Pediatric Interns Research Articles

Development and Validation of a Trauma-Informed Care Communication Skills Assessment Tool

BackgroundTrauma-informed care (TIC) is growing in medical education as health care systems recognize trauma’s impact on health outcomes. TIC acknowledges and responds to the effects of trauma on physical, psychological, and emotional health. As TIC trainings are developed and delivered to health care professionals across the learner continuum, curricula need evaluation beyond learner satisfaction and knowledge to better assess changes in skills. We developed the Gap Kalamazoo Communication Skills Assessment Form for Trauma-Informed Care (GKCSAF-TIC) to evaluate pediatric trainees' communication skills in TIC. We describe the development and validity evidence of the GKCSAF-TIC in assessing pediatric residents' TIC skills during standardized patient encounters. MethodsWe developed and implemented the TIC communication skills assessment tool in a one-year prospective cohort study involving pediatric residents. We conducted simulated patient encounters conducted before and after TIC training, with two pediatric faculty attendings assessing each encounter. We gathered validity evidence using Messick’s framework, focusing on content, response process, internal structure, and relationship with other variables. ResultsWe analyzed 57 standardized patient encounters with 33 pediatric interns, including 23 pre-post matched pairs. The development process and rater training supported content and response process validity. Internal consistency, measured by Cronbach’s alpha, ranged from 0.93 to 0.96, while inter-rater reliability, measured by intraclass correlations, ranged from 0.80 to 0.83. There was a significant improvement in scores from pre-training to post-training (3.7/5 to 4.05/5; P < 0.05). ConclusionThe GKCSAF-TIC demonstrated strong preliminary validity and offers educators a valuable means to assess and provide formative feedback to pediatric trainees about TIC.

Recognizing cardiac murmurs in childhood: a survey of physicians’ approaches and knowledge levels

ABSTRACT Objective This study aimed to assess physicians’ approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac anomalies. Methods The study intended to include all family physicians in the Adıyaman province of Turkey, but ultimately 150 out of 210 physicians participated and was completed with a percentage response rate of 71%. Participants were asked about their approach to cardiac murmurs, answered knowledge questions, and completed a questionnaire on demographic characteristics. Subsequently, eight heart sounds were played, and participants were asked to identify the nature of each sound. Results Family medicine specialists (all scores were p < 0.001) and physicians who completed a pediatric internship lasting over a month (knowledge score p = 0.012, behavioral score p = 0.021, recording score p = 0.01) demonstrated significantly higher knowledge, approach, and recording scores. Age and years in the profession showed a negative correlation with recording scores. Conclusions The study highlights the significant impact of various factors such as gender, specialization, internship duration, experience, and theoretical knowledge on the ability to recognize and approach cardiac murmurs. These findings underscore the importance of incorporating these factors into medical education and development programs, especially those aimed at improving cardiac examination skills.

Paediatric resident identification of cardiac emergencies.

Critical CHD is associated with morbidity and mortality, worsened by delayed diagnosis. Paediatric residents are front-line clinicians, yet identification of congenital CHD remains challenging. Current exposure to cardiology is limited in paediatric resident education. We evaluated the impact of rapid cycle deliberate practice simulation on paediatric residents' skills, knowledge, and perceived competence to recognise and manage infants with congenital CHD. We conducted a 6-month pilot study. Interns rotating in paediatric cardiology completed a case scenario assessment during weeks 1 and 4 and participated in paired simulations (traditional debrief and rapid cycle deliberate practice) in weeks 2-4. We assessed interns' skills during the simulation using a checklist of "cannot miss" tasks. In week 4, they completed a retrospective pre-post knowledge-based survey. We analysed the data using summary statistics and mixed effect linear regression. A total of 26 interns participated. There was a significant increase in case scenario assessment scores between weeks 1 and 4 (4, interquartile range 3-6 versus 8, interquartile range 6-10; p-value < 0.0001). The percentage of "cannot miss" tasks on the simulation checklist increased from weeks 2 to 3 (73% versus 83%, p-value 0.0263) and from weeks 2-4 (73% versus 92%, p-value 0.0025). The retrospective pre-post survey scores also increased (1.67, interquartile range 1.33-2.17 versus 3.83, interquartile range 3.17-4; p-value < 0.0001). Rapid cycle deliberate practice simulations resulted in improved recognition and initiation of treatment of simulated infants with congenital CHD among paediatric interns. Future studies will include full implementation of the curriculum and knowledge retention work.

CLINICAL INTERNSHIP PROGRAM DEVELOPMENT IN AN ACADEMIC CARDIOPULMONARY EXERCISE LAB

https://youtu.be/L4guyGQnFdQ BACKGROUND Programs in exercise physiology, exercise science, kinesiology, sports sciences, and human performance encompassing both undergraduate and graduate studies are increasingly popular, providing education for a growing career field. Preparing students for healthcare careers requires adequate exposure and hands-on learning using experiential internship and practicum opportunities. An initiative to formalize the exercise science academic requirements for university programs is already in place and requires institutional program CAAHEP accreditation by 2027. Participation in a clinical internship and the hours required vary among college programs. This retrospective study performed on the cardiopulmonary internship program at a large Midwest pediatric hospital provides insight to clinical education and research skill development for undergraduate and graduate exercise science students. METHODS A retrospective review of program metrics and outcomes was analyzed regarding university affiliations with the internship program, number of students accepted into the internship program, completion rate, training and competencies, student academic level and associated culminating student presentations, and program satisfaction surveys for students completing their internship experience. RESULTS Between 2012 to 2023, the program grew from 3 to 40 university affiliation agreements/institutions. 143 students participated in the internship program: 32 fulfilled shadowing experiences, 90 were undergraduate interns and 21 were graduate interns. Internship hour requirements varied from 100 to 600 hours, with most students completing 350-450 hours. In 2012, the program enrolled 1 student per year, and by 2013 the capacity expanded to 4 student positions per semester (each spring, summer, fall). Internship students have presented 38 poster/abstract presentations at regional conferences and seminars. Students achieved 99% completion of site-specific sign-off competencies in cardiopulmonary exercise testing, including expanded requirements for cardiac rehabilitation starting in 2018. 98% of the student interns completed the program. CONCLUSIONS The cardiopulmonary internship program has continued to expand additional affiliate universities from both local and out of state institutions referring students to the pediatric internship program. Secondary to our cardiology program’s growth to include pediatric and now adult congenital patients, our outreach sites, and the expansion into cardiac rehabilitation and exercise prescription, the lab team members and allocated space have increased to accommodate increasing patient volumes. This has led to the ability to increase student interns per semester and expand their preparation for transition into the healthcare workforce. Understanding of the skills and competencies obtained during the practicum experience may help to enhance academic curriculum to transition students into clinical opportunities.

A percepção do estudante de medicina sobre a simulação realística em pediatria

Abstract Introduction: The use of realistic simulation in pediatric emergencies is particularly valuable, as it allows the training of technical, attitudinal, and cognitive skills, helping to ensure patient safety. Objective: This study aims to describe the student’s perception of using the High-Fidelity Realistic Simulation in the pediatric emergency modules during the internship. Methods: Observational, descriptive study with a quantitative and qualitative approach. A semi-structured questionnaire was applied to sixth-year medical students at the end of the pediatric internship modules, which lasted eight weeks, from August to December 2020. All of them participated in two types of activities on 14 topics: high-fidelity simulation (HFS) and structured discussion of clinical cases (SDCC). Results: Of the 33 participants, 29 answered the questionnaire. The mean age was 24 ± 1.8 years, and 58.6% were female. All agreed that the experience with HFS contributed to safer performance in pediatric emergencies, considered optimal by 76% and good for the remainder. Most thought the association of HFS and SDCC was the ideal method (96%). The content analysis of the responses on HFS highlighted thematic units in five categories: significant learning, contribution to professional training, skills, attitude/behavior, and quality of the activity. Conclusions: Students’ reaction to using HFS in pediatric emergencies was very positive, and its association with SDCC was considered the ideal teaching method. Knowing the students’ reactions helps teachers plan their activities to improve the teaching-learning method.

The SOAP Feedback Training Program.

Accessible and efficient opportunities for health professional faculty to hone feedback skills are limited. In addition, feedback models to apply to the objective structured clinical examination (OSCE) setting are lacking. Annually, paediatric interns from Children's National Hospital and Walter Reed National Military Medical Center participate in an OSCE, which includes faculty observation and immediate feedback to trainees. In 2018, we incorporated the subjective, objective, assessment, plan (SOAP) Feedback Training Program during 20 min of the pre-OSCE faculty orientation. The SOAP Feedback Training Program introduced the SOAP feedback model (subjective, objective, assessment, plan), facilitated practice in pairs and distributed a cognitive aid referencing the model. We evaluated the quality of faculty feedback exchanges during the 2018 OSCE via retrospective video review using the Direct Observation of Clinical Skills Feedback Scale (DOCS-FBS). We compared the results to the 2015 initial evaluation and used focus groups to understand how and why faculty feedback changed. Comparison of the initial evaluation to the post-SOAP Feedback Training Program intervention data using a Wilcoxon signed rank test showed statistically significant improvement in six of eight feedback items on the DOCS-FBS. Causal coding of focus group transcripts revealed that the SOAP Feedback Training Program evoked affective responses, reinforced prior practice in feedback delivery, improved feedback organisation and increased feedback delivery preparation. The SOAP Feedback Training Program is an effective intervention to teach the SOAP feedback model and improve faculty feedback quality in an OSCE setting. It is efficient and low resource, facilitating its potential use in settings beyond the OSCE.

Um instrumento de avaliação do interno de pediatria na Atenção Primária à Saúde

Medical students have contact with different areas and scenarios during their internship and must have their performance evaluated in each of them. However, as many students do not feel properly evaluated, our objective was to develop an instrument to evaluate the performance of Medical students, during their internship in pediatrics, to be used during their practice in Primary Health Care. A methodological research was carried out with the elaboration of an instrument and the contribution of specialists with experience in teaching, using electronic invitations. At the end of the study, through the Delphi technique, seventeen of the twenty items contained in the original instrument were accepted by the 11 specialists who participated in the two rounds of analysis. Thus, the research reached its objective and, through this article, we disseminate the proposal of an “Instrument for the evaluation of Medical interns in the pediatric internship in Primary Health Care”.

Information and educational environment as a means of developing competences in residency in the pediatrics and pediatric cardiology

Introduction. At present, in connection with the development of new state educational standards in the system of higher medical education of the Donetsk People»s Republic, including at the postgraduate level, a competency-based approach is being widely introduced. Purpose setting. To familiarize teachers with the peculiarities of mastering competencies in residency in the specialties «Pediatrics» and «Pediatric Cardiology» at the Department of Pediatrics no. 3 of the Faculty of Internship and Postgraduate Education of the Donetsk State Medical University named after M. Gorky using remote technologies. Methodology and methods of the study. At the Department of Pediatrics no. 3, postgraduate training programs have been developed, including for the training of highly qualified personnel in residency in the specialties «Pediatrics» and «Pediatric Cardiology». The purpose of the residency is to train a qualified pediatrician or pediatric cardiologist who has a system of theoretical knowledge and professional competencies, capable and ready for independent professional activity, using modern scientific and technological achievements in the diagnosis and treatment of major diseases in children and adolescents. Results. Teachers of the Department of Pediatrics no. 3 have created selfstudy courses for pediatric residents and pediatric cardiologists on the university»s remote website. Each course contains general information, lectures and materials to prepare for practical exercises. The use of the information and educational environment stimulated the independent purposeful work of a pediatric intern or a pediatric cardiologist intern to form knowledge and further master all the competencies necessary for successful professional activity. Conclusion. The effectiveness of distance learning depends on the methodologically competently structured by the teacher of the educational process and the information and communication capabilities of the higher education institution.

E65 Assessment of Tunisian rheumatologists’ common practices towards children with rheumatic diseases

Abstract Background In the past few years, many advances have been made in the subspecialty of pediatric rheumatology in emerging countries. However, some gaps were identified requiring an update of rheumatologists' knowledge in this field [1]. Our study aimed to assess rheumatologists’ knowledge and common practices when managing children with rheumatic diseases. Methods We conducted an anonymous cross-sectional study including Tunisian rheumatologists. They were invited to answer an online questionnaire. The survey included demographic data, as well as outcomes of interest: rheumatologists’ knowledge and attitudes towards the management of patients with rheumatic diseases. We also inquired about the scores used to evaluate children with juvenile idiopathic arthritis (JIA). The level of confidence in the management of the pediatric population was assessed by the Likert scale. Results At the end of the survey, 51 responses were collected. The participants were rheumatology specialists (63%), university hospital assistants (21%), and residents (16%). Sixty-two percent of responders worked in the hospital. The mean number of years of practice (including years of residency) was 16.3 ± 5.9 [2–36]. Two rheumatologists reported that they managed over 10 children per month for rheumatic disorders. Four rheumatologists reported that they managed from 6 to 9 children per month for rheumatic disorders. Forty rheumatologists reported that they managed from 1 to 5 children per month for rheumatic disorders. And 5 rheumatologists reported that they do not manage any children with rheumatic disorders. Only 10 (20%) doctors received training in pediatric rheumatology during their curriculum: online training (6), national training program (2) and international training program (2). Regarding the scores used to assess the different subtypes of JIA, 23 (45%) rheumatologists were not aware of the JADAS 10 score and 39 (76%) did not know the JSPADAS score. When inquiring about the level of confidence in the management of the pediatric population the average level of confidence was 2.49 ± 1.82 [0–5]. Only 2% were not confident at all. A pediatric specialist was requested for a second opinion upon diagnosis in 51% of difficult cases and in 12% of less challenging cases. Only 19 respondents managed the patients by themselves without referring them to other specialists. The rheumatologists' apprehension regarding the management of the pediatric population was attributed to the lack of training in pediatric rheumatology (94%), the absence of pediatric internship during the specialization curriculum (43%) and the lack of mastery of children’s examination (12%). Conclusion Our study highlighted that only a few Tunisian rheumatologists considered themselves confident in the management of children with rheumatic disorders. The establishment of training programs in pediatric rheumatology could enhance rheumatologists' knowledge in this field and give them more confidence in the management of this population. [1] Zisman D, Samad A, Ardoin SP, et al. US Adult Rheumatologists' Perspectives on the Transition Process for Young Adults with Rheumatic Conditions. Arthritis Care Res (Hoboken). 2020; 72(3):432–40. This was an anonymous cross-sectional study. All subjects participated voluntary.

Medical Malpractice Lawsuits Involving Pediatric Trainees.

Introduction Pediatric medical trainees, like other medical professionals, can be held accountable for their actions and may be included in malpractice lawsuits. The aim of this study was to investigate the sources of malpractice cases involving pediatric trainees in order to inform the development of strategies to protect against such incidents. Methods LexisNexis, an online public legal research database containing records from the United States, was retrospectively reviewed for malpractice cases involving pediatric interns, residents, or fellows from January 1, 2000, to December 31, 2021. Cases were included if malpractice occurred following the delivery of a newborn through the care of young adults up to age 21. Results A total of 56 cases were included, consisting of 10 pediatric interns, 43 second- or third-year residents, and 11 pediatric fellows as defendants. Seventeen cases (30.4%) led to patient mortality. Incorrect diagnosis or treatment was claimed in 45 cases (80.4%), delay in evaluation in 24 (42.9%), failure to supervise trainee in 22 (39.3%), trainee inexperience in 21 (37.5%), procedural error in 21 (37.5%), lack of informed consent of resident being involved in two (3.6%), prolonged operative time in one (1.8%), and lack of informed consent of procedure/complications in one (1.8%). Conclusion Malpractice cases involving pediatric trainees highlight the importance of adequate supervision by attending physicians. These concerns are not exclusive to interns and residents and necessitate action by all members of the healthcare team. Given the interplay of supervision and diagnostic accuracy, trainee education and faculty development should emphasize malpractice education and strategies to mitigate lawsuits to both improve patient outcomes and reduce the likelihood of future malpractice claims.

Editorial introductions.

Editorial introductions.

Editorial introductions.

Editorial introductions.

How are French pediatric orthopedic surgeons affected by burnout? Results of a nationwide survey

IntroductionBurnout is a syndrome that adversely affects those who work in roles designed to assist and aid others, such as healthcare professionals. There is a paucity of data available on this topic among French pediatric orthopedic surgeons, registrars and interns. Therefore, we conducted a national survey to: (1) assess the prevalence of burnout syndrome among French pediatric orthopedic surgeons; (2) determine the risks and protective factors associated with this syndrome. HypothesisThe prevalence of burnout among French pediatric orthopedic surgeons is at least as high as in other medical and surgical specialties. Materials and methodsWe conducted a nationwide survey during the months of June and July 2022 by distributing a digitized questionnaire by e-mail. The burnout syndrome was assessed by the MBI (Maslach Burnout Inventory) score. Demographic and professional practice data were also collected. ResultsThirty-eight interns and 65 pediatric orthopedic registrars took part in the survey, i.e. a participation rate estimated at 65.5% and 44.4% respectively. Twenty-six percent (n=10) of interns and 13.9% (n=9) of registrars had MBI scores suggestive of moderate or severe burnout. Respectively 20.8% (n=9) and 9.2% (n=6) of interns and registrars reported suicidal thoughts in the past year. After statistical analysis, medical errors (OR: 3.4336; 95% CI: 1.7164–6.869; p<0.001) and suicidal ideation (OR: 2.3075; 95% CI: 1.0480–5.081; p=0.038) were associated with severe burnout. Having children (OR: 0.495; 95% CI: 0.2491–0.983; p=0.044) emerged as a protective factor. DiscussionWith a high participation rate, this study reveals a high burnout rate among French pediatric orthopedic interns and registrars, even if slightly lower than those found in other surgical specialties. Interns seem more exposed to this risk than their seniors. The consequences of burnout are diverse but can be significant. These results necessitate a vigilant approach to the occurrence of burnout among health professionals, and the appropriate management of it. Level of evidenceIII; descriptive cross-sectional study without a control group.

What Residents Want: Perceptions of Learning During a Pediatrics Night Float Rotation.

Most efforts to improve the educational value of night shifts focus on delivering content through structured sessions. Less is known about aligning curricular efforts with inherent nighttime learning. This study explored interns' nighttime experiences to better understand how learning works for the purpose of designing a curriculum to best support interns' learning at night. The authors employed a constructivist grounded theory approach. They conducted semistructured interviews with 12 Family Medicine and Pediatric interns recruited during their first-night float rotation at a tertiary care children's hospital between February 2020 and August 2021. Interviews elicited stories about nighttime experiences on the basis of a modified critical incident technique. Four authors used an inductive approach to data analysis and codebook development, then all authors participated in a thematic review. The authors identified distinctions between interns' perceptions of teaching and learning, with participants reporting rich instances of experiential learning at night. The authors discovered that interns do not want a didactic teaching curriculum at night. Rather, they want support to optimize workplace learning: the opportunity to independently initiate patient assessments, informal teaching arising from patient care, reassurance that support from supervisors is readily available, orientation to resources, and feedback. Findings suggest informal workplace learning is already occurring at night and historical attempts to implement formal curricula may have a low return on investment. A curricular frameshift is recommended to support learning at night that emphasizes informal teaching responsive to learning needs that arise from patient care, integrating but not emphasizing formal didactics when necessary.

Virtual Adaptation of Empathetic Communication Training for Pediatric Interns.

Evaluate feasibility and effectiveness of virtual adaptation of in-person simulation-based empathetic communication training. Pediatric interns participated in virtual training session then completed post-session and 3months follow up surveys. Self-reported preparedness on the skills all improved significantly. The interns report the educational value as extremely high both immediately after and 3months after training. 73% of the interns report using the skills at least weekly. A 1day virtual simulation-based communication training is feasible, well received, and similarly effective as in-person training.

A Nurse/Intern Partnership Program Accelerates Positive Relationship Formation Between Pediatric Interns and Pediatric Nurses.

The relationship between nurses and interns affects the quality of patient care; efforts to improve this relationship are necessary for optimal care. Previously, relationship formation was found to depend on mutual trust, respect, effective communication, and undergoing the process of role formation, all of which require time. This led to the hypothesis that instituting a Nurse/Intern Partnership Program (NIPP) would accelerate relationship formation. Using a semi-structured interview guide, prior to NIPP implementation, one nurse (n=5) and 2 second-year resident (total n=6) focus groups were held. After implementation, one nurse (n=6) and one intern (n=9) focus group were held. The focus group data were analyzed using the 5 stages of qualitative research framework. Thematic data analysis with 3 independent coders supported the previously developed model of relationship formation; the NIPP accelerated relationship formation between nurses and interns through creating an early ally, improving communication, and increasing role understanding. The program may have improved the culture of the pediatric unit. The interns reported more of a positive impact of the NIPP on nurse/intern relationship than the nurses. The NIPP was positively received by pediatric residents and nurses and successfully accelerated relationship formation between the 2 groups.

An Opus Like No Other.

A pair of twins in the newborn nursery - Yay, I'll take them! I imagined two humans in perfect synergy. The previous pair of twins I had cared for were a delight for me, a newly minted pediatric intern. Very quickly, I realized this pair would be different.

Pediatric Resident Insulin Management Education (PRIME): A Single-Session Workshop Emphasizing Active Learning.

Insulin is a high-risk medication, and errors can lead to patient morbidity and mortality. The American Board of Pediatrics recommends that all board-certified pediatricians be able to develop an insulin management plan for patients with diabetes. A needs assessment of pediatric residents revealed low self-efficacy at developing a new subcutaneous insulin plan despite didactic instruction on the topic. We created a 90-minute interactive workshop that targeted resident skills in devising subcutaneous insulin plans. Learners engaged in small-group, problem-based learning and peer teaching to promote active learning and participation. We compared self-efficacy and knowledge before and after the intervention using paired t tests and evaluated learner satisfaction. Twenty-eight pediatric interns participated, with 25 completing both the pre- and postworkshop surveys. The primary outcome was self-efficacy (an individual's confidence in the ability to perform a specific task in a given domain). There was a statistically significant improvement in self-efficacy at creating a new subcutaneous insulin plan ( p < .001) as well as knowledge ( p < .001) after course completion. Learners were highly satisfied with the course, with a mean overall conference quality rating of 4.8 (SD = 0.4) based on a 5-point Likert scale (1= poor, 5 = outstanding). An interactive workshop employing active learning methods resulted in improved self-efficacy and knowledge in first-year pediatric residents. Future work is needed to determine the impact of this workshop on patient care outcomes.

Editorial introductions.

Editorial introductions.

Effects of a Designated Note Writing Hour on Pediatric Intern Adherence to Duty Hours.

Interns spend an inordinate amount of the workday writing notes, leading to less time in direct patient care. Since the introduction of the 80-h workweek, it has been shown that interns spend 12% of the workday in direct patient care, compared to 40% at the computer. A dedicated note-writing hour was introduced into the pediatric intern shift to evaluate its effects on note writing behaviors. Within 1 year of implementation in July 2019, we aimed to establish that 80% of all pediatric intern notes were completed prior to the end of their shift. Time stamps from EPIC electronic health record (EHR) database were reviewed for all notes written by pediatric interns during three periods of interest: prior to the implementation of the hour (Jan-May 2019), immediately after implementation (July-Nov 2019), and a year after (May-Aug 2020). Prior to implementation, 67.9% of notes were completed by sign out. In the period immediately following implementation, and at a year post implementation, percentages increased to 72.5% and 73.5%, respectively. The percentage of notes completed prior to the end of the protected hour improved from 34.0% to 49.5% and 53.7%, respectively. The percentage of notes completed in less than 1 h also increased from 13.9% to 50.6% and 24.9%, respectively. These results indicate that a designated note writing hour for interns offer an effective intervention to improve note writing efficiency, however, the goal of 80% note completion by sign out was not met.