Academic Pediatrics Research Articles

Anti-Asian American, Native Hawaiian, and Pacific Islander Racism in Academic Pediatrics: Recommendations for Training, Research, and Clinical Practice

This paper discusses how anti-Asian American, Native Hawaiian, and Pacific Islander (AANHPI) racism affects pediatric training, research, and clinical practice. Extant research shows that racism and discrimination are social determinants of health that impact AANHPI populations, including youth. AANHPI youth face significant health disparities and a wide range of barriers to health care access. However, AANHPIs tend to be seen by clinicians and depicted in training as monolithic, high achieving, and a relatively low priority in terms of pediatric workforce recruitment and training and pediatric research. After a brief discussion of US policies that have explicitly aimed to exclude, punish, or imprison AANHPIs, the paper explains AANHPI racism and its consequences. The paper then describes evidence of anti-AANHPI racism in pediatrics and offers recommendations for training, research, and clinical practice.

Stress of Being Underrepresented in Academic Pediatrics

Stress of Being Underrepresented in Academic Pediatrics

Exploring Diversity in North American Academic Pediatric Otolaryngology.

Representation of women and minority groups is traditionally low in Otolaryngology-Head & Neck Surgery (OHNS). This cross-sectional study aims to assess the difference in gender and racial/ethnic representation within Academic North American pediatric OHNS. Cross-sectional study of North American pediatric OHNS faculty websites. North America. Canadian and American residency program registries were searched for accredited OHNS programs. Pediatric OHNS faculty were identified through program websites. Information regarding gender, race/ethnicity, time in practice, research productivity, academic title, and leadership positions was extracted from public profiles and Scopus. Demographic and academic data was also extracted for OHNS and pediatric OHNS department/division chairs. North American academic pediatric OHNS websites listed 516 surgeons, of whom 39.9% were women. Most surgeons were perceived as White (69.0%), followed by Asian (24.0%), Hispanic (3.7%), and Black (3.3%). Women surgeons had lower h-indices, less publications, and less citations than men (P < .001). Despite women surgeons having fewer years in practice (median 8.0 vs 13.0, P < .001), gender-differences in h-index persisted when controlling for years in practice (P < .05). Men surgeons had higher academic titles (P < .001), but there was no gender difference in leadership roles while accounting for years in practice (P = .559). White surgeons had higher academic titles than non-White surgeons (P = .018). There was no racial/ethnic difference in leadership roles (P = .392). Most pediatric OHNS surgeons are men and/or White. Significant gender-differences in research productivity and academic title exist, however surgeons of racial/ethnic minority have similar research productivity as their racial/ethnic majority counterparts.

Improving Evidence-based Management of Children and Adolescents with Elevated Blood Pressure during a Well-Child Encounter: A Quality Initiative

INTRODUCTION: Pediatric hypertension requires accurate diagnosis and management to reduce the burden of cardiovascular disease across the lifespan. Despite national guidelines, hypertension (HTN) is one of the most frequently missed diagnoses within pediatric primary care. This quality improvement (QI) project aimed to improve the management of patients aged 3–18 years with elevated blood pressure (BP) by 25% during a well-child encounter. METHODS: Over one year, a single-center QI project was conducted at an academic general pediatrics center. Multidisciplinary interventions, including team education, workflow standardization, and clinical decision support tools, were implemented using Plan-Do-Study-Act cycles to improve adherence to evidence-based guidelines. Outcome measures were the percentage of youth with an elevated BP on screening who had documentation of provider actions. We used run charts to analyze the effect of interventions, and descriptive statistics for demographic data and process measures pre- and postintervention. Chi-square tests compared process measures pre- and postintervention and provider actions stratified by age. RESULTS: Key drivers of change were the percentage of documented confirmatory BPs, BP stage, and scheduled follow-up appointments. At baseline, 13% of children with elevated BP on screening had guideline-adherent provider actions documented. This increased to 40% postintervention; however, discrepancies in adherence stratified by age were observed. Youth 13 and older were significantly more likely to receive a provider action than younger children (P &lt; 0.0001). CONCLUSION: BP management during a well-child encounter improved with multidisciplinary interventions that increased knowledge of evidence-based guidelines and standardized care.

Evolution of Pediatric Critical Care Medicine Physicians Clinical and Academic Profile by Gender.

To examine career trajectory and academic profile of Pediatric Critical Care Medicine (PCCM) physicians, with special focus on gender differences. Observational cross-sectional study of PCCM fellowship graduates using publicly available data. Publicly available databases including National Provider Identifier registry, American Board of Pediatrics, Doximity, official hospital websites, and Scopus. Two thousand one hundred twenty-nine PCCM fellowship graduates employed in clinical positions in U.S. practice locations. None. Physician demographic characteristics included gender and time since fellowship completion. Current career and academic characteristics included employment data, publication productivity (h-index), and academic rank. Data from 2129 career PCCM physicians was included, with recent graduates showing a notable increase in female representation. Workplace characteristics revealed that most PCCM physicians worked in university-affiliated hospitals, with higher percentages of female physicians working in university-affiliated hospitals compared with male physicians. The study also highlighted significant gender disparities in academic metrics, with male physicians having higher h-indices (3 vs. 2; p < 0.001) and more publications (6 vs. 4; p < 0.001) than their female counterparts across various career phases. Additionally, the analysis showed gender differences in academic rank, with a higher proportion of female faculty holding assistant and associate professor ranks (58.2% vs. 47.5%; p < 0.001), while a greater percentage of male faculty held the rank of professor (20.2% vs. 11.1%; p < 0.001). Multiple variable regression analysis identified both male gender and time since fellowship graduation as independently associated with a physician's h-index, while only time since fellowship graduation was linked to current academic rank. This is the first analysis of career and academic characteristics of practicing PCCM physicians, additionally studying the association of gender and career trajectory. Gender discrepancy was seen in employment hospital characteristics, h-indices, and academic rank. Additional studies are required to further explore the impact of gender on career trajectory.

Neonatal Resuscitation Online Registry in Shenzhen: protocol for a prospective, multicentre, open, observational cohort study

IntroductionPreterm birth complications and neonatal asphyxia are the leading causes of neonatal mortality worldwide. Surviving preterm and asphyxiated newborns can develop neurological sequelae; therefore, timely and appropriate neonatal resuscitation is...

Meaningful Work, Career Fit, and Professional Well-Being of Pediatric Academicians in the United States.

Examine associations between time spent in academic activities perceived as meaningful and professional well-being among academic pediatrics faculty. The sample comprised 248 full-time pediatric faculty (76% female, 81% white, non-Hispanic, 41% instructor or assistant professor) across the United States who completed an online survey in November 2019. Survey items included sociodemographic and professional characteristics, professional well-being measures (Stanford Professional Fulfillment Index; Maslach Burnout Inventory; Intention to Leave Academic Medicine), perceived meaningfulness of academic activities and assigned time to those activities. We defined global career fit as total percentage time assigned to professional activities considered meaningful by individuals, and activity-specific career fit as percentage time assigned to each meaningful professional activity. As global career fit scores increased, professional fulfillment increased (r = 0.45, P < .001), whereas burnout (r = -0.29, P < .001) and intention to leave (r = -0.22, P < .001) decreased. Regarding activity-specific career fit, for individuals who considered patient care meaningful, as assigned time to patient care increased, professional fulfillment decreased (r = -0.14, P = .048) and burnout (r = 0.16, P = .02) and intention to leave (r = 0.26, P < .001) increased. There was no significant correlation between assigned time for teaching, research, or advocacy and professional well-being. Faculty were less likely to intend to leave academic medicine as assigned time increased for administrative or leadership activities if considered meaningful (r = -0.24, P = .01). Time assigned to meaningful work activities may relate to professional well-being of academic pediatrics faculty. More time assigned to patient care, despite being meaningful, was associated with poor self-reported professional well-being. Effort allocation among diverse academic activities needs to be optimized to improve faculty well-being.

Accuracy and consistency of chatbots versus clinicians for answering pediatric dentistry questions: A pilot study

ObjectivesArtificial Intelligence has applications such as Large Language Models (LLMs), which simulate human-like conversations. The potential of LLMs in healthcare is not fully evaluated. This pilot study assessed the accuracy and consistency of chatbots and clinicians in answering common questions in pediatric dentistry. MethodsTwo expert pediatric dentists developed thirty true or false questions involving different aspects of pediatric dentistry. Publicly accessible chatbots (Google Bard, ChatGPT4, ChatGPT 3.5, Llama, Sage, Claude 2 100k, Claude-instant, Claude-instant-100k, and Google Palm) were employed to answer the questions (3 independent new conversations). Three groups of clinicians (general dentists, pediatric specialists, and students; n = 20/group) also answered. Responses were graded by two pediatric dentistry faculty members, along with a third independent pediatric dentist. Resulting accuracies (percentage of correct responses) were compared using analysis of variance (ANOVA), and post-hoc pairwise group comparisons were corrected using Tukey's HSD method. ACronbach's alpha was calculated to determine consistency. ResultsPediatric dentists were significantly more accurate (mean±SD 96.67 %± 4.3 %) than other clinicians and chatbots (p < 0.001). General dentists (88.0 % ± 6.1 %) also demonstrated significantly higher accuracy than chatbots (p < 0.001), followed by students (80.8 %±6.9 %). ChatGPT showed the highest accuracy (78 %±3 %) among chatbots. All chatbots except ChatGPT3.5 showed acceptable consistency (Cronbach alpha>0.7). Clinical SignificanceBased on this pilot study, chatbots may be valuable adjuncts for educational purposes and for distributing information to patients. However, they are not yet ready to serve as substitutes for human clinicians in diagnostic decision-making. ConclusionIn this pilot study, chatbots showed lower accuracy than dentists. Chatbots may not yet be recommended for clinical pediatric dentistry.

ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting

BackgroundCOVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence.MethodsA total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children’s Hospital of The King’s Daughters (CHKD) were included in the study. Patients were between the ages of 8–18 with a history of ADHD for three or more years that was medically managed with four or more prescription refills between January 2019 and May 2022. A retrospective chart review collected age, sex, race, refill schedule, appointment schedule, and number of telehealth appointments. Data analysis compared the variables and defined “pre-pandemic months” as January 2019 through March 2020 and “pandemic months” as April 2020 through June 2022.ResultsThe total percentage of patients who had their ADHD medications during pre-pandemic months ranged from 40 to 66% versus 31–44% during pandemic months. Additionally, the total percentage of patients who had quarterly ADHD management appointments during pre-pandemic months ranged between 59 and 70% versus 33–50% during pandemic months. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Regarding race, Black patients had a lower number of medication refills compared to White patients when controlled for appointment type. They also had a lower number of total appointments, but there was not a significant difference in the number of virtual appointments.ConclusionsSince the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence. However, racial inequities found in this study need to be addressed.

Valuable Papers: A Year in (Re)View From the Association of Pediatric Program Directors

Academic Pediatrics has been the official journal of the Association of Pediatric Program Directors (APPD) since 2009. The View from the APPD section of the journal is an important destination to highlight APPD members’ scholarship regarding issues impacting residency and fellowship training. Since 2020, the annual commentary (Re)View from the APPD summarizes articles published in View over the past year, including their alignment with the overall APPD mission, values, and organizational priorities. This year’s (Re)View summarizes the articles published over the past year, with commentary on how the scholarship aligns with APPD values.

When Taking Pay off the Table: A Qualitative Study of Gender Equity for Academic Leaders in the US Military.

Although gender inequity persists globally in academic leadership positions, the United States Military has equitable pay and, in academic pediatrics, has equitable gender representation in leadership positions. To better understand how the US Military framework affects physician leaders, pediatricians were interviewed to illuminate the factors that facilitated their success and what barriers they faced in their career. In 2022, following institutional review board approval, semi-structured interviews were conducted with 13 total participants (69% female, 31% male) serving as general pediatricians or pediatric subspecialists in the US Military. These pediatricians were in leadership positions of military academic medicine across seven graduate medical education (GME) sites. The interviews examined the leaders' perceptions of facilitators and barriers to their success. The authors analyzed the interviews using Acker's theory of gendered organizations as a theoretical framework, which explains embedded gender roles within work environments. Drawing on the theory of gendered organizations, the authors identified that participants described several facilitators to their success, including the availability of mentorship/sponsorship, inclusive leadership, and early and persistent exposure to women leaders in GME training and beyond. Because medicine's ideal worker was normed around the traditional roles of men, men observed and women experienced barriers to leadership success around issues related to childbearing, maternity leave, and microaggressions. This study revealed that equitability for pediatric GME leadership in the military heavily relied on structures and support created by former leaders and mentors. Isolating these structures within a unique context of military academic medicine can illuminate physicians' experiences to address barriers and better support equitable leadership roles in both military and civilian academic medicine.

Nuclear war and the academic pediatrician.

Nuclear war and the academic pediatrician.

Confidence of Faculty in Writing Letters of Recommendation for Pediatric Fellowship Applicants.

The assessment of pediatric residents applying to subspecialty fellowship programs relies on faculty letters of recommendation (LOR). However, it is unclear if pediatric faculty are confident that their LOR are effective. This study aims to assess the confidence of pediatric faculty in writing an effective LOR for pediatric residents applying to subspecialty fellowship programs. Survey development was conducted using evidence-based best practices. Surveys were distributed via email in 2021 to all full-time pediatric faculty members who taught pediatric residents in a large academic medical center. Categorical values were compared by chi-square test. Eighty-five out of 150 (57%) faculty members completed the survey. Forty-one percent of participants were very confident that their LOR provided adequate content to assess residents during the application process. Confidence was associated with higher academic rank (p=0.02), frequent contact with residents (p=0.01), and writing >2 LOR in the last five years (p=0.0002). Confident LOR writers were more likely to describe their own background, details about the resident's scholarly activity, and the resident's ability to work as part of a team. Thirty-five percent of respondents reported never considering gender bias when writing LOR, whereas 28% reported always considering gender bias. Eighty-seven percent of respondents reported an interest in receiving LOR writing guidelines. Half of the faculty respondents were not very confident in their ability to write an effective LOR for pediatric residents applying for a fellowship. Faculty development and standardized instructions on writing effective LOR may be helpful both at the institutional and national levels, including the importance of considering gender bias when writing LOR.

Moving the neonatal nephrology field forward: results from the Pediatric Academic Society Neonatal Nephrology Focus Group.

Moving the neonatal nephrology field forward: results from the Pediatric Academic Society Neonatal Nephrology Focus Group.

Enhancing Physician Advocacy Through Collaboration With Government Relations: Report From the Health Policy Scholars Program

ObjectiveTo explore barriers, facilitators, and benefits of collaboration between academic pediatricians and institutional offices of government relations (OGR) to enhance policy advocacy efforts. MethodsThe Academic Pediatric Associations' Health Policy Scholars met with the government relations team in their affiliated institutions as part of their experiential learning curriculum. Afterward, they submitted written reflections, which were coded and analyzed using inductive qualitative content analysis to identify key themes. ResultsReflections were completed by 21 of 23 (91.3%) participants. Most participants (76.2%) were faculty at free-standing children’s hospitals and had been at their institutions <5 years (52.3%) or 5 to 10 years (33.3%). Institutional OGR structure varied widely and not all institutions had well-defined priorities. Key themes of the reflections included that OGRs often had dynamic priorities and fiscal considerations frequently took precedence. Barriers to physician involvement with OGR are often related to difficulty identifying the correct staff contact and not having the time and support for advocacy work. Facilitators included leveraging existing relationships and collaborations, including those of peer or mentor connections to the OGR staff. Anticipated benefits to both OGR and physicians included improved knowledge of advocacy opportunities, enhanced advocacy efforts leveraging physicians’ expertise and patient stories, and message alignment and amplification of physician and institutional advocacy work. ConclusionsCollaboration between physician-advocates and institutional OGR is feasible and, with orientation and mentorship, may facilitate improved physician and institutional policy advocacy efforts. Supporting this type of collaboration may enhance physician and institutional advocacy on behalf of their shared patients and communities.

Development of a Multi-site Curriculum for Inequities in Newborn Care (CINC) Informed by Pediatric Resident and Community Engagement.

Inequities in health care are a well-identified contributor to adverse outcomes in neonates of vulnerable populations. 1 2022 March of Dimes Report Card. Accessed March 8, 2023. 〈https://www.marchofdimes.org/report-card〉 Google Scholar , 2 Warren M.D. Hirai A.H. Lee V. Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030. Pediatrics. Published online January. 2022; 3e2021052800https://doi.org/10.1542/peds.2021-052800 Crossref Scopus (2) Google Scholar , 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Societal and institutional inequities rooted within implicit biases and racism result in variable quality of care in the nursery, such as differences in time spent skin-to-skin with infants, clinical resource allocation based on racial background, and a lack of motivation to establish a therapeutic alliance with families who have differing social and cultural needs. 3 Sigurdson K. Morton C. Mitchell B. Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. Journal of Perinatology. 2018; 38: 600-607https://doi.org/10.1038/s41372-018-0057-3 Crossref PubMed Scopus (61) Google Scholar Most significantly, this inequitable care results in the increased mortality of non-Hispanic black and Hispanic infants as compared to infants of non-Hispanic white backgrounds. 4 National Vital Statistics Reports Volume 69, Number 7 July 16, 2020, Infant Mortality in the United States, 2018 : Data From the Period Linked Birth/Infant Death File. Google Scholar In light of these inequities, the Academic Pediatrics Association (APA) implemented initiatives rooted in active anti-racism to dismantle oppressive power structures across pediatric organizations. 5 Cohen A. et al. Changing Who Has a Seat and Voice at the Table: How the Academic Pediatric Association is Responding to Systemic Racism. Academic Pediatrics. 2022; 22: 352-355https://doi.org/10.1016/j.acap.2022.01.002 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar This urgent commitment to action is further supported by the Association of Pediatric Program Directors (APPD) which maintains that anti-racism involves actively dismantling racism in all that we do. 6 Blankenburg B. et al. Dismantling Racism: Association of Pediatric Program Directors’ Commitment to Action. Academic Pediatrics. 2020; 20: 1051-1053https://doi.org/10.1016/j.acap.2020.08.017 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Focus groups of trainees at 4 Bay Area academic medical centers explored gaps in education on newborn health inequities to best understand how to support providers in actively practicing anti-racism in clinical care. Trainees spotlight inequities in their rotations, but feel helpless to address them given a lack of action-based tools, education on inequities, protected time for reflection, and faculty role-modeling. 7 Hume P. , Bowers K. , Robertson L. , et al. Residents’ Perspectives on Neonatal Health Inequities to Guide an Innovative Curriculum. Poster Presentation presented at: APPD; March 2023; Atlanta, Georgia. Google Scholar Given these highlighted gaps, we sought to provide our pediatrics faculty and trainees with action-oriented education to address inequities.

Improving Diversity, Equity, and Inclusion Content in Pediatrics Grand Rounds.

Grand rounds (GR) is a quintessential component of medical education across the spectrum from undergraduate medical education to continuing medical education for established physicians with a goal of enhancing knowledge, changing physician behavior, and improving patient outcomes. The purpose and scope of GR has undergone many iterations over the hundreds of years of its practice and previous work has aimed to enhance its educational impact, 1 Van Hoof, Thomas MD, EdD, J. Monson, Robert PhD, J. et al. A Case Study of Medical Grand Rounds: Are We Using Effective Methods?. Academic Medicine. 2009; Volume 84 (August): 1144-1151https://doi.org/10.1097/ACM.0b013e3181ad1c0e Crossref Scopus (33) Google Scholar including innovations that seek to educate about the origin and ongoing consequences of the health crises of systemic racism and other structural inequities. 2 Perdomo J. Tolliver D. Hsu H. et al. Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees. MedEdPORTAL. 2019; 15: 10858https://doi.org/10.15766/mep_2374-8265.10858 Crossref PubMed Scopus (39) Google Scholar A primary audience for GR is established mid- and late-career faculty, an educational target group perhaps more in need of DEI pedagogy than our earliest medical career learners. 3 Rosenkranz Kari M. Arora Tania K. Termuhlen Paula M. et al. Diversity, Equity and Inclusion in Medicine: Why It Matters and How do We Achieve It?. Journal of Surgical Education. 2021; Volume 78 (ISSN 1931-7204): 1058-1065https://doi.org/10.1016/j.jsurg.2020.11.013 Crossref Scopus (34) Google Scholar Previous work on improving anti-racist content in medical education recognizes this group as in need of particular focus. 4 Blankenburg R. et al. Dismantling racism: Association of Pediatric Program Directors’ Commitment to Action. Academic Pediatrics. 2020; 20: 1051-1053 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Development of presentations that consistently and specifically address aspects of DEI is essential to sustainably re-orienting medical education to address health equity.

A Minimum Age for California's Juvenile Legal System: Lessons on Collaborative Research to Drive Legislative Change

Abstract: The Problem: Most U.S. states lack a minimum age of juvenile legal jurisdiction, which leaves young children vulnerable to a harsh, punitive system that causes lifelong adverse health and social outcomes. However, partnership between academics, advocates, and policymakers can catalyze legislative change to set minimum ages. Purpose of Article: We, an academic pediatrician and social worker, describe our stakeholder-policymaker-academic partnered research that led to the passage of California Senate Bill 439, which excludes children under age 12 from eligibility for juvenile legal prosecution. To stimulate future efforts, we also describe how the initial partnership led to a national coalition through which we are partnering with stakeholders across the United States to influence minimum age laws nationwide. Key Points: Stakeholder–policymaker–academic partners can contribute synergistically in the research-to-policymaking process. Conclusions: Through a stakeholder–policymaker–academic partnership, we were able to influence the passage of a minimum age law for the juvenile legal system in California. Lessons learned in this collaboration can be applied by researchers across disciplines who wish to influence policy.

Dear Black Folx in Academic Pediatrics

Dear Black Folx in Academic Pediatrics

American Pediatric Society 2023 Presidential Address-pathways and partnerships in academic pediatrics: the power of possibility.

American Pediatric Society 2023 Presidential Address-pathways and partnerships in academic pediatrics: the power of possibility.