Pediatric Chief Residents Research Articles

Training Young Pediatricians as Leaders

To the Editor .— We read with interest the recent Pediatrics article entitled“ Training Young Pediatricians as Leaders for the 21st Century” by Leslie et al.1 The article highlights the importance of addressing the training of young pediatricians as leaders. As recent graduates of our pediatric residency training program and a chief residency year, we are especially cognizant of this need. As stated in their article, in the current milieu of the health care field, all physicians (pediatrics trained or otherwise) have multiple opportunities to function as leaders. We are particularly committed to the training of pediatric residents and pediatric chief residents as leaders. We reiterate the authors’ statement …

Do pediatric chief residents recognize details of prepubertal female genital anatomy: a national survey

Objective: To evaluate how well a group of recently trained pediatric chief residents could label anatomic structures on two different photographs of female prepubertal genitalia. Additionally, the study sought to explore aspects of pediatric training in sexual abuse and clinical practice issues surrounding the routine genital examination. Method: A 38-item questionnaire was mailed to pediatric chief residents at all of the officially listed pediatric residency-training programs in the continental US. Comparisons were made between this study and the responses to two previous surveys, which asked a more heterogeneous group of physicians to label one of the photographs used in the study. The second photograph was added because of its improved clarity of each anatomic structure when compared to the first photograph used in the previous studies. The study also asked about clinical practice issues surrounding the prepubertal genital examination. Results: An overall response rate of 73% was achieved and analysis was done on 139 respondents. One-half of chief residents thought that their training during residency on sexual abuse was inadequate for practice. Sixty-four percent of chief residents correctly labeled the hymen on the photograph used in the previous studies, which was not significantly different from the 62% and 59% of physicians who correctly labeled the hymen in the previous surveys. In the second photograph, which more clearly displayed the various anatomic structures, 71% correctly labeled the hymen. Conclusion: Pediatric chief residents reported variable amounts of training on issues pertaining to child sexual abuse during residency, think that this time was inadequate, and, while doing slightly better than a more diverse group of previously studied physicians, did not achieve 100% accuracy in identifying basic genital structures correctly on two different photographs.

Pediatric Residency Training on Domestic Violence: A National Survey

Between 3.3 and 10 million children witness domestic violence (DV) each year. These children are at risk for both emotional and behavioral problems. In 1998, the American Academy of Pediatrics issued guidelines for pediatricians to screen for DV and for residency programs to include DV education. Prior studies have assessed practicing pediatricians' DV screening habits. This study was designed to assess chief residents' attitudes and training regarding DV screening. A 53-question survey regarding residents' attitudes and training surrounding DV was mailed to the chief residents of all 194 nonmilitary US pediatric residency programs. Descriptive and inferential analyses were performed. Sixty-eight percent of surveys were returned. Sixty-eight percent of respondents were female. Although 93% of chief residents felt that pediatricians should screen for DV, only 21% screen every patient. Only 24% agreed or strongly agreed that they felt experienced in handling DV cases. Although 60% of respondents say that they received 11 or more hours of residency training in how to handle child abuse, the majority (80%) received 4 hours or less of DV training. Seventy-one percent agreed or strongly agreed that pediatricians do not screen secondary to lack of training. Pediatric chief residents believe that DV is a significant pediatric health problem. However, screening practices are variable. Most chief residents feel that their training was not sufficient to make them comfortable screening for DV. Chief residents demonstrated openness to incorporating DV training into their programs, indicating a positive environment for DV curricula.

Pediatric Residency Training and the Needs of Gay, Lesbian, and Bisexual Youth

Objective: This study surveys the education of pediatric residents about the needs of gay, lesbian, and bisexual (GLB) youth. The report measures the extent to which such training is considered valuable by those responsible for its administration and it evaluates the awareness of community referrals for GLB youth. Methodology: U.S. pediatric residency directors and chief residents were surveyed using a questionnaire designed by the authors. Percentage tabulation of the questions was performed. Chi-square analysis of two questions was done to determine if there was an association between the responses given and whether or not a respondent was from a program that offered training to their residents. Results: Over half of the respondents indicated that their programs offered training in the care of GLB youth. This increased to over three fourths when those respondents who indicated that their program was planning such training efforts were included. There was a broad distribution in the form and prevalence of training techniques. Over 90% of the respondents indicated that they valued the inclusion of GLB youth issues into residency curricula. A lesser majority indicated an awareness of community referrals for GLB youth. Conclusions: A large majority of pediatric residencies are either training their residents about the needs of GLB youth or are developing such training opportunities. The form and extent of the training varies widely. As such, the continued development of educational approaches and evaluation measures are encouraged.

House staff supervision, workload, and experience in the neonatal intensive care unit: Results of a national survey

One hundred fifty-nine pediatric chief residents were surveyed regarding characteristics of the neonatal intensive care unit rotation for house staff at their institution. We documented substantial interinstitution variability in house staff NICU rotations in terms of number of rotations, and the workload and supervision of house staff. (J Pediatr 1998;132:889-91)

Variation in the management of pediatric diabetic ketoacidosis by specialty training.

To compare management strategies for pediatric diabetic ketoacidosis (DKA) among physicians with different specialty training. We conducted a mail survey of 1000 randomly selected physicians, including 200 pediatric endocrinologists, 200 general emergency physicians, 200 pediatric emergency physicians, 200 pediatric intensivists, and 200 pediatric chief residents. We posed questions regarding a hypothetical 10-year-old patient with new onset of diabetes mellitus who is approximately 10% dehydrated but alert, with venous pH of 7.1 and serum glucose concentration of 34.7 mmol/L (625 mg/dL). Questions involved the rate of rehydration, content of intravenous fluids, insulin therapy, potassium replacement, use of sodium bicarbonate, and adjustments in therapy for decreasing serum glucose concentration. We compared responses of physicians in each specialty and used multiple regression analysis to adjust for potential confounding variables, including number of years in practice, number of children with DKA seen per month, and practice setting. Five hundred eighty-one physicians (58.1%) completed the survey, with responses demonstrating significant, consistent differences between specialties. Extremes of responses included the following: (1) 59% of endocrinologists vs 11% of general emergency physicians would give an initial fluid bolus of less than 20 mL/kg (odds ratio [OR], 11.7; 95% confidence interval [CI], 5.0-27.7) (P < .001); (2) 83.5% of general emergency physicians vs 42.5% of pediatric intensivists would administer an initial insulin bolus (OR, 4.1; 95% CI, 2.0-8.7) (P < .001); (3) 58.2% of pediatric intensivists vs 9% of general emergency physicians would replace fluids over a period of greater than 24 hours (OR, 14.1; 95% CI, 5.5-37.5) (P < .001); and (4) 54.3% of general emergency physicians vs 7.3% of pediatric intensivists would use potassium chloride alone for potassium replacement (OR, 10.8; 95% CI, 5.0-23.8) (P < .001). All of these differences persisted after adjusting for the potential confounding variables. Substantial differences exist in the management of pediatric DKA among physicians of different specialties, presumably due to differences in specialty training. These differences obscure our ability to evaluate the treatment of DKA and highlight the necessity for further studies comparing the outcomes of different treatment strategies.

Pediatric injury prevention. Preparing residents for patient counseling.

To describe counseling practices on injury prevention and barriers to patient counseling by pediatric residents and determine whether education about injury prevention or use of educational aids promotes this activity in resident ambulatory practices. Cross-sectional mail survey. Accredited US pediatric residency programs. Pediatric chief residents. Reported frequencies of patient counseling performed on various injury prevention topics. All residents reported that they were expected to educate patients and families about injury prevention in the continuity clinic setting. Almost all residents (98.5%) reported that they counseled on at least 1 injury prevention topic. On all topics except for poisoning prevention, residents were most likely to counsel patients and families on those topics about which they had received education. Additionally, those residents familiar with the American Academy of Pediatrics The Injury Prevention Program included more injury prevention topics in their counseling repertoire (P = .01). The most frequently identified barriers to counseling included lack of information about the topic and lack of time in the visit. Most pediatric residents counsel their patients and families on a variety of injury prevention topics. This activity is promoted by the education offered during residency training. Focused efforts should be made to educate residents about those injury topics not being taught and to address counseling barriers with educational interventions that promote prevention counseling during patient visits.

Sports medicine training during pediatric residency.

To assess how sports medicine is taught within pediatric residency programs and to determine the level of comfort that pediatric graduates have in managing common sports injuries. Investigator-prepared cross-sectional survey. A survey questionnaire was mailed to 203 pediatric chief residents of pediatric residency programs in the United States. Seventy-three percent of the questionnaires were returned. Most pediatric chief residents (73%) reported that their program provided lectures on pediatric sports medicine topics. Lecture time devoted to sports medicine topics was reported to be less than 6 hours for many residency programs (83%). Instruction on the medical criteria for exclusion from sports was provided to 64% of the chief residents. Of those residents who completed the survey, 55% reported that clinical sports medicine training was available in their programs. Rotations in adolescent medicine (28%), pediatric orthopedics (26%), and ambulatory pediatrics (9%) provided the bulk of clinical training. Clinical exposure to sports medicine was reported to be less than 5 hours in a large number of programs (43%). Most of the chief residents reported that they would refer six of eight pediatric sports injuries for diagnosis and management. The pediatric chief residents who completed the survey received limited didactic instruction or clinical training in sports medicine. Because pediatricians are primary care physicians for many children and adolescents who participate in sports, pediatric residency directors should consider integrating sports medicine instruction into their programs.

Experiences and Reflections of Former Pediatric Chief Residents-Reply

We would like to thank Greenberg for his thoughtful comments regarding our recent survey of the experiences of former pediatric chief residents. As demonstrated in Figure 2 of our article, 1 our respondents did spend markedly less time performing ambulatory care compared with inpatient care. In addition, the amount of time spent in both of these clinical settings appears to be decreasing. We agree with Greenberg's observation that with the focus of medicine shifting to the outpatient arena, chief residents will need to reevaluate the specific components of their clinical duties. We were also interested in the methods by which chief residents are prepared for their role. Of our 1137 respondents, only 423 (37%) had received some form of orientation. The majority (n=228) had been in the form of workshops or seminars. One hundred four respondents indicated that their orientation was provided by the outgoing chief residents, chairperson,

Experiences and reflections of former pediatric chief residents.

To compare actual and ideal time commitments of pediatric chief residents between 1972 and 1992 and to determine if actual time commitments have changed. Descriptive, cross-sectional survey. One thousand two hundred eighty-four former pediatric chief residents. Chief residents between 1972 and 1982 spent a greater percentage of time teaching and providing patient care than chief residents between 1983 and 1992. Chief residents between 1983 and 1992 spent a greater percentage of time scheduling and performing other administrative tasks. In general, chief residents desired more time to teach, to conduct research, and to provide outpatient care and desired less time for scheduling and for performing other administrative duties. Although chief residents desire to spend more time teaching and less time performing administrative tasks, administrative duties have increased at the expense of teaching and patient care responsibilities over the past 20 years.

Chief Resident Training

Most future medical leaders receive little or no formal exposure to management and leadership training activities. Industry invests considerable resources in such training for middle and senior level managers. With the increasing complexity of health care delivery systems and the increased involvement of diverse teams of individuals in the care of patients, it was believed that a training activity designed to enhance participant human interaction skills and teach about group behavior and team management might be valuable to pediatric chief residents. This article describes a 3-day workshop designed to develop such leadership skills. It has been conducted for 3 years with 117 participants. Results of end-of-course and 6-month follow-up evaluations show that participants enjoyed the training experience and believed it was valuable in helping them fulfill their leadership role as chief resident.

Treatment of Children with Posttraumatic Transient Loss of Consciousness

Recommendations for the treatment of asymptomatic children who have had a brief period of loss of consciousness due to blunt head trauma are anecdotal and vary greatly. The purpose of this study is to define the range of practice in treating children with uncomplicated loss of consciousness by determining: (1) the frequency of "routine" hospitalization for observation and (2) those criteria which, when present, result in hospitalization. A total of 957 pediatricians representing five groups of physicians responded to a nationwide questionnaire survey to determine current treatment practices for uncomplicated loss of consciousness. Of all directors of pediatric emergency rooms and pediatric chief residents, 44% routinely hospitalize all patients who have had loss of consciousness. Academic child neurologists and child neurologists in private practice hospitalize these patients least frequently, 29% and 31%, respectively (P less than 0.05). Of pediatricians in private practice, 38% admit all children with loss of consciousness. Pediatricians from all groups who do not routinely hospitalize all children with uncomplicated loss of consciousness showed similarity in the criteria they use for admission. These variables include: abnormal vital signs (97% to 100%), skull fracture (96% to 100%), suspicion of child abuse (93% to 100%), observation of a change in level of consciousness (92% to 99%), unreliable caretaker at home (91% to 98%), vomiting (90% to 99%), history of a change in level of consciousness (88% to 100%), duration of loss of consciousness (88% to 96%), seizure (77% to 94%), age of child (62% to 75%), child nearly back to normal (32% to 48%), dizziness (22% to 49%), witness of loss of consciousness not reliable (24% to 36%), headache (9% to 16%), and decision deferred to neurosurgeon (2% to 7%).(ABSTRACT TRUNCATED AT 250 WORDS)