Pediatric Program Directors Research Articles

Upholding Our PROMISE: Underrepresented in Medicine Pediatric Residents' Perspectives on Interventions to Promote Belonging.

Underrepresented in medicine (UIM) residents experience challenges during training that threaten their sense of belonging in medicine; therefore, residency programs should intentionally implement interventions to promote belonging. This study explored UIM pediatric residents' perspectives on current residency program measures designed to achieve this goal. The authors conducted a secondary qualitative analysis as part of a national cross-sectional study, PROmoting Med-ed Insight into Supportive Environments (PROMISE), which explored pediatric residents' experiences and perspectives during training in relation to their self-identities. A 23-item web-based survey was distributed through the Association of Pediatric Program Directors Longitudinal Educational Research Assessment Network from October 2020 to January 2021. Participants provided free-text responses to the question "What are current measures that promote a sense of belonging for the UIM community in your training program?" The authors used conventional content analysis to code and identify themes in responses from UIM participants. Of the 1,748 residents invited to participate, 931 (53%) residents from 29 programs completed the survey, with 167 (18%) identifying as UIM. Of the 167 UIM residents, 74 (44%) residents from 22 programs responded to the free-text question. The authors coded more than 140 unique free-text responses and identified 7 major themes: (1) critical mass of UIM residents; (2) focused recruitment of UIM residents; (3) social support, including opportunities to build community among UIM residents; (4) mentorship; (5) caring and responsive leadership; (6) education on health disparities, diversity, equity, inclusion, and antiracism; and (7) opportunities to serve, including giving back to the local community and near-peer mentorship of UIM premedical and medical students. This is the first national study to describe UIM pediatric residents' perspectives on interventions that promote a sense of belonging. Programs should consider implementing these interventions to foster inclusion and belonging among UIM trainees.

The Early Effects of the Coronavirus Disease-19 Pandemic on Pediatric Resident Education: A National Assessment.

Residency programs must ensure resident competence for independent practice. The coronavirus disease-19 (COVID-19) pandemic disrupted health care delivery, impacting pediatric residencies. This study examines the impact on pediatric resident education. The authors conducted a mixed methods national survey of pediatric residency program directors (PDs) from May 2020 to July 2020. Data analysis included descriptive statistics, chi-square, and Wilcoxon rank sum tests. Multivariable modeling identified factors associated with resident preparation for more senior roles. Thematic analysis was performed on open-ended questions about PD COVID-19 pandemic recommendations to peers, Accreditation Council for Graduate Medical Education and American Board of Pediatrics. Response rate was 55% (110/199). PDs reported the COVID-19 pandemic negatively affected inpatient (n=86, 78.2%), and outpatient education (n=104, 94.5%), procedural competence (n=64; 58.2%), and resident preparation for more senior roles (n=50, 45.5%). In bivariate analyses, increasingly negative impacts on inpatient and outpatient education were associated with an increasingly negative impact on resident preparation for more senior roles (P=.03, P=.008), these relationships held true in multivariable analysis. Qualitative analysis identified 4 themes from PD recommendations: 1) Clear communication from governing bodies and other leaders; 2) Flexibility within programs and from governing bodies; 3) Clinical exposure is key for competency development; 4) Online platforms are important for education, communication, and support. The COVID-19 pandemic negatively impacted inpatient and outpatient education. When these were more negatively impacted, resident preparation for more senior roles was worse, highlighting the importance of competency based medical education to tailor experiences ensuring each resident is competent for independent practice.

National Pediatric Subspecialty Recruitment Sessions Increase Program Visibility and Impact Candidate Application Choices.

While the pediatric subspecialty applicant pool is increasing, so is the number of open positions, with an overall 1:1 ratio of applicant to position. Unfortunately, there is a wide disparity in this ratio dependent upon subspecialty, leaving many programs unfilled.1 Since 2020, recruitment has shifted to virtual, and while the impact on programs and applicants is not fully understood, some program leadership feel disadvantaged without the opportunity to showcase their programs in person. To satisfy the growing desire for pediatric subspecialty programs to be more visible to the applicant pool, a national virtual recruitment session was piloted for pediatric subspecialties using the virtual format created by FuturePedsRes.Individual subspecialty recruitment sessions were held during July 2022 from 8:00-9:30 pm ET featuring 2 to 3 subspecialties on 4 different dates. Prior to the evening, programs were given the option to post a slide on the Association of Pediatric Program Directors website describing their fellowship training program for applicant review. A representative for each participating subspecialty, identified through the Council of Pediatric Subspecialties, served as the communication director between programs and session organizers to coordinate logistics prior to the event. Each subspecialty had a unique virtual link on the night of their session, and each fellowship program within that subspecialty had an individual breakout room. Applicants rotated freely between program breakout rooms, with a suggestion to rotate every 10 minutes. A post-participation survey was sent to all participants.Eleven pediatric subspecialties participated, including 701 live participants representing programs and applicants (Table). Of the participating program leadership, 158 completed a post-participation survey, with half indicating the session increased the visibility of their program, several citing an appreciation of the intimate relationship with the applicants, and a majority wanting to participate again. Of the 49 applicants who responded to the survey, 100% felt the evening was a good use of their time, highlighting the face time with leadership and trainees and the opportunity to meet many programs in one setting as positives. Importantly, 92% (45 of 49) of applicants visited programs outside their current geographic location, 51% (25 of 49) visited programs they were not originally planning to apply to, and 42% (18 of 43) applied to new programs as a result of participating in the session. Challenges identified included: some programs having no applicants visit their breakout rooms, the late timing of sessions in this recruitment season, and some logistical issues during the sessions.The inaugural national pediatric subspecialty recruitment sessions were successful, resulting in increased visibility for programs and in applicants applying to programs they had not considered prior to the session. Applicants thought the accessibility of all programs on one platform simultaneously was helpful, and many visited programs they otherwise would not have had the opportunity to explore. In response to feedback, several logistical changes will be applied to subsequent sessions for the 2023 appointment year, including a shift to earlier in the year, prior to the submission of applications. This will allow for increased time for advertising the sessions and improved promotion of individual program information in advance. This model of training program informational sessions is applicable across graduate medical education programs and may serve to not only provide enhanced individual program visibility but also increase awareness about careers in subspecialities in general and potentially expand the applicant pool.

Pediatric Resident Confidence in Assessing Neurological Cases: A Nationwide Survey

BackgroundA relative shortage of pediatric neurologists in proportion to estimated neurological disorders often results in general pediatricians evaluating and treating children with complex neurological conditions. Dedicated rotations in pediatric neurology are not mandated during medical school or pediatric residency. We evaluated the perceptions of a large cohort of pediatric residents and program directors (PDs) regarding child neurology training. MethodsUsing an online tool, surveys were sent to pediatric residents and pediatric and pediatric neurology PDs. ResultsResponse rates were 41% from pediatric residency programs, yielding 538 resident responses; 31% from pediatric PDs; and 62% from pediatric neurology PDs. Only 27% of the surveyed residents reported completing a neurology rotation during residency, 89% of whom expressed a subjective improvement in confidence with neurological assessments. Factors affecting comfort with eliciting a neurological history included exposure to a neurology rotation during residency, year of training, duration of neurology rotation in medical school, and inpatient exposure to neurological patients, whereas those associated with examination additionally included program size and postresidency plans. Overall, 80% of surveyed residents, 78% of pediatric PDs, and 96% of pediatric neurology PDs acknowledged the potential value of a mandatory pediatric neurology rotation during residency. ConclusionWe suggest that a mandatory pediatric neurology rotation will boost the confidence of current and future pediatric trainees in assessing common neurological conditions of childhood.

The APPD Longitudinal Educational Assessment Research Network's First Decade.

In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. We report on evaluation of the network after 10 years of operation by reviewing program context, input, processes, and products to measure its progress in performing educational research that advances training of future pediatricians. Historical changes in medical education shaped the initial development of the network. APPD LEARN now includes 74% (148 of 201) of US Pediatric residency programs and has recently incorporated a network of Pediatric subspecialty fellowship programs. At the time of this evaluation, APPD LEARN had approved 19 member-initiated studies and 14 interorganizational studies, resulting in 23 peer-reviewed publications, numerous presentations, and 7 archived sharable data sets. Most publications focused on how and when interventions work rather than whether they work, had high scores for reporting rigor, and included organizational and objective performance outcomes. Member program representatives had positive perceptions of APPD LEARN's success, with most highly valuing participation in research that impacts training, access to expertise, and the ability to make authorship contributions for presentations and publication. Areas for development and improvement identified in the evaluation include adopting a formal research prioritization process, infrastructure changes to support educational research that includes patient data, and expanding educational outreach within and outside the network. APPD LEARN and similar networks contribute to high-rigor research in pediatric education that can lead to improvements in training and thereby the health care of children.

Child Neurology Residency Survey of Psychogenic Nonepileptic Seizure Education (P2-2.004)

<h3>Objective:</h3> To assess the learning needs of pediatric neurology resident trainees and program directors (PD) on the education of psychogenic nonepileptic seizures (PNES) during training. <h3>Background:</h3> PNES proves difficult to differentiate from epileptic seizures (ES) even for neurologists who see these conditions frequently, given overlapping semiologic findings between the two diagnoses. Previous studies have shown trainees, including neurology trainees, are not very accurate in differentiating PNES from ES. Neurologists often find the communication of PNES difficult. Despite these challenges, most programs do not have a formal curriculum for teaching PNES and there are no ABPN standards for residency curricula in this topic. <h3>Design/Methods:</h3> Two unique surveys were designed, one for child neurology trainees and one for PDs. Questions were designed to assess trainees’ abilities, current education received, and desired teaching. Similarly, PDs’ level of confidence in trainee management of PNES was assessed, as well as specific preferences for a standardized curriculum. <h3>Results:</h3> Sixty-five trainees out of approximately 202 and 21 PDs and associate PDs have responded to the survey. About one-third of trainees report neutral to low levels of confidence and 36.9% report neutral to low levels of knowledge in caring for PNES patients. Trainees reported that directing PNES patients to appropriate management was the most challenging aspect of care, followed by communicating the diagnosis, with 60.0% and 46.1% reporting difficulty, respectively. Trainees report preferring to learn about this topic through reading material and simulation. One-fifth of PDs feel their current PNES education is not sufficient and 52.4% of PDs would incorporate a standardized curriculum, with remaining PDs reporting willingness depending on the required time. <h3>Conclusions:</h3> Areas of needed training and desired teaching format were identified based on trainee responses. PDs desire a standardized curriculum and would incorporate one into their programs. Findings of this study will be utilized to create a national curriculum. <b>Disclosure:</b> The institution of Dr. Albert has received research support from Nationwide Children’s Hospital, Division of Neurology, Internal Research Grant. Dr. Freedman has nothing to disclose. Dr. Talai has nothing to disclose.

Resident Education and Virtual Medicine: A Faculty Development Session to Enhance Trainee Skills in the Realm of Telemedicine.

COVID-19 accelerated the use of telemedicine. Subsequently, clinical sites began conducting virtual visits. Academic institutions implemented telemedicine for patient care and simultaneously had to teach residents the logistics and best practices. To meet this need, we developed a training session for faculty focused on telemedicine best practices and teaching telemedicine in the pediatric realm. We designed this training session based on institutional and society guidelines and faculty experience with telemedicine. Objectives included telemedicine documentation, triage, counseling, and ethical issues in telemedicine. We conducted all sessions in a 60-minute or 90-minute format over a virtual platform for small and large groups using case scenarios with photos, videos, and interactive questions. A novel mnemonic ABLES (awake-background-lighting-exposure-sound) was created to guide providers during the virtual exam. Following the session, participants completed a survey evaluating content and presenter effectiveness. We presented the training sessions between May 2020 and August 2021 to 120 participants. Participants included pediatric fellows and faculty, reaching 75 participants locally and 45 nationally (at Pediatric Academic Society and Association of Pediatric Program Directors meetings). Sixty evaluations (response rate: 50%) showed favorable results for general satisfaction and content. This telemedicine training session was well received by pediatric providers and addressed the need for training faculty to teach telemedicine. Future directions include adapting the training session for medical students and developing a longitudinal curriculum that applies telehealth skills learned with patients in real time.

How Good is Good Enough?: Current-Day Pediatric Residency Program Directors' Challenges in Assessing and Achieving Resident Procedural Competency.

Significant gaps exist in the pediatric resident (PR) procedural experience. Graduating PRs are not achieving competency in the 13 ACGME recommended procedures. It is unclear why PR are not able to achieve competency, or how existing gaps may be addressed. We performed in-depth one-on-one semistructured interviews with 12 pediatric residency program directors (PPDs). The interviews were audio-recorded, and transcribed verbatim. Coding of the data using conventional content analysis led to generation of categories, which were validated through consensus development. We identified 4 main categories, including (1) programs struggle to ensure adequate training in procedural skills for PRs, with various barriers reported; (2) programs develop individualized strategies to address challenges in procedural skills training, and multiple options are necessary; (3) PPDs face challenges defining procedural competency and standardizing expectations; and (4) expectations for PR procedural training may require modification based upon current practice environments. Solutions include simulation, procedural boot camps, and procedural/subspecialty electives. Numerous methods to combat challenges in PR procedural training have been identified by participating PPDs, including simulation, tailoring electives, and developing institutional guidelines. However, accreditation bodies may need to update procedural expectations based on individual resident career goals and realities of current day practice.

Annual Vision Check: A 2022 Year in (Re)View from the APPD.

Since 2009, Academic Pediatrics has been the official journal of the Association of Pediatric Program Directors (APPD). The monthly View from the APPD section provides an important venue for its members to disseminate scholarship. Since 2020, Re(View) from the APPD serves to summarize the articles published in View over the past year, including their alignment with the overall mission and priorities.1,2

Directors of accredited pediatric ophthalmology fellowship programs: a descriptive analysis

To examine the characteristics of pediatric ophthalmology fellowship program directors (FPDs) through cross-sectional analysis. All pediatric ophthalmology FPDs whose programs participated in the San Francisco Match in January 2020 were included. Information was collected through publicly available sources. Scholarly activity was measured by peer-reviewed articles and the Hirsch index. Of the 43 FPDs, 22 (51%) were male, and 21 (49%) were female. The mean age of current FPDs was 53.5 ± 8.8 years old. There was a significant difference between the current age of male and female FPDs (57.8 ± 8 vs 49 ± 7.3, resp. [P <0.0001]). The mean term length of female and male FPDs also differed (11.5 ± 4.5 vs 16.1 ± 8.9 [P = 0.042]). Thirty-eight FPDs (88%) attended medical school in the United States. Forty-two FPDs had an MD (98%). Thirty-nine (91%) FPDs completed ophthalmology residency in the United States. Ten (23%) of the FPDs were dual fellowship trained. There was a significantly higher Hirsch-index among male than female FPDs (23.9 ± 15.7 vs 10.3 ± 10.1 [P = 0.0017]). There was a higher number of publications for male (91 ± 89) than female FPDs (31.5 ± 48.6 [P = 0.0099]). Pediatric ophthalmology fellowship programs have a uniquely equal representation of male and female FPDs as women continue to be underrepresented in ophthalmology. Female FPDs were younger and had spent less time in the position, suggesting a shift toward more female FPD over time.

The New Oncologic Diagnosis Discussion: Perspectives of Pediatric Oncologists.

We aimed to understand how new diagnosis discussions are conducted in pediatric oncology, and the training provided for their conduct. This mixed-methods study used a sequential exploratory design. Qualitative interviews (n = 20) were conducted with pediatric oncologists (n = 15) and fellows (n = 5) at a single institution, focusing on the process used to convey the diagnosis and treatment plan to the family. Accreditation Council for Graduate Medical Education-accredited pediatric oncology fellowship program directors (n = 38) and fellows (n = 70) were subsequently surveyed to confirm qualitative results and elucidate the training that fellows receive in conducting new diagnosis discussions. Our findings suggest that new diagnosis discussions in pediatric oncology are typically conducted in three stages: (1) concern for cancer; (2) confirmation of diagnosis; and (3) treatment plan/consent, and are fundamentally similar across settings; however, pediatric oncologists skillfully tailor their approach on the basis of clinical circumstances and parental needs. Decisions regarding inclusion of the child are primarily determined by parental preference, whereas inclusion of health care team members is driven by physician role (ie, trainee v program director) and health care organization-related factors. Physician preparation for discussions involves logistical, intellectual, and emotional components. Disclosure of prognosis is nuanced. There is variability across pediatric oncology fellowship programs in the provision of training for these discussions. We identified common practices of pediatric oncologists as they prepare for and lead new diagnosis discussions in pediatric oncology. We found variability in the training that pediatric oncology fellows receive regarding how to conduct these discussions, highlighting a need for standardized training curricula.

Perceptions on pregnancy and parenthood among program directors in pediatric dentistry.

This cross-sectional study assessed the perceptions of pediatric dental residency program directors (PDs) regarding policies and attitudes on pregnancy and parenthood during residency training. A 28-item electronic survey was administered to PDs of pediatric dental residencies in the United States. Statistical tests were performed. Variables were reported as counts (percentages) and compared using Fischer's exact test and chi-squared tests at a significance level of 0.05. Forty-two of the 97 PDs completed the survey for 43% response rate. Almost all programs had a formal maternal leave policy, but perceptions and policies varied regarding the effects of both pregnancy and parenthood on residents during training. Chi-square results compared if parenthood had a negative impact on the well-being a female trainee versus a male trainee had a p-value<.05. There appeared to be a lack of national uniformity regarding program policies on parental leave. Most PDs perceived having a child during residency had at least one negative effect on their female residents. Finally, PDs were likely to perceive parenthood to adversely impact the well-being and work of female trainees more so than their male counterparts.

Applying Practice Analysis to Develop a New Test Content Outline for the Pediatric Cardiology Certification Examination.

The evolving breadth and complexity of the contemporary pediatric cardiology specialty requires regular, systematic analysis of the practice to ensure that training and certification requirements address the demands of real-world clinical experience. We report the process of the American Board of Pediatrics (ABP) for conducting such a practice analysis and revising the test content outline (TCO) for the pediatric cardiology subspecialty certification exam. A panel of 15 pediatric cardiologists conducted seven 2-h virtual meetings, during which they identified 37 unique tasks that represent the work a pediatric cardiologist may reasonably expect to perform within the first 5years after training. These tasks were grouped into nine performance domains, similar to the entrustable professional activities (EPA), previously endorsed by the ABP in collaboration with the pediatric cardiology education community, and which represent the critical activities of the profession. The panel then enumerated the knowledge, skills, and abilities necessary to perform each task. These deliberations resulted in two work products: a practice analysis document (PAD) and subspecialty board TCO based on testable knowledge, skills, and abilities. Survey assessments of the panel's work were then distributed to pediatric cardiology fellowship program directors and to practicing pediatric cardiologists for their input, which largely aligned with the panel's recommendations. Survey responses were considered in the final revisions of the PAD and TCO. This approach to practice analysis proved to be an efficient process for describing the work performed by today's pediatric cardiologists and the knowledge, skills, and abilities needed to competently perform that work.

Clinical competency committee perceptions of entrustable professional activities and their value in assessing fellows: A qualitative study of pediatric subspecialty program directors

Objectives To examine the composition and processes of Clinical Competency Committees (CCCs) assigning entrustable professional activity (EPA) levels of supervision for pediatric subspecialty fellows and to examine fellowship program director (FPD) perspectives about using EPAs to determine fellows’ graduation readiness. Methods A qualitative study was performed using one-on-one interviews with a purposeful sample of pediatric subspecialty FPDs to yield a thematic analysis. Semi-structured interview guides were used for participants who self-identified as EPA users or non-users. Inductive analysis and coding were performed on transcripts until theoretical sufficiency was attained. Results Twenty-eight FPDs were interviewed. There was significant variability in the composition and processes of CCCs across subspecialties. FPDs felt that CCCs intuitively understand what entrustment means, allowing for ease of application of level of supervision (LOS) scales and consensus. FPDs perceived that EPAs provided a global assessment of fellows and are one tool to determine graduation readiness. Conclusions Although there was variability in the makeup and processes of CCCs across subspecialties, FPDs believe EPAs are intuitive and relatively easy to implement. Consensus can be reached easily using EPA-specific LOS scales focusing on entrustment. FPDs desire a better understanding of how EPAs should be used for graduation.

A Descriptive Analysis of Pediatric Ophthalmology Fellowship Program Directors

There is limited literature on the characteristics of pediatric ophthalmology leadership. The authors examined the demographics, academic backgrounds, and scholarly output of pediatric ophthalmology fellowship program directors. Despite a positive trend in gender equity in this position, efforts remain to resolve the "leaky pipeline" of women into ophthalmology leadership. [J Pediatr Ophthalmol Strabismus. 2022;59(6):e69-e72.].

Expectations versus reality: Understanding the accuracy of impressions made during virtual interviews of pediatric pulmonary fellowship programs.

As a result of the SARS-CoV-2 pandemic, all pediatric pulmonary fellowship programs conducted virtual interviews for the first time in the Fall of 2020. This study aimed to understand the accuracy of virtual-interview derived-impressions of fellowship programs, as well as applicant preference for future fellowship interview cycles. A group of pediatric pulmonary fellows and Program Directors designed a REDCap survey. The survey was distributed to all first-year pediatric pulmonary fellows who participated in the 2020-2021 virtual interview season. 23/52 (44%) of first-year pediatric pulmonary fellows completed the survey. 96% were able to form general impressions about fellowship programs during their virtual interviews. 96% reported that generally their fellowship experience matched their virtual-interview derived-impressions. 17 of the 19 factors applicants use to rank programs had no statistically significant change (p > 0.05) in impression from virtual interview to fellowship experience. The two factors with a statistically significant (p < 0.05) change in impression were patient care related-volume of "bread and butter" pediatric pulmonary patients and volume of tertiary care pediatric pulmonary patients. 87% prefer some form of in-person interview option in future application cycles. A tiered interview format in which applicants are first invited to a virtual interview day followed by an optional in-person second look day was the most popular preference for future interview cycles (48%). Virtual interviews may provide accurate representations of pediatric pulmonary fellowship programs and applicants prefer some type of in-person interview option in future application cycles.

The First Two Years of the Association of Pediatric Surgery Training Program Directors (APSTPD) Transition to Fellowship Course: Lessons Learned and Future Directions

The first transition to fellowship course for incoming pediatric surgery fellows was held in the US in 2018 and the second in 2019. The course aimed to facilitate a successful transition in to fellowship by introduction of the professional, patient care, and technical aspects unique to pediatric surgery training. The purpose of this study was to evaluate the feasibility and effectiveness of the first two years of this course in the US and discuss subsequent evolution of this endeavor. This is a descriptive and qualitative analysis of two years' experience with the Association of Pediatric Surgery Training Program Directors' (APSTPD) Transition to Fellowship course. Course development and curriculum, including clinical knowledge, soft skills, and hands-on skills labs, are presented. Participating incoming fellows completed multiple choice, boards-style pre- and post-tests. Scores were compared to determine if knowledge was effectively transferred. Participants also completed post-course evaluations and subsequent 3- or 12-month surveys inquiring on the lasting impact of the course on their transition into fellowship. Standard univariate statistics were used to present results. The first APSTPD Transition to Fellowship course was held at the Johns Hopkins Hospital in Baltimore, Maryland in 2018, and the second course was held at the Oregon Health and Science University in Portland, Oregon in 2019. All fellows entering ACGME-certified Pediatric Surgery fellowships in the United States were invited to participate. Twenty fellows accepted and attended in 2018, and fourteen fellows participated in 2019. There were 34 incoming pediatric surgery fellow participants over 2 years. Faculty represented more than 10 institutions each year. Pre- and post-test scores were similar between years, with a significant improvement of scores after completion of the course (67±10% vs 79±8%, p < 0.001). Feedback from participants was overwhelmingly positive, with skills labs being attendees' favorite component. When asked about usefulness of individual course sessions, more attendees found clinical sessions more useful than soft skills (93% vs 73%, p = 0.011). Almost all (90%) of participants reported the course met its stated purpose and would recommend the course to future fellows. This was further reflected on 3 and 12 month follow up surveys wherein 85% stated they found the course helpful during the first few months of fellowship and 90% would still recommend it. A transition to fellowship course in the US for incoming pediatric surgery fellows is logistically feasible, effective in transfer of knowledge, and highly regarded among attendees. Feedback from each course has been used to improve the subsequent courses, ensuring that it remains a valuable addition to pediatric surgical training in the US.

Benefits and Limitations of Virtual Recruitment: Perspectives From Subspeciality Directors.

Because of the coronavirus disease 2019 pandemic and recommendations from a range of leaders and organizations, the pediatrics subspecialty 2020 recruitment season was entirely virtual. Minimal data exist on the effect of this change to guide future strategies. The aim of this study was to understand the effects of virtual recruitment on pediatric subspecialty programs as perceived by program leaders. This concurrent, triangulation, mixed-methods study used a survey that was developed through an iterative (3 cycles), consensus-building, modified Delphi process and sent to all pediatric subspecialty program directors (PSPDs) between April and May 2021. Descriptive statistics and thematic analysis were used, and a conceptual framework was developed. Forty-two percent (352 of 840) of PSPDs responded from 16 of the 17 pediatric (94%) subspecialties; 60% felt the virtual interview process was beneficial to their training program. A majority of respondents (72%) reported cost savings were a benefit; additional benefits included greater efficiency of time, more applicants per day, greater faculty involvement, and perceived less time away from residency for applicants. PSPDs reported a more diverse applicant pool. Without an in-person component, PSPDs worried about programs and applicants missing informative, in-person interactions and applicants missing hospital tours and visiting the city. A model based upon theory of change was developed to aid program considerations for future application cycles. PSPDs identified several benefits to virtual recruitment, including ease of accommodating increased applicants with a diverse applicant pool and enhanced faculty involvement. Identified limitations included reduced interaction between the applicant and the larger institution/city.

The #PedsMatch21 Webinar Series: Coordinated Specialty-Level Communication During the Virtual Residency Application Cycle.

The landscape of pediatric medical education changed significantly in the wake of the COVID-19 pandemic. Fourth-year medical students applying to pediatric residency programs were particularly affected by alterations to traditional away rotations, the inability to conduct in-person visits, and resulting changes in ways of communicating with residency programs. Applicants were concerned about the virtual component of the application cycle and worried as to how to manage the COVID-19-related changes. Program leaders also faced apprehension at how to close communication gaps and effectively use virtual tools to reach applicants. Founders of the Twitter-based @FuturePedsRes (FPR) organization recognized these concerns and developed a webinar series during the 2020-2021 academic year to create opportunities for programs and applicants to communicate. Leaders of the Association of Pediatric Program Directors and the Council on Medical Student Education in Pediatrics joined as sponsors and co-hosts. The #PedsMatch21 webinar series consisted of 9 total webinars: 2 overviews, 5 regional, 1 for osteopathic students, and 1 for international medical graduates. A total of 138 pediatric residency programs across the country participated in the #PedsMatch21 webinar series. Each webinar brought in a mean of 431 attendees, from the United States and several other countries. Follow-up surveys immediately after each webinar and again at the end of the interview season demonstrated that the webinars decreased applicants' anxiety, provided helpful information on the virtual season, and increased their awareness of programs. The #PedsMatch21 webinar series demonstrated utility in addressing applicants' concerns and allowing applicants access to a greater number of programs. Webinar-based strategies should be considered across all medical specialties as a useful method of providing accessible forums for programs and applicants.

The Use of Parenting Electives in Pediatric Residency.

Financial considerations and the desire to not prolong training often influence residents' parental leave length. Some residencies offer parenting electives. These primarily self-directed electives can extend parental time at home, support transition back to work, and allow residents to remain in training and be paid during these transitions. Describe the prevalence and structure of parenting electives within pediatric residency programs from 3 geographic regions of the Association of Pediatric Program Directors (APPD). All 66 pediatric residency program directors in the Western, Mid-America, and Northeastern regions of APPD were invited to participate in a phone interview regarding existence of and structure of their programs' parenting elective. Thirty-six programs responded (55%). Of those, 24 (67% of responding programs) offer a specific parenting elective and an additional 5 (14%) offer a generic elective that can be tailored to new parents. Curricular elements shared by almost all programs offering specific parenting electives include self-reflective exercises, exploration of a community resource, and parenting articles/book review. Most programs incorporate clinic but not call into these electives. Parenting electives are increasingly available in pediatric residency programs to support new resident parents. Sharing common curricular elements may help other programs implement and/or enhance this elective offering.