Pediatric Residency Programs Research Articles

Clinical team debriefing post-critical events: perceptions, benefits, and barriers among learners.

Clinical team debriefings (TD) following critical events are pivotal in promoting team learning and enhancing patient outcomes. Despite their importance, perceptions and practices surrounding these debriefings remain under-researched. The purpose of this study was to explore learners' perceptions and experiences regarding debriefing practices, investigate correlations or discrepancies within those perceptions and experiences, and identify recommendations and potential practice improvements for clinical educators. This was a cross-sectional anonymous survey of healthcare professionals, including medical students, medical residents, nursing students, and respiratory therapy students. The survey was sent to respiratory therapy programs, nursing programs, internal and emergency medicine and pediatric residency programs in southern California and Michigan. The variables surveyed included demographics, team debriefing experience, code experience, TD perceptions, emotional status, cognitive load, and the benefits and barriers of conducting post-code TD. Emotional status and cognitive load were assessed using validated surveys by Paas et al. and Barrett and Russell. Of the 184 participants, 56% (n = 104) were female. The mean cognitive load was 6.14 ± 1.6. A notable negative correlation was found between mental effort in recent real code experiences and emotional scales: "tense: calm" (r = -0.210; p = 0.018), "nervous: relaxed" (r = -0.234; p = 0.008), and "stressed: serene" (r = -0.258; p = 0.004). While 68.5% had attended a cardiopulmonary arrest event, only 34.9 had TD after their most recent code, and only 48.4% reported ever having a post-code TD. Notably, nurses (75.4%) and attending physicians (73.8%) predominated these debriefings. Debriefings averaged 9.30 min (SD = 7.30) with a median of 6 min. The most recognized benefits were identifying areas of systems/process improvement and promoting teamwork and solidarity within the code team participants. The most commonly recognized barriers were lack of time and wanting a more senior person to initiate TD. The results of this study show a relatively low TD occurrence despite the high value learners attribute to TD. Addressing this inconsistency requires structured approaches, dedicated time, and an understanding of barriers. Recognizing the significant cognitive and emotional loads on learners further accentuates the need for structured post-event debriefings. Addressing these challenges with multi-disciplinary participation can enhance debriefing outcomes.

Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study.

Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee's experiences using existing tools. This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020-2022) were compared with class and graduated resident (classes of 2016-2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education.

Is “No News is Good News” Enough? A Thematic Analysis Exploring Clinical Reasoning Assessment in Pediatric Residency Programs

ObjectiveClinical reasoning (CR) includes numerous essential skills for clinicians, but how these skills are assessed in pediatric residency training is not well described. This study aimed to explore pediatric residency program leader perspectives on clinical reasoning assessment and identification of trainee deficiencies in this area. MethodsTaking a social constructionist worldview, we conducted a thematic analysis of 20 semi-structured interviews with pediatric residency program leaders. Interviews explored how pediatric residency programs assess CR and how deficiencies are identified. Recruitment and analysis continued iteratively until thematic sufficiency was reached. Member checking enhanced trustworthiness of the results. ResultsParticipants noted a perceived lack of a shared mental model for CR assessment between program leaders and clinical supervisors. Four themes were generated to highlight CR assessment in pediatric residency programs: 1) Clinical supervisors escalate concerns about behaviors representing symptoms of CR deficits rather than diagnosing CR competency deficiencies and that CR assessment requires: 2) an outward display of autonomous decision-making, 3) psychologically safe environments for inquiry, and 4) longitudinal, individualized observation. Elements of pediatric residency programs that impede CR assessment were identified, including family-centered rounds and team-based clinical care. ConclusionsThis study identified key components necessary for CR assessment and barriers that may lead to missed identification of deficiencies. While no single solution can create an ideal environment for CR assessment, this study identifies elements for enhancing assessment opportunities for early identification of deficiencies.

83 What is social paediatrics and how do we teach it? A scoping review of social medicine curricula in the child and youth health context across health disciplines

Abstract Background Social paediatrics is a field that focuses on addressing social and environmental factors that affect children’s health and wellbeing1. Over recent years in medical education, social paediatrics has become increasingly recognized as foundational to undergraduate and postgraduate paediatrics curricula. Paediatric residency programs worldwide have been developing and offering social paediatrics curricula, yet we lack understanding of effective strategies for teaching it to medical trainees. 1. Spencer N, Colomer C, Alperstein G, et al. Social paediatrics. J Epidemiol Community Health. 2005;59(2):106-108. doi:10.1136/jech.2003.017681 Objectives We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics. Design/Methods We conducted a scoping review to describe the various educational interventions used to teach content and practice related to social paediatrics. Our literature search first drew upon Ovid MEDLINE and MedEd PORTAL, with subsequent studies identified through reference searching in relevant articles. We included studies that described and/or evaluated educational interventions aimed to teach elements of social paediatrics. We excluded studies published before 2000. We extracted data from the selected articles and conducted thematic analysis. Results Our search yielded 443 articles. Initial screen by title and/or abstract and subsequent screen by abstract and/or full text yielded 28 papers. Where it was unclear if studies met inclusion criteria, two additional researchers reviewed the full text. With the addition of articles found in references of the provisional articles, a total of 36 papers were included in the review. Of those, 17 (47%) described curricular interventions at the level of paediatric residency, 7 (19%) described medical school curricula, and 8 (22%) included non-medicine fields such as dentistry, nursing, research, and others. Fifty percent of curricula required self-directed learning, while a different 50% subset had a formal reflection process as part of learning consolidation. We organized the literature thematically into the following themes: interdisciplinary collaboration, community partnership, advocacy training, and experiential learning. Conclusion Our scoping review describes a variety of curricular interventions aimed to teach elements of social paediatrics, with a large focus on social determinants of health, primarily poverty, and a relative lack of focus on the underlying structural, systemic, and social justice issues underpinning these health determinants. We need to consider how the pedagogical strategies on offer can be purposed towards the development of more robust social paediatrics curricula at the postgraduate level.

48 Evaluation without representation: Paediatric residents perspectives on CBME

Abstract Background Paediatrics transitioned in 2021 to Competence By Design (CBD), a postgraduate education model spearheaded by the Royal College of Physicians and Surgeons of Canada (Royal College). CBD replaced a time-based training system with one based on competencies demonstrated through regular observations of trainee performance. Although intended to be learner-centered, resident voices have been underrepresented in CBD’s design. Objectives We sought to (1) understand how paediatric residents perceived CBD as impacting their education and evaluation, and (2) explore their ideas to improve its implementation. Design/Methods We compared three Canadian postgraduate paediatric residency programs. First, we reviewed Royal College and program-specific documents regarding CBD to understand local and national priorities for its implementation. Program directors and local education leads were then interviewed to understand local priorities and implementation practices at these programs. Lastly, we conducted interviews with paediatric residents that began residency the year that CBD was launched. We used reflexive, inductive analysis to analyze their perspectives on how CBD has affected their education and develop learner-informed recommendations for improvement. Results We interviewed six program directors and CBD leads. Identified programmatic benefits included improved trainee surveillance, facilitated curriculum change, and competency committees. Challenges included untrained faculty, workplace-based assessment tensions, and administrative burden on residents and staff. Subsequent interviews with ten paediatric residents demonstrated CBD as having limited benefit to their education, leading to a checklist mentality of EPA completion and disengagement with the CBD system. These perceptions were influenced by (1) administrative burden, (2) poor quality feedback from disengaged staff with limited coaching experience, and (3) a lack of collaborative communication between the residents, their programs, and the Royal College. Residents suggested improvements, including: decreasing the number of assessments to alleviate time burden on both residents and faculty; implementing formal coaching instruction for residents and staff; and improving dialogue between Royal College, competency committees, and residents and physician evaluators to build buy-in with the system and facilitate continuing process improvement. Conclusion If we are to effectively adapt postgraduate educational systems to equip learners with the skills to meet the needs of the societies they serve, centering resident voices in curricular revision is paramount to maximize learner buy-in, minimize unintended administrative burden, and guide the development of necessary institutional supports (e.g., formal coaching) to ensure successful system transformation.

Point-of-Care Ultrasound for the General Pediatric Resident: A Needs Assessment.

Point-of-care ultrasound (POCUS) is a valuable tool in pediatric care, but formalized education on POCUS is not a standard part of pediatric residency. Our primary objective was to conduct a needs assessment to determine pediatric residents' attitudes toward ultrasound education. A Likert scale-based survey was distributed to residents at 48 pediatric residency programs. Respondents were asked to rate their agreement to statements about ultrasound education at their respective programs. Participants were also asked to rank ultrasound indications in order of importance. Ninety-seven survey responses were included in the final data set. Sixty percent of respondents had not performed any ultrasound scans during residency. Ninety-two percent of respondents indicated an interest in ultrasound training during residency and that they desired a formal POCUS curriculum. Eighty-one percent of residents indicated that having more ultrasound education would make their programs more attractive to applicants. Pediatric residents recognize the utility of POCUS and desire additional education during training.

Mapping out Remediation: An Actionable Roadmap to Support Trainees Through Remediation

What’s NewThis qualitative analysis offers an actionable, stepwise approach to remediation. IntroductionThe goal of graduate medical education is for trainees to develop the competence needed to practice independently; however, some residents struggle to achieve competency and require remediation. Evidence around how to best facilitate remediation is lacking. The objective of this study was to understand best practices for remediation in pediatrics. MethodA national web-based survey of pediatric residency program directors (PDs) on remediation practices was performed. The survey included 3 open-ended questions about PDs’ experiences with remediation. Self-reported barriers to and strategies for remediation were systematically analyzed using inductive thematic analysis to develop a theory of effective remediation in pediatric residency training. ResultsA total of 99 out of 195 (50.8%) program directors responded. Two main themes emerged: developing a personalized plan that ensures competency attainment and fostering psychological safety. Twelve categories outline actionable steps that PDs can take to make the remediation process successful. DiscussionBuilt from insight from pediatric PDs, we propose a conceptual model for effective remediation that accounts for competency attainment while safeguarding the emotional health of the resident. The conceptual model breaks the remediation process down into four phases: identification of the learner who struggles, planning the remediation process, implementation of the plan, and assessing the outcome of the process.

Factors influencing the choice of pediatric resident: program directors perspective in Saudi Arabia: a cross-sectional study

BackgroundPediatrics is one of the most important medical specialties in the Kingdom of Saudi Arabia) KSA) since it serves a large population. Therefore, the pediatrics residency program is considered one of the most important and competitive programs. Obtaining acceptance in Saudi programs depends mainly on the Saudi Commission for Health Specialties (SCFHS) score, then the applicant enrolls to do the interviews with the training centers in the accepted region. This study aimed to evaluate the factors used by pediatric program directors (PD) in accepting applicants in their pediatric residency program in KSA.MethodsIn this cross-sectional study, an online questionnaire consisting of 49 items was distributed among 76 current and former pediatric PDs in KSA. Participants were selected via non-probability convenience sampling. Data were collected and analyzed using the Social Sciences Statistical Package (SPSS version 26).ResultsOf the sample of PD studied, males represented 77.6%, while females represented 22.4%. Most of the PDs were over 50 years old. Most of them were former pediatric PDs (71.1%). The current study found that the Saudi Medical Licensing Exam was the most important factor [3.87 (0.89)] followed by services and electives [3.86 (0.65)], research [3.84 (0.83)], interview [3.77 (0.89)], GPA [3.50 (0.62)], and letter of recommendation [3.39 (0.76)].ConclusionsFor those interested in pediatrics residency programs in KSA, this study recommends that seeking a high Saudi Medical Licensing Exam (SMLE) score, taking pediatric elective rotations during internship, and acquiring excellent basic knowledge in research were the most important aspects of pediatrics residency selection from the pediatrics PD’s perspective.

MCW Develops Microaggressions Reporting Tool for Pediatric Residency Program

MCW Develops Microaggressions Reporting Tool for Pediatric Residency Program

Gender Distribution in Paediatric Cardiology Training Programs in Canada

BackgroundDespite female medical students being the majority, there are certain medical specialities that continue to have a prevalence of male trainees, such as adult cardiology. The purpose of this study is to examine gender distribution within Canadian paediatric cardiology training programs. MethodsBoth application and successful matches to core paediatric residency programs and paediatric cardiology programs were obtained through the Canadian Resident Matching Service. Analysis was performed to determine if the association between gender of paediatric residents and paediatric cardiology applicants/fellows was significant. ResultsBetween 2016 and 2024, 12% (n = 3/26) of individuals who successfully matched into a Canadian paediatric cardiology training program identified as female and 88% (n = 23/26) identified as male. Between 2013 and 2023, 78% (n = 947/1220) of individuals who successfully matched into a Canadian paediatrics residency identified as female and 22% (n = 273/1220) identified as male. There was a statistically significant difference between the gender of paediatric residents and the gender of paediatric cardiology residents (P < 0.0001). There was no significant association between applicant gender and match outcome within paediatric cardiology training programs (P < 0.23). ConclusionsThere is a gender discrepancy within Canadian paediatric cardiology training programs with a predominance of male trainees in the recent era. It appears that female under-representation in the field is due to the low number of female applicants. Although limited by sample size, there was no clear association between applicant gender and success of admission to a paediatric cardiology training program.

Preparation for PHM: Considerations for Pediatric Residency Programs.

Preparation for PHM: Considerations for Pediatric Residency Programs.

Application of principles learned in a prevention-focused pediatric dental residency curriculum to professional practice.

This study examined whether pediatric dentists who participated in a pediatric dental residency program focusing on disease prevention and management training and screening for social determinants of health (SDOH) were applying these principles to their professional practice upon graduation. Using a cross-sectional study design, a one-time-only online survey was disseminated to 75 pediatric dentists who graduated from the University of California, Los Angeles's training program between 2012 and 2022. The 21-item survey included questions on demographics, patient population characteristics, and application of preventive dentistry and SDOH to their professional practice. Descriptive statistics and bivariate analyses were used to assess survey items. The survey response rate was 64%. Over two-thirds (67%) of alumni reported accepting Medicaid, 34% saw patients in a medically underserved area and all reported seeing children with special needs in their practice. Strategies used to address SDOH in their practice included providing anticipatory guidance (98%) and educating families on oral disease prevention and screening for SDOH (96%). Alumni accepting patients with Medicaid/public health insurance were more likely to address SDOH in their practice, such as assisting patients with filling out Medicaid paperwork (p<0.05), conducting outreach to underserved communities (p<0.05), and using interpreters in their practice (p<0.01) in comparison with alumni not accepting patients with Medicaid/public health insurance. This study demonstrated that a pediatric dental residency program may be successful in training residents to educate children, families, and special needs patients on disease prevention and management in an ethical and culturally sensitive manner and screen for SDOH during patient visits.

A National Survey to Assess Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Curricular Needs in Pediatrics Residency Programs

ObjectiveDespite incremental increases in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) health education, there are no uniform training requirements in graduate medical education and the extent to which pediatrics residency programs incorporate LGBTQ+ curricula remains unknown. We aimed to assess the current state of LGBTQ+ health education in pediatrics residency programs. MethodsWe surveyed all 202 Accreditation Council for Graduate Medical Education (ACGME)-accredited categorical pediatrics program directors (PDs) in the United States. PDs were contacted via the Association for Pediatrics Program Directors (APPD) listserv with a link to an anonymous electronic survey. ResultsWe had a 53.4% response rate (107/202) with representation from all regions, sizes, and settings. Only 7.5% of programs have robust LGBTQ+ curricula, but many (71%) offer some sessions. About half (54.2%) believe their residents are not at all or somewhat prepared to care for LGBTQ+ patients after training. Many PDs are not at all or somewhat confident their residents learn about gender affirming care (49.5%) or are aware of community resources for LGBTQ+ youth (54.2%). In 91% of programs, 0–25% of faculty educate trainees about LGBTQ+ health. The majority (74.8%) of PDs are very or moderately likely to implement a standardized LGBTQ+ health curriculum. The most prominent barriers were inadequate time (55.1%) and lack of faculty training (51.4%). ConclusionMany pediatrics programs have implemented some LGBTQ+ health education; however, PDs lack confidence in residents’ abilities to independently care for LGBTQ+ youth after training. An accessible and standardized curriculum is not only needed but desired by programs.

Using an Innovative Model to Improve Performance of the Infant Hip Examination.

Determine if a new teaching bundle targeting developmental dysplasia of the hip screening improved interns' examination skills across multiple pediatric residency programs. This multicenter prospective cohort study included interns across 6 pediatric residency sites within the Academic Pediatric Association's Better Outcomes through Research for Newborns Network in 2022. Participants underwent a baseline hip examination assessment on models using a checklist derived from textbook descriptions of Galeazzi, Ortolani, and Barlow maneuvers before receiving a teaching bundle. Repeat testing occurred after instruction. Data were analyzed using t-test for continuous and χ2 test for categorical variables. Semistructured focus groups provided qualitative feedback regarding the teaching bundle. We enrolled 117 of 155 interns across 6 sites (76%) for participation in the teaching bundle. Only 2% of participants (n = 2) identified a positive Galeazzi sign at baseline, whereas 88% (n = 103, P < .001) did so on the postinstructional assessment. Although 27% of participants (n = 32) correctly identified a positive Barlow sign at baseline, 69% (n = 81, P < .001) did so on the postinstructional assessment. The ability to correctly detect a positive Ortolani sign increased from 22% (n = 26) to 92% (n = 108, P < .001). Fifteen interns participated in the semistructured focus groups, with resultant themes reinforcing the limited experience of the infant hip examination before this intervention and the positive impact of the teaching bundle. Most participants in this study did not have strong infant hip examination skills at entry into residency. A standardized teaching bundle significantly improved skills in examination technique and identifying abnormalities.

Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs

ObjectiveDespite increases in the US foreign-born population, medical education opportunities in immigrant and refugee health (IRH) remain limited. We summarize findings for published IRH curricula and offer recommendations for integrating IRH into pediatric residency programs. MethodsWe performed a literature review of articles describing the design, implementation, or assessment of IRH curricula for US-based undergraduate and graduate medical trainees. ResultsThe literature review identified 36 articles from 21 institutions describing 37 unique curricula. Three curricula included pediatric residency programs. Commonly taught topics included cultural humility, interpreter use, and immigration status as a social determinant of health. Immigrant-focused training experiences existed at continuity clinics, clinics for refugees or asylum seekers, and dedicated electives/rotations. Curricula were most frequently described as stand-alone electives/rotations. ConclusionsIRH curricula provide opportunities to develop skills in clinical care, advocacy, and community partnerships with immigrant populations. Pediatric residency programs should align the IRH curriculum with existing learning priorities, support and hire faculty with expertise in IRH, and partner with community organizations with expertise. Programs can also consider how to best support learners interested in careers focusing on immigrant populations. Further work is needed to establish competencies and validated tools measuring trainee satisfaction and clinical competency for IRH curricula.

Prioritizing Health Literacy Educational Objectives for Pediatric Residents – A Delphi Study

ObjectiveChildren of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum. MethodsOur Delphi panel participated in three rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential. ResultsThirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After three survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies. ConclusionsA panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.

Does Addressing the Intersections between Climate Change and Health/Healthcare in Residency Lead to Practice and/or Attitude Change?

The current trend in climate has been associated with adverse health effects and disruption to healthcare delivery. Recent papers have emphasized the importance of addressing this topic in medical education (medical school and residency) in order to prepare physicians to care for patients in a changing climate. However, most medical schools and residency programs have not incorporated this topic into their curriculum. The goal of this research project was to see if implementing a 5 lecture curriculum on the intersections between climate change and peditric health would be an effective way of addressing this issue in a pediatric residency program.

Pediatric Primary Care of Children With Intrauterine Opioid Exposure: Survey of Academic Teaching Practices

ObjectiveIntrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the primary care of children with IOE. We aimed to characterize clinician-reported screening and referral practices, barriers to effective primary care for children with IOE, and clinician- and practice-level characteristics associated with perceived barriers. MethodsWe conducted a cross-sectional survey of pediatric residents, pediatricians, and advanced practitioners at 28 primary care clinics affiliated with 7 pediatric residency programs (April–June 2022). We assessed screening and other clinical practices related to IOE and perceived barriers to addressing parental opioid use disorder (OUD). We used descriptive statistics to analyze survey responses, assessed the distribution of reported barriers, and applied a 2-stage cluster analysis to assess response patterns. ResultsOf 1004 invited clinicians, 329 (32.8%) responses were returned, and 325 pediatric residents and pediatricians were included in the final analytic sample. Almost all (99.3%) reported parental substance use screening as important, but only 11.6% screened routinely. Half of the respondents routinely refer children with IOE to early intervention services and social work. Lack of standard screening for substance use was the most frequently selected barrier to addressing parental OUD. Participants reporting fewer barriers to addressing parental OUD identified having greater access to OUD treatment programs and home visiting programs. ConclusionsPediatricians report variations in primary care screenings and referrals for children with IOE. Access to parental OUD treatment programs may mitigate perceived barriers to addressing parental OUD in the pediatric office.

Ensuring Patient Safety in Pediatric Dental Care

This review aims to examine safety concerns in pediatric dental care and underscore the need for comprehensive patient safety initiatives within the Korean Academy of Pediatric Dentistry. Drawing insights from the prevailing patient safety policies of the American Academy of Pediatric Dentistry, case reports, and systematic reviews, this review elucidates issues such as dental fires during sedation, ocular complications from local anesthesia, and surgical emphysema. This review highlights the significance of safety toolkits encompassing infection control, medical error reduction, dental unit waterline infection, and nitrous oxide safety in pediatric dental settings, underscoring the need to foster a safety culture. Furthermore, this study explores the curriculum for pediatric dentistry residency programs, emphasizing concepts such as high-reliability organizations and mortality and morbidity conferences. The study suggests the need for initiatives to enhance patient safety, including establishing safety committees, expanding reporting systems, policy development, and supporting research related to patient safety. In conclusion, this study underlines key messages, emphasizing the utmost priority of patient safety, acknowledging the inevitability of human error, promoting effective communication, and cultivating a patient safety culture. These principles are vital for advancing patient safety in pediatric dental care and improving outcomes among pediatric patients.

A Case-Based, Longitudinal Curriculum in Pediatric Behavioral and Mental Health.

Pediatric behavioral and mental health (BMH) disorders are increasingly common, but most pediatricians feel inadequately trained to manage them. We implemented a case-based, longitudinal curriculum in BMH within a pediatric residency program to prepare trainees to diagnose and manage these conditions. The pediatric residency program at Wright State University/Wright-Patterson Medical Center implemented a new BMH curriculum in 2020-2021. The curriculum consisted of five simulated cases involving depression, anxiety, attention deficit disorder with hyperactivity (ADHD), developmental delays, behavioral concerns, and autism. To reflect follow-up within a continuity clinic, cases included initial encounters and multiple follow-up visits. Faculty facilitators led residents in monthly small-group meetings over the academic year, with each session consisting of two to three simulated patient encounters. Residents completed pre-post surveys regarding their confidence in diagnosing and managing BMH conditions and pre- and posttests to evaluate the impact of the curriculum on knowledge gains. All 47 pediatric residents participated in the curriculum; 38 (81%) completed pre-post surveys. Upon completion of the curriculum, residents reported significantly increased confidence in managing ADHD, treating depression, creating safety plans for suicidality, recognizing autism, and counseling patients and families on special education services. Knowledge-based pre- and posttests completed by 25 residents (53%) also demonstrated significant improvement (M = 92.4, SD = 10.9, pre vs. M = 99.3, SD = 6.6, post, p = .009). This case-based, longitudinal curriculum in pediatric BMH simulating patient continuity improved residents' confidence and knowledge in diagnosing and managing common BMH conditions.