Pediatric Clerkship Research Articles

Effectiveness of Modalities to Teach Evidence Based Medicine to Pediatric Clerkship Students: A Randomized Controlled Trial

ObjectiveTo evaluate the effectiveness of a traditional didactic session (TDS) as compared to a self-paced, interactive, multimedia module (SPM) on the application of evidence-based medicine (EBM) skills among medical students during their inpatient pediatric rotation.MethodsWe conducted a randomized controlled trial from June, 2017 to June, 2018 at a quaternary care children's hospital. Students were randomized to TDS or SPM during each 2-week block. All students completed a critical appraisal tool (CAT) of evidence related to a clinical question in a standardized appraisal form and self-reflected about the EBM process. The primary outcome was the numeric score of the CAT derived by using the validated Fresno tool. Secondary outcomes of knowledge, attitudes, confidence, and self-reported behaviors related to EBM were measured using validated surveys. Statistical analysis was performed using Student's t test for CAT scores and mixed-model procedure (PROC MIXED), with subject as random effect and time as repeated measure for the secondary outcomes.ResultsOne hundred twenty-seven clerkship students were included. Overall, there was no significant difference in mean CAT scores for TDS (n = 59) versus SPM (n = 66) groups (90.3 vs 92.0, P = .65). There were no significant differences between SPM and TDS groups for knowledge (P = .66), attitudes (P = .97), confidence (P = .55), and accessing evidence (P = .27). Both groups showed significant gains in knowledge, attitudes, confidence, and accessing evidence from baseline to postcourse. Improvements in knowledge and confidence were sustained at 3-months.ConclusionA SPM learning module is as effective as a TDS module for application of EBM concepts and knowledge to patient care.

Loma Linda University School of Medicine.

Loma Linda University School of Medicine.

University of North Dakota School of Medicine and Health Sciences.

University of North Dakota School of Medicine and Health Sciences.

East Tennessee State University James H. Quillen College of Medicine.

East Tennessee State University James H. Quillen College of Medicine.

Can an online clinical communication course impact learner behaviour?

Background: Effective communication between doctors and patients leads to better compliance, health outcomes and higher doctor and patient satisfaction. Although in-person communication skills training programs are effective, they require high resource utilisation and may provide variable learner experiences due to challenges in standardisation. Objective: This study aimed to develop and implement an evidence-based, self-directed and interactive online communication skills training course to determine if the course would improve learner application of communication skills in real clinical encounters. Methods: The course design utilised the Kalamazoo Consensus framework and included videos based on common paediatric clinical scenarios. Final year medical students in academic year 2017/2018 undergoing a two-week paediatric clerkship were divided into two groups. Both groups received standard clerkship educational experiences, but only the intervention group (88 out of 146 total students) was enrolled into the course. Caregiver/patient feedback based on students’ clinical communication was obtained, together with pre- and post-video scenario self-reported confidence levels and course feedback. Results: There were minimal differences in patient feedback between intervention and control groups, but the control group was more likely to confirm caregivers’/patients’ agreement with management plans and provide a summary. However, caregivers/patients tended to feel more comfortable with the intervention compared to the control group. Median confidence levels increased post-video scenarios and learners reported gains in knowledge, attitudes and skills in paediatric-specific communication. Conclusion: Although online video-based communication courses are useful standardisation teaching tools, complementation with on-the-job training is essential for learners to demonstrate effective communication.

The Brody School of Medicine at East Carolina University.

The Brody School of Medicine at East Carolina University.

University of Nevada, Reno School of Medicine

University of Nevada, Reno School of Medicine

The Frank H. Netter MD School of Medicine at Quinnipiac University.

The Frank H. Netter MD School of Medicine at Quinnipiac University.

Otitis Media Module in the Pediatric Preclerkship Educational Exercises (PRECEDE) Curriculum.

IntroductionThe Johns Hopkins Pediatrics Clerkship developed the PRECEDE (preclerkship educational exercises) curriculum with the primary goal of offering students formative instruction in essential pediatric clinical skills to prepare them for their clerkship. PRECEDE sessions occur at the beginning of each basic clerkship for new clinical clerkship students. The otitis media module is one in a series of modules presented in the curriculum and consists of a lecture and four short skills-development stations, each with a faculty facilitator.MethodsThis 2-hour module began with a 1-hour didactic overview of otitis media. Medical students were divided into three groups. One group learned about writing prescriptions via two otitis media clinical vignettes. Another group explored visualization and diagnosis of otitis media via video. The last student group was subdivided and learned proper techniques for positioning and restraining pediatric patients during otoscopic exams and the psychomotor skills for performing otoscopic examinations, including pneumatic otoscopy. Student groups rotated through all four activity stations. Students were guided through discussion to develop interpretation, diagnostic, and treatment skills for acute otitis media.ResultsBetween 2010 and 2012, 254 third- and fourth-year medical students participated in this module. When asked to evaluate overall quality, 86% of learners rated the module as excellent, and 14% rated it as good.DiscussionBy establishing these important skills, students may be better equipped to develop appropriate otitis media assessments, diagnoses, and care plans for patients and to use otitis media as a platform for broad education in other essential pediatric skills.

Remote Assessment of Video-Recorded Oral Presentations Centered on a Virtual Case-Based Module: A COVID-19 Feasibility Study.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has resulted in the suspension of our pediatric clerkship, which may result in medical student skill erosion due to lack of patient contact. Our clerkship has developed and assessed the feasibility of implementing a video-recorded oral presentation assignment and formative assessment centered on virtual case-based modules.MethodsThis retrospective study examined the feasibility of providing a remote formative assessment of third-year medical student video-recorded oral presentation submissions centered on virtual case-based modules over a one-week time period after pediatric clerkship suspension (March 16th to 20th, 2020). Descriptive statistics were used to assess the video length and assessment scores of the oral presentations.ResultsTwelve subjects were included in this study. Overall median assessment score [median score, (25th, 75th percentile)] was 5 (4,6), described as “mostly on target” per the patient presentation rating tool.ConclusionPatient-related activities during the pediatric clerkship were halted during the COVID-19 pandemic. This study demonstrated the possibility of remotely assessing oral presentation skills centered on virtual case-based modules using a patient presentation tool intended for non-virtual patients. This may prepare students for their clinical experiences when COVID-19 restrictions are lifted. Future studies are needed to determine if suspended clerkships should consider this approach.

Remote Assessment of Clinical Skills During COVID-19: A Virtual, High-Stakes, Summative Pediatric Objective Structured Clinical Examination.

Due to requirements for social distancing to protect the health of students, faculty, and standardized patients (SP) during the coronavirus pandemic, the pediatric clerkship Objective Structured Clinical Examination (OSCE) could not safely take place within our simulation center.

Voluntary assignments during the pediatric clerkship to enhance the clinical experiences of medical students in the United States

PurposePediatric clerkships that utilize off-campus clinical sites ensure clinical comparability by requiring completion of patient-focused tasks. Some tasks may not be attainable (especially off-campus); thus, they are not assigned. The objective of this study was to evaluate the feasibility of providing a voluntary assignment list to third-year medical students in their pediatric clerkship.MethodsThis is a retrospective single-center cross-sectional analysis of voluntary assignment completion during the 2019–2020 academic year. Third-year medical students were provided a voluntary assignment list (observe a procedure, use an interpreter phone to obtain a pediatric history, ask a preceptor to critique a clinical note, and follow-up on a patient after the rotation ends). Descriptive statistics were used to assess the timing and distribution of voluntary assignment completion.ResultsIn total, 132 subjects (77 on the main campus, 55 off-campus) were included. Eighteen (13.6%) main-campus and 16 (12.1%) off-campus students completed at least 1 voluntary assignment. The following voluntary assignments were completed: observe a procedure (15, 11.4%), use an interpreter phone (26, 19.7%), ask a preceptor to critique a clinical note (12, 9.1%), and follow-up on a patient after the rotation ends (7, 5.3%). Off-campus students completed the assignments more often (29.1%) than on-campus students (23.4%)ConclusionOur clerkship values specific patient-focused tasks that may enhance student development, but are not attainable at all clinical sites. When provided a voluntary assignment list, 34 out of 132 students (25.8%) completed them. Clerkships that utilize off-campus sites should consider this approach to optimize the pediatric educational experience.

Essential Anatomy for General Pediatrics in the Undergraduate Medical Curriculum

IntroductionTo prepare medical students for clinical training and practice, it is critical to understand the anatomical knowledge considered most important for different clinical specialties.AimTo address this issue, a consortium of anatomists in the US and Canada is collecting data from clinical educators in Pediatrics clerkships and electives to identify the anatomy they consider essential.MethodsAn IRB‐approved, online survey (Qualtrics, Seattle, WA) was used to assess the importance of 98 anatomical topics in seven body regions. The study first examined the percentage of Pediatrics clinical educators (clerkship/elective directors and attending physicians) that considered each anatomical region important to their specialty. Second, the study examined the rank assigned to each anatomical topic using an ordinal scale from 1 (not important) to 4 (essential).ResultsAt the time of abstract submission, data had been collected from 66 Pediatrics clinical educators at 20 medical schools. The percentage of Pediatrics clinical educators that considered each anatomical region important to their specialty were (highest‐to‐lowest): Abdomen (100%), Head & Neck (98%), Lower Limb (96%), Thorax (96%), Pelvis & Perineum (94%), Upper Limb (93%), and Back (83%). Further data analysis has identified the highest ranked anatomical topics in each body region for the Pediatrics clerkship/elective.Discussion and ConclusionThis database provides detailed information regarding the most clinically relevant anatomical topics as identified by Pediatrics clinical educators. This information can aid in focusing preclinical learning to best prepare medical students for success in their undergraduate and graduate clinical experiences.

Development and Evaluation of an Objective Tympanic Membrane Visualization Assessment Technique.

To introduce an inexpensive method for objectively evaluating otoscopic visualization of the tympanic membrane wherein learners match what they visualize in standardized patients to tympanic membrane photographs. Two standardized patients had photographs taken of their tympanic membranes using a commercially-available digital otoscope. First- and third-year medical students were asked to perform an otoscopic examination on each patient using a conventional handheld otoscope and to match what they saw with the correct tympanic membrane image among distractor photographs belonging to other patients. The ability of students to match the standardized patients' tympanic membrane to the correct photographs was assessed before and after a didactic training session. These measurements were compared between the two cohort groups for construct validity. Fifty-one first-year medical students (with no previous otoscopy experience) and 44 third-year medical students (with otoscopy experience from completing pediatric and family medicine clinical clerkships) were recruited to voluntarily participate in this study. At baseline, a larger percentage of third-year students correctly matched both tympanic membranes compared to first-year students (27% vs 8%, P < .01). After otoscopy training, correct matching of both tympanic membranes significantly improved among both first-year students (8-31%, P < .01) and third-year students (27-54%, P < .01). The use of tympanic membrane photographs from standardized patients provides a novel technique for objectively assessing proficiency in otoscopic visualization of the middle ear. The concept is low cost, uses live patients, and can be easily implemented in pre-clinical instruction and beyond.

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Theory Self-regulated learning theory suggests that individualized learning plans can benefit medical trainees by providing a structured means of goal setting, self-monitoring, and self-evaluation. External feedback also plays an important role in affecting learner motivations, perceptions, and self-evaluations. Accordingly, having learners share individualized learning plans with preceptors might promote self-regulated learning by helping align the feedback they receive with their learning goals. Hypothesis: We hypothesized having medical students share individualized learning plans with attendings and residents would improve the quality of the feedback they received, increase the likelihood that feedback correlated to their learning goals, and improve their perceptions of feedback received. Method: In this multisite study, third-year medical students on their pediatric clerkship created individualized learning plans and shared them with residents and attendings by writing a learning goal on at least one of their required faculty feedback forms. The quality of feedback on forms with versus without a learning goal written on top was scored using a validated scoring tool and compared using a Wilcoxon signed-ranks test, and the frequency with which feedback directly correlated to a student learning goal on forms with versus without a learning goal written on top was compared using a chi-square test. Students completed a post-clerkship survey rating the quality of feedback and teaching they received, perceptions of the individualized learning plans, progress toward achieving learning goals, and whether or not they received teaching and/or feedback related to learning goals. Results: Thirty-six students completed a total of 108 learning goals and 181 feedback forms, of which 42 forms (23.2%) had a learning goal written on top. The mean (SD) feedback score between forms with [3.9 (0.9)] versus without [3.6 (0.6)] a learning goal written on top was not different (p = .113). Feedback on forms with a learning goal written on top was more likely to correlate to a student learning goal than feedback on forms without a learning goal (92.9% vs 23.0% respectively, p < .001). Student perceptions of the usefulness of learning goals did not differ between students who reported receiving teaching or feedback related to a learning goal and those who did not. Conclusions: Sharing individualized learning plans with preceptors helped align feedback with learning goals but did not affect the quality of feedback. Further research should examine the bidirectional relationship between individualized learning plans and feedback in light of other contextual and interpersonal factors.

A Blended Model of Case-Based Learning in a Paediatric Clerkship Program.

Education during the clinical clerkship years requires active learning. Students cannot be bystanders, but rather they must discover, apply, and integrate new information in a clinical context. We present a novel model of case-based learning that encourages active learning, focusing on problem-solving skills for the clinical environment.

Total and Pediatrics Course load of Brazilian Medical Schools

Abstract: Introduction: Brazilian guidelines for undergraduate medical courses recommend a minimum curricular course load (CL) of 7,200 hours and the Brazilian Society of Pediatrics recommends that 10% of this load be allocated to pediatrics. The aim of this study was to analyze the total course load and the course load in pediatrics of Brazilian medical schools’ curriculum. Method: Cross-sectional and descriptive study. Of the 294 existing medical schools in Brazil in October 2017, those with curricular matrix/grid or political-pedagogical project of the course and pediatrics CL available on their homepage were included. The studied variables included total curricular CL, pediatrics CL and year of inclusion of pediatrics in the curriculum. Data were analyzed using descriptive statistics, calculating absolute and relative frequencies for categorical variables and mean and Standard Deviation (SD) and median and 25-75 percentile (P25-75) for continuous variables. Results: One hundred and fifty-one medical schools were included (51.4% of the total). The curriculum CL median was 7,975 hours (P25-75=7,440-8,550), with a mean of 4,665.7 hours (SD=593.8) before clerkship and 3,388.1 hours (SD=430.3) during clerkship. The mean pediatrics’ CL was 778.2 hours (SD=180.8), with a median CL of 220 hours (P25-75=160-300) before clerkship and 514 (P25-75= 405-640) during clerkship. The median pediatrics practice course load before clerkship (n=70) was 123 (SD=90-180). The mean of the proportion between general pediatrics and the curricular CL was 9.7% (SD= 2,2), and 68.5% schools had a CL &gt;720 hours. The median of the proportion between the CL in pediatrics clerkship and in the course was 16% (P25-75=12.5-18.9), ranging from 6% to 26%. The median of the proportion between pediatrics CL before pediatrics clerkship and course load was 4.7% (P25-75=3.6-6.5), ranging from 1% to 13%. Two schools started the teaching of pediatrics in the first year (1,3%), 19 in the second (12.6%), 63 in the third (41.7%) e 67 in the fourth year of the medical course (44.4%). Conclusions: The schools meet the minimum curricular course load established by the national guidelines, tending to exceed it, and not all of them meet the minimum pediatrics course load requirement of 720 hours recommended by the Brazilian Society of Pediatrics.

Total and Pediatrics Course load of Brazilian Medical Schools

Abstract: Introduction: Brazilian guidelines for undergraduate medical courses recommend a minimum curricular course load (CL) of 7,200 hours and the Brazilian Society of Pediatrics recommends that 10% of this load be allocated to pediatrics. The aim of this study was to analyze the total course load and the course load in pediatrics of Brazilian medical schools’ curriculum. Method: Cross-sectional and descriptive study. Of the 294 existing medical schools in Brazil in October 2017, those with curricular matrix/grid or political-pedagogical project of the course and pediatrics CL available on their homepage were included. The studied variables included total curricular CL, pediatrics CL and year of inclusion of pediatrics in the curriculum. Data were analyzed using descriptive statistics, calculating absolute and relative frequencies for categorical variables and mean and Standard Deviation (SD) and median and 25-75 percentile (P25-75) for continuous variables. Results: One hundred and fifty-one medical schools were included (51.4% of the total). The curriculum CL median was 7,975 hours (P25-75=7,440-8,550), with a mean of 4,665.7 hours (SD=593.8) before clerkship and 3,388.1 hours (SD=430.3) during clerkship. The mean pediatrics’ CL was 778.2 hours (SD=180.8), with a median CL of 220 hours (P25-75=160-300) before clerkship and 514 (P25-75= 405-640) during clerkship. The median pediatrics practice course load before clerkship (n=70) was 123 (SD=90-180). The mean of the proportion between general pediatrics and the curricular CL was 9.7% (SD= 2,2), and 68.5% schools had a CL &gt;720 hours. The median of the proportion between the CL in pediatrics clerkship and in the course was 16% (P25-75=12.5-18.9), ranging from 6% to 26%. The median of the proportion between pediatrics CL before pediatrics clerkship and course load was 4.7% (P25-75=3.6-6.5), ranging from 1% to 13%. Two schools started the teaching of pediatrics in the first year (1,3%), 19 in the second (12.6%), 63 in the third (41.7%) e 67 in the fourth year of the medical course (44.4%). Conclusions: The schools meet the minimum curricular course load established by the national guidelines, tending to exceed it, and not all of them meet the minimum pediatrics course load requirement of 720 hours recommended by the Brazilian Society of Pediatrics.

Integrating iPads into Team-Based Learning in the Pediatrics Clerkship: Do They Provide Any Value?

Background:Team-Based Learning (TBL) is an instructional strategy that embraces the concept of a flipped classroom. At our institution, the Clerkship in Pediatrics utilizes TBL sessions to deliver curricular content rather than lecture format. In 2016, matriculating medical students were given iPads for the purpose of transitioning to electronic delivery of curricular materials in the pre-clinical phase of their study. In 2017, the Clerkship in Pediatrics was tasked with investigating methods to integrate iPad use into clinical education.Activity:We employed the web-based platform Examplify to deliver test questions for TBL sessions over the span of 1 academic year (2018-2019). Curricular content was converted to Examplify for half of the TBL sessions and team performance for the sessions was compared to those administered traditionally. Students participating in the course were surveyed regarding their satisfaction with the 2 formats using a 15-item survey with a 4-point rating scale and open-ended questions.Results and discussion:Integration of technology into TBL sessions was met with mixed results. Performance on the eTBL sessions was significantly higher for 2 of the 6 sessions: the Abdominal Pain (90.2% vs 84.1%, P = .04) and the Toxicology (85.6% vs 79.4%, P = .03) sessions. A majority of students felt that the eTBL sessions facilitated multiple learning styles, promoted discussions, and nurtured different learning styles. However, students also felt that the electronic sessions were more cumbersome and difficult to navigate. Future research comparing the 2 modalities using a more comprehensive integration of media content, such as video and audio files, will further inform the success of this endeavor.

New Paradigm of Pediatric Clinical Clerkship during the Epidemic of COVID-19.

New Paradigm of Pediatric Clinical Clerkship during the Epidemic of COVID-19.