Pediatric Residency Curriculum Research Articles

Implementation and Evaluation of a Novel Media Education Curriculum for Pediatric Residents.

Despite increasing awareness of media exposure to children and adolescents and the known value of media education for physicians, residency programs lack formal media education. We designed an interactive curriculum for pediatric residents to teach health effects of media as well as screening and counseling strategies. Instructional methods were based on constructivism, experiential learning, and situated learning theories. Participants independently reflected on a media viewing, then participated in two facilitator-led 1-hour workshops of two to three residents. Facilitators received speaker notes based on American Academy of Pediatrics media guidelines. Changes in knowledge, reported skills, and attitudes were assessed by pre- and posttests. Twenty-one residents completed the curriculum from September 2021 through April 2022. Knowledge improved after the curriculum as the median score increased from 3 to 5 out of 6, although 4 months later it was insignificant. Reported skills in screening did not significantly change. Residents strongly agreed that media use was an important health issue, with medians of 9 or 10 out of 10 on all tests. Attitudes regarding residency preparedness and confidence in screening and counseling significantly improved from pretest medians of 6 and 6 out of 10, respectively, to posttest medians of 8 and 9 to 4-month posttest medians of 6 and 8. A media curriculum for pediatric residents resulted in improved knowledge and attitudes. Enhanced attitudes demonstrated sustainability. All participants found the curriculum relevant and engaging and felt it should be continued.

An evaluation of a Transition to Foundations curriculum for first year pediatric residents in Competency Based Medical Education

Implication Statement A Transition to Foundations (TTF) curriculum that includes didactic and simulation components prepares first-year pediatric residents for increased roles and responsibilities in the Foundations of Discipline stage of Competency Based Medical Education, including junior night float rotations. Simulations of acute presentations improve resident comfort before overnight on-call experiences.

FOSTERING COMMUNITY ENGAGEMENT TO ADDRESS RACISM: DEVELOPMENT AND IMPLEMENTATION OF A SERVICE-LEARNING CURRICULUM FOR PEDIATRIC RESIDENTS.

In recent years, there has been a call for Academic Health Centers to increase community engagement to address racism. 1 Blanchard A.K. Blanchard J.C. Suah A. et al. Reflect and reset: Black academic voices call the graduate medical education community to action. Acad Med. 2022; 97: 967-972 Crossref PubMed Scopus (6) Google Scholar Alongside didactic education and building a diverse learning environment, community engagement allows trainees to better understand the structural underpinnings of inequities and better recognize their own biases to create a framework for how to improve care for marginalized populations. 2 Khazanchi R. Keeler H. Strong S. et al. Building structural competency through community engagement. Clin Teach. 2021; 18: 535-541 Crossref PubMed Scopus (8) Google Scholar Community-based service learning (CBSL), a teaching strategy that combines community service with “explicit learning objectives, preparation, and reflection,” 3 Seifer S.D. Hermanns K. Lewis J. Creating community-responsive physicians: Concepts and models for service-learning in medical education. American Association for Higher Education, 2000〈https://files.eric.ed.gov/fulltext/ED449734.pdf〉 Google Scholar is one methodology that can be used to give participants the opportunity to engage with the local community while also learning about the context in which the service is provided.

Application of an Interactive, Hands-On Nutritional Curriculum for Pediatric Residents.

Currently, there exists a scarcity of suitable nutrition training resources for the primary care physician (PCP) and a paucity of educational materials for pediatric residency programs. Barriers to nutritional education include: a lack of well-defined competencies, a dearth of centralized resources for nutritional education, and a reliance on didactic teaching methodology. Because PCPs often cite a lack of confidence as a primary reason for not providing nutritional counseling, we created an interactive 3-pronged nutritional curriculum for pediatric residents with the aim of increasing their confidence to provide nutritional counseling to patients. This curriculum included an in-person visit to a local supermarket, an online, interactive case during the resident's continuity clinic, and an interactive lecture. There was a statistically significant change in pediatric residents' confidence to manage issues of outpatient nutrition management. We find this particularly relevant as increasing physician confidence is key to increasing nutritional counseling in a clinical setting.

The Virtual Visit: A Telehealth Curriculum for Internal Medicine Residents Featuring a Virtual Physical Examination.

During the COVID-19 pandemic, medical professionals were obligated to adapt to virtual care. Most resident physicians had no formal telehealth training. The virtual physical examination remained underutilized. We describe a needs assessment leading to the creation of a telehealth curriculum for internal medicine (IM) and internal medicine pediatric (IM/P) residents, and report changes in residents' confidence level as well as feasibility data. We hypothesized that residents' confidence in delivering virtual care would significantly improve after implementing a telehealth curriculum. A needs-based assessment for all University of California Los Angeles (UCLA) IM and IM/P residents was conducted in July 2020. Specific competencies were identified: (1) telehealth legal guidelines; (2) virtual physical examination; (3) health equity; and (4) telehealth chronic disease management. The curriculum was presented via 3 synchronous interactive online interventions between November 2020 and March 2021. Pre- and post-intervention learner assessments were conducted. Out of all 180 residents, 146 UCLA IM and IM/P residents completed pre- and post-Virtual Physical Examination curriculum surveys, which were not uniquely linked to individuals. Residents reported statistically significant increased confidence levels in performing a targeted virtual physical examination (P<.001; 95% CI 0.97-1.35), engaging patients or caregivers to assist in virtual examinations (P<.001; 95% CI 0.76-1.21), and using remote monitoring devices (P<.001; 95% CI 0.58-1.03). Our results demonstrate that, within our IM and IM/P residency programs, a formalized telehealth curriculum significantly improved residents' confidence in delivering virtual care.

Childhood Homelessness and Housing Insecurity: A Curriculum for Pediatric Residents

Childhood Homelessness and Housing Insecurity: A Curriculum for Pediatric Residents

Primary Palliative Care for Pediatric Residents: A Curricular Framework and Pilot.

Palliative care (PC) is high-value, holistic care for a child and their family across the entire arc of an illness. All physicians should be competent in symptom management and providing goal-concordant care that acknowledges the quality of life; however, there is insufficient education in pediatric residency to develop competence in basic or ..úPrimary..Ñ PC. We completed a needs assessment and developed a longitudinal, comprehensive, and integrated primary PC curriculum for pediatric residents with the goal of developing foundational primary PC skills regardless of eventual career trajectory. After 1 year of implementation, we assessed resident comfort with primary PC skills via a retrospective pre-post survey. We found a statistically significant (P.ß<.ß.05) increase in residents... comfort with pain management, delivering serious news, and discussing goals of care. An increase in comfort with the management of other symptoms was not statistically significant. After 1 year of implementation, residents describe an increase in comfort with primary PC skills. The next steps include more rigorous evaluation and expansion to include more education in medical ethics. While the educational need is universal, resident needs are constantly evolving and each institution should tailor this curriculum to fit their specific trainee needs and institutional expertise.

Improved Patient Outcomes and Pediatric Resident Performance With a Parent and Faculty Communication Coaching Curriculum.

Communication skills are an important part of patient care, but an often neglected part of residency training. Longitudinal active coaching of communication has the potential to effectively improve communication curricula. A novel communication coach curriculum was implemented with approximately half of a pediatric residency class. Residents were coached by both a parent and faculty coach on multiple occasions throughout their intern year. Effectiveness was evaluated through self-assessment, direct observation, chart review, and follow-up phone calls with families. This longitudinal communication coach curriculum was well-received and resulted in increased self-awareness of communication skills. Coachable behaviors improved in intervention residents, and their patients spoke more positively of their experiences with communication. Additionally, these patients were less likely to be readmitted than patients cared for by control residents. A longitudinal communication coaching model is a feasible and effective curriculum for pediatric residents.

Beyond Residents-as-Teachers: The Development of an Advanced Medical Education Pilot Elective for Pediatric Residents.

Introduction An advanced medical education elective can encompass themes that transcend traditional residents-as-teachers curricula. The literature is scarce regarding the development of such a curriculum for pediatric residents. Objectives To develop and implement an advanced medical education elective for pediatric residents and evaluate the effectiveness of the educational strategies and curriculum. Methods Kern's Six Steps were applied to create a two-week-long elective for pediatric residents. Residents worked through Kern's model to collaboratively develop the elective. Faculty were recruited based on expertise and content previously created. Residents developed teaching sessions for fourth-year medical students and received feedback. The curriculum was evaluated using quantitative and qualitative feedback with a five-point Likert scale and open-ended questions, group discussions, elective evaluations, and the New World Kirkpatrick Model. Results Five residents, 17 students, and 22 faculty participated. Lectures, expert panels, group discussions, and teaching sessions were seen as effective instructional methods. All residents were satisfied with the elective and its strategies and developed useful skills. Resident-led teaching sessions and interactive learning strategies were cited as a strength, while some redundancy was noted as a weakness. Faculty recommended more formal feedback on resident-led teaching sessions in the future. Conclusions Our medical education elective was designed collaboratively with residents on a medical education track. Strong faculty participation, asynchronous learning, and resident-led teaching sessions were strengths of the curriculum. The curriculum's reproducible components may serve as a foundation for institutions interested in improving their medical education didactics for residents. More research is needed to determine the external validity of this novel curriculum.

Pediatric Emergency Medicine Didactics and Simulation: JumpSTART Secondary Triage for Mass Casualty Incidents.

Mass casualty incidents (MCI), particularly involving pediatric patients, are high-risk, low-frequency occurrences that require exceptional emergency arrangements and advanced preparation. In the aftermath of an MCI, it is essential for medical personnel to accurately and promptly triage patients according to their acuity and urgency for care. As first responders bring patients from the field to the hospital, medical personnel are responsible for prompt secondary triage of these patients to appropriately delegate hospital resources. The JumpSTART triage algorithm (a variation of the Simple Triage and Rapid Treatment, or START, triage system) was originally designed for prehospital triage by prehospital providers but can also be used for secondary triage in the emergency department setting. This technical report describes a novel simulation-based curriculum for pediatric emergency medicine residents, fellows, and attendings involving the secondary triage of patients in the aftermath of an MCI in the emergency department. This curriculum highlights the importance of the JumpSTART triage algorithm and how to effectively implement it in the MCI setting.

Utilization of a Delphi Study to Determine Core Concepts for a Pediatric Residency Disaster Medicine Curriculum

Introduction:As disasters increase globally in both frequency and intensity, the vulnerability of children during disasters has become obvious. Pediatricians are often left to manage the resulting physical and mental repercussions. With minimal to no disaster medicine training offered at most U.S. pediatric residencies, the need for an easily accessible pediatric disaster medicine curriculum has been exacerbated. While this need has been highlighted in the literature, material to include or methods to sustainably incorporate disaster medicine into training programs has not been established.Method:From a thorough literature review, 19 topics were selected as potentially necessary to include in a disaster medicine curriculum for pediatric residents. Utilizing the Delphi method, subject matter experts were asked to rank these topics with an option to add others. Two independent surveys separated by time were administered with the goal of identifying ten critical core concepts for pediatric resident disaster medicine education. A virtual roundtable discussion then took place to finalize the ten core concepts, discuss objectives, and consider realistic methods of incorporating the curriculum into the residency timeline.Results:The ten core concepts identified were 1) introduction to disaster medicine, 2) patient triage, 3) surge capability, 4) mental health effects of a disaster, 5) preparedness for children with special healthcare needs, 6) communicating personal/family disaster preparedness, 7) hospital disaster mitigation, 8) reunification, 9) drills and training, and 10) disaster ethics and crisis standards of care.Experts agreed upon a longitudinal multi-modal approach with inclusion of short didactics, case scenarios, questions/answers, games, and links to further educational activities and opportunities focused on individualized needs.Conclusion:The Delphi method was a successful approach to gathering expert consensus to establish core concepts for a pediatric resident disaster medicine curriculum.

A Longitudinal Evaluation of a Multimodal POCUS Curriculum in Pediatric Residents.

Introduction: Pediatric residency programs often do not include a point of care ultrasound (POCUS) curriculum. We analyzed a novel POCUS curriculum for pediatric residents that incorporated an online question bank (QB), in addition to a traditional teaching model of didactic instruction and hands-on learning experience. Methods: Four high-yield POCUS topics were chosen: Focused Assessment by Sonography for Trauma (FAST), soft tissue, lung, and cardiac. Residents completed online multiple-choice quizzes before and after each of four in-person learning sessions, taught by ultrasound faculty and fellows. At the end of the academic year participants completed a knowledge retention quiz. Confidence surveys were administered to participants throughout the course of the study. Differences in means were compared by Student's t-test. Results: Learners demonstrated post-intervention score improvement for each of the four modules. Retention testing demonstrated retained improvement for the soft tissue and cardiac modules, but not for the FAST module. Self-reported confidence increased across all four topics. Conclusion: A multimodal POCUS curriculum utilizing a combination of an online QB and in-person teaching demonstrated lasting knowledge for pediatric trainees.

Priorities and Progress in Complex Care Education.

Pediatricians routinely care for children with medical complexity (CMC), yet complex care is not a standard part of their training. In “Core curricular priorities in the care of children with medical complexity: A North American modified Delphi study,” we reported on a consensus development process that identified essential topics to include in a formal complex care curriculum for pediatric residents.1 We described 11 curricular priorities related to multisystem clinical issues, as well as medical technology care, safety/emergency planning, care coordination, and advocacy.

80. Implementation and Evaluation of a Novel Media Education Curriculum for Pediatric Residents

80. Implementation and Evaluation of a Novel Media Education Curriculum for Pediatric Residents

Structured Engagement of Community Partners to Revise a Pregnancy Options Counseling Curriculum for Pediatric Residents.

The engagement of community partners, including patients, is increasingly recognized as important in developing medical education curricula. Structured methodology for partner engagement in curriculum development is lacking in the existing literature. This article describes a structured approach to engaging community partners to provide input on revising a curriculum for pediatric residents about pregnancy options counseling with adolescents. We used the five-step Method for Program Adaptation through Community Engagement: (1) development of a panel of community partners including patients and professionals, (2) and (3) partner evaluation of the existing curriculum and recommendations for revisions, (4) summarization of partner feedback, and (5) development of the revised curriculum. We surveyed partners about their perceived impact on the revision and satisfaction with the process. Seventeen partners participated. Five experienced adolescent pregnancy, while the remaining 12 included healthcare and social service professionals. All partners provided multiple recommendations, generating 124 discrete recommendations. Twenty recommendations were suggested by multiple individuals. The authors reviewed all recommendations by category during consensus meetings and determined which recommendations would be incorporated into the revised curriculum to meet stated learning objectives. We implemented 14 of these 20 recommendations, including adding a values clarification exercise, information about mental health crisis resources, and more detail about adoption. We also incorporated 15 individual recommendations pertaining to curriculum clarity. Recommendations from professionals and patients were similar. Fourteen out of 17 participants completed the survey at the close of the project. All respondents understood their roles, were satisfied with their degree of engagement, and felt that their expectations for participation were met or exceeded. This study describes a methodology for a formal process to engage community partners in curriculum development and revision processes. Such methodology can ensure that medical education curricula are optimally attuned to the needs of key community members and integrate the patient's voice.

Impact of a Structured Transfusion Medicine Curriculum for Pediatric Residents

Impact of a Structured Transfusion Medicine Curriculum for Pediatric Residents

Knowledge and Attitudes of Pediatric Residents to Smoking Intervention in Adolescents.

Tobacco use is an important, preventable public health problem, and its use usually begins in adolescence. For this reason, smoking intervention for tobacco control is considered one of the fields of pediatrics. This study aims to examine the knowledge and attitudes of pediatric residents toward tobacco control and smoking intervention. In this multicenter study, pediatric residents were asked about their knowledge and attitudes toward adolescent smoking intervention and tobacco control through an online questionnaire. A total of 271 pediatric residents participated in the study, and 56% of the residents stated that they asked adolescents with respiratory tract symptoms whether they smoked or not. However, 22% of pediatric residents stated that they asked the same question to adolescents regardless of their symptoms, 92% of residents were unaware of the International Diagnostic Code for tobacco use, and 86% of the participants reported that they did not receive any training on tobacco control. It was determined that the residents, who knew the national smoking cessation hotline, were female, smokers, and seniors. They asked the adolescents whether they smoked or not and the results were statistically significant (P < .05). The results show that pediatric residents have insufficient knowledge about tobacco control and cannot guide adolescents in smoking intervention. This research reveals that pediatric residents need a training program for adolescent smoking intervention in the pediatric resident curriculum. Pediatricians who are well trained in adolescent tobacco control can make important contributions to the prevention of tobacco use in adults.

Tackling Impostor Syndrome Individually and Institutionally: A Longitudinal Impostor Syndrome Curriculum for Pediatric Residents.

Purpose: Medical professionals may be particularly susceptible to “impostor syndrome” (IS), the inability to internalize successes that leads individuals to believe they are less qualified and intelligent than others know them to be. 1–4 Although IS is associated with poor psychological (anxiety, depression, emotional exhaustion) and professional (job satisfaction, career advancement) outcomes, few interventions have been created for trainees, and none are longitudinal in design. 2,5 In a needs assessment sent to incoming interns in our large pediatric residency program from 2018 to 2020, greater than 88% endorsed feelings of IS. We aimed to create a longitudinal curriculum that would increase residents’ awareness and understanding of IS and decrease the distress and anxiety associated with these common thoughts. We also aimed to equip residents with actionable steps to combat IS individually and also consider how IS is more broadly generated and perpetuated institutionally. This included incorporating how IS may interact with structural and societal biases (e.g. racism, sexism), impact professional advancement, and lead to underrepresentation in leadership. Approach: As transitions are known to amplify IS, 4 3-hour-long sessions were designed to target the transition from medical student to physician (new interns), intern to supervisor (new juniors), and resident to fellow/attending (new seniors). Residents and program leaders outlined the curriculum’s specific objectives, which informed the educational strategies chosen. These were further informed by self-determination theory and therapeutic strategies recommended to address IS, including normalization of feelings and reframing of maladaptive thought processes. 5 Each session followed a similar format, including a presession survey, evidence-based didactic, and sharing of common experiences; later sessions also incorporated reflective writing exercises. Sessions concluded with the recitation of a verbal contract, first in the form of group affirmations followed by statements of self-actualization. Sessions were evaluated via an anonymous survey. Outcomes: The first session was piloted in 2018 and assessed for acceptability and value before curricular expansion. From 2018 to 2020, 113/150 interns (75%) completed a postsession survey and rated the first session as highly useful, with a mean of 9.3 (SD 1.3) on a scale of 1 (not useful) to 10 (invaluable); 95% (107/113) of respondents “definitely” (66%) or “most likely” (28%) wanted IS discussed in a longitudinal curriculum. In 2019 and 2020, objectives were assessed: a majority reported improvement in their understanding of (90% “much better” or “better) and feelings associated with IS (89% “better/relieved”). Junior and senior sessions were introduced in 2021; 23/40 (58%) and 31/40 (78%) residents completed surveys, respectively. Although sessions were rated less useful (means 7.9 ± 2.6 and 6.7 ± 1.4) and impactful on IS feelings (65% and 67% positive), the majority of juniors (79%) and seniors (80%) felt the longitudinal curriculum was “definitely” or “most likely” valuable to their training. Significance: A novel longitudinal curriculum introduced pediatric trainees to IS, highlighted its commonality, and provided action steps to mitigate its effects on individual and institutional levels. The first session was particularly valuable to participants, with a large majority reporting positive changes in their understanding of and feelings associated with IS. Subsequent sessions were perceived as slightly less valuable, though a majority still felt better/relieved about their IS feelings as a result of the sessions. This decline may be due to residents’ existing awareness of IS from the first session and also may be due to later sessions focusing more on broader (rather than individual) impacts of IS. However, this content is lacking from existing residency curricula and is important when considering the implications of IS on the diversity of our workforce. Explicitly addressing IS among trainees early in postgraduate education is needed and valuable, particularly during intern year. Longitudinal curricula that allow for ongoing exploration of this phenomenon, including discussions about its potential downstream effects, are also critical to efforts around workforce diversity and representation. Similar curricula can easily be adopted by other programs.

Evaluation of a Novel Point-of-Care Ultrasound Curriculum for First-Year Pediatric Residents.

The aim of the study is to evaluate a novel point-of-care ultrasound (POCUS) educational curriculum for pediatric residents. The cohort study in graduate medical education was completed from January 2017 to March 2019. Postgraduate year 1 (PGY1) pediatric residents attended the educational curriculum that consisted of 3 half-day sessions over a 3-month period. Each session consisted of a lecture (introduction, extended focused assessment with sonography for trauma, soft tissue/musculoskeletal, cardiac, and resuscitative applications) followed by supervised hands-on scanning sessions. Group ratio was 3 learners to 1 machine/expert instructor. Main outcome measures included pre- and post-written test scores, as well as objective structured clinical examination (OSCE) scores. Forty-nine PGY1 residents (78% women) completed the curriculum. The mean (SD) pretest score was 68% (8.5), and the mean posttest score was 83% (8.3) with a difference of 15 (95% confidence interval, 12.5-17.6; P < 0.001). Mean (SD) focused assessment with sonography for trauma OSCE score after the curriculum was 88.7% (11.9). The number of PGY1 pediatric residents that were comfortable performing POCUS examinations increased from pretraining to posttraining for soft tissue/musculoskeletal (14%-61%, P < 0.001), extended focused assessment with sonography for trauma (24%-90%, P < 0.001), and cardiac (18%-86%, P < 0.001). All participants found the curriculum useful, and 42 of 49 (86%) stated the curriculum increased their ability to acquire and interpret images. Postgraduate year 1 pediatric residents learned the basics of POCUS through 3 brief educational sessions. The increase in posttest scores demonstrated improved POCUS knowledge, and the high OSCE score demonstrated their ability to acquire ultrasound images. Point-of-care ultrasound guidelines are needed for pediatric residency programs.

French national survey on simulation-based neonatology education of pediatric residents

The French Society of Neonatology (SFN) conducted a national questionnaire survey on the simulation-based education neonatal curriculum for pediatric residents. The response rate was 93% for the pediatric curriculum coordinators and 97% for the neonatal intensive care unit medical directors and neonatal transport teams. The average hourly volume during the curriculum was 21 ± 17 h. Overall, 89% of regional pediatric curricula offered at least one simulation session. Each simulation program involved newborn resuscitation in the delivery room but often lacked a formalized program. Additionally, half of the neonatology departments provided simulation-based education. Simulation education is now common for training pediatric residents in neonatology in France but it is heterogeneous in the French territory.