Pediatric Program Research Articles

Pediatric oncohematological exercise program in hospital: clinical trial study protocol.

Leukemias are the most common types of hematological cancers in children, and negatively impact functional capacity. There is evidence in the literature that therapeutic exercises can have a positive impact on functions. The aim of this study is to evaluate functional capacity, muscle strength, fatigue and quality of life through the application of a protocol of therapeutic exercises during pediatric leukemia hospitalization. Children will be allocated into two groups: one will carry out a protocol of therapeutic exercises, while the other will undergo conventional respiratory physiotherapy. The protocol is approved by the ethics and research committee of the host institution (No. 5.439.594). Results will be disseminated through peer-reviewed journal articles and conferences. Clinical trial registration: RBR-8sxnfyd (https://ensaiosclinicos.gov.br).

Assessing Trends in Supply and Demand for Pediatric Surgery Training

This study assessed the supply and demand for Pediatric Surgery training in the U.S. from 2008 to 2022. We hypothesized that in the Pediatric Surgery Match: match rates would increase over time; U.S. MD Graduates would have higher match rates than non-U.S. MD Graduates; and fewer applicants would match at one of their top fellowship choices. This was a retrospective cohort study of Pediatric Surgery Match applicants (2008-2022). Cochran-Armitage tests elucidated temporal trends and chi square tests compared outcomes by applicant archetype. Accreditation Council for Graduate Medical Education (ACGME)-accredited Pediatric Surgery training programs in the United States and non-ACGME-accredited programs in Canada. A total of 1,133 applicants for Pediatric Surgery training. From 2008 to 2012, growth in the annual number of fellowship positions (34-43, 27% increase) exceeded growth in number of applicants (62-69, 11% increase) (p < 0.001). Over the study period, the applicant-to-training ratio peaked at 2.1 to 2.2 in 2017 to 2018 and decreased to 1.4 to 1.6 in 2021 to 2022. The annual match rate for U.S. MD Graduates increased from 60% to 68% (p < 0.05), but decreased from 40% to 22% (p < 0.05) for non-U.S. MD Graduates. In 2022, there was a 3.1-fold difference in match rates between U.S. MD and non-U.S. MD Graduates (68% vs 22%, p < 0.001). The percentage of applicants that matched at their first choice (25%-20%, p < 0.001), second choice (11%-4%, p < 0.001), and third choice (7%-4%, p < 0.001) fellowships decreased over the study period. The percentage of applicants that matched at their fourth choice to least desirable fellowship increased from 23% to 33% (p < 0.001). The demand for Pediatric Surgery training peaked in 2017 to 2018 and has decreased since. However, the Pediatric Surgery Match remains competitive especially for non-U.S. MD Graduates. More research is needed to understand barriers to matching into Pediatric Surgery for non-U.S. MD Graduates.

Employment and leave while parenting children with medical complexity.

Children with medical complexity (CMC) require frequent medical care and are at risk of recurrent hospitalizations. The Family Medical Leave Act (FMLA) allows some workers to take unpaid leave from work to care for family members. This study examines caregiving obligations of parents of CMC, the availability and appropriateness of FMLA in facilitating their roles as caregivers and employees, and how these challenges affect employment and financial security. Parents of CMC were recruited from a primary care pediatric care management program for semistructured interviews. An integrated approach, using both deductive and inductive codes, was used to conduct a thematic analysis. All 16 respondents were female, with half working full-time, five working part-time, and three not employed at the time of participation. On average, their CMC experienced 1.8 hospitalizations in the prior 12 months. Parents described that caring for CMC required ongoing and unpredictable time commitments that conflicted with job duties and schedules. This conflict led to frequent employment changes that negatively impacted parents' eligibility for FMLA, their financial health, and their own well-being. Parents often described not having access to FMLA due to exhausting the allotted time, part-time status, insufficient tenure at their job, or the inability to take unpaid leave. Parents depended on informal workplace policies and relationships with supervisors to maintain employment, as well as personal and formal supports to care for CMC and their families' financial stability. Parents want and need to work in order to support their families and pay for the added expenses related to care for their CMC. Remaining active in the workforce requires that they have flexible schedules that accommodate their unpredictable and ongoing caregiving responsibilities. The eligibility criteria and unpaid nature of FMLA, however, make employment and financial stability elusive for caregivers of CMC. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

HPR21 Implementation Challenges and Real-World Impacts of Switching Pediatric Vaccines: A Global Systematic Literature Review

Switching a vaccine for another on a pediatric national immunization program is often done for the betterment of society. Poorly implemented switches may introduce challenges, such as unaccounted for resource use consumed during the transitions or suboptimal transitions, negatively affecting vaccine access or producing unwanted health system impacts. Therefore, this systematic review aimed to evaluate the global evidence indexed in electronic databases on implementation challenges of pediatric vaccine switches and the real-world impact of those challenges.

Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children

Background: Community-acquired pneumonia (CAP) is a common indication for antibiotic use in hospitalized children and is a key target for pediatric antimicrobial stewardship programs (ASPs). Building upon prior work, we developed and refined an electronic algorithm to identify children hospitalized with CAP and to evaluate the appropriateness of initial antibiotic choice and duration. Methods: We performed a cross-sectional study including children 6 months to 17 years hospitalized for CAP between January 1, 2019, and October 31, 2022, at a tertiary-care children’s hospital. CAP was defined electronically as an International Classification of Disease, Tenth Revision (ICD-10) code for pneumonia, a chest radiograph or chest computed tomography scan (CT) performed within 48 hours of admission, and systemic antibiotics administered within the first 48 hours of hospitalization and continued for at least 2 days. We applied the following exclusion criteria: patients transferred from another healthcare setting, those who died within 48 hours of hospitalization, children with complex chronic conditions, and those with intensive care unit stays &gt;48 hours. Criteria for appropriate antibiotic choice and duration were defined based on established guidelines. Two physicians performed independent medical record reviews of 80 randomly selected patients (10% sample) to evaluate the performance of the electronic algorithm in (1) identifying patients treated for clinician-diagnosed CAP and (2) classifying antibiotic choice and duration as appropriate. A third physician resolved discrepancies. The electronic algorithm was compared to this medical record review, which served as the reference standard. Results: Of 80 children identified by the electronic algorithm, 79 (99%) were diagnosed with CAP based on medical record review. Antibiotic use was classified as the appropriate choice in 75 (94%) of 80 cases, and appropriate duration in 16 (20%) of 80 cases. The sensitivity of the electronic algorithm for identifying appropriate initial antibiotic choice was 94%; specificity could not be calculated because no events of inappropriate antibiotic choice were identified based on chart review. The sensitivity and specificity for determining appropriate duration were 88% and 97%, respectively (Table 1).Conclusions: The electronic algorithm accurately identified children hospitalized with CAP and demonstrated acceptable performance for identifying appropriate antibiotic choice and duration. Use of this electronic algorithm may improve the efficiency of stewardship activities and could facilitate alignment with updated accreditation standards. Future studies validating this algorithm at other centers are needed.Disclosures: None

Editor's Choice Articles for June.

Editor's Choice Articles for June.

Unmasking ethnic disparities in Asian representation in U.S. oncology training programs.

e18548 Background: Asian Americans are not traditionally considered underrepresented in oncology; however, prior analyses of oncology workforce representation have not disaggregated Asian race by ethnicity. This study assessed Asian representation in U.S. oncology training programs by country of origin. Methods: All trainees with self-reported race/ethnicity data in U.S. Radiation (Rad Onc), Medical (Med Onc), Pediatric (Peds Onc), and Surgical Oncology (Surg Onc) programs were identified using 2013-2022 data from the Association of American Medical Colleges. Complex Surgical, Gynecologic, and Orthopedic Oncology programs were included within the Surg Onc category. Asian race was disaggregated by available subgroups (i.e., Bangladeshi, Cambodian, Chinese, Filipino, Indian, Indonesian, Japanese, Korean, Pakistani, Taiwanese, and Vietnamese). Asians with &gt; 1 or no subgroup classification were excluded. Representation quotients (RQ) were used to measure representation relative to the U.S. census population adjusted by age and year, whereby RQ = 1 denoted proportional representation; RQ &gt; 1 and RQ &lt; 1 denoted representation greater or less than expected; RQ = 0 denoted no representation. Linear regression assessed trends in RQ over time for each subgroup. Results: Overall, 27% of oncology trainees identified as Asian (31% Rad Onc, 30% Med Onc, 30% Peds Onc, 19% Peds Onc, 16% Surg Onc). Apart from Indonesians in Rad Onc (median [IQR] RQ, 1.21 [0-3.54]), RQ = 0 for all Indonesians, Cambodians, and Laotians, while median RQ was &lt; 1 for all Filipinos, regardless of program type. In contrast, all other Asian ethnic subgroups had median RQ values &gt; 1, except for Taiwanese and Vietnamese fellows in Surg Onc (0.84 [0.45-0.96]) and Peds Onc (0.43 [0.30-0.63]), respectively. Among Filipinos, median RQ values for Med Onc (0.39 [0.31-0.48]) and Peds Onc (0.51 [0.45-0.58]) were approximately half that of their respective primary residencies (Internal Medicine, 0.75 [0.75-0.73]; Pediatrics: 0.97 [0.99-91]). From 2013-2021, representation remained largely stable for all ethnic groups, with the exception of increased representation among Taiwanese Med Onc (RQ slope [95%CI], 2.96 [1.81, 4.11]; p&lt; 0.001) and Indonesian Rad Onc (0.94 [0.53 to 1.35]; p= 0.001) trainees; and decreased representation among Indian Med Onc (-0.44 [-0.65, -0.23]; p= 0.002) and Korean Surg Onc (-0.04 [-0.61, -0.20], p= 0.003) trainees. No changes in Filipino representation were observed. Conclusions: In this first workforce analysis of oncology trainees to disaggregate Asian race by ethnicity, Cambodians, Filipinos, Indonesians, and Laotians were consistently underrepresented in oncology training programs. Further investigation is needed to understand these differences to ensure that efforts to promote diversity in oncology avoid overlooking ongoing imbalances in representation and inclusion in the U.S. physician workforce.

Core components of a rehabilitation program in pediatric cardiac disease.

There is increasing effort in both the inpatient and outpatient setting to improve care, function, and quality of life for children with congenital heart disease, and to decrease complications. As the mortality rates of surgical procedures for congenital heart disease decrease, improvement in perioperative morbidity and quality of life have become key metrics of quality of care. Quality of life and function in patients with congenital heart disease can be affected by multiple factors: the underlying heart condition, cardiac surgery, complications, and medical treatment. Some of the functional areas affected are motor abilities, exercise capacity, feeding, speech, cognition, and psychosocial adjustment. Rehabilitation interventions aim to enhance and restore functional ability and quality of life for those with physical impairments or disabilities. Interventions such as exercise training have been extensively evaluated in adults with acquired heart disease, and rehabilitation interventions for pediatric patients with congenital heart disease have similar potential to improve perioperative morbidity and quality of life. However, literature regarding the pediatric population is limited. We have gathered a multidisciplinary team of experts from major institutions to create evidence- and practice-based guidelines for pediatric cardiac rehabilitation programs in both inpatient and outpatient settings. To improve the quality of life of pediatric patients with congenital heart disease, we propose the use of individualized multidisciplinary rehabilitation programs that include: medical management; neuropsychology; nursing care; rehabilitation equipment; physical, occupational, speech, and feeding therapies; and exercise training.

Storage Practices, Devices, and Presence of Children Among Owners of Firearms: Informing Pediatric Firearm Safety.

Firearm injury is the leading cause of death in children and prevention is the most effective method to reduce severe morbidity and mortality. Injury prevention programs have used community firearm lock giveaway events to promote safe firearm storage practices. The locks are generally simple and inexpensive devices suitable for mass distribution but may not possess the owner-desired attributes for use in the home. Because data on owner preferences for firearm lock type is lacking, we conducted a community survey to inform firearm safety outreach efforts. We performed an anonymous cross-sectional survey at a large community fair. We elicited responses regarding reasons for firearm ownership, current storage practices, and preferences for firearm storage devices. Participants were offered a choice of a free trigger lock or cable lock and education on its use. Two-hundred and sixty-seven of 394 (67.7%) respondents reported firearm ownership, with 64.8% reporting children in the home regularly. Most (60.7%) owned handguns and cited personal protection as the main reason for ownership (88.4%). The ability to store the firearm loaded and the need for rapid access were identified as the main storage considerations. Respondents preferred trigger locks over cable locks at a rate of almost 2:1. The majority of firearm owners had handguns for self-defense. Owners preferred simple locking mechanisms that allowed the firearm to remain loaded. The pragmatic pediatric injury prevention program will include firearm owners' preferences when considering which lock to purchase and distribute during firearm injury prevention programs. IV, Epidemiological.

Family-centered pediatric psychosocial care in Qatar

Pediatric psychosocial care approaches are used to advocate for family and child strength and durability in health scenarios and to improve the overall well-being of children impacted by severe medical situations. This article focuses on family-focused care in pediatric psychosocial services in Qatar. Using secondary sources, this desk review advocates for a family-centered care approach to support hospitalized children, their families, and the healthcare provision team in pediatric psychosocial care. It argues that if improvements are made to four main areas including education and training, healthcare environment, financial support and advocacy, and future research and audits, Qatar’s pediatric psychosocial care program would more effectively cater to evidence-based child and family-friendly approaches. This article concludes by providing policy recommendations for Qatar’s pediatric psychosocial care provision.

Establishing a pediatric acute stroke protocol: experience of a new pediatric stroke program and predictors of acute stroke.

Pediatric stroke is among the top 10 causes of death in pediatrics. Rapid recognition and treatment can improve outcomes in select patients, as evidenced by recent retrospective studies in pediatric thrombectomy. We established a collaborative protocol involving the vascular neurology and pediatric neurology division in our institution to rapidly diagnose and treat pediatric suspected stroke. We also prospectively collected data to attempt to identify predictors of acute stroke in pediatric patients. IRB approval was obtained to prospectively collect clinical data on pediatric code stroke activations based on timing metrics in resident-physician note templates. The protocol emphasized magnetic resonance imaging over computed tomography imaging when possible. We analyzed performance of the system with descriptive statistics. We then performed a Bayesian statistical analysis to search for predictors of pediatric stroke. There were 40 pediatric code strokes over the 2.5-year study period with a median age of 10.8 years old. 12 (30%) of patients had stroke, and 28 (70%) of code stroke patients were diagnosed with a stroke mimic. Median time from code stroke activation to completion of imaging confirming or ruling out stroke was 1 h. In the Bayesian analysis, altered mental status, hemiparesis, and vasculopathy history were associated with increased odds of stroke, though credible intervals were wide due to the small sample size. A trainee developed and initiated pediatric acute stroke protocol quickly implemented a hospital wide change in management that led to rapid diagnosis and triage of pediatric stroke and suspected stroke. No additional personnel or resources were needed for this change, and we encourage other hospitals and emergency departments to implement similar systems. Additionally, hemiparesis and altered mental status were predictors of stroke for pediatric acute stroke activation in our Bayesian statistical analysis. However credible intervals were wide due to the small sample size. Further multicenter data collection could more definitively analyze predictors of stroke, as well as the help in the creation of diagnostic tools for clinicians in the emergency setting.

304 A Novel Burn Education Program in a New Comprehensive Burn Center

Abstract Introduction In 2020 a large academic hospital with an existing pediatric burn program expanded its services to take adults. Prior to opening the comprehensive center, training and education for the nursing staff was designed and implemented, in amalgamation with the existing pediatric education program. This study describes and evaluates the implementation and efficacy of a novel burn nursing education program, established using the American Burn Association’s (ABA) nursing competencies and Kolb’s Experiential Learning Model. Methods For the purpose of this study Cohort 1 (C1) is defined as 83 nurses hired prior to 2021 and Cohort 2 (C2) is defined as 304 nurses hired after 2022. Didactic and simulated education sessions were created and presented in tandem for both initial and ongoing competency. Didactic sessions were evaluated in two cohorts because the program content was redesigned after 2021. C1 was evaluated using a pre-posttest, whereas, C2 was evaluated using only a post-test. Simulated content was evaluated using the verification in practice method with a check off sheet created using institutional wound care guidelines. Course efficacy was evaluated by attendees using a 1-5 Likert scale. Test scores from 2020-2022 were compared using a T-test with a p-value of &amp;lt; 0.05 considered significant. Results To date 387 nurses have completed a written exam, been validated in practice, and if in C1, completed an annual ongoing burn competency activity. In 2020, C1 showed a statistically significant increase in pre and posttest scores from 66.87%±9.36 to 88.26%±7.90, p=0.000015. When C1 was retested in 2021 using the same posttest, the scores were 80%±1.73 in 2020 to 84.33%±3.84 in 2022, p=0.36. The mean score for posttests for C2 in 2022 was 88%. Course evaluations returned by 155 nurses (77%) in 2020 indicated the course was too long, and some of the information was exorbitant for nursing practice. Therefore, in 2021 the course was redesigned. An additional 251 (65%) nurses have taken the course since, and have reported a mean of 4.5/5 for course efficacy and 4.9/5 for an increase in nursing confidence to care for the burn patient population. Conclusions The education program resulted in significantly higher posttest scores in C1 during the 2020-2021 period showcasing an increase in initial burn knowledge. Although the scores for C1 in 2022 were not statistically significant, the increase in mean scores shows the nurses not only retained the initial information, but built on it throughout the year with the addition of clinical practice. Nurses in C1 continue to practice at high levels and train nurses in C2 who reported the course was critical to their understanding of burn care. Nurses in both C1 and C2 will be required to complete an annual burn competency module to ensure ongoing competency in burn care. Applicability of Research to Practice Nursing Education

The paediatric physiotherapy curricula landscape: A survey of United Kingdom entry-level programs.

To identify the paediatric curriculum content covered in entry-level physiotherapy programs within the United Kingdom (UK), and report faculties perceived importance. Strengths, weaknesses, barriers and facilitators, to the implementation of paediatric content were explored. A cross-sectional online questionnaire captured entry-level physiotherapy programme leaders' perceptions of paediatric programs. Fifty-five responses were submitted, providing a 67% completion rate. Faculty perceived that students' felt the inclusion of paediatric content within the curricula was 'Important' (Mean 3.60±SD 0.74). Of 30 diagnoses surveyed, only two were covered 'Well' within curriculums, despite 23 rated at least 'Important' by respondents. Of the 18 assessment/examination components, 13 were covered 'Well' with five 'Somewhat'. All were considered to be at least 'Important'. Perceived strengths were grouped into three main categories (1) integrated/lifespan approach, (2) links to clinical specialists, and (3) a broad/detailed curriculum. Perceived weaknesses included curriculum time pressures and paediatric placement availability. The majority of paediatric conditions were only somewhat covered by UK curriculums, despite respondents in the main believing they should be an important element of the entry-level syllabus. Some UK physiotherapy entry-level students may not be exposed to any paediatric teaching or clinical placements.

Is it too complex? A survey of pediatric residency program’s educational approach for the care of children with medical complexity

BackgroundAlthough Entrustable Professional Activities (EPAs) regarding pediatric training in care for children with medical complexity (CMC) exist, it is unknown what US pediatric training programs provide for education related to care of CMC and whether educators perceive that pediatric residents are prepared to care for CMC upon graduation.MethodsFrom June, 2021 through March 2022, we surveyed US pediatric residency program delegates about practice settings, current educational offerings, perception of resident preparedness regarding care of CMC, and likelihood to implement CMC education in the future.ResultsResponse rate was 29% (56 /195). A third of responding programs (34%, n = 19) provide a specific educational CMC offering including combinations of traditional didactics (84%, n = 16), asynchronous modules/reading (63%, n = 12), experiential learning (58%, n = 11), and simulation-based didactics (26%, n = 5). The majority (93%, n = 52) of respondents agreed residents should be competent in providing primary care for CMC upon graduation and CMC should receive primary care from a resident (84%, n = 47). A total of 49% (n = 27) of respondents reported their residents are very or extremely well prepared to care for CMC after graduation. A total of 33% (n = 18) of programs reported CMC receive primary care from residents. Respondent average perception of resident preparedness was significantly higher in programs with educational offerings in five of eleven EPAs (nutrition and weight, transitions, feeding tubes, advocacy, and care coordination). The majority (78%, n = 29) of programs without educational offerings are at least somewhat likely to implement CMC curricula in the next three years.ConclusionPediatric residency programs report residents should be competent in care for CMC upon graduation. Pediatric residents are exposed to a wide variety of clinical care models for CMC. The minority of responding programs have intentional CMC educational offerings. Of those programs that provide CMC education, the offerings are variable and are associated with a perception of improved preparedness to care for CMC upon graduation.

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.

Enhancing Postoperative Pain Management and Decreasing Hospital Length of Stay on a Pediatric Orthopedic Unit: Implementation of an Ambulatory Continuous Peripheral Nerve Block Program

PurposePediatric Ambulatory Continuous Peripheral Nerve Block (ACPNB) programs are a safe and effective pain management modality that can reduce patient length of stay (LOS) while ensuring optimal, multimodal pain management at home after surgery. Our institution previously solely used electronic infusion pumps to deliver local anesthetic via peripheral nerve catheters, requiring postoperative inpatient admissions for pain management. We aimed to enhance postoperative pain management and decrease hospital LOS after orthopedic foot and ankle surgery through implementation of an ACPNB program. DesignAn ACPNB program was developed and implemented for pediatric patients undergoing foot and ankle reconstruction surgery. MethodsWe provide a detailed description of the multidepartment collaboration led by the acute pain service (APS) and orthopedics that resulted in the development and implementation of a pediatric ACPNB program using portable, elastomeric devices for patients undergoing reconstructive foot and ankle surgery. Implementation tools, including caregiver and nursing education resources, a data collection log, a process map, and staff surveys are shared. FindingsTwenty-eight patients received elastomeric devices during the 12 months of data collection. All 28 patients who required a continuous peripheral nerve block (CPNB) for pain management following foot and ankle reconstruction surgery received their block via an elastomeric device rather than an electronic hospital infusion pump. All patients and caregivers expressed positive satisfaction with pain management after hospital discharge. No patient with an elastomeric device required scheduled opioids for pain management by the end of their hospital admission. LOS on the orthopedic inpatient unit for foot and ankle surgery decreased by 58%, representing an estimated 29 days and $27,557.88 saved. A majority (96.4%) of staff survey respondents reported feeling satisfied with their overall experience working with an elastomeric device. ConclusionsThe successful implementation of a pediatric ACPNB program has led to positive patient outcomes, including a significant decrease in hospital LOS and health system cost savings for this patient population.

Pediatric Pulmonary Fellowship Program Size Effect on Recruitment and Workforce Distribution.

Concerns about the pediatric pulmonology workforce suggest a need to improve fellowship recruitment. Program size is related to the financial health and recruitment success of pediatric subspecialty education programs, but there are few data on how program size impacts recruitment and workforce in pediatric pulmonology. Assess the impact of program size in pediatric pulmonology through examination of the distribution of applicants matching into pediatric pulmonology training programs over time and relationships to workforce distribution. Data from the National Residency Match Program from 2010 to 2022 were extracted from published documents. Positions offered, positioned filled, and match rates were calculated for each appointment year. Statewide statistics for the number of fellows matched were analyzed relative to the number of pediatric pulmonologists per capita using data from the American Board of Pediatrics. From 2010 to 2018, the size and distribution of programs in pediatric pulmonology were stable, with most fellows (82.4%) matching into programs with one or two positions per cycle. Starting in 2019, programs offering three or more positions steadily increased in number and aggregate positions offered. This change was associated with an increase in total filled positions (38.9 ± 7.3 in 2010-2018 vs. 50.5 ± 8.7 in 2019-2022; P < 0.03) and an increased fraction who matched into larger programs (17.6% in 2010-2018 vs. 36.9% in 2019-2022; P < 0.001). Among states with fellowship programs, the number of fellows matched over the past 5 years correlated with the number of practicing pediatric pulmonologists per capita (r = 0.78; P < 0.001). The period 2019-2022 saw a marked shift of pediatric pulmonary trainees matching into a relatively small number of larger programs. This shift was associated with overall growth in the number of trainees but may have implications on geographical distribution of practicing pediatric pulmonologists.

Benefits of virtual externships with a pediatric dentistry program for potential residents.

To determine if a virtual externship (VE) is beneficial to potential applicants regarding their perceived knowledge of a pediatric dentistry residency program. Secondarily, this study identified general program characteristics that influence resident ranking decisions. All applicants who applied to a pediatric dentistry residency program in the Southeast were invited to participate in a VE. Those who participated in the externship (n=65) were asked to voluntarily complete Pre- and Post-VE surveys. Participants were asked 22 questions about their level of knowledge of both tangible and intangible aspects of the program such as stipend, patient volume, faculty-resident interaction, and resident comradery. Participants were also asked to rank 9 general characteristics that influence ranking decisions such as geography, cost to attend, and reputation of the program and were asked to rate their satisfaction with the VE. Post-VE data were compared to pre-VE data to determine level of knowledge gained via Wilcoxin matched pairs signed rank test (significance set at p<0.05). When comparing Pre- and Post-VE ratings of level of knowledge about each category, all 22 categories assessed showed statistically significant mean differences indicating perceived knowledge gain with the most knowledge gained for "resident satisfaction in the program." Of the nine program characteristics, clinical experience was the most important factor to participants. Participants (100%) were satisfied with the VE experience and indicated the VE gave them the opportunity to get to know the program. A virtual externship is a satisfactory option for increasing applicant knowledge of the tangible and intangible aspects of a residency program.

A self-guided curriculum on endocrinology standard of care for gender diverse youth, including ethical considerations

ObjectiveWhile the field of pediatric endocrinology, and the American Board of Pediatrics, continues expanding training to include gender-affirming care, many pediatric endocrinology fellowship programs do not have formal curriculum for this patient population. Members of the Pediatric Endocrine Society (PES) that have a special interest in transgender health designed a curriculum based on Endocrine Society practice guidelines to expand the knowledge of gender affirming care for medical trainees' and faculty. MethodsPES members designed a 5-part self-guided educational module series with embedded knowledge questions. Uniquely, medical ethical reflections were included within each module. Participants completed baseline demographic and baseline and follow-up knowledge surveys. ResultsMost participants were pediatric endocrinology fellows and 44 % percent (n = 21) completed all study components, including the follow up knowledge survey. Knowledge question data analysis demonstrated knowledge gained in medical management of pubertal youth and surgical interventions. ConclusionThis is the first medical education curriculum in gender-affirming care created by pediatric endocrinologists grounded in the Endocrine Society practice guidelines. This study demonstrates medical knowledge gained in caring for gender diverse youth and is the first to incorporate ethical considerations for this patient population. While initially designed for pediatric endocrinology trainees and faculty, this curriculum may be of great utility for any provider interested in caring for gender diverse youth.

Evaluation of a Childhood Obesity Program Serving a High-Need Population in Brooklyn, New York Using Survival Analysis

In this study, we used survival analysis to evaluate whether contact hours intensity was associated with a reduction in time to improvement of various BMI metrics over a 5-year follow-up period at the Live Light Live Right pediatric obesity program in Brooklyn, New York. This was a single-center retrospective longitudinal study of 406 patients during 2010-2016. Participants were categorized based on hours of exposure to Live Light Live Right's interventions; high contact hours (≥50 h) vs. low contact hours (<50 h). At baseline, 88% of patients in the high contact hour group had severe obesity and the mean age for this group was 10.0 ± 2.66. High contact hours were independently associated with a shorter time to BMI improvement in the sample. There was also a significant association between high contact hours and a longer duration in the improved state. Survival analysis was successful in evaluating the efficacy of the Live Light Live Right Program and demonstrated a positive association between greater intervention intensity and a healthier metabolic profile. Patients' active engagement in a robust treatment model exemplified by Live Light Live Right is recommended to address the childhood obesity crisis in central Brooklyn.