Ambulatory Pediatric Association Research Articles

50 Years Ago in TheJournalofPediatrics: Pediatric Nurse Practitioners: 50 Years of Partnering for Children's Health

Silver HK. A blueprint for pediatric health manpower for the 1970's: the 1972 George Armstrong Lecture. J Pediatr 1973;82:149-56. Dr Henry Silver's lecture to the Ambulatory Pediatric Association is as resonant today as it was 50 years ago. He noted that there was an inadequate supply of pediatric health care providers and recounted a few rejected solutions, such as shortening the medical school curriculum. The focus of his lecture, however, was emphasizing the importance of nurse practitioners (NPs) in providing care for children. The first NPs in the US graduated from Dr Silver's program in 1965 after 4 months of postnursing training. Dr Silver found that both pediatricians and parents were satisfied with care received from the NP when using a combined model: having a NP provide care with a physician available for consultation as needed. NPs showed the potential to provide quality health care in primary are settings, and Dr Silver proposed that their roles could be expanded into the community by providing care in school-based clinics. The role of the NP has continued to evolve, and training has become more intense since Dr Silver's “blueprint for pediatric health manpower” lecture. NPs can select a master's program that can be completed in 2-3 years and, for those interested in educational advancement, a post-master's doctoral program that can be completed in 2-3 years. They also have the option to select the primary care or acute care tracks. The primary care track focuses education within the primary care setting, specialty clinics, or in the community, whereas the acute care track focuses on the care of hospitalized patients. Today, NPs have a presence in a variety of settings fulfilling their roles in the “diagnosis and management of acute and chronic illness, health promotion, disease prevention, health education and counseling.”1American Association of Nurse PractitionersDiscussion Paper: Standards of Practice for Nurse Practitioners, 2019 update.https://storage.aanp.org/www/documents/advocacy/position-papers/StandardsOfPractice.pdfDate accessed: October 11, 2020Google Scholar NPs play critical roles partnering with pediatricians in the care of children in primary care offices, school-based health centers, neonatal intensive care units, as members of surgical teams, and many other areas. Dr Silver was prescient in his call for enhancing the care for children by partnering with NPs, yet the shortage of health care providers is likely to continue. By the year 2030, there is estimated to be 76.3 million children in the US, with a decreasing number of pediatricians and only 1025 pediatric NPs becoming licensed yearly.2Gigli K.H. Beauchesne M.A. Dirks M.S. Peck J.L. White Paper: Critical shortage of pediatric nurse practitioners predicted.J Pediatr Health Care. 2019; 33: 347-355Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar It remains as important as ever for pediatricians and NPs to continue working together and encourage ongoing development of both workforces.

The APA and the Rise of Pediatric Generalist Network Research

The Academic Pediatric Association (APA, formerly the Ambulatory Pediatric Association) first encouraged multi-institutional collaborative research among its members over 30 years ago. Individual APA members subsequently went on to figure prominently in establishing formal research networks. These enduring collaborations have been established to conduct investigations in a variety of generalist contexts. At present, 4 generalist networks—Pediatric Research in Office Settings (PROS), the Pediatric Emergency Care Applied Research Network (PECARN), the COntinuity Research NETwork (CORNET), and Pediatric Research in Inpatient Settings (PRIS)—have a track record of extensive achievement in generating new knowledge aimed at improving the health and health care of children. This review details the history, accomplishments, and future directions of these networks and summarizes the common themes, strengths, challenges, and opportunities inherent in pediatric generalist network research.

A community based tuberculosis control project in children in urban and rural settings: A public-private mix approach

A community based tuberculosis control project in children in urban and rural settings: A public-private mix approach B. Cabrera1,∗, J. Aldaba2, R. Buzon3, A. Fernandez3, B.J. Sablan3, F. Valdes4 1 Philippine Ambulatory Pediatric Association,Inc, Pasay City, Philippines 2 Philippine Ambulatory Pediatric Association,Inc, Manila, Philippines 3 Philippine Ambulatory Pediatric Association,Inc., Manila, Philippines 4 The Medical City hospital, PAsig City, Philippines

Patient- and Family-Centered Care of Children in the Emergency Department

Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care. This technical report has been endorsed by the Academic Pediatric Association (formerly the Ambulatory Pediatric Association), the American College of Osteopathic Emergency Physicians, the National Association of Emergency Medical Technicians, the Institute for Family-Centered Care, and the American College of Emergency Physicians. This report is also supported by the Emergency Nurses Association.

Updates in Health Supervision Guidelines for Children, Part 2

<P>This issue of <cite>Pediatric Annals</cite>, 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. <cite>Bright Futures Guidelines for the Health Supervision of Infants, Children, and Adolescents</cite>, 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.</P><h4>ABOUT THE GUEST EDITORS</h4><P>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.</P><P>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 “<CITE>Bright Futures: Pocket Guide</CITE>” and creation of educational materials for <a href="http://www.pediatricsinpractice.org" target="_new">www.pediatricsinpractice.org</a>, now also available in print form from Springer Publishing’s <CITE>Series on Medical Education</CITE>. He is a National Partner for Implementation of a 3-volume text of standardized case-based curriculum, “<CITE>Bright Futures Case Studies for Primary Care Clinicians: Pediatric Education in Growth and Development, Behavior, and Adolescent Health</CITE>,” available at <a href="http://www.pedicases.org" target="_new">www.pedicases.org</a>.</P><P>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.</P><P>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.</P><P>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 <CITE>Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents</CITE>, 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.</P>

Updates in Health Supervision Guidelines for Children, Part One

<P><CITE>Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents</CITE>, third edition, offers numerous opportunities to improve the quality and delivery of health supervision for infants, children, and adolescents. The authors of the series of articles within this and the next issue of <CITE>Pediatric Annals</CITE> are committed to the highest quality, multidisciplinary health promotion visits for our country’s most valuable resource — our children — in the context of their families and communities. Many authors were involved in the development of <CITE>Bright Futures</CITE>, third edition. The opportunity to work with hundreds of child health professionals who reviewed these guidelines was inspiring. Decreasing the gap between recommended and actual health supervision practices for children in the United States motivated us to embark on this writing project. Our purpose is to challenge all child healthcare professionals to review their own health supervision practices and to provide information and tools to enhance their practice.</P> <h4>ABOUT THE GUEST EDITORS</h4> <P>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.</P> <P>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 “<CITE>Bright Futures: Pocket Guide</CITE>” and creation of educational materials for <a href="http://www.pediatricsinpractice.org" target="_new">www.pediatricsinpractice.org</a>, now also available in print form from Springer Publishing’s <CITE>Series on Medical Education</CITE>. He is a National Partner for Implementation of a 3-volume text of standardized case-based curriculum, “<CITE>Bright Futures Case Studies for Primary Care Clinicians: Pediatric Education in Growth and Development, Behavior, and Adolescent Health</CITE>,” available at <a href="http://www.pedicases.org" target="_new">www.pedicases.org</a>.</P> <P>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.</P><P>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.</P><P>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 <CITE>Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents</CITE>, 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.</P>

2007 APA Presidential Address Ambulatory Pediatric Association: Past, Present, and Future

2007 APA Presidential Address Ambulatory Pediatric Association: Past, Present, and Future

Strengthening the Academic Base of General Pediatrics Fellowship Programs: A National Program and Curriculum Development Project

To improve academic general pediatrics (AGP) fellowship programs by 1) developing curriculum guidelines and program standards and 2) creating a process for program review and consultation that might later be used for accreditation of AGP fellowship programs. This project of the Ambulatory Pediatric Association (APA) created 4 documents: AGP fellowship program requirements, core curriculum, educational goals and objectives, and a standardized form to describe required program characteristics. Site visits were conducted at 7 volunteer AGP fellowship programs, selected for diversity of content, structure, and location. Evaluations were conducted using a uniform checklist of requirements that combined numerical ratings with a written evaluation summary. Feedback from programs on the review process enabled refinement of the documents. The site visits revealed great variety in emphasis among the 7 programs. In general, faculty were dedicated and capable, and programs showed considerable educational strengths. Typical problems were lack of integration of the program within departmental structures, overburdened faculty, and uncertain funding. Many programs demonstrated suboptimal curriculum planning and weak evaluation methods. Most program leaders felt that the project materials helped to improve the quality of their programs, and 5 of 7 programs expressed willingness to be involved in formal accreditation review in the future. AGP fellowship programs that volunteered for piloting of an accreditation process were diverse and vital, with rich educational offerings despite a lack of optimal curriculum structure, minimal evaluation, limited faculty resources, and tenuous funding. An APA accreditation process appears to be feasible and may enhance AGP fellowship programs.

Advances in Scholarship in Pediatric Education

Medical education attracts many talented clinicians and teachers who invest substantial parts of their careers to improving the education of medical students and young physicians. Having developed well beyond the notion of the “born teacher” to the recognition that even excellent teachers need to develop and refine their skills and that the process of medical education requires ways to assure quality in education and appropriate outcomes, medical education has drawn imaginative scholarship in methods of assessment and improving critical outcomes. Pediatrics has particularly attracted a large number of excellent teachers with much interest in understanding and improving the educational experience of students and residents. New organizations, such as the Federation of Pediatric Organizations, in concert with the American Board of Pediatrics and the American Academy of Pediatrics, provide much direction in innovative ways to assure quality of pediatric care and the education leading up to that care. The Ambulatory Pediatric Association (APA) has long provided leadership in these efforts, with its emphases on pediatric scholarship, the development of curricula in pediatric education, and the several efforts to improve faculty development in systematic ways. Highlights among the many APA efforts include the work of the large team led by Diane Kittredge to develop the APA Educational Guidelines for Pediatric Residency and the work begun and fully developed under Lucy Osborn’s direction in faculty development (see the supplement to Ambulatory Pediatrics in January-February 2004). Indeed the journal has published over 30 manuscripts related to faculty development since 2000. This work of course continues and expands, especially through the guidance of the APA Education Committee. This issue of Ambulatory Pediatrics includes four papers that expand knowledge in pediatric education and represent new thinking and evaluation strategies. Dorene Balmer, with her colleagues at the University of Pennsylvania, carried out an imaginative qualitative and observational study examining role modeling in pediatric continuity clinics and how the experience with practicing clinicians affects the development of practice skills among pediatric residents. This study uses careful and appropriate qualitative methods to address a number of issues in pediatric education that more traditional quantitative

Ambulatory Pediatric Association Policy on Tobacco

Tobacco use is the leading preventable cause of death and illness in the United States, causing more than 440 000 deaths each year. It is a cycle of addiction and exposure that begins at conception and continues throughout life. Most ( 80%) users of tobacco start before age 18, prompted by exposure to parental and peer smoking, smoking in movies and other media, advertising directed to children and adolescents, and other factors. The members of the Ambulatory Pediatrics Association (APA) are uniquely positioned to intervene in the cycle of tobacco use in their capacity as members of the academic community, training medical students, residents, and fellows; in their clinical roles, caring for patients, particularly the underserved; as researchers, providing an evidence base for children’s health, practice change, and public health; and as policy makers, guiding governments and other entities towards a tobacco-free world.

2006 George Armstrong Lecture: Who’s Worrying About the Children—And What Are They Doing About It?

I am deeply honored to have been selected to give the George Armstrong Lecture. I am well aware who the previous Armstrong Lecturers have been, and I am both proud and humbled to be on a list with them. And I am well aware who George Armstrong was and the contributions he made. He worked hard to provide needed services to indigent children, he taught, he published, and he died in poverty, all of which make him an icon for us in the Ambulatory Pediatric Association (APA). I want to use the opportunity of this Armstrong Lecture to invite you to think broadly with me about health services for children and, in particular, the role that pediatricians in community hospital settings can play. Permit me to begin with a personal story that goes back some 30 years. The chair of the department of pediatrics at the University of Virginia in Charlottesville invited me to consider a position at Roanoke Memorial Hospital that would enable him to send medical students there. I was eager to apply my 2 years of training at the Centers for Disease Control (CDC) as an trainer/educator and my 2 “extra” years of pediatrics as chief resident, so I was attracted to the opportunity to develop a teaching program and clinical service. My wife and I drove to Roanoke. I made rounds with the family practice residents who were covering the hospitalized children and were hungry to be taught pediatrics, I met with community pediatricians, I met with the hospital administrators—and then something happened that I clearly had not anticipated. As I looked at a map of the region, I found that I could not get a particular question out of my mind: “Who is worrying about the children in southwestern Virginia—and what are they doing about it?” The practitioners were busy in their offices, and they were pleased for someone to staff the hospital, so they could send their overflow there, and they were happy for the hospital to take care of the children who were not

2006 Ambulatory Pediatric Association Presidential Address Sustainable, Renewable Educational “Energy”

2006 Ambulatory Pediatric Association Presidential Address Sustainable, Renewable Educational “Energy”

Pediatric Hospitalists: Report of a Leadership Conference

To summarize a meeting of academic pediatric hospitalists and to describe the current state of the field. The Ambulatory Pediatric Association sponsored a meeting for academic pediatric hospitalists in November 2003. The purpose of the meeting was to discuss and to define roles of academic pediatric hospitalists, including their roles as clinicians, educators, and researchers, and to discuss organizational issues and unique hospitalist issues within general academic pediatrics. Workshops were held in the areas of organization and administration, academic life, research, and education. A literature review was also conducted in the areas discussed. More than 130 physicians attended. Thirteen workshops were held, and all information was summarized in large-group sessions for all attendees. Pediatric hospital medicine is a rapidly growing field, with an estimated 800 to 1000 pediatric hospitalists currently practicing. Initial work has defined the clinical environment and has begun to stake out a unique knowledge and skill set. The Pediatric Hospitalists in Academic Settings conference demonstrated the audience for additional development and the resources to move forward.

How we changed from paper to online education: Teaching Immunization Delivery and Evaluation

This article discusses meeting the challenges encountered in changing a paper-based, interactive immunization delivery curriculum into an online, self-paced format. The program, TIDE (Teaching Immunization Delivery and Evaluation), was developed through collaborative efforts of medical educators and content experts with initial funding from the Centers for Disease Control and Prevention, the Ambulatory Pediatric Association and the Medical University of South Carolina. We summarize the efforts of the development team to create interactive case scenarios, provide ready access to resource materials and an audit tool for assessing the immunization rate of the learner's clinic or practice, and meet the rigorous requirements of awarding continuing education credit. Data based on more than 100 doctors’ and nurses’ evaluations indicate a trend toward higher overall ratings of the online version than the paper version (88% online vs. 76% paper reported module as very good or excellent). As the TIDE program is evaluated, the team's goal is to incorporate instructional methods to increase relevance and learners’ opportunities for ‘learning by doing.’ Future plans include extending online office assessment tools to encourage use for continuous quality improvement, and providing a mechanism for learners to share their techniques for obtaining and maintaining high immunization rates.

Ambulatory Pediatric Association Policy Statement: Ensuring Integrity for Research With Children

Conflicts of interest (both financial and nonfinancial) have eroded public trust in medical research. There is now overwhelming evidence for systematic bias due to conflicts of interest associated with financial links between researchers and their institutions to commercial entities. To help manage and eliminate conflicts of interest and to regain public trust, the Ambulatory Pediatric Association developed a code of ethics for research in general pediatrics. While researchers in general pediatrics encounter many of the same ethical challenges as other medical researchers, many issues apply uniquely to the study of children’s health because children may not be able to protect their own interests. Background

Youth and Disability in the 21st Century: The 2004 George Armstrong Lecture of the Ambulatory Pediatric Association

Youth and Disability in the 21st Century: The 2004 George Armstrong Lecture of the Ambulatory Pediatric Association

Paediatrics & Child Health: A different kind of journal

Paediatrics & Child Health is a publication that serves as a means of communication, a documentary record, and the voice of the Canadian Paediatric Society (CPS). Moreover, by design, it is a tool for improving the health and health care of children and youth in Canada. Recently, the editor-in-chief asked the CPS Board to initiate a review to see if Paediatrics & Child Health was “on target”. Did it meet the mission that had been established for it? Was it meeting the needs of the readers and the needs of the society of professionals that sponsors it? The CPS was fortunate to be able to engage Dr Robert Haggerty for this external review. Dr Haggerty is renowned as the editor of Pediatrics in Review, emeritus professor at the University of Rochester, Rochester, New York, and founder of the Ambulatory Pediatric Association. If anyone understands the dual mandate of continuing health professional education and advocacy, it is Dr Haggerty. In fall 2003, Dr Haggerty met with the editorial board, the staff and the publisher of Paediatrics & Child Health. His report applauds the CPS for establishing a unique role for the journal. Mission of Paediatrics & Child Health To advocate for the health of all children and youth in Canada. To provide educational material and information to all providers of health care to children in Canada. View it in a separate window The emphasis on advocacy distinguishes Paediatrics & Child Health from other Canadian medical publications. It enables the CPS to use position statements on issues such as nutrition, immunization and injury prevention to make real changes. Paediatrics & Child Health is sent to Ministers and Deputy Ministers of Health, Medical Officers of Health and others who make things happen in Canada. We know that it is used by federal and provincial officials who formulate government policy and allocate resources. Dr Haggerty applauded the use of Paediatrics & Child Health theme issues for this purpose. Dr Haggerty was impressed by the quality of the articles and the position statements. This reflects the work of the editor (Dr Noni MacDonald), associate editor (Dr Lee Ford-Jones) and senior editorial coordinator (Colette Laplante), who put much effort into the “writes and rewrites” of the material. Drs MacDonald and Ford-Jones view this extra effort to nurture the writing abilities of contributors as a “labour of love”. Readability is a very practical consideration. In Noni’s words, “if no one reads an article, the article won’t change anything.” A key issue of the review was whether Paediatrics & Child Health should put greater effort into getting Index Medicus citation status. At present, Paediatrics & Child Health is cited in EMBASE/Excerpta Medica and is distributed to 15,500 paediatricians and family physicians across Canada. Articles are chosen expressly for this target audience. Obtaining citation status could require solicitation and publication of much more original research. Obtaining citation status could mean that Paediatrics & Child Health could attract the best in Canadian paediatric research. However, these articles would likely crowd out the review articles and position statements, which are used so extensively by our readers. Dr Haggerty counselled against dramatically modifying the journal to win Index Medicus approval. On the contrary, he felt that, considering the increasing emphasis on translational research, Index Medicus may eventually sanction journals such as Paediatrics & Child Health that focus on the distillation of research literature and advocacy for societal change. The review produced several practical suggestions. Among these were adding page numbers to the articles listed on the cover to better draw in the reader, adding graphs to certain articles to heighten reader interest, and soliciting more articles on topics in child development and adolescent medicine. The availability of the journal through the Web site of the publisher, Pulsus Group Inc, was seen as a big plus. Increasingly, professional audiences use the Internet to search for new information and review previously published guidelines and policies. The fact that articles in Paediatrics & Child Health are used to formulate questions for Royal College certification exams keeps paediatric residents attuned to our publication. Lastly, the review underscored that this remarkable publication is produced by a skeletal staff. The Paediatrics & Child Health senior editorial coordinator, Colette Laplante, is also responsible for the coordination of CPS position statements. Dr Noni MacDonald turns the publisher’s editorial fees back to the journal to help with operating expenses. Dr Lee Ford-Jones does extensive editorial work without recompense. The CPS owes an enormous debt of gratitude to these three individuals. Dr Haggerty’s final remarks suggest that “the journal is a very visible vehicle of the CPS and needs to be publicized as a jewel in their crown”. We know that the CPS membership regards Paediatrics & Child Health as their top member benefit. Clearly, we know quality when we read it.

Pediatric Phylogeny and Lessons Learned in the Garden

Pediatrics is a dynamic, organic, and evolving medical specialty. It is a living and breathing entity the substrate of which is the collective work of the many dedicated women and men who are members of the Ambulatory Pediatric Association (APA) and the other member organizations of these Pediatric Academic Societies (PAS) meetings. Of course, pediatrics includes not only the physicians who care for children, but also other health care providers. In describing pediatrics, we often use language that speaks to the biologic growth and development of our profession. For example, we call pediatrics a branch of medicine; we refer to the growth of subspecialties; and note the fruits of our work. In this address, I would like to exploit that metaphor of pediatrics as an organic growth, a living breathing species, and trace its phylogeny. Phylogeny (phy-log-e-ny) n. The development or evolution of a kind or type of animal or plant. My endeavor is to examine what has happened in the growth of pediatrics and, in particular, general pediatrics. In addition, I hope to explore some of the lessons learned in the garden, to underscore some cautions and suggest some new directions. I love to spend time in the garden. Although I work in the heart of the city, I am blessed by living in a green area. My home office looks over a garden and I often look to that small bit of land for personal comfort and inspiration. Like many of you who garden, I find it a place to think or dig my way through unresolved emotions and worries. It is a place where I can get my hands dirty and where I can think away from the electronic pests of pager devices, telephones, e-mails, or faxes. Thus far, the garden has served as psychiatrist, muse, and intellectual personal trainer. Francis Bacon wrote 1

Commentary: Federation of Pediatric Organizations implementing the FOPE II recommendations

Commentary: Federation of Pediatric Organizations implementing the FOPE II recommendations

Pediatric emergency department directors' benchmarking survey: fiscal year 2001.

To answer basic questions, using precise definitions, regarding emergency department (ED) utilization, wait times, services, and attending physician staffing of representative pediatric EDs (PEDs). Ten questions with precise definitions were developed and sent to members of the Ambulatory Pediatric Association's PED Directors' Special Interest Group in November of 2001, with two repeated requests 3 and 6 months later. Twenty-one PEDs from 14 states, the District of Columbia, and Canada responded (41%). The average PED has 48,000 patient visits per year (range, 25,000-97,000). Two thirds have urgent care or fast track areas to see nonurgent patients, while only 29% have 23-hour treatment units. The average admission rate is 13.2% (range, 6.8-20.8%). The average rate of patients who leave without being seen is 1.6%. The average patient waits 1 hour to see a physician and spends a total of 3 hours in the PED. The majority of attending staffing is by pediatric emergency medicine (PEM) Board-certified/eligible physicians (73%), although a few PEDs are staffed only by PEM specialists. Attending staffing is 2.8 patients per attending per hour, or 0.36 hours per patient, with more staffing for PEDs with higher admission rates or acuity. The average entry-level base salary for PED physicians in 2000 was 117,250 dollars (range, 98,000 dollars-145,000 dollars). Benchmarking of PEM staffing and performance indicators by PEM directors yields important administrative data. PEDs have higher census and admission rates compared with information from all EDs, while their attending staffing, wait times, and rate of patients who leave without being seen are comparable to those of general EDs.