be inline with existing national problems.Additional knowledge, and competence, and the present lengthof study was considered appropriate. Graduate knowledge issufficient and fulfills pediatric standards. Furthermore, the objec-tives of the current program are clearer and placement of train-ees enables them to follow each division at least three times

Sir .—I write to laud the articles by Hoekelman 1 and Cohen and colleagues 2 in the February 1989 issue of AJDC . In looking at the balance between the financial needs of young people in pediatric training and the financial distress that institutions increasingly are incurring and are going to incur to an even greater degree, one wonders whether, in addition to some of the solutions suggested by the above authors, pediatric residency training should be changed, both at the training program level and at the American board level. Of the total 3 years in pediatric residency at our institution, 3 months are spent on vacation and 6 months are spent in electives. Of these electives, one is psychosocial and of definitive value in future practice. On the other electives, the resident acts as a junior fellow, by and large, doing the initial consultation on the patient for the fellow

The pediatric residency training on tobacco project: Baseline findings from the patient tobacco survey

To assess the current status of pediatric residency training on tobacco use and smoke exposure. A nationwide survey of all pediatric residency training directors in the United States was conducted from November 2010 to May 2011 via use of surveymonkey.com. The survey assessed training director characteristics, attitudes and beliefs about pediatricians' role in addressing tobacco control in patients and parents, past training in tobacco use and smoke exposure, inclusion of tobacco control in their training curriculum, and barriers to inclusion. Data are presented as percentages, with χ(2) tests of significance. Sixty-five percent of programs included tobacco control in the curriculum, and training directors who received past training in tobacco prevention and control were significantly more likely to include tobacco use and smoke exposure than those without training. The vast majority of training programs focused on health effects as opposed to intervention, failed to employ active learning to teach tobacco intervention skills, did not evaluate resident tobacco knowledge and skills, and did not encourage use of medications to help parents quit smoking. Pediatric residency training programs must do more to prepare residents to address tobacco use and smoke exposure. Given the many competing priorities of residency training, there is a need to explore new ways of integrating tobacco control into the 3-year curriculum.

Editorial introductions.

Editorial introductions

Editorial introductions

Editorial introductions

This study focused on investigating the educational value of combining standardised patient (SP) teaching videos with simulation-based medical education (SBME) in paediatric resident training. Forty paediatric resident trainees (June 2023-June 2024) were randomised into a control group (n = 20, routine teaching) and a study group (n = 20, routine teaching plus SP videos and SBME). Upon completion of the rotation, participants were assessed on clinical skills, clinical reasoning and theoretical knowledge. Professional qualities (questioning skills, information gathering, information provision and understanding patient perspectives), learning ability, learning interest, teamwork, mastery of subject content and teaching satisfaction were also evaluated. The study group achieved higher scores in clinical skills and clinical thinking (p < 0.05), while theoretical knowledge scores were comparable between groups (p > 0.05). Professional quality, learning ability, interest, teamwork and mastery of medical interview, communication, humanistic care and overall clinical competence were all superior in the study group (p < 0.05), with no difference in physical examination or clinical judgement (p > 0.05). Satisfaction with teachers' attitude, teaching methods and teaching effectiveness was higher in the study group (p < 0.05), but satisfaction with teaching intensity showed no difference (p > 0.05). The combination of SP teaching videos and SBME enhances clinical skills, professional qualities, engagement and satisfaction in paediatric resident education, offering a valuable supplement to conventional teaching.

Current Opinion in Pediatrics was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of pediatrics are divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. EDITOR Philip A. PizzoPhilip A. PizzoPhilip A. Pizzo, MD, is the David and Susan Heckerman Professor and Founding Director of the Stanford Distinguished Careers Institute, USA. Dr Pizzo served as Dean of the Stanford School of Medicine from April 2001 to December 2012, where he was also the Carl and Elizabeth Naumann Professor of Pediatrics and of Microbiology and Immunology. Dr Pizzo has devoted much of his distinguished medical career to the diagnosis, management, prevention and treatment of childhood cancers and the infectious complications that occur in children whose immune systems are compromised by cancer and AIDS. He has also been a leader in academic medicine, championing programs and policies to improve the future of science, education and healthcare in the US and beyond. Dr Pizzo received his MD degree with Honors and Distinction in Research from the University of Rochester, USA in 1970, and completed an internship and residency at Children's Hospital Medical Center in Boston, USA, a teaching fellowship at Harvard Medical School, USA, and a clinical and research fellowship in pediatric oncology at the National Cancer Institute. Pizzo served as Head of the Institute's Infectious Disease Section, Chief of the NCI's Pediatric Department, and Acting Scientific Director for NCI's Division of Clinical Sciences between 1973 and 1996. Before joining Stanford in 2001, he was the Physician-in-Chief of Children's Hospital in Boston and Chair of the Department of Pediatrics at Harvard Medical School, where he was also the Thomas Morgan Rotch Professor of Pediatrics. Dr Pizzo is the author of more than 615 scientific articles and 16 books and monographs, including Principles and Practice of Pediatric Oncology, the Seventh Edition of which was published in 2015. He co-led a multidisciplinary committee for the Institute of Medicine (IOM) that resulted in the 2011 report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research; he also co-chaired the IOM report Dying in America: Improving Quality and Honoring Individual Preferences at the End of Life, which was published in 2015. Dr Pizzo has received numerous awards and honors, among them the Public Health Service Outstanding Service Medal in 1995, the Barbara Bohen Pfiefer Award for Scientific Excellence in 1991, the Elizabeth Kubler-Ross Award in 2008, the Ronald McDonald Charities Award of Excellence in 2009, and the John and Emma Bonica Public Service Award in 2013. He is the 2012 recipient of the John Howland Award, the highest honor for lifetime achievement bestowed by the American Pediatric Society. He has been elected to a number of prestigious organizations and societies, including the Association of American Physicians, the American Society of Clinical Investigation, the American Pediatric Society and the Institute of Medicine of the National Academy of Sciences, where he was also elected to the Governing Council. The IOM became the National Academy of Medicine in 2015. Dr Pizzo has served as Chair of the Association of Academic Health Centers, and Chair of the Council of Deans of the Association of American Medical Colleges, and was elected to the Board of Directors of the American Society for Clinical Oncology and the Infectious Diseases Society of America. He was President of the International Immunocompromised Host Society (1998–2011). He served on the Governing Board for the California Institute of Regenerative Medicine from 2004–2012. In 2009 he was elected to the Board of Trustees of the University of Rochester and the Board of Overseers of Koc University in Istanbul, Turkey. He is also a member of the Board of Directors of MRI Interventions and the Academic Advisory Council for Merritt Hawkins. In 2014 he was elected to the Board of Directors of the Ludwig Institute for Cancer Research and in 2015 he was elected to the Board of Directors of Global Blood Therapeutics. SECTION EDITORS Susan M. BlaneySusan M. BlaneySusan M. Blaney, MD, is a Professor and Executive Vice Chair for the Department of Pediatrics at Baylor College of Medicine, USA and the Director of Texas Children's Cancer Center at Texas Children's Hospital, USA. She is a board-certified pediatric oncologist whose career over the past 25 years has focused on the development of new agents and therapeutic strategies for children with recurrent or refractory cancer, particularly for those with malignancies of the central nervous system. She has extensive experience in clinical translational research and currently serves as the Vice Chair for the Children's Oncology Group (COG), an NCI-funded cooperative effort of 200 leading children's hospitals across North America. Dr Blaney has played a leadership role in the development of numerous early phase clinical trials of novel agents for the treatment of childhood cancer over the course of her career. Dr Blaney has also served as a mentor to many pediatric medical students, residents, fellows and faculty who are current or developing leaders in the field of pediatric oncology. Her influence in the field also extends to numerous advisory roles that she has held including an service on the National Cancer Institute's Clinical Trial Advisory Committee, as a member of the Investigational Drug Steering Committee for the National Cancer Institute, as a regular consultant for the FDA's Pediatric Oncology Drug Advisory Committee, as well as for other leading cancer organizations such as the American Association for Cancer Research and the American Society of Clinical Oncology. She also directs or has served on the scientific advisory boards for many not-for-profit foundations for childhood cancer research. Dr Blaney has published more than 200 articles in peer-reviewed journals, has authored numerous book chapters, and is an editor for Rudolph's Pediatrics as well as an Associate editor for Pizzo and Poplack's Principles and Practice of Pediatric Oncology, the leading textbook in the field of pediatric oncology. Daniel W. GreenDaniel W. GreenDr Daniel W. Green has been practicing at the Hospital for Special Surgery, USA since 1998 and is currently the Director of the Pediatric Sports Program for the Division of Pediatric Orthopedic Surgery. While he thoroughly enjoys caring for patients from birth into early adulthood, he has a special interest in pediatric sports injuries and pediatric knee injuries, in addition to pediatric orthopedic trauma. He provides emergency treatment for pediatric fractures and other orthopedic emergencies at New York Presbyterian Hospital-Manhattan, USA and the Hospital for Special Surgery. His focus is to provide the finest, most advanced orthopedic care available and is devoted to advancing treatments in order to improve patient outcomes and the overall patient experience. His research focuses on pediatric knee surgery, cartilage repair and restoration, pediatric ACL surgery, pediatric growth plate surgery, pediatric fracture care, and osteogenesis imperfecta. He has extensively studied the surgical options for patellar dislocations, evaluating both conservative and surgical approaches to stabilizing the patella. He has also investigated surgical techniques for ACL reconstruction in the skeletally immature. Dr Green is a clinical professor of orthopedic surgery at the Weill Cornell Medical College, USA. Yvonne J. BrysonYvonne J. BrysonDr Yvonne J. Bryson is a Distinguished Professor and recent past Chief of Global Pediatrics Infectious Diseases at David Geffen School of Medicine at UCLA, Mattel Children's, USA. She is a world-renowned leader, researcher, virologist and clinician in the field of HIV pathogenesis, prevention, and treatment of maternal-fetal and pediatric HIV-1, and is an active member of the HIV CURE Scientific Committee of International Maternal Pediatric and Adolescent AIDS Clinical trials network (IMPAACT) and the Adolescent trials network for identification and treatment of HIV acute infection. She is past Chair of the NIH Network IMPAACT PMTCT Committee (Prevention of Mother-to-Child Transmission of HIV) as well as a previous past chair. She has served a national and international leadership role for the past 25 years in studies of prevention and treatment of pediatric HIV. She has served on the HIV Therapeutics Trans NIH panel to set the NIH agenda for the past eleven years. Dr Bryson was influential in the development of CDC and Public Health guidelines for the diagnosis and treatment of HIV-infected pregnant women and has been involved in the planning and execution of national cooperative studies of maternal-fetal HIV transmission. She has made significant contributions to the development of the original studies of the use of Zidovudine and Nevirapine for the prevention of perinatal HIV. She published studies of maternal risk factors for vertical transmission of HIV including viral load and autologous neutralizing antibody, as well as advances in the early diagnosis of HIV in newborns. Her research at UCLA has been funded by NIH for over twenty-five years. She has over 190 original peer-reviewed publications and is a sought-after lecturer and reviewer. She was founding advisor and one of the original health board advisors of the Elizabeth Glaser Pediatric AIDS Foundation, with co-founders Elizabeth Glazer, Susie Zeegan and Susan Delorentis, and colleagues Dr Richard Stiehm and Phil Pizzo. She participated and helped plan the EGPAF thinktanks, the Ariel Project, the Elizabeth Glazer Scientist Award, and fundraising strategies for the foundation and the role of NIH in promoting new investigators in the field. She also was involved in political activism in Washington DC and California with Elizabeth and cofounders to focus attention on children. Dr Bryson has served on numerous NIH study section reviews and panels. She had significant experience in global health issues related to reduction of maternal infant mortality and morbidity and meeting the millennium goals. Dr Bryson has had significant leadership and field experience setting up NIH funded clinical trials, laboratories and infrastructure in Brazil over the past 13 years. She has trained a large number of students and post-doctoral MD, PhD scholars and junior faculty who are now national and international leaders as academic faculty or public health professionals in the US and around the world. Dr Bryson is a strong advocate for mothers and children for the prevention and treatment of infectious disease and is now committed to the CURE for HIV. She still has active NIH RO1 grants for studies of HIV remission and cure in infants and children, collaboration on an infant maque monkey model, and most recently, studies in adolescents in Los Angeles and New Orleans. She is an expert in perinatal infections, pediatric infectious disease, antivirals herpes infections, and other viral, bacterial, and opportunistic infections, and serves as a pediatric infectious disease consultant. Henry H. BernsteinHenry H. BernsteinDr Bernstein is a Professor of Pediatrics at Hofstra Northwell School of Medicine in New York, USA. He taps into his extensive 32-year experience as a general pediatrician in private practice and in academia at urban, suburban, and rural children's hospitals to promote the health and wellbeing of children, their families, and their communities. His private, community-based primary care (generalist) experiences in combination with academic experiences have provided him with a value-added, translational science perspective, unique from many others in academia. This tacit knowledge enables him to fulfill a lifelong passion of communicating, educating, and translating science into clinical settings, educational venues, policy-making, and media interactions to advance the health of children. Research is consistently woven into the fabric of Dr Bernstein's clinical practice, which has served as a “laboratory” for his active studies. His research and quality improvement initiatives focus on issues important to Academic General Pediatrics and community-based practice, including immunizations, postpartum newborn discharge, childhood obesity, breastfeeding, health promotion, preventive health screening in primary care, technology, and medical education. His commitment, innovative spirit, and enthusiasm also encompass many facets of medical education along the continuum, from training and mentoring future physicians to fostering lifelong learning, to supporting the continuous professional development of practicing pediatricians. Hank is an ex-officio member of the American Academy of Pediatrics’ Committee on Infectious Diseases (Red Book Committee), Associate Editor of Red Book Online, and AAP liaison to the CDC Advisory Committee on Immunization Practices’ Influenza Workgroup, spearheading both seasonal and pandemic influenza preparedness and policy for children. In addition, he is Editor-in-Chief Emeritus of PediaLink, the AAP's online home for lifelong learning and chair of the interdisciplinary Bright Futures Health Promotion Workgroup, which has created a distinctive health promotion curriculum, videos, and a companion educational website (www.pediatricsinpractice.org). He regularly shares his knowledge and expertise by educating the public, writing for health information websites, and participating in media interviews on a variety of pediatric health care issues including immunization, diagnosis and treatment of common childhood infectious diseases and illnesses, and practical information for parents, teachers and caregivers. In the spirit of lifelong learning, Hank earned a masters in healthcare management at Harvard School of Public Health, USA, in 2013. He actively maintains his certification by the American Board of Pediatrics. He completed his residency training in pediatrics at St Christopher's Hospital for Children in Philadelphia, USA, after earning his medical degree from the University of Medicine and Dentistry of New Jersey - School of Osteopathic Medicine, USA. Hank and his wife, Sophie, have been married for 36 years and are extremely proud of their 31-year-old daughter, Lauren, and 26-year-old son, David.

A curriculum developed for pediatric orthopaedic residency training is described. The curriculum is practice based, emphasizing those components thought to be necessary for orthopaedic practice. Highly technical or esoteric topics are deemphasized, because they are not relevant to practice capabilities at the end of residency training. The curriculum is designed to serve as a guide for educational direction in pediatric orthopaedic residency training, and not as a description of competency. Resource materials are being developed to provide the educator with relevant clinical material, objectives, and bibliography. The advantages of a practice based curriculum warrant further development of this model for other orthopaedic subspecialties.

Pediatric residency training programs need regular revision, but there is little evidence to support changes. The recent reduction in time spent in the newborn nursery may negatively affect the care of infants in pediatric practice. This survey was undertaken to assess the preparation of recent graduates of training programs with respect to newborn care in their current practice. A nationwide survey was sent to 1997 pediatric residency graduates in May 1999. The American Medical Association Masterfile was used to identify pediatricians who met the criteria. The survey included questions about preparation and confidence in topics obtained from the Residency Review Committee guidelines for the newborn nursery. There were questions about duration of nursery experience, learning barriers, teaching preferences, current nursery responsibility, and practice location along with other information about the respondents. After 2 mailings, 801 surveys were received. Practice distribution was comparable to those who took the pediatric boards for the first time in 1997, and response was nationwide. Overall, 45% attend deliveries and 71% care for sick newborns. Respondents with only 1 month of normal newborn nursery felt this was insufficient preparation. Bedside teaching by faculty members was rated most highly. The most commonly rated areas of poor preparation were prenatal visits, perinatal infections, and management of breastfeeding issues. The current structure of nursery training in many residency programs may be insufficient preparation for primary care practice. Results of this and future surveys of recent graduates provide evidence to direct changes in residency training.

Although practicing pediatricians spend a major portion of each day in the management of acute illness via telephone, information concerning instructional programs in telephone management is scanty. A 34-item questionnaire was mailed to the 242 program directors of US training programs to obtain information on how telephone calls are handled in pediatric training programs and how pediatric house officers are trained in telephone management. Fifty-five percent of programs have a formalized system for handling telephone calls. One half of programs have a policy on who can answer telephone calls; 11% stated that only physicians are permitted to handle calls. Residents handle an average of 19 calls per day (39% of the total calls received). Only 51% of programs document any telephone calls and only 19% document all calls. Despite the volume of calls handled by pediatric residents, only 45% of training programs offer specific training in telephone management. The most common instructional method is lecturing. Less than one third of programs have a review system or periodically audit telephone calls. Programs that offer resident training in telephone management are significantly more likely to have a system for handling calls, to document calls, and to have a review system.

To evaluate the change over time of attitudes about withdrawal of care from hopelessly ill children among a cohort of pediatric residents. Prospective data collection via surveys. A pediatric residency program in a children's hospital. Pediatric residents beginning training in 1987 and 1988; 29 residents completed the study. Study participants completed a structured case-oriented questionnaire yearly from June 1988 through the completion of their residency training. The withholding of vasoactive agents or cardiopulmonary resuscitation, and the withdrawal of intravenous fluids, nutrition, or mechanical ventilation were the specific therapeutic options presented for a patient in a persistent vegetative state. The effects of time (further training) and parental wishes on resident decisions were assessed. No resident wanted to provide intensive care to a child in a persistent vegetative state who was in respiratory failure; all residents would withhold vasoactive agents and CPR from such a child. At the conclusion of training, most (97%) would withdraw mechanical ventilation. A minority would withdraw intravenous (IV) fluids (41%) or nutrition (35%). Residents became more willing to withdraw IV fluids from these patients (0/16 vs 6/16; P = .03) and to withhold or withdraw therapies in general (P = .03) over the course of their training. All of this change occurred over the first year of training. Parental wishes altered treatment plans for these patients significantly, both when parents desired additional treatment (P < .0001), and when parents wanted treatment stopped (P = .04). The residents' level of training had no effect on responses to parents' therapeutic requests. Although exposure to level of care issues occurs throughout pediatric residency training, almost all changes in trainees' attitudes occur during the first year. Efforts to promote effective learning and coping should be concentrated in this period.

Pediatric residents often finish their training lacking sufficient procedural proficiency and resuscitation experience in the care of critically ill children. Simulation is gaining favor in pediatric residency programs as a modality for procedural and resuscitation education. We reviewed the literature assessing simulation and its role in pediatric resident training. We conducted a Medline and PubMed search of simulation training in pediatric resident education from January 2007 to July 2012. Eight studies were included and divided into simulated procedural assessments and simulated resuscitation scenario assessments. The studies varied widely in their approach and analysis, and they yielded mixed results. Although some studies show the merits of simulation in the procedural and resuscitation training of pediatric residents, more research is needed to assess the effectiveness of simulation as an educational tool. Goals of future simulation research should include creation of validated assessment tools and applying skills learned to patient care outcomes.