Pediatric Attending Physicians Research Articles

Attending physicians and trainees' perspective of patient safety culture in operating room: A mixed methods study

BackgroundRegulatory quantitative assessments are routinely undertaken to understand the patient safety culture within an organization. However, adjunctive qualitative approaches to explore low-scoring areas of safety culture in the operating room (OR) are lacking and may provide additional insight. Thus, we explored OR patient safety culture perceptions of pediatric surgical providers, specifically among attending physicians and trainees. MethodsA cross-sectional survey was pilot-tested by pediatric surgical attending physicians and surgical trainees from one academic hospital OR. The “Safer Culture” survey was developed using validated survey measures of concepts from the Safer Culture framework and modified by cognitive interviews with subject-matter experts. The survey was electronically administered, and the results were analyzed descriptively, and percent positive scores were computed. Semi-structured interviews with a purposive sample of participants were then conducted and thematically analyzed. ResultsOf the 144 participants, 67 completed the survey (response rate: 46.5 %). Safety competence (>95 %) and individual commitment & prioritization of safety (>90 %) were rated highest by attending physicians and trainees. Trainees rated policies & resources for safety and cohesion the lowest (<60 %). Attending physicians and trainees rated just culture the lowest (<56 %). Interview data revealed three overarching themes explain the lowest ratings: 1) feedback and fear influence incident reporting, 2) lack of accountability and learning affect just culture, and 3) individual and group preparedness impact safe surgical care. ConclusionsSafer Culture survey identified low-performing issues affecting OR safety culture by pediatric surgical providers. Their perceptions specified areas to focus initiatives to improve OR safety culture. Levels of evidenceLevel III.

A Multisite Survey of Pediatric Hospitalists' Practices in Soliciting Feedback From Trainees.

There is evidence that pediatric attending physicians value receiving feedback from trainees. With this study, we sought to determine the extent to which pediatric hospitalists value, solicit, and receive feedback from residents and medical students on specific areas of the attending's performance and identify perceived barriers to trainees' providing feedback. A web-based survey was sent to pediatric hospitalists at 9 institutions in 2022. Survey questions were developed from existing literature, trainee input, faculty expertise, and a framework on the qualities of exemplary pediatric educators. Respondents answered yes-no and multiitem Likert scale questions and selected answers from predetermined lists related to feedback solicitation from trainees. χ-Square and Wilcoxon rank test statistics were used to analyze questions. Responses were gathered from 91 of 189 surveyed individuals (response rate: 48.1%). Respondents almost unanimously "agreed" or "strongly agreed" that feedback from medical students (88, 96.7%) and residents (89, 97.8%) can be valuable, but feedback was considered more valuable from residents (P <.05). Attending physicians asked for and received feedback more from residents than from medical students (P <.05). Attending physicians most commonly asked for feedback on "teaching skills." The largest perceived barriers to receiving feedback from trainees were trainee lacking comfort with giving feedback, trainee lacking awareness that providing feedback is within their role, and fear of retaliation. Although pediatric hospitalist respondents nearly unanimously valued feedback from trainees, attending physicians were inconsistent in their feedback solicitation practices. Attending physicians were more likely to ask for and receive feedback from residents than from medical students.

Dissemination and Use of Point-of-Care Ultrasound by Pediatricians in Europe: A Research in European Pediatric Emergency Medicine Network Collaborative Survey.

We surveyed the dissemination and use of point-of-care ultrasound (POCUS), physician training levels, and barriers and limitations to use of POCUS among pediatricians and pediatric emergency medicine (PEM) physicians across Europe and Israel. A questionnaire was distributed through the PEM section of the European Society for Emergency Medicine and the Research in European Pediatric Emergency Medicine Network. A total of 581 physicians from 22 countries fully completed the questionnaire. Participants were primarily pediatric attending physicians (34.9% [203 of 581]) and PEM attending physicians (28.6% [166 of 581]). Most of the respondents, 58.5% (340 of 581), reported using POCUS in their practice, and 61.9% (359/581) had undergone POCUS training. Point-of-care ultrasound courses represented the most common method of becoming proficient in POCUS. Overall, the Focused Assessment with Sonography in Trauma scan was the mostly taught application, with 76.3% (274 of 359). Resuscitative, diagnostic, and procedural POCUS were rated as very useful or useful by the most of respondents.The lack of qualified personnel to train (76.9% [447 of 581]), and the insufficient time for physicians to learn, POCUS (63.7% [370 of 581]) were identified as the main limitations to POCUS implementation. The dissemination of pediatric POCUS in the European and Israeli centers we surveyed is limited, and its applications are largely restricted to the Focused Assessment with Sonography in Trauma examination. This is likely related to lack of training programs. In contrast, the potential value of use of POCUS in PEM practice is recognized by the majority of respondents.

Improving emergency airway cart efficiency in compliance with Joint Commission standards

Background and objectiveEmergency Airway Carts (EAC) are essential for pediatric otolaryngologists to provide rapid bedside care for emergent airway scenarios. At many institutions, EAC bronchoscopy equipment is individually peal-packaged due to Joint Commission (JC) standards, creating significant inefficiency in equipment assembly during time sensitive clinical settings. The objective of this quality improvement initiative was to improve the efficiency of use of our emergency airway cart equipment. MethodsIndividually peel-packaged bronchoscope equipment was replaced with JC compliant sets. Otolaryngology trainees (N = 8) and pediatric otolaryngology attending physicians (N = 11) were tested in a simulated airway emergency scenario, requiring bronchoscope assembly. Complete bronchoscope assembly and time to tracheal visualization (TTV) was measured for each participant, which started with initial clinical scenario presentation and ended with successful visualization of the trachea using the rigid bronchoscope. ResultsPre-airway cart interventions, 68.4% of participants built a complete bronchoscope with no missing pieces, which improved to 100% with the new cart organization. Post-EAC interventions, all 19 participants reduced TTV significantly by a mean of 177.7 s (p < 0.001). Trainees reduced TTV by a mean of 251.2 s (46.2%, p < 0.0001) and attendings by 124.2 s (31.5%, p < 0.0022). All participants found the new airway cart sets easier to use and improved equipment setup efficiency. ConclusionsCompiling bronchoscope equipment into sterile sets allowed for improved TTV and bronchoscope quality for trainees and attending physicians while maintaining JC standards. Simulation improved confidence among both trainees and attending surgeons in providing optimal patient care in airway emergencies.

Physician Perspectives on the Impact of the COVID-19 Pandemic on Family-Centered Rounds.

The coronavirus disease 2019 pandemic has required modifications to family-centered rounds (FCR), although the specific changes and the effects on patients, families, and providers are not well known. In this study, we explore physician perspectives on changes made to FCR during the initial wave of the coronavirus disease 2019 pandemic and recommendations for the future. Semistructured individual interviews were conducted with 20 pediatric attending and resident physicians who cared for hospitalized patients between March and May 2020 on pediatric hospital medicine and subspecialty services that typically perform FCR. Transcripts were reviewed by using principles of framework analysis to iteratively develop a codebook. Review of coded segments, with attention to code co-occurrences, was used to clarify themes in the data relating to the research objective and the conceptual framework. The rounding format changed for all providers and varied on the basis of clinical service and phase of the pandemic. Themes highlighted specific areas of change: (1) the process of FCR, (2) reaching consensus with families, (3) collaboration with members of the medical team, and (4) resident education, modeling, and supervision. Participants offered recommendations, including standardization of rounds, intentional involvement of nursing staff, and inclusion of families through virtual or small-group bedside rounds. The pandemic led to a variety of modifications to FCR, and these changes had varied effects on communication and education. These findings provide insight into the state of FCR during the pandemic and may frame future recommendations for the development of shared guidelines for circumstances requiring limited bedside rounding.

Improving resident education through unstable chicken hips: a novel way to teach an infant hip examination.

Current clinical screening for infantile hip dysplasia relies on combined Ortolani and Barlow maneuvers, which have a quoted sensitivity and specificity of 74-98 and 84-99%, respectively. Teaching this delicate physical examination maneuver is difficult as it requires a distinct tactile feel. The purpose of this study is to validate a benchtop learning grocery-bought chicken simulator model of newborn hip instability through a pre- and post-test surveys. This model of hip dysplasia uses whole chickens. A posterior capsulotomy of the chicken's hip joint was performed to create instability. Provocative maneuvers to dislocate and relocate the hip were taught by a pediatric orthopedic surgeon. All participants completed an anonymous pre- and post-training surveys. A total of 58 participants were included in the study: 10 medical students, 13 pediatric residents, 15 orthopedic residents, and 20 orthopedic or pediatric attending physicians. The pediatric residents had performed the Barlow/Ortolani tests more than the orthopedic residents (96.15 ± 83.19 vs. 37.53 ± 60.89; P = 0.01); however, fewer pediatric residents reported feeling a positive examination (31 vs. 67%). The majority of the group agreed that the simulation felt and moved like an infant's hip (3.95 and 4.13; Likert five-point scale). The participants unanimously agreed that the model could be used to teach someone new to pediatrics the basic steps of the examination (4.91; Likert five-point scale) and should be implemented in the teaching curriculum (100%). The current study validates the benchtop model in teaching the clinical steps in detecting hip dysplasia. The model improved confidence and comfort level for all participants and proved to be a valuable tool for resident education in multiple specialties. By improving education with this model, we hope to improve early identification of hip dysplasia with increased accuracy across subspecialties.

A PRIS network survey study of faculty physicians’ background and experiences with family-centered rounding

ABSTRACT Introduction: The benefits of the Family-Centered Rounding (FCR) model are well established and the attending physician's role in FCR has been demonstrated to be important in its implementation. The purpose of this study is to evaluate the background, training, preparedness and perceived role of pediatric attending physicians with regards to FCR. Methods: An online survey was administered via the Pediatric Research in Inpatient Settings (PRIS) listserv. It included 25 multiple-choice questions regarding agreement and adherence with published FCR guidelines, training experiences and preparedness in leading FCR, frequency of discussing goals and specifics of FCR with new trainees, and perception of who leads FCR. Results: The response rate was 63% (76/120). All 76 respondents report being familiar with FCR. Ninety – seven percent (73/76) of respondent’s report using the FCR model when conducting inpatient rounds at least sometimes. Twenty percent (15/76) of respondent’s received formal training on the FCR model as a medical student, resident, or fellow. As an attending physician, 38% (29/76) of respondents received formal training on FCR. Most respondents report feeling prepared (30%, 23/76) or very prepared (58%, 44/76) to lead FCR. The attending physician (49%) and resident (76%) were most frequently perceived to be the leaders of FCR. Conclusions: This study provides information on areas that may be barriers to providing better care when using this rounding model. First, the leader of FCR is not agreed upon nor are their responsibilities well defined. Secondly, FCR training and education is inconsistent in its format and frequency of occurrence.

Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.

A novel approach to reducing admissions for children with sickle cell disease in pain crisis through individualization and standardization in the emergency department.

Vaso-occlusive crisis (VOC) is frequent in children with sickle cell disease (SCD) creating significant burden on patients, families, and emergency departments (ED). The objective of the project was to reduce the admission rate for children with SCD presenting to our ED with VOC by>20% within 6 months of initiating individualized pain plans (IPP). A multi-disciplinary quality improvement team was assembled. A Plan-Do-Study-Act (PDSA) format was employed. The IPP document was created in a unique folder within the electronic medical record. IPPs were created through retrospective chart review for our 80 highest resource users. Pediatric residents, ED residents, and ED attending physicians were instructed on use of the IPPs. Our study measured the presence of an IPP, adherence to the IPP, and time to opiate administration. Our primary outcome was admission rate. Length of stay and 72-hr return to the ED were assessed as balancing measures. Overall, admission rate decreased by 24% following implementation compared with the previous 5 years (P=0.046). IPPs were created for 78% of patients and followed by ED staff in 86% of visits. Admission rate was significantly lower for patients receiving a second opiate dose within 45min of the first dose (P<0.01). There was no difference in readmission rate or 72-hr return rate to ED. This study presents an effective strategy to reduce admission rate for children with SCD presenting with VOC. Shorter time to second opiate dosing was also associated with reduced risk of admission.

Contraception for Adolescents and Young Adults in the Inpatient Setting: The Providers' Perspective.

To assess pediatric providers' attitudes and barriers to initiating a contraceptive method in the inpatient setting. Pediatric attending physicians and trainees from 5 academic institutions were surveyed about contraceptive prescribing practices, attitudes, and potential barriers to initiating contraception in the inpatient setting. In 2016, 271 pediatric providers (34.0% were attending physicians, 18.1% fellows, and 47.9% residents) completed the survey; the response rate was 19.2%. Most participants practiced in both inpatient and outpatient settings (95.7% and 85.0%, respectively). More providers felt confident screening for sexual activity among young adults as compared with adolescents (71.9% vs 65.6%). The same was true for discussing contraceptive options (44.0% vs 38.8%, respectively). Inpatient providers reported seeing adolescents and young adults privately, discussing confidentiality, and asking about sex less than half of the time. More than 80% of providers agreed that it would be appropriate to initiate a contraceptive method for inpatients; 35.8% had done so, and 85.2% indicated that having additional consultation would increase initiation of a contraceptive method in the hospital (88.1% felt similarly for long-active reversible contraception methods). General barriers to initiating contraception included insufficient training, insufficient exposure to adolescents and young adults to maintain skills, and lack of time. Barriers specific to the inpatient setting included concerns about follow-up, confidentiality, and interference with the treatment plan. Initiation of a contraceptive method in the inpatient setting is acceptable to providers. In our findings, it is suggested that strategies are needed to enhance provision of these services by addressing confidentiality concerns and educating providers.

Script Concordance Testing to Determine Infant Lumbar Puncture Practice Variation.

Script concordance testing (SCT) is used to assess clinical decision-making. We explore the use of SCT to (1) quantify practice variations in infant lumbar puncture (LP) and (2) analyze physician's characteristics affecting LP decision making. Using standard SCT processes, a panel of pediatric subspecialty physicians constructed 15 infant LP case vignettes, each with 2 to 4 SCT questions (a total of 47). The vignettes were distributed to pediatric attending physicians and fellows at 10 hospitals within the INSPIRE Network. We determined both raw scores (tendency to perform LP) and SCT scores (agreement with the reference panel) as well as the variation with participant factors. Two hundred twenty-six respondents completed all 47 SCT questions. Pediatric emergency medicine physicians tended to select LP more frequently than did general pediatricians, with pediatric emergency medicine physicians showing significantly higher raw scores (20.2 ± 10.2) than general pediatricians (13 ± 15; 95% confidence interval for difference, 1, 13). Concordance with the reference panel varied among subspecialties and by the frequency with which practitioners perform LPs in their practices. Script concordance testing questions can be used as a tool to detect subspecialty practice variation. We are able to detect significant practice variation in the self-report of use of LP for infants among different pediatric subspecialties.

Positive Change in Feedback Perceptions and Behavior: A 10-Year Follow-up Study.

Providing and learning from feedback are essential components of medical education, and typically described as resistant to change. But given a decade of change in the clinical context in which feedback occurs, the authors asked if, and how, perceptions of feedback and feedback behaviors might have changed in response to contextual affordances. In 2017, the authors conducted a follow-up, ethnographic study on 2 general pediatric floors at the same children's hospital where another ethnographic study on a general pediatric floor was conducted in 2007. Data sources included (1) 21 and 34 hours of observation in 2007 and 2017, respectively, (2) 35 and 25 interviews with general pediatric attending physicians and residents in 2007 and 2017, respectively, and (3) a review of 120 program documents spanning 2007 to 2017. Data were coded and organized around 3 recommendations for feedback that were derived from 2007 data and served as standards for assessing change in 2017. Data revealed progress in achieving each recommendation. Compared with 2007, participants in 2017 more clearly distinguished between feedback and evaluation; residents were more aware of in-the-moment feedback, and they had shifted their orientation from evaluation and grades to feedback and learning. Explanations for progress in achieving recommendations, which were derived from the data, pointed to institutional and national influences, namely, the pediatric milestones. On the basis of follow-up, ethnographic data, changes in the clinical context of pediatric education may afford positive change in perceptions of feedback and feedback behavior and point to influences within and beyond the institution.

Domestic Minor Sex Trafficking in the Medical Setting: A Survey of the Knowledge, Discomfort, and Training of Pediatric Attending Physicians

ABSTRACTDomestic minor sex trafficking (DMST) is a severe manifestation of sexual abuse and a major domestic health issue. The adverse health consequences of DMST bring victims into contact with health institutions and medical providers frequently, providing the opportunity for identification and intervention. Youth at risk or involved in DMST, however, are difficult to identify and often go unrecognized during health care visits. Little is known about the knowledge, comfort, and training gaps of physicians in identifying and managing patient victims of DMST. Our objectives were to assess (1) reported training and experiences; (2) perceived knowledge, comfort, and barriers; and (3) performance on medical decision-making questions regarding the identification, screening, and management of DMST in a population of pediatric attending physicians. An anonymous electronic survey was sent to pediatricians in Rhode Island from November 2014 through January 2015. Voluntary participants were 109 Rhode Island general pediatric and pediatric subspecialist physicians. Overall, participants perceived having limited knowledge, comfort, and training and reported barriers that corresponded with inaccurate answers on medical decision-making questions. These findings identify the impediments and obstacles to the care of DMST patients and inform the need for standardized education and training for pediatricians on this issue.

Antibiotic Use by Pediatric Residents: Identifying Opportunities and Strategies for Antimicrobial Stewardship

To determine the antibiotic prescribing practices of pediatric residents and assess how they acquire knowledge leading to prescribing behaviors. We performed a cross-sectional electronic survey of all pediatric residents at the Children's National Medical Center and Nicklaus Children's Hospital, assessing antibiotic prescribing patterns for common pediatric infections, use of antibiograms, and factors influencing antibiotic choice. Eighty-five surveys (45%) were returned complete and included in the analysis. Increased deviations from clinical guideline recommendations were observed for antibiotic treatments of sinusitis and community-acquired pneumonia as compared with otitis media and group A streptococcal pharyngitis. Only 57% of residents reported having used antibiograms. General pediatric inpatient attending physicians were identified as the most influential source for house staff antibiotic knowledge. Results illustrate the need for better promotion and integration of clinical guidelines with antibiograms when developing antibiotic education programs for residents in training. In addition, pediatric hospitalists should play an active role in the implementation of these programs and can provide valuable insight into the development of educational programs in conjunction with graduate medical education divisions.

Development of metabolic and inflammatory mediator biomarker phenotyping for early diagnosis and triage of pediatric sepsis.

IntroductionThe first steps in goal-directed therapy for sepsis are early diagnosis followed by appropriate triage. These steps are usually left to the physician’s judgment, as there is no accepted biomarker available. We aimed to determine biomarker phenotypes that differentiate children with sepsis who require intensive care from those who do not.MethodsWe conducted a prospective, observational nested cohort study at two pediatric intensive care units (PICUs) and one pediatric emergency department (ED). Children ages 2–17 years presenting to the PICU or ED with sepsis or presenting for procedural sedation to the ED were enrolled. We used the judgment of regional pediatric ED and PICU attending physicians as the standard to determine triage location (PICU or ED). We performed metabolic and inflammatory protein mediator profiling with serum and plasma samples, respectively, collected upon presentation, followed by multivariate statistical analysis.ResultsNinety-four PICU sepsis, 81 ED sepsis, and 63 ED control patients were included. Metabolomic profiling revealed clear separation of groups, differentiating PICU sepsis from ED sepsis with accuracy of 0.89, area under the receiver operating characteristic curve (AUROC) of 0.96 (standard deviation [SD] 0.01), and predictive ability (Q2) of 0.60. Protein mediator profiling also showed clear separation of the groups, differentiating PICU sepsis from ED sepsis with accuracy of 0.78 and AUROC of 0.88 (SD 0.03). Combining metabolomic and protein mediator profiling improved the model (Q2 =0.62), differentiating PICU sepsis from ED sepsis with accuracy of 0.87 and AUROC of 0.95 (SD 0.01). Separation of PICU sepsis or ED sepsis from ED controls was even more accurate. Prespecified age subgroups (2–5 years old and 6–17 years old) improved model accuracy minimally. Seventeen metabolites or protein mediators accounted for separation of PICU sepsis and ED sepsis with 95 % confidence.ConclusionsIn children ages 2–17 years, combining metabolomic and inflammatory protein mediator profiling early after presentation may differentiate children with sepsis requiring care in a PICU from children with or without sepsis safely cared for outside a PICU. This may aid in making triage decisions, particularly in an ED without pediatric expertise. This finding requires validation in an independent cohort.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1026-2) contains supplementary material, which is available to authorized users.

Freelisting on Costs and Value in Health Care by Pediatric Attending Physicians

ObjectiveIn preparation for the development of a curriculum on health care costs and value for pediatricians, the goal of this study was to assess pediatricians' baseline perceptions about the concepts of “cost” and “value” in health care, and topics that should be included in a curriculum that teaches about costs and value in pediatrics. MethodsPhysicians in the Department of Pediatrics at The Children's Hospital of Philadelphia received an online freelisting survey asking them to generate lists of words that come to mind when thinking about “costs” in health care, “value” in health care, and topics to include in a curriculum on costs and value in pediatrics. AnthroPac software generated salience scores, indicating the relative importance of each term. ResultsA total of 207 surveys were completed for a 40% response rate. For the “cost” prompt, the most salient responses were “excessive,” “waste,” and “insurance.” For the “value” prompt, the most salient responses were “outcomes” and “quality.” For elements to include in a curriculum, the most salient responses were “insurance” and “costs.” Analyzing responses based on years in practice, percentage clinical time, and division resulted in slightly different lists and salience scores. ConclusionsIn this freelisting exercise, there was general agreement that health care costs are “excessive,” that “outcomes” and “quality” are integral to value, and that there is a need for education in these areas, especially around “insurance.” Differences based on years in practice, percentage clinical time, or division can inform the development of targeted curricula that consider the needs, knowledge, and interests of these groups.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

Medical students' experiences working with frequently rotating pediatric inpatient attending physicians.

To explore medical students' experiences working with frequently rotating pediatric inpatient attending physicians. We performed a qualitative study using focus groups and individual interviews of medical students who rotated on the general pediatric inpatient service at Children's Hospital Colorado. The majority of inpatient pediatric attending physicians worked 1-week blocks. We used a semistructured interview guide and analyzed data using the constant comparative method. In accordance with the grounded theory method, codes were developed using an iterative approach, and major themes were identified. Analysis indicated theoretical saturation was achieved. We created a theory that arose from analysis of the data. Twenty-seven medical students participated. Data analysis yielded 6 themes: learning climate, continuity, student resilience, opportunity to progress, growth into a physician, and evaluation. In the learning climate, the emotional environment was often stressful, although students valued exposure to different patient care and teaching styles. Senior resident continuity promoted student function; lack of continuity with attending physicians inhibited relationship development. Students were resilient in adjusting to changing faculty with different expectations. In the context of frequently rotating faculty, students had difficulty showing improvement to a single attending physician after feedback, which limited students' opportunities to progress. Students perceived summative evaluation as less meaningful in the absence of having a relationship with their attending physicians. Medical students valued exposure to different patient care and teaching styles. However, frequently changing attending physicians caused students stress and limited students' perceived ability to achieve and show professional growth.

General Pediatric Attending Physicians’ and Residents’ Knowledge of Inpatient Hospital Finances

There is evidence suggesting that physicians have a limited foundation of knowledge on health care finances and limited awareness of hospital costs and charges. The objective was to analyze general pediatric attending physicians' and residents' knowledge of costs, charges, and reimbursements for care rendered in the inpatient setting. An online survey was administered to all general pediatric attending physicians who work on the inpatient service and the entire pediatric residency program at The Children's Hospital of Philadelphia (CHOP) in spring of 2011. Participants' estimates of costs, charges, and reimbursements for several common tests, medications, and services were obtained and analyzed. A total of 38 attending physicians and 100 residents participated in the study (84% and 76% response rates, respectively). The majority of both attending physicians (71%) and residents (75%) characterized their understanding as "Minimally knowledgeable" or "Completely unaware". Only 15% of attending physicians' estimates and 11% of residents' estimates were within ±25% of true values across all surveyed costs, charges, and reimbursements. Percent error did not vary by level of experience or self-reported knowledge for attending physicians and residents. Attending physicians and residents demonstrated limited knowledge of costs, charges, and reimbursements as shown by a low accuracy of estimates and a high percent error, compared with the actual values. To meet expectations for competency in systems-based practice and to be effective stewards of medical resources, it appears that pediatricians need further financial education.

General Pediatric Attending Physicians' and Residents' Knowledge of Inpatient Hospital Finances

General Pediatric Attending Physicians' and Residents' Knowledge of Inpatient Hospital Finances