Pediatric Fellowship Training Research Articles

Care of the Pediatric Patient for Ambulatory Tonsillectomy With or Without Adenoidectomy: The Society for Ambulatory Anesthesia Position Statement.

The landscape of ambulatory surgery is changing, and tonsillectomy with or without adenoidectomy is one of the most common pediatric surgical procedures performed nationally. The number of children undergoing tonsillectomy on an ambulatory basis continues to increase. The 2 most common indications for tonsillectomy are recurrent throat infections and obstructive sleep-disordered breathing. The most frequent early complications after tonsillectomy are hemorrhage and ventilatory compromise. In areas lacking a dedicated children's hospital, these cases are managed by a nonpediatric specialized anesthesiologist and general otolaryngology surgeon. In response to requests from our members without pediatric fellowship training and/or who care for pediatric patients infrequently, the Pediatric Committee of the Society for Ambulatory Anesthesia (SAMBA) developed a position statement with recommendations for the safe perioperative care of pediatric patients undergoing tonsillectomy with and without adenoidectomy in freestanding ambulatory surgical facilities. This statement identifies children that are more likely to experience complications and to require additional dedicated provider time that is not conducive to the rapid pace and staffing ratios of many freestanding ambulatory centers with mixed adult and pediatric practices. The aim is to provide health care professionals with practical criteria and suggestions based on the best available evidence. When high-quality evidence is unavailable, we relied on group consensus from pediatric ambulatory specialists in the SAMBA Pediatric Committee. Consensus recommendations were presented to the Pediatric Committee of SAMBA.

Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020-2021.

To understand the perspectives of pediatric fellows training in critical care subspecialties about providing spiritual care. Cross-sectional survey of United States National Residency Matching Program pediatric fellows training in critical care specialties. Online survey open from April to May 2021. A total of 720 fellows (165 cardiology, 259 critical care, and 296 neonatology) were contacted, with a response rate of 245 of 720 (34%). None. We assessed fellows' survey responses about spiritual care in neonatal and pediatric critical care units. Categorical data were compared using chi-square test or Fisher exact tests. The Wilcoxon rank-sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Free-text responses were independently coded by two research investigators. A total of 203 of 245 (83%) responding fellows had never received training about spiritual care and 176 of 245 (72%) indicated that they would be likely to incorporate spiritual care into their practice if they received training. Prior training was associated with increased familiarity with a framework for taking a spiritual history ( p < 0.001) and increased knowledge of spiritual practices that could influence medical care ( p = 0.03). Prior training was also associated with increased self-reported frequency of taking a spiritual history ( p < 0.001) and comfort in referring families to spiritual care resources ( p = 0.02). Lack of time and training were the most reported barriers to providing spiritual care. Providing spiritual care for families is important in critical care settings. In 2020-2021, in the United States, 245 pediatric critical care fellows responded to a survey about spiritual care in their practice and reported that they lacked training in this subject. An opportunity exists to implement spiritual care curricula into pediatric fellowship training.

Through the Webcam: Impact of Telehealth on Developmental and Behavioral Pediatric Fellowship Training.

The purpose of this study was to examine how fellowship program directors (PDs) and their fellows perceived the impact of telehealth on fellowship education in developmental behavioral pediatrics (DBP) during the COVID-19 pandemic. Two surveys were designed targeting DBP PDs and fellows and were distributed by e-mail from January to May 2021. Surveys consisted of closed-ended and open-ended questions about telehealth's impact on didactics, clinical teaching, and clinical experience. Analyses included descriptive statistics, Fisher's exact test, χ 2 test, and qualitative classical content analysis. A total of 31 PDs (82%) and 62 fellows (51%) responded. Before the pandemic, 0% of programs had fellows do telehealth visits at least weekly vs during the pandemic, and 85% of the programs had fellows conduct telehealth video visits at least once/week ( p < 0.001). PDs and fellows agreed on many advantages of learning through telehealth particularly preceptors giving "real-time" feedback by private text messages and being able to observe fellow-run encounters unobtrusively. Ninety-four percent of fellows and 100% of fellowship directors believe that telehealth should be a formal part of DBP fellowship training even if in-clinic visits are available. Prepandemic and pandemic learning experiences differed significantly. PDs and fellows shared similar perceptions on how telehealth affected fellow education, except how telehealth affected didactics. Institutions varied in how telehealth was used to teach fellows, but many reported they found benefit in giving real-time feedback using chat functions during telehealth appointments. DBP fellowship programs should consider providing specific guidance to effectively teach telehealth to fellows.

Comorbidity of Obsessive-Compulsive Symptomatology and Bowel and Bladder Dysfunction in a Tertiary Children's Hospital: A Case Series

ObjectiveTo improve understanding of co-occurring obsessive-compulsive disorder (OCD) and bowel and bladder dysfunction (BBD) in an outpatient pediatric urology clinic setting. To provide a series of clinical care recommendations to enhance the identification and integrated medical and behavioral health treatment of these disorders. MethodsAuthors participated in a series of discussions to define the patient population and specific aims for the study. Efforts were made to select index patients of diverse background despite limited sample availability. Three patients were ultimately selected for the study. ResultsThe case studies highlight the connection between urinary issues and underlying OCD symptoms. All patients were initially seen for medical treatment of urological symptoms, then referred for psychological evaluation, and were diagnosed with and received treatment for OCD. Similarities among the cases, including experience of phantom urinary incontinence, stressors present that contributed to symptoms, and obsessive fears of incontinence that led to compulsive behavior, were discussed. Differences between the cases, including patient age, sex, and compulsive behavior demonstrated (ie, urinary frequency, excessive wiping) were also reviewed. ConclusionAccess to a behavioral health provider can enhance the identification of comorbid psychological disorders and can reduce duration of symptoms through appropriate psychological treatment. Authors provide recommendations for screening measures and reinforce importance of including basic education on psychiatric diagnoses and impact on urological symptoms in urology and pediatric fellowship training programs. Future research exploring prevalence of comorbid psychiatric conditions and efficacy of treatment interventions in a pediatric urology population would be beneficial.

Parental leave during pediatric fellowship training: A national survey.

Until recently, no uniform requirements for parental leave (PL) existed in graduate medical education. We implemented a national survey, with the objective of ascertaining fellows' perceptions of PL policies and their impact. This is the first study to focus exclusively on pediatric subspecialty fellows. An online survey instrument was created targeting pediatric fellows. The survey was accessed by 1003 (25%) of the estimated 4078 pediatric subspecialty fellows and 853 (21%) submitted surveys. Respondent demographic data paralleled the data reported by the American Board of Pediatrics. Half of respondents did not know whether their program had a written PL policy. Over 40% reported ≥ 5 weeks of paid PL. Most indicated that fellows use vacation, sick leave, and unpaid time for PL. Almost half of respondents (45%) indicated that their program's PL policy increases the stress of having a child. Fellows chose establishing/extending paid leave and intentionally fostering a more supportive program culture as the most crucial candidate improvements. The importance of equitable PL polices between parent fellows and co-fellows was an important theme of our qualitative data. Fellows feel there is a moral misalignment between the field of pediatrics' dedication to maternal and child health and current PL policies governing pediatric trainees. PL policies vary widely among pediatric fellowship programs and are often not known by fellows. Fellows are not satisfied with PL policies, which often exacerbate stress for new parents and burden their co-fellows. Targeted modification of several aspects of PL policies may improve their acceptance.

Integrated diversity, equity, and inclusion curriculum into pediatric anesthesia fellowship training: Another step forward

Integrated diversity, equity, and inclusion curriculum into pediatric anesthesia fellowship training: Another step forward

Differences in Lifetime Earning Potential for Pediatric Subspecialists.

Our 2011 report, reflecting data from 2007-2008, demonstrated that, for many pediatric subspecialties, pursuing fellowship training was a negative financial decision when compared with practicing as a general pediatrician. We provide an updated analysis on the financial impact of pediatric fellowship training and model interventions that can influence the results. We estimated the financial returns a graduating pediatric resident might anticipate from fellowship training followed by a career as a pediatric subspecialist and compared them with the returns expected from starting a career as a general pediatrician immediately after residency. We evaluated the potential effects of eliminating medical school debt, shortening the length of fellowship training, and implementing a federal loan repayment program for pediatric subspecialists. We compared the financial returns of subspecialty training in 2018-2019 to those from our previous report. Pursuing fellowship training generated widely variable financial returns when compared with general pediatrics that ranged from +$852 129 for cardiology to -$1 594 366 for adolescent medicine. Twelve of 15 subspecialties analyzed yielded negative financial returns. The differences have become more pronounced over time: the spread between the highest and lowest earning subspecialties widened from >$1.4 million in 2007-2008 to >$2.3 million in 2018-2019. The negative financial impact of fellowship training could be partially ameliorated by shortening the length of training or by implementing pediatric subspecialist specific loan repayment programs. This report can be used to help guide trainees, educators, and policy makers. The interventions discussed could help maintain an adequate and balanced pediatric workforce.

Impact of Pediatric Subspecialty Training on Perioperative Complications in Adolescent Idiopathic Scoliosis Surgery.

This was a retrospective study of data prospectively collected from 2012 to 2016 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The objective was to evaluate the effect of pediatric fellowship training on 30-day perioperative morbidity and mortality following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Several pathways exist in North America by which physicians acquire the clinical and technical skills to manage AIS surgically. Previous work has noted that surgeons with pediatric fellowship training tend to perform the bulk of pediatric spine surgeries. However, no study has been performed that examines if pediatric fellowship training (PFT) has an impact on early postoperative outcomes. A total of 14,194 AIS surgical patients were identified from the ACS NSQIP database. A cohort receiving isolated PSF was abstracted from this group and separated into 3 groups according to surgeon training: (1) ped+ (with PFT, n=4455); (2) ped-(without PFT, n=325); and (3) ped+match (patients selected from ped+ matched to ped- for age, sex, and fusion levels, n=325). The groups were compared for 30-day perioperative morbidity and mortality. No significant differences were noted for the 3 groups in terms of wound infections, length of hospital stay, readmissions, and unplanned returns to the operating room. Ped+match and ped- groups had no difference in neurologic injury rates. However, the ped+ and ped+match groups had significantly lower rates of blood transfusion and average volume of blood lost compared with the ped- group. Surgeons with pediatric fellowship training have a significantly lower average blood loss volume and blood transfusion rate in PSF for AIS than surgeons without such training. Understanding that different training pathways for surgeons may directly impact operative outcomes invites further examination of surgical education in North America to improve training consistency. [Orthopedics. 2020;43(5):e454-e459.].

The Maturation of a Proficient Neonatologist: From the Delivery Room to Independent Practice.

* Abbreviations: ACGME — : Accreditation Council for Graduate Medical Education ELBW — : extremely low birth weight GME — : graduate medical education NPM — : neonatal-perinatal medicine VLBW — : very low birth weight A critical question for all pediatric fellowship training programs is whether the clinical experiences and education provided prepare trainees for “life after fellowship.” One essential potential exposure gap for fellows in neonatal-perinatal medicine (NPM) is in delivery room resuscitation of extremely preterm infants. These deliveries are rare (∼1% of all deliveries), and numbers vary considerably between training sites. Accreditation Council for Graduate Medical Education (ACGME) program requirements for graduate medical education (GME) in NPM include the provision of patient care experiences that are necessary for fellows to acquire skill in delivery room stabilization and resuscitation of critically ill neonates.1 Graduated pediatric residents enter NPM fellowships with wide variation in previous neonatology exposure for both knowledge and procedures because of both decreased exposure and increased supervision. NPM fellowship program directors report perceived deficiencies in preparedness for incoming NPM fellows across multiple domains.2 This variation in preparedness leaves NPM program directors with a complicated problem to tackle: individualized educational training, some of which is at the mercy of available clinical experiences and luck of the draw. The ACGME educational milestones were developed to describe developmental progression through medical training and provide individualized feedback on progression toward competency. However, clear and consistent definitions of competency … Address correspondence to Eric Eichenwald, MD, Division of Neonatology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Suite 2NW28, Philadelphia, PA 19118. E-mail: eichenwald{at}email.chop.edu

Impact of COVID-19 on Pediatric Gastroenterology Fellow Training in North America.

ABSTRACTBackground:The COVID-19 pandemic has drastically changed healthcare systems and training around the world. The Training Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition sought to understand how COVID-19 has affected pediatric gastroenterology fellowship training.Methods:A 21 question survey was distributed to all 77 pediatric gastroenterology fellowship program directors (PDs) in the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition program director database via email on April 7. Responses collected through April 19, 2020 were analyzed using descriptive statistics.Results:Fifty-one of 77 (66%) PDs from the United States, Canada, and Mexico responded to the survey. Forty-six of 51 (90%) PDs reported that they were under a “stay-at-home” order for a median of 4 weeks at the time of the survey. Two of the 51 (4%) programs had fellows participating in outpatient telehealth before COVID-19 and 39 of 51 (76%) at the time of the survey. Fellows stopped participating in outpatient clinics in 22 of 51 (43%) programs and endoscopy in 26 of 51 (52%) programs. Changes to inpatient care included reduced fellow staffing, limiting who entered patient rooms, and rounding remotely. Fellows in 3 New York programs were deployed to adult medicine units. Didactics were moved to virtual conferences in 47 of 51 (94%) programs, and fellows used various online resources. Clinical research and, disproportionately, bench research were restricted.Conclusions:This report provides early information of the impact of COVID-19 on pediatric fellowship training. Rapid adoption of telehealth and reduced clinical and research experiences were important changes. Survey information may spur communication and innovation to help educators adapt.

60. NEEDS ASSESSMENT AND EARLY EXPERIENCE USING PEDIATRIC SUBSPECIALITY EPAS AS A FORMATIVE ASSESSMENT TOOL

Background Compared to semi-annual Milestone-based assessment models of fellowship training, Entrustable Professional Activities (EPAs) may be better at assessing fellow development. EPAs' formative assessment capabilities are unknown, nor have they been adopted as a method for evaluation. The use of EPAs' entrustment scales could allow for more specific, actionable feedback from faculty during training. Methods In a pilot study, we created a needs assessment on feedback in pediatric fellowship training and a readily accessible online EPA assessment form. Fellows use the form to ask faculty to choose EPAs to assess following a clinical experience. Fellows from Neonatology, Endocrinology, Adolescent Medicine, and Developmental & Behavioral Pediatrics were recruited. Fellows are asked to obtain a minimum of four EPA assessments monthly. Time spent completing forms and providing feedback is recorded for each encounter. Results 20 faculty, 4 program directors and 9 fellows completed the needs assessment. 77% of fellows reported current Milestone-based feedback aided their professional development, but only 60% were satisfied with the quantity and quality of feedback received. 80% of faculty believed fellows were provided adequate feedback using Milestones, but only 50% reported they provided good feedback. Faculty identified many barriers to giving good feedback using Milestones. 85% felt use of a structured EPA template and more frequent opportunities would improve their feedback. In the first 4 months of the pilot, 27 episodes of EPA based feedback occurred. 12 different faculty members have provided feedback using the template. The most often used EPA was Lead Team while Public Health was least used. An average of 9 minutes of feedback per assessment was reported. Conclusions Our pediatric faculty and fellows feel an opportunity exists to improve the quality and quantity of feedback from our current Milestone approach. An online EPA tool is being used by faculty and fellows to provide more frequent feedback. Future assessments will evaluate the utility and specificity of feedback provided.

COMPLICATION ANALYSIS OF PEDIATRIC AND ADOLESCENT ACL RECONSTRUCTIONS IN THE ABOS DATABASE

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed in adolescents. Similarly, the rate of ACL reconstructions performed in pediatric patients has been increasing, and this population has the highest rate of primary and revision ACL Surgery. The purpose of this study was to review data on ACL reconstructions performed in patients under the age of 19 years that were submitted to the American Board of Orthopaedic Surgeons (ABOS) Part 2 examination to evaluate post-operative complications and trends over time in applicant fellowship training. METHODS: A query to the ABOS SCRIBE database was submitted for all ACL reconstructions performed in patients less than 19 years old. The database query was based on ICD-9 and ICD-10 diagnostic codes submitted by each applicant. Data included geographic region, fellowship training of the applicant, exam subspecialty, and reported complications. A subgroup analysis of complications was also performed in patients less than 15 years compared to those 15-18 and amongst different applicants based on fellowship training. RESULTS: From 2000 – 2016, 9,767 ACL reconstructions were performed by candidates taking Part 2 of the ABOS board certification process. The mean age at surgery was 16 years (reported age range 0-18) and a meniscus procedure was performed in 57% of cases. There was a 41% increase in ACL reconstructions in those under the age of 15 years between 2000 and 2016. In each age group, the incidence of ACL reconstruction in males was higher than in females (ratio 5:4) except in those 12 and 13 years old whereby the incidence was higher in females (ratio 2:1). A majority (70.5%) of ACL reconstructions were performed by candidates with a sports medicine fellowship. In patients less than 15 years old 24.5% of reconstructions were performed by candidates with a pediatric or dual pediatric and sports medicine fellowship training. The overall complication rate was 13.6% with 0.4% anesthetic related complication (0.2% related to regional anesthesia). The reoperation rate was 0.8% and the readmission rate was 0.5%. Twelve patients (0.14%) sustained a venous thromboembolic event (6 deep vein thrombosis and 6 pulmonary embolism). A majority of complications (10.83%) were related to the surgery. The most common surgery related complications were infection (1.51%) and arthrofibrosis (1.3%). The overall incidence of reported complications was not statistically different between those with sports (13.7%), pediatric (16.3%), or both sports and pediatric fellowships (17.5%). Differences in specific complications were noted when comparing those with only pediatric training and those with only sports medicine fellowship training including graft related problems (1.9% vs. 0.7%, p=0.001, respectively) and nerve palsy/injury (1.9% vs. 0.6%, p&lt;0.001, respectively). CONCLUSION/DISCUSSION: ACL reconstruction in the adolescent and pediatric age groups are primarily performed by candidates with a sports medicine fellowship. Complications rates between candidates reporting either sports medicine or pediatric fellowship training are overall comparable. Graft related complication and nerve palsy/injury were lower in those with sports medicine fellowships and both pediatric and sports medicine fellowships suggesting that additional training in sports medicine or arthroscopy may help minimize those complications. Longitudinal studies evaluating long term risks and complications after pediatric/adolescent ACL reconstruction are needed.

The pediatric rheumatology objective structured clinical examination: progressing from a homegrown effort toward a reliable and valid national formative assessment

BackgroundOf 37 pediatric rheumatology fellowship training programs in the United States, many have three or fewer fellows at a given time, making large-scale assessment of fellow performance difficult. An objective structured clinical examination (OSCE) is a scenario-based simulation method that assesses individual performance, thus indirectly measuring training program effectiveness. This study describes the development and implementation of two national pediatric rheumatology OSCEs and methods used for programmatic improvement.MethodsOSCEs for pediatric rheumatology fellows were held in 2009 and 2011 during national rheumatology meetings using scenarios and assessment forms originally developed by a fellowship program director. The seven scenarios tested medical knowledge, physical exam and interpersonal skills. Pediatric rheumatologist evaluators assessed fellows’ performance using checklists and gave immediate feedback. Program directors were sent summaries of their fellows’ performances. Fellows evaluated the OSCE, providing organizational and scenario improvement suggestions. Programmatic changes to the 2011 OSCE were based on 2009 performance data and program evaluation feedback.ResultsTwenty-two fellows participated in 2009 and 19 in 2011. Performance scores in similar scenarios did not change considerably over the two iterations. In 2009, 85.7% of participants reported desire to change clinical behavior. Assessors’ 2009 program evaluation data prompted changes in rating scales and removal of invalid or unreliable assessments. Negative evaluation data about individual stations decreased from 60% in 2009 to 15.4% in 2011. Fellows’ ratings of the experience’s overall value were similar in 2009 and 2011. The average experience ratings were lower among fellows who proposed scenario-specific improvements and higher among those who recommended organizational improvements.ConclusionsThe 2011 examination exhibited programmatic improvement via reduction in fellows’ scenario-specific negative feedback. Fellows’ overall satisfaction did not change. Further work in scenario selection, assessment validation and inter-rater reliability will improve future pediatric rheumatology OSCEs.

Re: Trauma surgeon performance of appendectomy in 5- to 10-year-old children is safe and decreases length of hospital stay.

BACKGROUND Even in metropolitan areas, on-call pediatric surgeons may not always be immediately available for surgical care of appendicitis, potentially leading to delays in care. In 2012, the in-house trauma group at a suburban Level 1 trauma center (none with formal pediatric fellowship training) assumed surgical care of 5-year- to 10-year-old children with appendicitis, who had previously been cared for by pediatric surgeons. We propose to compare the outcomes of the trauma and pediatric surgery groups. METHODS Retrospective chart review of 5-year- to 10-year-olds undergoing emergency appendectomy at a suburban Level 1 trauma center between January 2007 and December 2016 was performed. Patients were classified as having surgery performed by the trauma surgery group or the pediatric surgery group. Patient characteristics, clinical course, and outcomes were compared. RESULTS A total of 220 patients were identified for study, 138 in the trauma group and 82 in the pediatric surgery group. Patients cared for by the trauma group were more likely to be female (47% vs. 32%; p = 0.03), were less likely to be diagnosed without imaging (2% vs. 26%; p < 0.0001), had a shorter time from diagnosis to surgery (214 vs. 318 minutes; p = 0.01), were more likely to have laparoscopic surgery (70% vs. 55%; p = 0.04), had a shorter operative time (40 vs. 49 minutes; p < 0.0001), and had a shorter length of stay (32 vs. 41 hours; p < 0.0001), despite more of them needing to be transferred from outside hospitals (60% vs. 37%; p < 0.001). There were no significant differences in patient age, rate of perforated appendicitis, 30-day readmissions, surgical site infections, or unanticipated procedures. CONCLUSIONS Trauma surgeon performance of emergency appendectomy in 5-year- to 10-year-old children decreased length of hospitalization with similar complication rates as compared with pediatric surgeons. LEVEL OF EVIDENCE Therapeutic study, level IV.

Emergency Physician Training on Mild Traumatic Brain Injury: A Systematic Review.

Mild traumatic brain injury (mTBI) is the most common emergency department (ED) brain injury presentation worldwide. Despite its frequency, practice variation and care gaps exist among emergency physicians (EPs) in diagnosing and appropriately managing mTBI in the ED. The objective of this review was to identify mTBI-specific training undertaken to improve the detection and management of mTBIs by EPs and its impact on practice. A comprehensive search strategy utilized four bibliographic databases, the gray literature and the keywords concussion, mild traumatic brain injury, medical education, and continuing medical education (CME). To be included, studies were required to report on mTBI training received by practicing EPs at any point during their medical education or career. Studies examining clinical practice guidelines or use of diagnostic tools without active implementation or formal training were not included. Two reviewers screened unique citations for relevance and reviewed the full texts of relevant articles. Two independent researchers extracted data and assessed methodologic quality. At all stages, a third independent reviewer adjudicated discrepancies. Overall, five studies were included from 409 unique results. None of the included studies were of high quality. Identified training on mTBI consisted of three training toolkits, conference presentations and academic journal articles, and pediatric fellowship training. Training primarily occurred as CME and focused on awareness of and management of mTBI; three studies reported physician practice changes, including increases in the use of evidence-based return-to-school and return-to-activity recommendations. The few studies identified addressing mTBI training targeting EPs demonstrate the limited attention given to this issue. The current evidence-to-practice gap in mTBI management places patients at risk for suboptimal care in the ED, and existing mTBI knowledge translation, including education, requires optimization to effectively address the current gap in evidence-based practice for mTBI diagnosis and management in the ED.

Development of the joint Children’s Cancer Hospital Egypt (CCHE-57357) Dana-Farber Boston Children’s Hospital Pediatric Oncology Fellowship Program.

e18226 Background: Children diagnosed with cancer in low- and middle-income countries (LMIC) have markedly inferior outcomes compared to those in high income countries. While some of these issues can be resource availability, a major problem is the quality of training and traditional methods of clinical practice where decision making is centered on the most senior person on the team. To ensure real change, highly-trained locally based specialists with a strong emphasis on problem-solving and critical thinking using evidence-based approaches are needed. Methods: The Children’s Cancer Hospital Egypt (CCHE-57357) and Dana-Farber Boston Children’s Hospital (DFBCH) at Harvard Medical School developed a 30 month pediatric oncology fellowship training program following the American Academy of Pediatrics fellowship guidelines. The primary objective of the program was to implement a shared education model to develop highly educated physicians who are able to follow evidence-based approaches and who are committed to sustained practice in LMIC. Results: DFBCH staff provide ongoing education to the fellows through visits to CCHE-57357 every 2-3 months, weekly video sessions with the fellows for case presentation and journal clubs, and weekly conference calls with the fellowship program staff to ensure that the goals and objectives for each fellow and the program are met. Each of the current 15 fellows spend 6 weeks/year in Boston participating in evidence-based multi-disciplinary based rounds; the remainder of the curriculum takes place at CCHE-57357 and incorporates an array of individual, small group and e-learning modules specifically created for the program. Three classes of fellows have been enrolled and the senior class will graduate in the spring of 2017. Conclusions: Training of fellows following the same standards and methods as those applied to North American candidates is feasible and has the potential to advance the quality of education and expertise in LMIC. By focusing on the education of the next generation of clinicians, the opportunity to implement many of the important principles of clinical care can be realized.

P102: Education and training on mild traumatic brain injury among emergency department physicians: a systematic review

Introduction: Mild traumatic brain injury (mTBI) is the most common emergency department (ED) brain injury presentation in Canada; however, an evidence-practice gap in mTBI management exists among ED physicians, evidenced by significant practice variation. This review aimed to identify mTBI education and training directed at ED physicians and its relationship with practice patterns and physician knowledge. Methods: A comprehensive literature search of four bibliographic databases and the grey literature was performed using the keywords: concussion, mTBI, medical education, and continuing medical education. Included studies were required to report on mTBI education received by practicing ED physicians. Two independent reviewers screened unique citations for relevance and reviewed the full-texts of relevant articles. Two independent reviewers assessed methodological quality using the Methodological Index for Non-Randomized Studies. Data were extracted in duplicated onto standardized forms. Throughout the review process, discrepancies were adjudicated by an independent third party. Results: A total of 409 unique results were retrieved, and five studies were included. None of the included studies were of high methodological quality. Included studies assessed mTBI educational toolkits (n=3), conference presentations and academic journal articles (n=1), and pediatric fellowship training (n=1). Training primarily occurred after residency (i.e., continuing professional development) and focused on awareness and management of mTBI. Three studies measured ED physicians self-reported knowledge uptake and retention, and all three studies reported positive changes in knowledge uptake including self-reported increases in appropriate return-to-school and return-to-play recommendations. An increase in appropriate return-to-school/sports recommendations was reported in one study, measured by surveying parents of children diagnosed with mTBI. Conclusion: After a systematic and comprehensive search, few studies on mTBI education or training targeting ED physicians were identified and focused on process change rather than outcomes, highlighting an evidence-practice gap that needs to be addressed to improve mTBI patient care. Existing mTBI knowledge translation, including EDP education, needs to be optimized to effectively disseminate evidence-based best-practices for mTBI management in the ED.

The African Pediatric Fellowship Training Program in Pediatric Pulmonology: A Model for Growing African Capacity in Child Lung Health.

Childhood respiratory diseases are the major cause of mortality and morbidity in African children. However, there is limited expertise in pediatric pulmonology in Africa. The African Pediatric Fellowship Program (APFP) was developed in the Department of Paediatrics and Child Health at the University of Cape Town in partnership with African academic institutions beyond South Africa to promote training of African child health professionals and to build capacity. From 2008 to 2016, 11 fellows have completed APFP training in pediatric pulmonology. Fellows have come from Kenya, Nigeria, Ghana, and Uganda. All but one returned to their home institutions, where they are building academic departments, improving clinical service delivery, growing research capacity, and advancing advocacy and policies to improve child lung health. In parallel, training of South African pediatric pulmonologists has been strengthened with a further nine South African fellows trained during this period. The African Pediatric Pulmonology program provides a highly successful model, with high retention of graduates in their home countries. The long-term goal is to grow African clinical capacity and strengthen services, research, training, and advocacy for child lung health in Africa.

Measuring pediatric hematology-oncology fellows' skills in humanism and professionalism: A novel assessment instrument.

Educators in pediatric hematology-oncology lack rigorously developed instruments to assess fellows' skills in humanism and professionalism. We developed a novel 15-item self-assessment instrument to address this gap in fellowship training. Fellows (N = 122) were asked to assess their skills in five domains: balancing competing demands of fellowship, caring for the dying patient, confronting depression and burnout, responding to challenging relationships with patients, and practicing humanistic medicine. An expert focus group predefined threshold scores on the instrument that could be used as a cutoff to identify fellows who need support. Reliability and feasibility were assessed and concurrent validity was measured using three established instruments: Maslach Burnout Inventory (MBI), Flourishing Scale (FS), and Jefferson Scale of Physician Empathy (JSPE). For 90 participating fellows (74%), the self-assessment proved feasible to administer and had high internal consistency reliability (Cronbach's α = 0.81). It was moderately correlated with the FS and MBI (Pearson's r = 0.41 and 0.4, respectively) and weakly correlated with the JSPE (Pearson's r = 0.15). Twenty-eight fellows (31%) were identified as needing support. The self-assessment had a sensitivity of 50% (95% confidence interval [CI]: 31-69) and a specificity of 77% (95% CI: 65-87) for identifying fellows who scored poorly on at least one of the three established scales. We developed a novel assessment instrument for use in pediatric fellowship training. The new scale proved feasible and demonstrated internal consistency reliability. Its moderate correlation with other established instruments shows that the novel assessment instrument provides unique, nonredundant information as compared to existing scales.

Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey

V IEW F ROM THE A SSOCIATION OF P EDIATRIC P ROGRAM D IRECTORS Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey Geoffrey M. Fleming, MD; Michael M. Brook, MD; Bruce E. Herman, MD; Chris Kennedy, MD, PhD; Kathleen A. McGann, MD; Katherine E. Mason, MD; Pnina Weiss, MD; Angela L. Myers, MD, MPH From the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn (Dr Fleming); University of California San Francisco, San Francisco, Calif (Dr Brook); Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah (Dr Herman); Children’s Mercy Kansas City, University of Missouri–Kansas City School of Medicine, Kansas City, Mo (Drs Kennedy and Myers); Department of Pediatrics, Duke University Medical Center, Durham, NC (Dr McGann); Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, Ohio (Dr Mason); and Department of Pediatrics, Yale University, New Haven, Conn (Dr Weiss) The authors declare that they have no conflict of interest. Address correspondence to Geoffrey M. Fleming, MD, Department of Pediatrics, Division of Critical Care Medicine, Vanderbilt University School of Medicine, 5112 DOT, 2200 Children’s Way, Nashville, TN 37232 (e-mail: geoffrey.fleming@vanderbilt.edu). A CADEMIC P EDIATRICS 2016;16:415–418 core program requirements: “The program director must devote a minimum of 0.5 FTE regardless of the size of the program.” 14 Core pediatric residency programs have recommendations for additional effort support in a graded increase on the basis of the size of the program and includes PDs, associate PDs, residency coordinators, and liaisons. Currently the “ACGME Program Requirements for Graduate Medical Education in the Subspecialties of Pediatrics” do not delineate any specific required time allotment for fellowship PDs but requires “sufficient pro- tected time.” 2 The goal of this study was to describe current time allotted for PDs in pediatric subspecialty fellowship training programs and to delineate the minimum time required for program administration to meet the regula- tions outlined by the ACGME. P EDIATRIC FELLOWSHIP TRAINING programs are the primary source of subspecialty practitioners who care for our nation’s children. There are 16 Accreditation Council for Graduate Medical Education (ACGME)-accredited pe- diatric subspecialties made up of 837 individual training programs that graduated over 8500 trainees from 2004 to 2013 in addition to those who graduated from combined board specialty programs that include a pediatric training component. 1 Explicit in the requirements for graduate medical education (GME) accreditation is the key role of the program director (PD), who is responsible for over- seeing all educational activities, assessing all trainee and faculty performance, maintaining and distributing all pro- gram policies and procedures, directing programmatic evaluation and process improvement, and monitoring compliance with all ACGME regulations. 2 Prior study has identified inadequate PD time as a barrier to complying with ACGME requirements in the nonpediatric subspe- cialties. 3 Dedicated administrative time has been identified as necessary for innovation and curricular design, and has been linked to ongoing accreditation by the ACGME. 4–12 The ACGME program requirements for core residency programs and many nonpediatric subspecialties now delin- eate program administration time requirements for PDs, associate PDs, and other support staff. The time allotted differs by specialty and varies in specification from hours per week to a percentage of total effort. 13 Current require- ments set forth by the ACGME range from 10% to 50% full-time equivalent (FTE) staff for the core medical and surgical specialties and for many of the subspecialty fel- lowships accredited by the American Board of Medical Specialties. For core pediatric residency programs, support of administrative efforts are specifically delineated in the A CADEMIC P EDIATRICS Copyright a 2016 by Academic Pediatric Association M ETHODS The study was conducted in 2 phases through the use of an anonymous national survey of fellowship PDs. An initial survey was created by the author group using a modified Delphi technique through 5 iterations and con- sisted of 23 items, including demographic data, definition of an FTE in the respondent’s institution, time allotted to administer the program, and the time needed by the respondent to administer their program. The survey was created in REDCap hosted by Vanderbilt University Med- ical Center. 15 This survey was distributed from August 20, 2013, to October 16, 2013, using the Association of Pediatric Program Directors (APPD) Fellowship Program Director (FPD) e-mail list. As a result of an initial low response rate, these data were considered pilot data. Volume 16, Number 5 July 2016