Stress Experienced During Pediatric Residency Training Program

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

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.

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.

This article describes the design of an innovative curriculum for pediatric residency newborn nursery rotation. In 1989, the Accreditation Committee for Graduate Medical Education added the requirement of newborn care to pediatric residency training; in 1996, the Accreditation Committee for Graduate Medical Education expanded that requirement. Specifically, certification required 4 weeks of newborn care, separate from any neonatal intensive care experience, and with at least 2 weeks in a newborn nursery. In response, we designed a structured newborn nursery curriculum for our pediatric residency training program. Three areas of focus were identified, from which the content and the strategies for teaching were derived. The areas of focus were (1). primary care, (2). confluence of levels of care that arise in newborn care, and (3). limitations and advantages of the structure and the environment of the rotation. The curriculum was implemented on a pediatric level 1 (PL-1) rotation entitled "primary care neonatology."

BackgroundGeneral pediatricians often initially address children’s musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients’ rheumatologic conditions. This study assessed the effectiveness of a structured curriculum in enhancing pediatric residents’ knowledge, MSK examination skills, and confidence during a 4-week pediatric rheumatology rotation.MethodsPediatric residents in their either second or third year who participated in the 4-week rheumatology rotation once across three academic years (July 2020–June 2023) were enrolled. Residents’ knowledge, MSK examination skills, and confidence were assessed at pre- and post-rotation by using 25 multiple-choice questions, the Thai pediatric Gait Arms Legs Spine examination, and a questionnaire, respectively. The curriculum comprised instruction on MSK examinations, interactive lectures, case-based discussion, topic reviews, MSK radiology conference, clinical experience in rheumatology clinic and consultations, with self-guided learning with educational resources.ResultsFifty-eight pediatric residents (48 females, 10 males) with a mean age of 28.9 ± 0.8 years participated. Significant improvements were noted postrotation. Knowledge scores rose from 63.0 ± 12.2 to 79.7 ± 9.1 (mean difference 16.7 ± 10.3, p < 0.001). Similarly, MSK examination scores increased from 67.5 ± 14.4 to 93.6 ± 8.7 (mean difference 26.1 ± 14.6, p < 0.001). Residents also reported a marked increase in confidence across all evaluated areas, including history taking, MSK examination, arthrocentesis, and diagnosing and treating rheumatologic conditions (p < 0.001).ConclusionsThe 4-week structured curriculum in the pediatric rheumatology rotation significantly enhanced pediatric residents’ knowledge, MSK examination skills, and confidence. These findings support the integration of pediatric rheumatology rotations into pediatric residency training programs.

Multiple-choice examinations were given three times each year in a pediatric residency training program. The test scores correlated highly with subsequent scores on the intraining examination of the American Board of Pediatrics. The results were replicated and cross-validated in another study the following year. Use of the local tests and the board examination to evaluate the residents makes it possible to provide continual feedback to the residents regarding the adequacy of their performance and feedback to faculty members regarding the effectiveness of the program. Local test scores can be used to predict the residents' standing on the national examination, and they provide a sound basis for counseling individual residents and for improving specific components of the training program.

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.

&lt;P&gt;This issue of &lt;cite&gt;Pediatric Annals&lt;/cite&gt;, the second of two issues devoted to updating pediatric health supervision guidelines for infants, children, and adolescents, takes Bright Futures beyond the practice setting and into the community. Implementing Bright Futures successfully can only be accomplished when all the child health disciplines and organizations in a region or state work together and share a common understanding and language of health promotion and prevention. &lt;cite&gt;Bright Futures Guidelines for the Health Supervision of Infants, Children, and Adolescents&lt;/cite&gt;, third edition, takes into consideration this broad perspective, as the writing for each age-stage section was co-led by a clinician and family partner. Acknowledging the importance of a multidisciplinary approach to child health, Bright Futures was developed for the medical home but with continued and extensive input from an array of community colleagues that brought to this edition a diversity of perspectives facing children and families at this time.&lt;/P&gt;&lt;h4&gt;ABOUT THE GUEST EDITORS&lt;/h4&gt;&lt;P&gt;Gregory S. Blaschke, MD, MPH, FAAP, is Captain, Medical Corps, U.S. Navy. Dr. Blaschke is currently the Medical Director of Simulation and a practicing pediatrician in the Department of Pediatrics, Naval Medical Center San Diego, California (NMCSD). His academic appointment as an Associate Professor of Pediatrics is at the F. Edward Hebert School of Medicine, Uniformed Services University, but he also teaches students and residents at the University of California-San Diego. After earning a B.S. in medical sciences at the University of Wisconsin, Milwaukee, he attended the Medical College of Wisconsin and completed his residency training at Naval Hospital, Oakland, California. He taught pediatrics to Family Practice Residents at Naval Hospital Charleston, South Carolina, prior to joining the teaching staff at NMCSD. Between tours at NMCSD, he completed a 3-year General Academic Pediatrics Fellowship at Boston Children’s Hospital, which included a clinical emphasis on Developmental and Behavioral Pediatrics. While in fellowship, he obtained a M.P.H. with concentration on Clinical Effectiveness from the Harvard School of Public Health and completed the Harvard-Macy Physician Educator program at Harvard’s Medical and Graduate School of Education.&lt;/P&gt;&lt;P&gt;As NMCSD Pediatrics Principle-Investigator for the San Diego Community Pediatrics Training Initiative (CPTI), he incorporated public health and community perspectives into both pediatric residency training programs in San Diego County. Dr. Blaschke has been involved in local and national faculty development efforts since 1996, conducting site visits at more than 40 training programs. Projects have focused on teaching and learning for faculty, residents, and programs including all aspects of curriculum development, implementation, and evaluation. He was awarded the 2006 AAP National Education award and is a current member of the AAP’s Committee on Pediatric Education. Dr. Blaschke is a former member of the Executive Committee of the Uniformed Services Section of the AAP, which focuses on faculty development and educational initiatives for more than 700 members. He is a current member of the AAP’s Program Advisory Committee for the Bright Futures Education Center, Pediatric Implementation Project, and Users Group. Prior work with Bright Futures includes membership on the Health Promotion Work Group, which assisted in re-development of the “&lt;CITE&gt;Bright Futures: Pocket Guide&lt;/CITE&gt;” and creation of educational materials for &lt;a href="http://www.pediatricsinpractice.org" target="_new"&gt;www.pediatricsinpractice.org&lt;/a&gt;, now also available in print form from Springer Publishing’s &lt;CITE&gt;Series on Medical Education&lt;/CITE&gt;. He is a National Partner for Implementation of a 3-volume text of standardized case-based curriculum, “&lt;CITE&gt;Bright Futures Case Studies for Primary Care Clinicians: Pediatric Education in Growth and Development, Behavior, and Adolescent Health&lt;/CITE&gt;,” available at &lt;a href="http://www.pedicases.org" target="_new"&gt;www.pedicases.org&lt;/a&gt;.&lt;/P&gt;&lt;P&gt;Judith S. Shaw, EdD, MPH, RN, is Research Associate Professor of Pediatrics at the University of Vermont College of Medicine and Executive Director, Vermont Child Health Improvement Program (VCHIP) since its inception in 1999. In addition, she is principal investigator for several federally funded projects designed to improve delivery of health care to children.&lt;/P&gt;&lt;P&gt;Dr. Shaw earned her nursing degree from the Children’s Hospital School of Nursing in Boston, and subsequently received a bachelor’s degree from Yale University, a master’s degree in public health from Boston University, and a doctorate in education from the University of Vermont.&lt;/P&gt;&lt;P&gt;Nationally, Dr. Shaw is the co-chair of the AAP’s Bright Future Steering Committee and Education Center Project Advisory Committee and co-editor of &lt;CITE&gt;Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents&lt;/CITE&gt;, third edition. In 2007, she received the Director’s Award from the Health Resources Services Administration’s (HRSA) Maternal Child Health Bureau (MCHB) and also Citizen of the Year from the Vermont Medical Society. She was a 2002 Department of Health and Human Services Secretary’s Primary Care Health Policy Fellow, a member of the Board of Directors of the Ambulatory Pediatric Association from 1999-2002, and currently serves on the Board of Directors at the Stern Center for Language and Learning in Vermont.&lt;/P&gt;

Background Learning environment in a pediatric specialist training program is complex and may influence trainees’ performance and achievement. We evaluated the trainees’ perception on learning environment and compared it between levels of the training. Methods We conducted a cross-sectional study to pediatric trainees in Pediatric Specialist Training Program at Universitas Gadjah Mada, Yogyakarta, Indonesia in May 2019. The data was collected online using the Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire, which was translated into Indonesian language and was self-completed by the trainees. Results All (136) trainees, which consisted of 35 (25.7%) junior, 44 (32.3%) middle, and 57 (42%) senior levels, completed the survey. The mean total score of PHEEM for all trainees was 108.10 (+ 17.03), which was not different between levels of the trainees. The mean scores for the role of autonomy, teaching, and social support were not different between levels of training either. Nevertheless, the junior scored less than the middle and senior trainees for questions on performing inappropriate tasks. Conclusion The learning environment of the pediatric training program in our setting was perceived good but improvement was required. There was no difference in perception of learning environment based on the level of the training.

To measure the prevalence of alcohol-related problems among pediatric trainees. An alcoholism screening test was administered anonymously to participants at a mandatory substance abuse education and prevention program. A large urban pediatric residency training program. One hundred fifteen pediatric residents attended the program during 3 consecutive years (1996-1998). Eighty-five (74%) screening tests were returned and 81 (70%) were analyzed The 25-item Michigan Alcoholism Screening Test (MAST). Differential MAST cutpoints have been established to "suggest" or "indicate" a lifetime diagnosis of alcoholism. Twelve residents (15%) had scores suggestive and 6 (7%) indicative of alcoholism. Twenty-eight (35%) admitted to having alcohol-associated amnesia (blackouts), 13 (16%) to "feeling bad" about their drinking, 9 (11%) to drinking before noon, 6 (7%) to getting into fights when drunk, and 2 (2%) to alcohol-related marital problems. However, only 1 (1%) had gone to anyone for help and none admitted to alcohol-related problems at work. These screening data suggest that alcohol abuse and related problems exist among pediatric trainees at troubling rates. While more than one third of the trainees had experienced a serious consequence from heavy drinking, only 1 had gone for help and problems were not apparent at work. Greater emphasis should be placed on alcohol prevention and early intervention programs as a routine part of pediatric training.

Appendectomy has traditionally been considered as a training operation for junior pediatric surgeons during their training period. However, with the increase of laparoscopic appendectomy, there has been a growing concern about the performance of this procedure by junior trainees. Our aim is to analyze intra-/postoperative appendectomy outcomes according to the number of training years during Pediatric Surgical residency training program. A retrospective study was performed in patients who underwent appendectomy between 2018 and 2021 in our institution, who were divided into 5 groups according to the number of training years of the junior surgeon who performed the intervention (Y1-Y5). Demographics, complicated appendicitis rate, operation time, and postoperative complications were compared. A stratified analysis according to the technique performed (open/laparoscopic) was performed. A total of 1274 appendectomized patients were analyzed, of which 1257 (98.7%) were operated on by junior trainees (81 in Y1; 407 in Y2; 337 in Y3; 261 in Y4; and 171 in Y5) without demographic differences between groups. As the year of training increased, an elevation in complicated appendicitis rate was observed, although without statistically significant differences. However, laparoscopic/open appendectomies ratio increased with increasing year of training (p < 0.001). Operative time decreased significantly with increasing year of training (p < 0.001), both in open and laparoscopic appendectomies. There were no significant differences in postoperative complications, nor in the stratified analysis according to surgical technique. Appendectomy performed by junior pediatric surgery trainees can be considered a safe procedure from the first year of training, regardless of the technique used.

To describe the establishment of pediatric clinical pharmacy services in a Malawian hospital as part of a pharmacy residency program's engagement in global health. While pharmacy is expanding its role in global health through the introduction of international advanced pharmacy practice experience (APPE) rotations at US schools of pharmacy, international experiences for pharmacy residents are currently very limited. Such programs are advantageous for pharmacists planning for a career in public or global health, and there is also great opportunity for clinical pharmacists to work with international partners for professional development and to help advance pharmacy practice. The University of North Carolina at Chapel Hill Eshelman School of Pharmacy recently expanded its international APPE rotation in Malawi into the postgraduate training space through creation of a pediatric pharmacy residency training program, with the specific aim of working with partners in Malawi to introduce pediatric pharmacy services at Kamuzu Central Hospital. As this was the first time there was a pharmacist involved in patient care on the pediatric wards, the focus for the participating pharmacy resident was on establishing a positive relationship with the medical team through providing high-quality collaborative patient care for the pediatric population. In addition to working to establish pediatric clinical pharmacy services, the resident further contributed to sustainable improvements in pediatric patient care by identifying areas for quality improvement. We discuss several considerations for the successful implementation of international experiences and their impact on participating residents. Pharmacy has an opportunity to build on the success of international APPE rotations and expand postgraduate offerings. Through collaboration with other institutions already involved in global health and identifying international rotation sites, residency programs across the country can create similarly beneficial global health experiences for their pharmacy residents.

Motivational interviewing (MI) is a collaborative, evidence-based, person-centred counselling style for addressing ambivalence about behaviour change. Despite its proven effectiveness, there is little formal instruction of MI in paediatric training programmes. Second-year paediatric residents participated in a 4-hour MI workshop, followed by a 1-hour small group review course and hands-on supervision during their Adolescent Medicine rotation. After the MI workshop, and again after their refresher course, we assessed residents' attitudes and skill with written and online surveys, as well as with a modified Helpful Responses Questionnaire (HRQ). Results revealed a statistically significant improvement in residents' confidence in eliciting health behaviour change [t-score(59)=3.76, p=0.008]. HRQ scores for all three clinical scenarios improved significantly following the workshop (p<0.000). Residents most valued the interactive components of the workshop and review course, particularly the practice exercises, videos/video vignettes, feedback and coaching. A standardised MI curriculum for paediatric residency training improved residents' confidence in eliciting health behaviour change and use of empathic, reflective language. The curriculum is both feasible and widely accepted by residents, with opportunities for residents to practise MI under supervision during resident training. In conclusion, providing a 4-hour MI workshop for paediatric residents, with reinforcement through a review course and clinical opportunities to practise MI under supervision, improved confidence in eliciting health behaviour change and the use of MI-consistent language. This innovative and time-sensitive effort could serve as a future model for MI training for paediatric residents. There is little formal instruction of MI in paediatric training programmes.

Patient handoffs are a key source of communication failures and adverse events in hospitals. Despite Accreditation Council for Graduate Medical Education requirements for residency training programs to provide formal handoff skills training and to monitor handoffs, well-established curricula and validated skills assessment tools are lacking. Developing a handoff curriculum is challenging because of the need for standardized processes and faculty development, cultural resistance to change, and diverse institution- and unit-level factors. In this article, the authors apply a logic model to describe the process they used from June 2010 to February 2014 to develop, implement, and disseminate an innovative, comprehensive handoff curriculum in pediatric residency training programs as a fundamental component of the multicenter Initiative for Innovation in Pediatric Education-Pediatric Research in Inpatient Settings Accelerating Safe Sign-outs (I-PASS) Study. They describe resources, activities, and outputs, and report preliminary learner outcomes using data from resident and faculty evaluations of the I-PASS Handoff Curriculum: 96% of residents and 97% of faculty agreed or strongly agreed that the curriculum promoted acquisition of relevant skills for patient care activities. They also share lessons learned that could be of value to others seeking to adopt a structured handoff curriculum or to develop large-scale curricular innovations that involve redesigning firmly established processes. These lessons include the importance of approaching curricular implementation as a transformational change effort, assembling a diverse team of junior and senior faculty to provide opportunities for mentoring and professional development, and linking the educational intervention with the direct measurement of patient outcomes.