Impact of implementing a structured patient handoff on communication in a pediatrics residency program.

A 2011 study evaluating oral health training in pediatric medical residency programs highlighted opportunities to improve residents' oral health competence. The aim of this 2017 follow-up study was to assess progress since 2011 in promoting development of pediatric residents' oral health competence. A survey was sent to all 281 pediatric and med-peds medical residency program directors to assess the structure and determinants of oral health training in their programs. A total of 110 program directors responded to the 2017 survey (response rate 40%). Just over half (54%) of the respondents reported that their residents received one to two hours of oral health education during residency, while 38% received ≥3 hours (compared to 47% and 48%, respectively, in 2011). There was improvement in the proportion of respondents reporting that their residents integrated fluoride varnish application training in 2017 vs. 2011 (83% vs. 43%; p<0.001). Departmental support for integrating oral health and having an oral health elective were significantly associated with satisfaction with residents' oral health competence. These findings suggest that pediatric and med-peds medical residency programs have improved their residents' oral health awareness and training through integration of at least one hour of oral health education and fluoride varnish training. However, given deficiencies in program structure and uneven perceptions of residents' oral health competence found in this study, opportunities remain to improve pediatric residency programs' oral health curricula.

As point-of-care ultrasound (POCUS) evolves into a standard tool for the care of children, pediatric residency programs need to develop POCUS training programs. Few POCUS training resources exist for pediatric residents, and little is known about POCUS training in pediatric residencies. We aim to describe pediatric residency leadership perspectives regarding the value of POCUS and to elucidate the current state of POCUS training in pediatric residency programs. A group of pediatric educators and POCUS experts developed a novel survey followed by cognitive interviews to establish response-process validity. The survey was administered electronically to pediatric residency associate program directors between December 2019 and April 2020. Program characteristics, including region, setting, and size, were used to perform poststratification for analyses. We performed comparative analyses using program and respondent characteristics. We achieved a 30% (58 of 196) survey response rate. Although only a minority of respondents (26%) used POCUS in clinical practice, a majority (56%) indicated that all pediatric residents should be trained in POCUS. A majority of respondents also considered 8 of 10 POCUS applications important for pediatric residents. Only 37% of programs reported any POCUS training for residents, primarily informal bedside education. Most respondents (94%) cited a lack of qualified instructors as a barrier to POCUS training. Most pediatric residency programs do not provide residents with POCUS training despite its perceived value and importance. Numerous POCUS applications are considered important for pediatric residents to learn. Future curricular and faculty development efforts should address the lack of qualified POCUS instructors.

The goals were to examine pediatric resident and program director experiences implementing the Accreditation Council for Graduate Medical Education work hour limits and to compare duty hours, moonlighting, and fatigue before and after the limits became effective. National random samples of 500 pediatric residents who graduated in 2002 and in 2004 were surveyed to compare resident duty hours and fatigue before and after the Accreditation Council for Graduate Medical Education limits were implemented. In addition, all US pediatric residency program directors were surveyed at the end of the 2003/2004 academic year, to provide a complementary retrospective examination of limit implementation. Totals of 65%, 61%, and 83% of 2002 residents, 2004 residents, and program directors, respectively, responded. The proportion of residents who reported working >80 hours per week declined from 49% for NICU/PICU rotations before the limits to 18% after limit implementation. Resident well-being was the factor identified most often by both residents and program directors as being improved since the limitations. Multivariate modeling also showed reductions in the proportions of residents who reported falling asleep while driving from work or making errors in patient care because of fatigue. Overall, 89% of pediatric residents and program directors reported that the current system is effective in ensuring appropriate working hours. Since the Accreditation Council for Graduate Medical Education duty hour limits went into effect, pediatric residents report working fewer hours and making fewer patient care errors because of fatigue. Although room for additional improvement remains, the experiences of residents and program directors suggest that implementation of the Accreditation Council for Graduate Medical Education limits in pediatric residency programs is improving resident well-being.

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.

Competence in basic orthopedic assessment and interpretation of radiographs is important for pediatricians because appropriate initial management of fractures can expedite therapy and minimize morbidity. However, requirements for training in orthopedics and radiology are poorly defined in pediatric residency programs. To assess the ability of pediatric residents to recognize and to manage appropriately pediatric fractures. This study involved administration of a case-based questionnaire with radiographs to volunteer categorical pediatric residents in 3 geographically diverse training programs. The diagnosis and management of 8 orthopedic complaints were evaluated. Responses were scored according to the number of features identified accurately, including the presence or absence of a fracture. Residents who were able to identify a fracture were assessed with respect to their ability to classify the fracture and to provide initial management. The study was pretested with a group of pediatric emergency medicine attending physicians, to establish the suitability of the cases. Among the 3 residency sites, 102 of 190 eligible pediatric residents (53.7%) participated, yielding 95 completed questionnaires. The mean number of cases in which a resident correctly answered the question, "Is a fracture present?" and correctly identified the fractured bone (if a fracture was present) was 6.5 +/- 1.2 of 8 cases (81.6%; 95% confidence interval: 78.5-84.7%). The diagnostic accuracy of Salter-Harris classification in cases in which such fractures were present was 40.9%. The mean score of correctly identified features for the resident group was 38.5 +/- 9.4, of a possible 64 points (proportion correct: 60.1%; 95% confidence interval: 57.2-63%). There was a small but significant difference in mean correct responses between first-year residents (proportion correct: 55.4%; 95% confidence interval: 50.8- 60.3%) and third-year residents (proportion correct: 65.1%; 95% confidence interval: 60.7-69.5%). There was no association between the proportion of correct responses and whether or not residents had taken radiology or orthopedics elective courses in medical school. Overall, 43% of cases were both identified and managed correctly by the pediatric residents. For residents from the participating training programs, skills in recognizing and managing pediatric fractures were suboptimal. Additional review of training requirements is necessary to identify more clearly areas of improvement for current curricula.

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.

To establish how many pediatric residency programs offer home visits, to assess the feasibility of making home visits as part of pediatric training, and to determine whether residents perceive home visits as worthwhile learning experiences. A questionnaire was mailed to all medical school pediatric departments in the United States and Puerto Rico to determine the prevalence of home visits during residency training. To study the feasibility of residents making home visits, a pilot program was instituted. Fourteen pediatric residents participated in the study. Each resident visited a house, trailer, apartment, or shelter for the homeless that was within a 20-minute radius from the medical center. To determine the educational value of home visits, each resident wrote a one-page report immediately on his or her return to the hospital. After about 6 months, all participating residents completed a questionnaire retrospectively evaluating their home visits. Interns who were neither on-call nor postcall the day of the visits were invited to participate. Patients were selected because they were homebound (eg, ventilator-dependent), had missed follow-up appointments, or had transportation difficulties. Thirteen percent of the pediatric residency programs surveyed currently include home visits. In all 14 of the pilot visits, the home was located without difficulty and the patient was at home. In each case, the family welcomed the visit. All the pediatric residents believed that the home visit was a worthwhile learning experience. Although very few programs (13%) currently offer home visits as part of pediatric residency training, such visits are feasible within a large urban area. Residents are enthusiastic about seeing how and where their patients live, and consider home visits a worthwhile learning experience.

Breastfeeding Education and Support Services Offered to Pediatric Residents in the US

Pediatric Resident Exposure to Urology: Identifying a Need

After completing their critical care rotations, pediatric residents are expected to have acquired skills in the resuscitation of critically ill newborns and children. Recent Accreditation Council on Graduate Medical Education (ACGME) guidelines have limited the time devoted to critical care training during pediatric residency. We sought to determine how individual programs have structured their critical care training experience in light of these changes. A questionnaire was mailed to each pediatric residency program listed in the 1996-1997 Graduate Medical Education Directory. Information was obtained regarding the structure of critical care training. Data were analyzed using descriptive techniques, one-way analysis of variance with Scheffé post hoc test, and Fisher exact test as appropriate. Data were received from 149 programs (71% response rate). Most programs were in compliance with ACGME standards regarding the number of months devoted to neonatal intensive care, pediatric intensive care, and emergency medicine. There were no significant differences in the total number of rotations in either the neonatal intensive care unit (NICU) or the pediatric intensive care unit (PICU) when the programs were stratified by size. There were no significant differences in the percentage of programs requiring night call in either the NICU or the PICU during off-service months. However, small programs (< 25 residents) required significantly fewer rotations in emergency medicine (P < 0.001). Most programs complemented the critical care experience by offering additional rotations and advanced life support training. Pediatric residency programs have structured their critical care rotations in a similar fashion in accordance with ACGME guidelines. The success in meeting the stated objectives, as measured by the ability of graduating residents to stabilize critically ill children, is not known and will require further study.

Background: The University of Rwanda is the only African residency to have implemented the pediatric International In-Training Examination (I-ITE) as a tool to monitor resident knowledge acquisition. The objective of this study was to better understand the acceptance and relevance of this exam to residents from this setting, and their perceptions regarding this assessment tool. Methods: A retrospective, survey-study was undertaken to describe candidate feedback. Immediately on completing the I-ITE residents provided feedback by filling in an electronic questionnaire comprised of four closed Likert questions and an open text box for free-text feedback. Participants were pediatric residents from the University of Rwanda, the only university in Rwanda with a pediatric residency program. Quantitative analysis of the Likert questions was undertaken descriptively using SPSS. Free-text feedback was coded and analysed employing a phenomenological approach, with coding and analysis undertaken by two researchers. Results: Eighty-four residents completed a total of 213 I-ITE sittings during the five exam cycles undertaken during the study period. The survey was completed after 206 of the 213 exam sittings, giving a response rate of 97%. Five themes emerged from the qualitative analysis; 1) undertaking the I-ITE was a positive experience; 2) exam content; 3) formative nature of the assessment; 4) challenges to completing the exam; 5) practicalities to undertaking the exam. Conclusion: Qualitative feedback demonstrates that the I-ITE, a standardized, and independent exam, produced by the American Board of Pediatrics, was valued and well accepted by Rwanda pediatric residents. Its formative nature and the breadth and quality of the questions were reported to positively contribute to the residents' formative development.

Alcohol and other drug use and misuse are increasing in pediatric populations. As part of a US Substance Abuse and Mental Health Services Administration resident training grant, we sought to demonstrate the feasibility and effectiveness of initiating screening, brief intervention, and referral to treatment (SBIRT) in a pediatric residency program. We evaluated the efficacy of a training program for all second- and third-year pediatric and/or medicine/pediatric residents in an adolescent medicine rotation located in an urban teaching hospital. Main outcome measures were pre-/post-training knowledge scores, performance of the Brief Negotiated Interview (BNI) as measured by the BNI adherence scale in pre-/post-training standardized patient encounters (SPE), training satisfaction, and tracking of BNI performance. Thirty-four residents were trained (30 in pediatrics and four in medicine/pediatric programs). The mean age of participants was 28 years (range, 25-35 years); 26 (76%) were women. Fifty percent reported 0-5 hours of didactic training in medical school and residency. Thirty-five percent reported that they never had formal or informal teaching regarding alcohol and drug problems in their residency. There was a significant improvement in knowledge scores pre-/post-training (20.5 versus 23.4, p < 0.001) and a significant improvement in BNI adherence scores during SPE (3.1 versus 8.4, p < 0.001). Residents were very satisfied with their training, reporting a score of 1.6 on a scale of one to five (one = very satisfied, five = very dissatisfied). Integrating an SBIRT curriculum into a pediatric residency program is feasible and effective in increasing residents’ knowledge and skills in performing screening and brief interventions among adolescents and young adults.

&lt;sec&gt;&lt;st&gt;Background&lt;/st&gt; The pressure to incorporate issues of global health into pre-/post-graduate medical curricula is increasing in order to provide new generations of doctors with a multicultural perspective on health care. Herein we update the experience of a partnership between the Paediatric Residency Program (PRP) of the Padua University (Italy) and the Non-Governmental Organisation ‘Doctors for Africa CUAMM’ (CUAMM), recently published in the Italian Journal of Paediatrics, which aims to offer residents the opportunity to attend a 6-month elective in Africa, called ‘JPO’. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Methods&lt;/st&gt; The constitutive elements of the JPO are: a memorandum-of-understanding between Padua University and CUAMM; periodic site-visits; candidate selection process; pre-departure educational course; preceptorship in Padua and Africa; personalised learning objectives and job description; hands-on experience; evaluation; feed-backs/reports. The African hospitals (Beira- Mozambique and Wolisso/Ethiopia) were chosen based on the presence of paediatrics in staff from CUAMM. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Results&lt;/st&gt; Between 2006 and 12/2013, 16 residents, aged 27–33 years, three attending the III, ten the IV and three the V year of residency consecutively joined the JPO. All worked in paediatric in-patient units; eight in out-patient clinics, six in emergency rooms, nine in community health centres. Thirteen were involved in teaching activities; six in clinical research. All residents completed successfully the 6-month elective and achieved their learning objectives. &lt;/sec&gt; &lt;sec&gt;&lt;st&gt;Conclusions&lt;/st&gt; To our knowledge no other European PRP provides international electives based on such strategic framework. We updated this experience convinced of the importance of stimulating a debate on this matter, of generating criticisms, ideas and hopefully inspiring similar experiences. &lt;/sec&gt;

Program Goals Professional standards and formal training opportunities related to physician use of non-English languages are lacking. Such standards and training are needed to assure high-quality, safe communication with culturally and linguistically diverse patients. Our objective was to describe the first decade of a culture and language coaching program for bilingual (Spanish-English) pediatric residents, including educational, clinical, and residency program outcomes. Evaluation We developed a culture and language coaching model for …

Evaluating Curricular Modules in the Care of Children With Medical Complexity: A Mixed-Methods Randomized Controlled Trial