Academic Pediatrics Research Articles

Program Evaluation of the Research in Academic Pediatrics Initiative on Diversity (RAPID): Impact on Career Development and Professional Society Diversity.

Despite a demographic surge in U.S. minority children, pediatric workforce diversity has failed to keep pace. The study aim was to evaluate the Research in Academic Pediatrics Initiative on Diversity (RAPID), a research-education program aimed at recruiting, retaining, and professionally advancing diverse early-career faculty in general pediatrics who are pursuing research careers. RAPID includes the following components: small research grants, mentoring by nationally renowned senior investigators, mentoring and networking at an annual breakfast, an annual career-development conference, and monthly mentoring conference calls. Outcomes data from the first 5 years (2012-2017) of RAPID were analyzed. Data sources were Academic Pediatric Association (APA) membership data and postconference, baseline, and end-of-program/follow-up surveys. Outcome measures included mentoring quality, presentations, publications, subsequent grants, impact on career success, conference ratings, and APA membership diversity. For the 10 Scholars from the first 4 cohorts, mean scores were 4.5 (5 = strongly agree) for RAPID fostering mentoring, developing research skills, and helping Scholars feel more comfortable as underrepresented minority (URM) faculty; 78% delivered platform or poster presentations on their project. They published 56 total articles and received a mean of 2.5 subsequent grants. Their mean score for RAPID "advancing my career by facilitating promotion or getting a job" was 4.6. The first 4 RAPID Conferences were highly rated (mean scores = 4.2-4.8) and brought in 33 additional URM young investigators. Pre-RAPID, URM APA membership stagnated at 6%-7% for 5 years. In RAPID's first year, URM APA membership rose to 8%, then to 10% by 2017 (43% increase; P < .001). RAPID Scholars generated multiple presentations and publications. RAPID mentoring and Conferences were highly rated. RAPID was associated with career advancement and increased professional society diversity. RAPID could serve as a national model for enhancing URM career development and professional society diversity.

4552 Pediatrician Readiness to Participate in Clinical Trials: Roles of interest, barriers and interventions

OBJECTIVES/GOALS: Clinical trials are the gold standard for developing evidence-based medicine. However, 20% of pediatric randomized clinical trials are discontinued and about 30% of completed trials go unpublished. (Pica and Bourgeois, 2016) Although patient recruitment is the most cited barrier to completing clinical trials, trials funded by academia are more likely discontinued compared to those funded by industry. This study is an attempt to gain additional insights into clinical trials in academic pediatrics. METHODS/STUDY POPULATION: Junior pediatrics faculty (Instructors and Assistant Professors) were recruited to participate in an online survey through RedCAP. The physicians were asked if they had prior experiences with clinical trials and whether they have interest in participating in clinical trials. Those interested were asked three additional questions: what role they were interested in, barriers to participating and interventions they thought would educate them about participating in clinical trials. RESULTS/ANTICIPATED RESULTS: Ninety two (92) out of 119 (77%) junior pediatrics faculty completed the survey. Twenty (20) pediatric subspecialties were represented and respondents were on various academic pathways. A third of the respondents (35%) had previously participated in clinical trials. A majority of the faculty respondents (84; 70%) are on the clinical educator pathway. The 13 respondents who were not interested in clinical trials indicated their preference for patient care, education and quality improvement. Of those interested in clinical trials, the top three preferred roles were site co-investigator (68%), help designing future protocol (47%) and site principal investigator (44%). Other than time, the top barriers to participation were a lack of awareness of what it takes to lead or engage in clinical trials (53%) and a lack of training on clinical trials (45%). Mentoring from an experienced clinical trialist emerged as the top preferred intervention (78%). DISCUSSION/SIGNIFICANCE OF IMPACT: Although limited to one institution, the findings of this study provide insights into pediatric faculty interest in clinical trials. If academic pediatricians are provided with mentoring, there could be an uptick in completed and published clinical trials involving pediatric populations.

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.

Climate Change as a Social Determinant of Health.

* Abbreviations: AAP — : American Academy of Pediatrics SDOH — : social determinant of health Social determinants of health (SDOHs), defined as the social circumstances in which people are born, grow, live, work, and play, profoundly affect children’s health and drive health disparities.1 SDOHs are shaped by the distribution of money, power, and resources at global, national, and local levels. The list of potential SDOHs is expansive and includes food insecurity, housing instability, violence exposure, structural racism, poverty, and immigration-related stressors. Addressing SDOHs within the pediatric medical home has garnered considerable interest lately as a potential solution to both improving health across the life course and mitigating health care costs.1 However, one critical determinant is missing from the pediatric community’s definition of SDOHs: climate change. Climate change (also called global warming) is arguably one of the greatest public health threats of our time. Climate change is caused by rising greenhouse gas emissions from human activity, resulting in higher global average temperatures and changes to environmental and human systems. The American Academy of Pediatrics (AAP) issued a policy statement in 2007 (revised in 2015) encouraging pediatricians to reduce carbon emissions and support families experiencing the effects of climate change.2 We agree with this call to action. However, given the current national focus of policymakers, funders, and health care systems on addressing SDOHs, along with the ubiquitous impact of the changing climate on the social and environmental circumstances in which children live, we recommend climate … Address correspondence to Maya I. Ragavan, MD, MPH, MS, Division of General Academic Pediatrics, University of Pittsburgh, 3414 Fifth Ave, Pittsburgh, PA 15213. E-mail: ragavanm{at}chp.edu

Update on the Evaluation of Text Messaging as an Educational Method to Improve Health Care Utilization.

We would like to update readers on the research related to the 2018 publication of our randomized controlled trial (RCT; NCT03235830) “Evaluation of Text Messaging as an Educational Method to Improve Healthcare Utilization Among Infant Caregivers with Low Health Literacy” in Academic Pediatrics. In that study, we enrolled 231 caregivers (which includes parents, legal guardians, and foster parents) and randomized them into 2 groups, those receiving written health education (n = 99) and those receiving the educational materials in addition to 4 text messages/week for 6 months (n = 108).

Langerhans Cell Histiocytosis With Vertebral Involvement Diagnosed and Treated Over the Last 15 Years in a Single Canadian Pediatric Academic Institution.

We report 11 children with vertebral lesion of Langerhans cell histiocytosis (LCH) diagnosed and treated between 2000 and 2015. Vertebral lesions were usually present at LCH diagnosis. No child developed neurologic symptoms. Among 29 vertebral lesions, only 2 were unstable. Chemotherapy was used in all children but 3. A LCH recurrence was observed in 6 patients, involving vertebrae in 4 cases. All children were disease-free at their last follow-up. Sequelae were more often radiologic than clinical. Since potential recurrences and incomplete bone regeneration exist, discussion about optimal treatment and long-term follow-up of vertebral lesions are essential.

Exploring Academic Pediatrician Perspectives of Factors Impacting Physician Well-Being.

Promotion of physician well-being has emerged as a national priority, yet meaningful interventions depend on further understanding the factors that promote and detract from physician well-being. The aim of this study was to better understand the perspectives of academic pediatricians regarding the factors influencing their well-being. We conducted a qualitative study using grounded theory methodology. In June 2018, we performed facilitated focus groups with academic pediatric faculty at our institution. Focus groups were audio recorded, transcribed, and analyzed using the constant comparative method to identify key themes. Fifty-four pediatricians participated in the focus groups. Key themes included 1) pediatricians feel inundated by collective professional and personal pressures, 2) pediatricians feel they have lost control over how time at work is spent, and 3) obscured professional-personal boundaries can cause erosion of personal life. Pediatricians identified 3 key barriers to well-being: collective pressures, including increasing and competing academic and clinical responsibilities; low value tasks that consume their time; and erosion of personal life. This study adds to the growing literature describing physician well-being as strongly influenced by workplace factors, and offers examples of modifiable factors for further investigation.

Better Health Service Use for Families of Children With Special Health Care Needs.

* Abbreviations: CSHCN — : children with special health care needs ED — : emergency department The article by Fuller et al,1 which examines relationships between family material hardships, resilience, and suboptimal health care use, is a refreshing and constructive step forward in unpacking the relationship between family difficulties, ability to cope with those difficulties, and health care needs that both go unmet and are met through the less-desirable route of the emergency department (ED). Including children both with and without special health care needs, this article paves the way toward potential practical interventions to enhance family resilience and mitigate material hardships that could address the difficult problem of excessive ED use and, instead, point families toward care that meets their child’s needs in a more durable way. In previous work,2 the authors added to the growing body of evidence3,4 linking material hardships with unmet health care needs and increased ED … Address correspondence to Christopher J. Stille, MD, MPH, Section of General Academic Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, 13123 E 16th Ave, Mailstop B032, Aurora, CO 80045. E-mail: christopher.stille{at}childrenscolorado.org

Developing a career in academic paediatrics

Abstract Many trainees think about research towards the end of clinical training, but at that stage, it may be too late to get the most from the limited opportunities that remain. Ideally, trainees should consider research early in their career. For some, a career in academic paediatrics may be attractive, in which case following the clinical academic pathway as outlined by the National Institutes of Health Research may be appropriate. For others, research may be part of a wider clinical training. This article discusses a variety of research opportunities available to trainees, and offers advice on a career in academic paediatrics.

On-Line Patient Portal Use By Caregivers in Pediatric Oncology: Are We Widening Sociodemographic Disparities?

BACKGROUND: Financial and regulatory incentives stemming from the Health Information Technology for Economic and Clinic Health Act have encouraged and, hence, increased the availability of online patient portals ('portals') that connect to electronic health records. Through portals, caregivers have direct access to portions of their child's medical record. Direct access is intended to engage caregivers in treatment and, consequently, to improve disease management. However, demonstrated associations between portal use and engagement in care is limited within pediatrics and non-existent in pediatric oncology. Caregivers of children with cancer have increased anxiety in response to their child's diagnosis and treatment (Myers et al, Cancer, 2014). Allowing caregivers swift access to results via portals may reduce anxiety for some, however, complicated written material may exacerbate anxiety and cause confusion (Schultz, et al, Pediatric Blood &amp; Cancer, 2018). Furthermore, differences in sociodemographic variables between portal users and non-users potentially highlights widening healthcare disparities. Little is known about the use of portals by caregivers of children with cancer or what effect use may have on caregivers. As a first step, this study sought to examine whether sociodemographic and clinical care variables are associated with portal activation in a pediatric oncology sample. METHODS: Data were extracted from the electronic health records of pediatric oncology patients diagnosed or treated for their first known cancer within Nemours Center for Cancer and Blood Disorders in the Delaware Valley from January 1, 2012 through June 30, 2017. Sociodemographic variables (patient age, gender, race, preferred language, insurance, zip-code), clinical characteristics (cancer type, date of diagnosis, total number of laboratory and radiology tests within the study period), and portal activation date were gathered. A cost of living index (COLI) was computed using zip-code data. Cancer type was classified as "liquid" or "solid" based on chemotherapy and radiology follow-up procedures. Those who activated the portal more than 30 days before a cancer diagnosis were excluded from evaluation to better isolate portal activation related to cancer diagnosis. Data were summarized with descriptive statistics. Chi-square and independent samples t-tests compared those who did and did not activate the portal. RESULTS: The initial sample included 445 children; 73 families activated the portal more than 30 days before cancer diagnosis. Of the remaining 372 patients, 197 families (53%) activated the portal. Those who activated did not differ from those who did not in regard to patient age, gender, COLI, or type of cancer. Those who were of non-majority race, spoke a language other than English, and did not have private insurance were overrepresented among those who did not activate (TABLE). Families of children undergoing more radiology and lab tests were more likely to activate. For those who activated the portal, 39% did so within 1 month of diagnosis (day -30 to day +30), 13% did so from day +31 to +90, 36% did so from day +91 to +365, and 11% did so greater than 366 days post diagnosis. CONCLUSION: There are significant differences in patient portal activation by race, preferred language, and type of insurance. These results suggest sociodemographic disparities in portal activation, similar to patterns found in our pediatric primary care network (Ketterer et al, Academic Pediatrics, 2013). In that sample, however, only 26% of patients activated accounts in contrast to the 53% of families in pediatric oncology activating accounts. In our sample, while general type of cancer was not associated with portal activation, greater burden of treatment evaluation was. This study is the initial step in a program of research evaluating the use, utility, and outcomes of portal use in pediatric oncology. Further work will include evaluation of patterns of portal usage along with evaluations of health literacy and portal related anxiety. As portals become more ubiquitous, we must better understand how they are used and mitigate any disparities in or ill effects of access to this information. Disclosures No relevant conflicts of interest to declare.

Editorial introductions

Editorial introductions

10 Year Retrospective Review of Cytopathology at an Academic Pediatric Specialty Hospital in the United States

10 Year Retrospective Review of Cytopathology at an Academic Pediatric Specialty Hospital in the United States

Factors That Influence the Choice of Academic Pediatrics by Underrepresented Minorities.

Our objective for this study was to explore the experiences of faculty in academic pediatrics who are underrepresented minorities (URMs) at 2 urban medical centers, in particular, the experiences that influenced their pursuit of academic pediatrics. Three focus groups were conducted in 2016 with URM faculty from Howard University College of Medicine and Children's National Health System to explore how they were influenced to pursue academic pediatrics. Ten 1-on-1 interviews were also conducted in 2017 with URM faculty at Children's National Health System. Focus groups were coded and analyzed by the research team using standard qualitative methods. The 1-on-1 interviews were coded and analyzed by the primary investigator and verified by members of the research team. A total of 25 faculty participated in the study (15 in the focus groups and 10 in individual interviews). Eighteen of the faculty were women and 7 were men. Findings revealed that mentorship, family, and community influenced participants' career choices. Barriers for URMs in academic pediatrics included (1) lack of other URMs in leadership positions, (2) few URMs practicing academic pediatrics, and (3) the impact of racism and gender and implicit bias in the medical field. Mentorship and family are major influences on why URMs become academic pediatricians. Lack of URMs in leadership positions, racism, gender bias, and implicit bias are barriers for URMs in academic pediatrics. More research should be conducted on ways to enhance the experience of URMs and to reduce barriers in academia.

The Role of Sponsorship in Achieving Workforce Diversity in Academic Pediatrics.

* Abbreviation: URM — : underrepresented minority Despite large-scale initiatives to promote workforce diversity in academic medicine, results have been disheartening, with marginal improvements in some areas and clear regression in others.1 Although the proportion of underrepresented minority (URM) faculty in US academic medical centers has remained essentially flat over the last 2 decades (7% vs 8%), the number of African American men in medical school is currently lower than it was in 1978.2,3 These data unquestionably reveal that workforce diversity in medicine is not only stagnating but failing to keep pace with population trends toward a majority minority country.1 In “Factors That Influence the Choice of Academic Pediatrics by Underrepresented Minorities” in this issue of Pediatrics , Dixon et al4 explore, through focus groups and interviews, the experiences of URM academic faculty in their professional identities. The authors identified 7 themes that framed being a URM in academic pediatrics. These themes collectively overlap with a group of factors colloquially termed the “minority tax,” defined as the burden of extra responsibilities placed on minority faculty to achieve diversity.5 The responsibilities representative of the minority tax manifest in numerous areas of academic life. URMs may be disproportionately charged to lead institutional diversity initiatives. These commitments rarely come with time allocation or resources and leave less time for scholarly productivity … Address correspondence to Jean L. Raphael, MD, MPH, Texas Children’s Hospital, 6701 Fannin St, Suite D.1540.00, Houston, TX 77030. E-mail: raphael{at}bcm.edu

22. NATIONAL SURVEY OF RESEARCH OUTCOMES FOR PEDIATRIC HOSPITAL MEDICINE FELLOWSHIP GRADUATES

Background Pediatric Hospital Medicine (PHM) fellowships were developed between the 1990s and early 2000s and have advanced to meet established goals and forthcoming accreditation standards. Few studies have evaluated the research outcomes of PHM fellowship graduates. Objective To describe research outcomes of PHM fellowship graduates. Methods IRB-approved, cohort study using an electronic survey emailed to all PHM Fellowship graduates in July-December 2018. Questions were modified from an existing survey and developed by expert consensus to address study objectives, and were pilot tested. The 88-item survey addressed demographics, characteristics of fellowship training, and research and leadership outcomes. Results 143/228 (63%) PHM fellowship graduates completed the survey, representing 20 states in the US and Canada (graduation dates, 2000-2018). Of the 143 respondents, 127 (89%) graduated from dedicated PHM fellowship programs, 13 (9%) from academic general pediatrics programs with inpatient clinical experience, and 3 (2%) from combined programs. The median fellowship duration was 2 years. Among the graduates, 67 (47%) hold a Masters’ or Doctoral degree in addition to their medical degree. Participants were on average very satisfied with their decision to do PHM fellowship (mean 4.4/5, st dev 0.77). Nearly half (45%) are currently employed by their fellowship institution. 112 (78%) now practice primarily at a university or children's hospital, 7 (5%) at a community hospital, and 24 (17%) at both. The most common types of research conducted during fellowship were clinical, (N=74, 52%), quality improvement (N=57, 40%), health services (N=34, 24%) and medical education (N=27, 19%), with some fellows reporting multiple categories of research. 48 (34%) applied for a grant during fellowship, and 30 (21%) received a grant during fellowship. 63 (44%) published their primary fellowship research. 110 (77%) fellowship graduates continued to do research after graduation. 90 (63%) published during fellowship or after graduation, with 70 (49%) publishing first-author peer-reviewed original research manuscripts. Conclusions This study demonstrates robust research activity among PHM fellowship graduates and can serve as a benchmark for educational leaders to advise potential fellowship candidates and for fellowship leaders to inform training. Future directions include studying the facilitating factors to research success during fellowship and outlining successful models of research training for fellows.

8. LEARNERS, TEACHING, & EDUCATION SYSTEMS FACTORS: PEDIATRIC FACULTY PERSPECTIVES OF IMPACT ON WELLBEING

Introduction Many pediatricians report burnout and low professional fulfillment. While it is assumed that academic pediatricians garner professional fulfillment from teaching, little is known about the perceived intersection of teaching and pediatrician wellbeing. Methods In June 2018, pediatric faculty focus groups were conducted at a university-based pediatrics department, addressing work-related factors with greatest impact on wellbeing. Focus groups were audio recorded, transcribed, and de-identified. All excerpts about learners and teaching were manually coded using the constant comparative method. Results Participants included 47 faculty in 8 focus groups, of whom 55% were female. A small number of comments described positive impact of teaching on wellbeing. “It's a great privilege to be around young learners that are energized to extract as much as they possibly can...[teaching] helps sustain most of us.” A larger subset described negative impact of teaching. Four themes emerged: (1) Perceived institutional devaluation of teaching as an academic pursuit, “If teaching doesn't get you promoted, I don't know what should... I know that it really stresses me out just thinking about it and having to come up with things to do that count because what I'm already doing, I don't think counts enough.” (2) Perceived decline in trainee work ethos, “The patients have to be cared for. You're the one answering [pages], and [the residents are] gone. Then they don't have the ownership that you may have had during your training.” (3) Perceived disparity in work hour protection and wellness support for faculty as compared to trainees, “I would love to have work-hour restrictions and all those sorts of things... I'm not angry or bitter at [trainees], but... everyone just makes the assumption that you're in charge and you've already figured out how to cope with your 80-hour work weeks.” (4) Perceived burdens of teaching, “There's fewer and fewer faculty involved with teaching because of a lack of rewards and more administrative [workload] when you do teach, like the 20-page evaluations of a medical student you spend an hour with.” Conclusion Teaching may be both protective and detrimental to pediatrician wellbeing. Future studies should further explore teaching-related factors that contribute to a sense of fulfillment and burnout to ensure faculty remain engaged and fulfilled in their work.

Kinder und Krieg im Blick deutscher Pädagogen, Psychologen und Kinderärzte 1914 bis 1918

ABSTRACT The First World War marked a turning point in the lives of children, whose daily existence and emotional experiences were deeply impacted. “War children” faced significant emotional strain, for example due to separation or the loss of family members, as well as material sacrifices, malnutrition and famine. In addition, they were exposed to a culture of war which stylised them as heroic members of their communities. The topics of this paper are war experiences and perceptions of children in Germany. In addition, the paper assesses the academic conceptualisation of children’s war experiences in contemporary academic literature. This paper shows that leading researchers, in particular psychologists, practicing and academic pedagogues and paediatricians, did not focus on the reality of children during the war, marginalised the psychological and physical consequences of war and prioritised the stabilisation of the home front over the needs of children. Nationalist hubris, the interpretation of war as a “natural” phenomenon, which was seen as rooted also in children’s minds, as well as the limitations of contemporary research on children are key reasons for the lack of focus on the consequences of separations and losses caused by war as well as the misinterpretation or downplaying of children’s fears and grief.

Medicaid Policy Commentaries: An Expanded Academic Pediatrics Section

Medicaid Policy Commentaries: An Expanded Academic Pediatrics Section

Mo1011 – Utilizing Social Media to Share Scientific Information in Academic Pediatrics

Mo1011 – Utilizing Social Media to Share Scientific Information in Academic Pediatrics

Overview and Preparation Guide for Academic Careers in Pediatric Pharmacy, Part 1: Career as a Pediatric Pharmacy Practice Faculty Member.

Pediatric clinical pharmacy is a growing and evolving field with an increasing number of pediatric clinical pharmacists in academia. In 2017, pediatric practice faculty members represented approximately 7.6% of all pharmacy practice faculty in the United States. The benefits of practicing in an academic environment are many, including, but not limited to, the ability to shape the future of pharmacy practice through the training of the next generation of pharmacists, contributing to science through research and scholarly activities for the care of pediatric patients, and positively impacting patient care for the most vulnerable of patients. Part one of this two-part series describes careers in academic pediatric pharmacy, as well as faculty roles and responsibilities, and provides information and advice related to the preparation and transition into careers in academic pediatric pharmacy.