Academic Pediatric Department Research Articles

A "global village": promoting research and careers in the pediatric radiology community through diversity.

There is a severe shortage of pediatric radiologists in the USA and across the globe due to multiple factors. These severe shortages, along with increased clinical demand, growing research costs and limited funding sources place pediatric radiologists, particularly those in academic departments, under increasing time pressure, affecting their ability to maintain research productivity. In this paper, we model a new concept that should help boost the research efforts within the pediatric radiology community, while diversifying the academic workforce through the involvement of international medical graduates (IMGs). We describe the mutual advantages this concept could have on academic pediatric radiology departments and IMGs alike, as well as pose some of the unique challenges that could impact this concept and effective strategies to ensure success.

Creation and evaluation of a participatory child abuse and neglect workshop for medical students

BackgroundSince child abuse and neglect (CAN) is prevalent worldwide, medical students should acquire basic knowledge, skills, and confidence in identifying and addressing CAN. Although significant educational efforts have been previously described, none has focused on using participatory methods to teach medical students CAN.PurposeTo: 1) develop a participatory educational workshop in CAN for medical students, 2) gather, train, and establish a peer-to-peer teaching group, and 3) assess the effectiveness of the workshop in gain of knowledge and improvement of self-confidence for participants.MethodsA two-hour workshop was created with role-playing, the use of mannikins and peer-to-peer teaching. A 15-item knowledge and a 9-item self-confidence questionnaire were used before, right after, and six months after each workshop.ResultsNine workshops in two academic pediatric departments with a total attendance of 300 6th year medical students were conducted. For the 69 students who completed the questionnaires at all three times, there were statistically significant gains in knowledge right after (p < .001) and six months after (p < .0001) the workshops. Similarly, self-confidence increased right after (p < .0001) and six months after (p < .001) the workshops. Self-selection bias testing indicated that these 69 students who completed all three questionnaires were representative of those who completed the pre-testing and the testing right after.ConclusionsWe successfully established a peer-to-peer teaching group to conduct nine participatory workshops that improved the participants’ knowledge and self-confidence in CAN. This feasible and novel active learning approach may help address inadequacies in medical curricula.

Multidisciplinary Health Care Professionals' Perceptions About Pediatric End of Life Discussions: A Cross-Sectional Survey and Needs Analysis.

Pediatric end of life (EOL) care involves complex coordination of providers from multiple disciplines. Many of these providers' experiences have not been completely described. This study aims to explicate the alignment and divergence of health care professionals' perceptions of the training, timelines, comfort, and effectiveness of pediatric EOL discussions as well as identify methods to improve medical education training. A cross-sectional survey was conducted. Analyses included Fisher's exact and post-hoc tests for all pairwise comparisons. A total of 160 of 508 eligible participants at a single academic Department of Pediatrics completed the survey (response rate 31%). Participants included attending physicians, fellows, residents, mid-level providers, nurses, and social workers. Sixty percent thought EOL discussions occurred late and 70% thought discussions should occur earlier. Attending physicians were more likely to think discussions occurred late and should occur earlier (P <.01). Residents and fellows were more likely to think participating in and leading discussions was stressful (P <.02 and P <.01, respectively). Respondents that were female, younger than forty years old, had been in their provider role less than five years, or were residents and fellows were more likely to agree that these discussions led to changes in plan of patient care (P <.05). The majority of multidisciplinary pediatric health care professionals believe pediatric EOL discussions are stressful, occur too late, and should occur earlier. Future efforts in medical education should prioritize curriculum development focusing on workshops and simulations.

Behavioral economics in neonatology-balancing provider wellness and departmental finances.

High work relative value units (wRVU) per clinical full-time-equivalent (cFTE) productivity by Neonatologists have played a key role in enhancing departmental revenue in Pediatrics. However, such high productivity is not sustainable due to recent changes in trainee schedules and global daily codes and is likely to impact physician morale and wellness. Incentives based on wRVU benchmarks have the capacity to promote desirable behavior such as better documentation and in-person attendance in delivery room resuscitation and consults but comes at a cost of physician time providing care. An alternate method of funding academic Pediatric departments using time- or point-based staffing models, a reduction in productivity benchmarks for academic neonatologists through more accurate reporting of effort and physician leadership that promotes transparency and mutual respect are warranted to improve neonatologist well-being and morale.

Effect of a Multispecialty Faculty Handoff Initiative on Safety Culture and Handoff Quality.

Introduction:Structured handoffs at transitions of care are vital components of patient safety. A safety culture survey showed that “handoffs and transitions” were among the lowest scoring dimensions at our hospital. We sought to improve physician handoffs and safety culture scores by implementing standardized handoff communication across multiple divisions of an academic pediatric department.Methods:We used a modified learning collaborative model to implement an I-PASS program, including training, standardized verbal handoff processes, observation and feedback, and sustainment. The setting was the Department of Pediatrics (DoP) within a tertiary academic children’s hospital encompassing 13 clinical divisions. The primary outcome was a change in the DoP staff physician “handoffs and transitions” score on the Agency for Healthcare Quality (AHRQ) Hospital Survey on Patient Safety Culture. Process measures included handoff duration and proportion of handoffs using the complete I-PASS mnemonic.Results:Five hundred sixty-seven physicians from clinical divisions participated over 14 months. One hundred percent of eligible physicians completed an introductory online I-PASS training module. The “handoffs and transitions” score improved from 46% to 54% from 2018 to 2020. From May 2019 to February 2020, the proportion of observed handoffs with all five elements of the I-PASS mnemonic improved from 62% to 100%, and the duration of handoffs per patient did not change.Conclusions:We successfully implemented an I-PASS program across an academic department of pediatrics. The departmental staff physician safety culture “handoff and transitions” score improved. The adherence to the I-PASS mnemonic improved. The duration of handoffs did not change over the study period.

Perioperative use of glucose containing solutions in infants less than 6months of age: A clinical practice survey among US academic centers.

Although there is a wide breadth of literature on glucose homeostasis in infants, standardization of perioperative hypoglycemia diagnosis and management is lacking. Survey of academic pediatric anesthesiology departments across the USA to evaluate institutional policies regarding the perioperative use of glucose containing solutions in infants less than 6months of age. A questionnaire was sent to 20 United States university affiliated academic pediatric anesthesiology departments. The responses suggest that, in the centers surveyed, glucose administration in infants is largely practitioner dependent. Two respondents (10%) claim to have a departmental policy regarding glucose administration in infants less than 6months of age. In premature infants, 75% of respondents administer glucose. When administering glucose, 75% of physicians surveyed replete infants at their maintenance intravenous fluid rate. There was discrepancy among practitioners regarding initiation of hypoglycemia treatment, 35% treat infants at a blood glucose level of 70mg/dl, 30% at BG 60mg/dl, 25% at 50mg/dl, and 10% are unsure. This survey highlights the lack of consensus, at least among pediatric anesthesiologists working in US academic centers, regarding blood glucose management in infants less than 6months of age. There is a need to define the indications for using glucose containing solutions in infants during the perioperative period, their ideal content, the appropriate thresholds for hypo- and hyperglycemia as well as the optimal point-of care glucose monitoring intervals.

Implementation of a Software Distribution Intervention to Improve Workload Balance in an Academic Pediatric Radiology Department.

In our pediatric radiology department, radiographs (XR) are the shared responsibility of the body section and interpreted in addition to modality or site-specific assignments. Given an unequal contribution amongst radiologists to the XR workload, a software solution was developed to distribute radiographs and improve workload balance. Metrics to evaluate the intervention's effectiveness were compared before and after the intervention. Data was retrieved from the radiology analytics platform, scheduling software, and the peer learning database. Metrics were compared 12months pre (March 2018-February 2019) and 6months post (March 2019-August 2019) intervention on non-holiday weekdays, 7 am-5 pm. To evaluate the intervention's effectiveness, variance between radiologists' contributions to XR volume was assessed using Levene's and Fisher's tests. Changes in turnaround times (TATs) and error rates pre- and post-intervention were evaluated as secondary metrics. Following the intervention, the average number of XR interpreted on target rotations increased by 8.9% (p = 0.011) while the departmental volume of radiographs increased only 4.5%. The variance between radiologists' daily XR contribution was 21.3% (p < 0.0001) higher prior to the intervention. Days where target rotations read fewer than 5 XR decreased from 17.8 to 1.1% (p < 0.0001) after the intervention. Days in which more than 75% of all XR had a TAT less than 60min improved from 26.8 to 39.7% (p = 0.017) after the intervention. There was no statistically significant difference in error frequency (error rate 2.49% pre and 2.72% post, p = 0.636). In conclusion, the software intervention improved XR workload contribution with decreased variability. Despite increased volumes, there was an improvement in turnaround times with no effect on error rates.

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

A national educational campaign to raise awareness of child physical abuse among health care professionals.

Education is necessary to improve child physical abuse detection and management. A few studies have described national child abuse training programs, but none has measured changes in knowledge among participants. A collaboration of child abuse experts from the USA, an academic pediatric department, and a non-governmental organization in child protection aimed at (a) training hospital physicians in a train-the-trainer course for the detection and management of child physical abuse and (b) conducting workshops and measuring attendance and gain of knowledge of participants. A train-the-trainer and a national curriculum were created. A 78-item and a 20-item knowledge questionnaire were used pre and post the train-the-trainer course and all workshops, respectively. Nineteen physicians from all pediatric departments of the seven medical schools in Greece attended the course. Eight workshops in seven cities took place with a total attendance of 1220 health care professionals. Gain of knowledge was demonstrated for participants in the train-the-trainer course (p = 0.0015) and local workshops (p < 0.001).Conclusion: We successfully engaged physicians from all medical schools in Greece and conducted a train-the-trainer module and eight workshops in major cities that improved the participants' knowledge in child physical abuse. This approach may help address physician deficiencies in emerging areas of child abuse clinical practice. What is Known: • Education is necessary to improve child physical abuse detection and management. • Although national training programs have been described, none has measured participants' changes in knowledge. What is New: • A collaboration of child abuse experts, all medical schools in Greece, and a non-governmental organization resulted in a national educational campaign in child physical abuse and gains in knowledge for participants. • This approach may help address deficiencies in emerging areas of clinical practice.

Gender Differences Among Academic Pediatric Radiology Faculty in the United States and Canada

It is currently unknown whether efforts in recent years to create equal opportunities for female faculty in academic medicine have succeeded. We looked at faculty members in academic pediatric radiology departments across the United States and Canada to assess for evidence of gender disparities and differences in academic performance between males and females. The analysis included diagnostic radiology programs across the United States and Canada, as specified by the American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA Online) and the Canadian Resident Matching Service website. The Scopus database was used to retrieve the H-index, number of publications, and number of citations for each faculty member. We examined the distribution of male and female faculty members across geographical regions, academic ranks, and leadership roles. Academic performance was also compared. Across all regions and academic ranks, disparities exist between the number of male and female faculty members. The greatest disparity was found amongst the professor rank, where more than 70% of positions were occupied by males. Female professors were found to demonstrate similar levels of academic performance compared to their male counterparts, although this parity was not observed amongst assistant and associate professors. Women occupied almost half (46.6%) of the total academic pediatric radiology workforce, despite having been previously shown to make up only 21% of radiologists. However, gender disparities currently exist among academic pediatric radiology faculty, with a significantly higher percentage of men in pediatric radiology faculty positions. Women, however, currently occupy a greater percentage of leadership positions compared to men, even though the majority of senior academic ranks are held by men.

Lesion Morphology in Multifocal Infantile Hemangiomas.

Multifocal infantile hemangiomas (MIHs; previously called neonatal hemangiomatosis) can be associated with extracutaneous hemangiomas. We observed different morphologic types of hemangiomas in children with MIHs and sought to find out whether they are related to the clinical course. This was a retrospective study of 103 infants with MIHs and a control group of 261 age-matched patients with solitary focal infantile hemangiomas (IHs) seen at an academic pediatric dermatology department between 2004 and 2014. Two morphologic subtypes of hemangiomas were identified: miliary focal hemangiomas (MFHs; small, lens shaped) in 58 of 103 MIH patients (56.3%), and classical nonmiliary focal IHs (NMIHs; larger, irregularly shaped) in 17 of 103 patients (16.5%). MIHs featuring both types (mixed type) were observed in 28 of 103 patients (27.2%). MFH lesions were significantly smaller (mean 5.3mm [range 1-20mm] vs 22.0mm [range 2-100mm]), more numerous (23.4±27.3 [range 5-175] vs 7.4±2.8 [range 5-15] p<0.001), and occurred up to an older age (6.0±5.8months [range 0-27months] vs 3.8±2.6months [range 0-9months]) than NMIHs. There was a weakly positive correlation between the number and presence of extracutaneous IHs in children with MFHs. Significantly more children with MIHs were delivered preterm than those with solitary IHs. The number of IHs correlates inversely with their size. MFHs follow a clinical course different from that of classical IHs, are associated with prematurity, and may confer greater risk of extracutaneous hemangiomas. Miliary hemangiomas thus appear to present a separate IH subset requiring special attention.

Social Media Use in Pediatric Dermatology.

Social media is predicted to become increasingly important in dermatology because of its potential to serve as a platform for public health campaigns, aid in participant recruitment for clinical trials, increase public engagement in health care, and facilitate scientific discourse. No study of social media use in pediatric dermatology has been performed, so we analyzed the use of the seven leading social media platforms in pediatric dermatology, with a focus on patient advocacy groups, professional societies, research journals, and research institutions. We observed that 89% of patient advocacy groups, 100% of professional societies, 62.5% of research journals, and 0% of academic pediatric dermatology departments maintained one or more social media accounts. Our observations suggest that all stakeholder groups, and in particular members of the research community, have the potential to further their engagement, connections, and communications through social media.

Pitfalls in pediatric radiology.

This essay depicts some of the diagnostic errors identified in a large academic pediatric imaging department during a 13-year period. Our aim is to illustrate potential situations in which errors are more likely to occur and more likely to cause harm, and to share our difficult cases so other radiologists might learn without having to experience those situations themselves.

Assessing Gender Equity in a Large Academic Department of Pediatrics

To determine the extent of gender inequity in a large academic pediatrics department and to demonstrate an assessment methodology other departments can use. Using deidentified data, the authors evaluated all promotion track faculty in the University of Colorado School of Medicine's Department of Pediatrics in 2009 by five parameters: promotion, tenure, leadership roles, faculty retention, and salary. Outcome metrics included time to promotion and at rank; awards of tenure, time to tenure, and time tenured; departmental leadership positions in 2009; attrition rates from 2000 to 2009; and salary in academic year 2008-2009 compared with national benchmarks. Women constituted 54% (60/112) of assistant professors and 56% (39/70) of associate professors but only 23% (19/81) of professors. Average years to promotion at each rank and years at assistant and associate professor were identical for men and women; male professors held their rank six years longer. Only 18% (9/50) of tenured faculty were women. Men held 75% (18/24) of section head and 83% (6/7) of vice chair positions; women held 62% (13/21) of medical director positions. More women than men retired as associate professors and resigned/relocated as professors. Women's pay (98% of national median salary) was lower than men's (105% of median) across all ranks and specialties. These gender disparities were due in part to women's later start in academics and the resulting lag time in promotion. Differences in the awarding of tenure, assignment of leadership roles, faculty retention, and salary may also have played important roles.

Design and implementation of a near‐miss reporting system at a large, academic pediatric anesthesia department

Current incident reporting systems encourage retrospective reporting of morbidity and mortality and have low participation rates. A near miss is an event that did not cause patient harm, but had the potential to. By tracking and analyzing near misses, systems improvements can be targeted appropriately, and future errors may be prevented. An electronic, web based, secure, anonymous reporting system for anesthesiologists was designed and instituted at The Children's Hospital, Denver. This portal was compared to an existing hospital incident reporting system. A total of 150 incidents were reported in the first 3 months of operation, compared to four entered in the same time period 1 year ago. An anesthesia-specific anonymous near-miss reporting system, which eases and facilitates data entry and can prospectively identify processes and practices that place patients at risk, was implemented at a large, academic, freestanding children's hospital. This resulted in a dramatic increase in reported events and provided data to target and drive quality and process improvement.

Impact of Immigration on Pulmonary Tuberculosis in Spanish Children

From the Academic Department of Pediatrics, Imperial College London, England. Accepted for publication February 10, 2010. Address for correspondence: Beate Kampmann, MD, PhD, Norfolk Place, London W2 1PG UK. E-mail: [email protected].

Pediatric Hospitalist Medicine: An Overview and a Perspective From Toronto, Canada

spent on inpatient wards, the emergency department, intensive care settings, and primary care clinics; physicians may work at community or academic centers; and models included those with regular daytime hours versus shift work, as well as incorporating house staff versus staff-only models. Communication between hospitalists and referring pediatricians was identified as a priority. A teaching and an educational component were important parts of most models and required support in terms of both faculty development and compensation. Similarly, leadership in administration and research was beginning to emerge as hospitalist fellowships and research priorities began to evolve. Evidence in support of the hospitalist model has been published, most notably by Landrigan et al, who systematically reviewed and reported 20 primary-data studies of pediatric hospitalist systems. Although limited data were available on the quality of patient care provided, length of stay and inpatient hospital costs—factors closely related to one another—were consistently decreased when hospitalist systems were compared with traditional models. Ratings of parental experience and those of house staff ’s educational experiences were also positive. Less clear is the financial impact as hospitalist programs subject to economic analyses have been found overall to lose money. Pilot data, however, indicate adjustable factors that may serve to increase hospitalist program’s profits, namely increasing the daily census and professional and consultative services. Few centers have measured clinical outcomes associated with pediatric hospitalist care, which need to be addressed in future research. The term hospitalist was introduced by Wachter and Goldman in 1996 and was more recently defined by the Society of Hospital Medicine as “physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital care.” Although hospitalists were originally described in the context of adult internal medicine, their prominence in the care of general pediatric inpatients has rapidly emerged. By 1999, 50% of academic pediatric departments in North America had incorporated a hospitalist model, and estimates suggest that 1000 pediatric hospitalists are currently in practice. Growth of the pediatric hospitalist movement is attributed to multiple factors, namely the demand for expertise specific to inpatient medicine; limitations on resident work hours, and financial pressures to decrease both admission rates and length of stay, leading to an increase in patient complexity. Recent literature describing the state of pediatric hospitalists emphasizes the diverse nature of the field. At a 2003 meeting of academic pediatric hospitalists, Lye et al found that the hospitalist role varied widely: inpatient clinical work made up 75% ± 32% of their time, which may be

Leadership Trends in Academic Pediatric Departments

To examine recent turnover trends among chairs of academic pediatric departments. Membership data for the 150 institutions represented by the Association of Medical School Pediatric Department Chairs in the United States, Canada, and Puerto Rico were reviewed for the time period of 1993-2003. From 1993 to 2003, 278 individuals (250 men and 28 women) held the position of chair. The mean time of service was 5.58 +/- 3.2 years (median: 5 years). Twenty-nine individuals served continuously as chairs during the 11-year period. Seventy-two individuals served as interim chairs. Twenty-eight women were appointed either chairs or interim chairs during the 11 years. The number of female chairs decreased from 13 in 1993 to 11 in 2003. Female chairs were in office 3.42 +/- 2.72 years. A total of 123 departments had a change in leadership, with a mean annual turnover rate of 17% (range: 4.6-24%). Three departments had 5 different leaders as either interim chair or chair and 6 departments had 4 different leaders during this time period. Neonatology was the most common subspecialty represented by recent pediatric chairs, although nephrology was the subspecialty with the greatest proportional representation. Departments of pediatrics have high turnover of leadership. Women, in particular, serve for relatively short periods and appear to be under-represented within the leadership of pediatrics. Efforts should be made to ascertain personal qualities that allow sustained leadership and to attract more women into leadership positions.

The Challenge of Developing Career Pathways for Senior Academic Pediatricians

Physicians are living longer and are healthier than in previous times. The opportunity to use their experience, expertise, and wisdom after what would be "normal" retirement age needs to be explored. The object of this study was to survey senior academic pediatricians and pediatric department chairs to define the present status of pediatricians who are in academic settings and are older than 65 y, to explore the options that are open to pediatricians who are older than 65 y for continuing to use their skills, and to increase the awareness of the unused potential that exists among senior pediatricians. Structured questionnaires were sent to the 1444 members of the American Pediatric Society (APS) and to the 148 pediatric department chairs of the medical schools in the United States and Canada to identify current practices concerning retirement and utilization of senior pediatricians. Thirty-five percent of APS members and 40% of chairs of pediatrics responded. The responding APS members were interested in exploring avenues to continue to use the skills that they had developed. The responding pediatric chairs reported that they were constrained from supporting their senior faculty members by institutional pressures for space, salary monies, and the need to recruit new faculty members. However, they recognized the value of senior pediatricians. The skills and expertise of senior pediatricians (and probably other physicians) are often not used after the usual age of "retirement." New programs and pathways need to be developed not only to use the resource of these skills but also to enhance the health and sense of satisfaction of senior pediatricians.

In the footsteps of Abraham Jacobi, an early international medical graduate: contributions of a single South African medical school to US pediatrics.

Abraham Jacobi is generally recognized as the father of pediatrics in the United States. He was born in Germany and graduated from the University of Bonn in 1851 at a time of political turmoil. He was jailed for 2 years for high treason as a result of his activities as a member of a democratic revolutionary group. He was advised to leave the country to escape additional prosecution. After a brief, unsuccessful attempt to set up a practice in England, he made his way to the United States in 1853 during a period when immigrants from Europe were being welcomed with open arms. He established a practice in the Bowery in New York City, which, at the time, housed a quarter of a million German immigrants and hundreds of thousands of others seeking opportunities in the land of the free. His practice grew by leaps and bounds, and he began translating abstracts of articles from Germany dealing with diseases of children as well as publishing in US journals. In 1859, he co-authored the textbook Midwifery and Diseases of Women and Children. His 1860 appointment as Professor in Infantile Pathology and Therapeutics at New York Medical College was one of the first, if not the first, such academic appointment in pediatrics in the United States. In recognition of his clinical skills, his dynamic bedside teaching, and his contributions to the scientific literature, he was offered and accepted a professorial appointment at Columbia in 1870. However, he had to wait 18 years before he was granted faculty voting privileges. Jacobi’s Therapeutics of Infancy and Children was first published in 1895. He remained at Columbia until his death in 1919, having served as president of both the American Pediatric Society (APS) and the American Medical Association.1–3 As the first international … Reprint requests to (G.S.G.) Emeritus Staff Office, Plummer 10, Mayo Clinic, Rochester, MN 55905. E-mail: gilchrist-gerald{at}msn.com