Pediatric Residency Training Programs Research Articles

Reliability of renal point-of-care ultrasound (POCUS) performed by pediatric postgraduates to diagnose hydronephrosis in infants.

Point-of-care ultrasound (POCUS) has gained prominence in a variety of medical specialties due to advances in ultrasound technology. POCUS has not been fully integrated into pediatric residency training programs despite its widespread use and proven benefits. At our institution, renal POCUS is performed by pediatric residents for the evaluation of hydronephrosis, which is the main pathology for which ultrasound is used in the clinical practice of pediatric nephrology. This study was conducted to evaluate the quality of renal POCUS performed by pediatric residents in infants. Four pediatric residents, comprising two first-year and two second-year residents at Konyang University Hospital, participated in the study conducted from May 2021 to May 2022. All participants had completed our Point-of-Care Ultrasound (POCUS) training program. The study focused on infants admitted to the pediatric inpatient unit, identified by attending physicians as requiring renal ultrasound. All infants underwent their initial kidney ultrasound examination. Temporal alignment between renal Point-of-Care Ultrasound (POCUS) performed by pediatric residents and conventional ultrasound (USG) conducted by radiologists was asynchronous. Pediatric residents conducted POCUS sessions during scheduled radiologist appointments throughout the day, occurring either before or after the radiologist's examination. There was no mutual awareness of each other's results. Inter-observer agreement between radiologists and pediatric residents was compared for the presence or absence of hydronephrosis and its grade, which are primary considerations in pediatric renal ultrasound. Our study found that 53 infants (68.8%) were diagnosed with hydronephrosis using point-of-care ultrasound (POCUS), compared to 48 infants (62.3%) diagnosed with conventional ultrasound (USG). Among the POCUS examinations conducted by pediatric residents, hydronephrosis of SFU grades 1, 2, 3, and 4 were observed in 56.6%, 35.8%, 7.5%, and 0%, respectively. Inter-observer reliability between POCUS and conventional USG showed good agreement, with Cohen's kappa coefficients exceeding 0.8 for sensitivity and 0.6 for grading. Renal POCUS performed well in diagnosing and grading hydronephrosis in infants when performed by pediatric residents who had completed a two-phase training program.

Implementation and assessment of a structured curriculum for a 4-week pediatric rheumatology rotation for pediatric residents

BackgroundGeneral pediatricians often initially address children’s musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients’ rheumatologic conditions. This study assessed the effectiveness of a structured curriculum in enhancing pediatric residents’ knowledge, MSK examination skills, and confidence during a 4-week pediatric rheumatology rotation.MethodsPediatric residents in their either second or third year who participated in the 4-week rheumatology rotation once across three academic years (July 2020–June 2023) were enrolled. Residents’ knowledge, MSK examination skills, and confidence were assessed at pre- and post-rotation by using 25 multiple-choice questions, the Thai pediatric Gait Arms Legs Spine examination, and a questionnaire, respectively. The curriculum comprised instruction on MSK examinations, interactive lectures, case-based discussion, topic reviews, MSK radiology conference, clinical experience in rheumatology clinic and consultations, with self-guided learning with educational resources.ResultsFifty-eight pediatric residents (48 females, 10 males) with a mean age of 28.9 ± 0.8 years participated. Significant improvements were noted postrotation. Knowledge scores rose from 63.0 ± 12.2 to 79.7 ± 9.1 (mean difference 16.7 ± 10.3, p < 0.001). Similarly, MSK examination scores increased from 67.5 ± 14.4 to 93.6 ± 8.7 (mean difference 26.1 ± 14.6, p < 0.001). Residents also reported a marked increase in confidence across all evaluated areas, including history taking, MSK examination, arthrocentesis, and diagnosing and treating rheumatologic conditions (p < 0.001).ConclusionsThe 4-week structured curriculum in the pediatric rheumatology rotation significantly enhanced pediatric residents’ knowledge, MSK examination skills, and confidence. These findings support the integration of pediatric rheumatology rotations into pediatric residency training programs.

How does the number of training years in pediatric surgery affect appendectomy outcomes?

Appendectomy has traditionally been considered as a training operation for junior pediatric surgeons during their training period. However, with the increase of laparoscopic appendectomy, there has been a growing concern about the performance of this procedure by junior trainees. Our aim is to analyze intra-/postoperative appendectomy outcomes according to the number of training years during Pediatric Surgical residency training program. A retrospective study was performed in patients who underwent appendectomy between 2018 and 2021 in our institution, who were divided into 5 groups according to the number of training years of the junior surgeon who performed the intervention (Y1-Y5). Demographics, complicated appendicitis rate, operation time, and postoperative complications were compared. A stratified analysis according to the technique performed (open/laparoscopic) was performed. A total of 1274 appendectomized patients were analyzed, of which 1257 (98.7%) were operated on by junior trainees (81 in Y1; 407 in Y2; 337 in Y3; 261 in Y4; and 171 in Y5) without demographic differences between groups. As the year of training increased, an elevation in complicated appendicitis rate was observed, although without statistically significant differences. However, laparoscopic/open appendectomies ratio increased with increasing year of training (p < 0.001). Operative time decreased significantly with increasing year of training (p < 0.001), both in open and laparoscopic appendectomies. There were no significant differences in postoperative complications, nor in the stratified analysis according to surgical technique. Appendectomy performed by junior pediatric surgery trainees can be considered a safe procedure from the first year of training, regardless of the technique used.

Assessment and Management of Attention-Deficit/Hyperactivity Disorder: Pediatric Resident Perspectives on Training and Practice.

Attention-deficit/hyperactivity disorder (ADHD) is a common presenting concern in primary care. This study examined the relationship between pediatric residency training program characteristics and residents' ADHD knowledge, attitudes, and comfort in providing ADHD services. Given the familiarity that pediatric chief residents have with the training and experiences within their residency programs, a 30-item survey was mailed to pediatric chief residents. A total of 100 residents returned their surveys (response rate 49.5%) and were included in the descriptive quantitative and thematic qualitative analyses. The majority of participants rated their ADHD knowledge as at least average. However, approximately half of the participants were comfortable with screening, and less than half were comfortable with managing stimulant medication or behavioral treatments. Participants emphasized the importance of interprofessional collaboration, clinical experiences, and integrated ADHD education throughout training. These results emphasize the importance of improved training in screening, diagnosing, and managing ADHD to increase resident comfort regarding these practices.

Impact of COVID 19 Pandemic on Pediatric Residency Training Program in Sudan: Challenges and the Way Forward

Impact of COVID 19 Pandemic on Pediatric Residency Training Program in Sudan: Challenges and the Way Forward

The role of a pharmacy residency program in global health: Establishing pediatric clinical pharmacy services in a Malawian hospital

To describe the establishment of pediatric clinical pharmacy services in a Malawian hospital as part of a pharmacy residency program's engagement in global health. While pharmacy is expanding its role in global health through the introduction of international advanced pharmacy practice experience (APPE) rotations at US schools of pharmacy, international experiences for pharmacy residents are currently very limited. Such programs are advantageous for pharmacists planning for a career in public or global health, and there is also great opportunity for clinical pharmacists to work with international partners for professional development and to help advance pharmacy practice. The University of North Carolina at Chapel Hill Eshelman School of Pharmacy recently expanded its international APPE rotation in Malawi into the postgraduate training space through creation of a pediatric pharmacy residency training program, with the specific aim of working with partners in Malawi to introduce pediatric pharmacy services at Kamuzu Central Hospital. As this was the first time there was a pharmacist involved in patient care on the pediatric wards, the focus for the participating pharmacy resident was on establishing a positive relationship with the medical team through providing high-quality collaborative patient care for the pediatric population. In addition to working to establish pediatric clinical pharmacy services, the resident further contributed to sustainable improvements in pediatric patient care by identifying areas for quality improvement. We discuss several considerations for the successful implementation of international experiences and their impact on participating residents. Pharmacy has an opportunity to build on the success of international APPE rotations and expand postgraduate offerings. Through collaboration with other institutions already involved in global health and identifying international rotation sites, residency programs across the country can create similarly beneficial global health experiences for their pharmacy residents.

Impact of an osteopathic presence in a large categorical pediatric residency training program

Nationwide Children's Hospital (NCH) has a large pediatric residency program with 43 residents in the categorical pediatric program and 10 residents in the Internal Medicine-Pediatrics (IM-Peds) program per class. Of the 43 categorical pediatric residents, four are in the osteopathic recognition track (ORT) and continue their osteopathic education throughout residency. There is currently a lack of data examining the effect of an ORT, and specifically a pediatric ORT, on a residency program. To evaluate the impact of an ORT osteopathic recognition track on an overall residency program's perceptions of osteopathic manipulative treatment (OMT) and to evaluate allopathic (MD) resident perception of osteopathic educational sessions. An anonymous survey was conducted in June 2017 and distributed to 141 residents (both categorical andIM-Peds) to gather baseline information regarding perceptions and knowledge of OMT. Based on the initial results, a four-part case-based educational series was implemented during the 2018-2019 academic year to teach osteopathic principles to MD residents. A second survey was distributed following each session. For the initial survey, 59 (41.8%) residents responded. Survey results demonstrated that resident perceptions of OMT as an efficacious treatment option increased after starting their residency at NCH (p=0.04), and 25 of 43 (58.1%) MD residents stated an interest in learning OMT skills. A total of 140 attendees were present at the four educational sessions. One hundred and thirty-eight residents (98.5%) found the educational sessions beneficial and 132 (94.2%) stated they would refer a patient for OMT. ORT residents make a significant impact on their colleagues' perceptions and knowledge of OMT. This study suggests that further efforts to highlight the clinical applications of OMT in pediatric patients would be welcomed by residents.

Identifying and Making Recommendations for Pediatric Anxiety Disorders in Primary Care Settings: A Video-Based Training.

IntroductionPediatric anxiety disorders have high rates of prevalence and confer risk for later disorders if they go undetected. In primary care, they are underdiagnosed, partly because pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of anxiety disorders in primary care.MethodsVideo content was consistent with the American Academy of Pediatrics Behavioral Health Competencies, as applied to the evaluation of anxiety disorders and guidance for discussing treatment options. This training can be delivered in two formats: videos (43 minutes) can be shown in a live, group-based format, or accessed via an online, asynchronous training. We tested this training program using both formats and developed surveys to evaluate knowledge about child anxiety, perceived evaluation skills, and satisfaction with the training. We also developed a video-based vignette to measure sensitivity to detecting disorders (how much the condition is interfering, diagnostic severity, and referral urgency).ResultsPediatric residents from two residency programs completed the training and pre- and posttraining assessments to evaluate program efficacy. Residents’ knowledge and perceived evaluation skills increased posttraining, with large effect sizes. Residents also demonstrated increased sensitivity to detecting anxiety disorders on the vignette-based assessment and reported high levels of satisfaction.DiscussionOur results suggested that residents participating in this training improved their evaluation skills and that residents found the training beneficial. Video-based trainings can significantly supplement existing education. This cost-effective and minimally burdensome training program can be used to enhance resident education in a much-needed area.

105 Actually, it is easy being green: Ten years of the Canadian PAediatric Society Annual General Meeting viewed through a sustainability lens

Abstract Introduction/Background The Canadian Paediatric Society (CPS) recently released the “Global climate change and health of Canadian Children” statement. As climate rapidly evolves from “change” to “crisis” there is an increasing pressure toward sustainable conferencing. Knowing the value of attending meetings, the growing body of literature evaluating travel-related carbon cost and convention sustainability can inform environmental harm minimization. Conferences can pressure venues to increase sustainability by choosing sites and venues wisely and communicating their requirements to rejected venues. They can also offer carbon offset purchase through credible companies (e.g. Gold Standard). Over the last 10 years the CPS has conducted its Annual General Meeting (AGM) at host cities that reflect Canada’s large geographic footprint. Venues included both hotel and standalone conference centers. There is no published evaluation of sustainable practices for CPS meetings. Objectives Evaluate the past 10 CPS Annual General Meetings (AGMs) for: Design/Methods Travel-related carbon cost was estimated with a round-trip calculator for economy seating the most direct available flights (https://co2.myclimate.org/en/offset_further_emissions). Cities of origin for attendee were the 11 CaRMS-matched pediatric residency training programs (https://www.carms.ca/match/psm/program-descriptions/). Venues were evaluated based on current publicly available self-reported information using conference sustainability criteria suggested through a literature review and public rating tools (Green Key, Quality Standards of the International Association of Convention Centres). Ground transportation from the airport was scored /3 by: public transport from airport (1), formal shared transport (1), fee deterrence for parking (1). Venue type was split by hotel-associated (H) and standalone convention centre (CC) meeting facilities. Sustainability of meeting facilities was divided into supports /2 (rentable supports, links to local vendors, catering and personnel) for exhibitors (1) and event planners (1), policies /3 by: sustainability, promotion of a green community (1), and waste management (1), and walkability from accommodation /1. Results The last 10 CPS AGMs were held in western (3; Vancouver 2010, Edmonton 2013, Vancouver 2017), eastern (1; Charlottetown 2016) and central (6; Quebec City 2011, London 2012, Montreal 2014, Toronto 2015, Quebec City 2018, Toronto 2019) provinces; in 2020 it is in Vancouver. Central Canada sites had the lowest air travel carbon cost per attendee. Average air travel-related carbon cost per attendee for different host cities ranged from 0.479 (London) to 0.919 (Vancouver) tonnes, with Ontario and Quebec sites averaging 0.518, Charlottetown 0.654 and Edmonton 0.756 tonnes. Ground transportation scores differed by city from Montreal (3/3 with public transit, formal transportation share and parking fees to dissuade driving) to London (0/3), with more favorable public transit options in larger cities. Venues differed when divided by hotel with meeting facilities (H) vs standalone conference center (CC), with CC outranking H for clearly posted sustainability plans (1.6 vs 1.2/2; 2=venue-specific, 1=company chain policy, 0=no plan), green and sustainable community building plans (1.6 vs 1.2/2; 2=greening local communities, 1=company chain policy, 0=no plan) and green waste management policies (1.2 vs 0/2; 2=venue-specific, 1=company chain policy, 0=no plan). Walkable accommodation was equal and present for all venues, with attached accommodation for all but one CC (Montreal), which had immediately adjacent hotels available. Conclusion As expected, the carbon cost of air transportation per attendee was lower in central provinces. Ground transportation from the airport was better in larger host cities. Standalone conference centres had more sustainable event support and locally focused policies regarding sustainability, environmentally friendly community building initiatives and waste management solutions, three major components of “greening” conferences. Based on the available resources across Canada, we recommend that the CPS considers these sustainability criteria in planning future events.

Addressing the Behavioral and Mental Health Educational Gap in Pediatric Residency Training.

* Abbreviations: ABP — : American Board of Pediatrics B/MH — : behavioral and mental health In the study “Competency of Future Pediatricians Caring for Children With Behavioral and Mental Health Problems” in this issue of Pediatrics , Green et al1 describe the continued deficit in pediatric resident competence in assessing and treating behavioral and mental health (B/MH) conditions based on survey questions asked during the 2018 initial pediatrics certifying examination application. B/MH concerns in pediatric practice are rising in prevalence. Approximately 13% to 20% of children in the United States experience a mental health disorder each year, and suicide is now the second leading cause of death for children ages 10 to 14 and adolescents and young adults ages 15 to 24.2 Nearly 25% of pediatric primary care visits involve a concern for B/MH issues.3 Throughout the pediatric education and training community, there has been a call for action to address the gap in trainee education on B/MH issues. The American Board of Pediatrics (ABP) entrustable professional activity 9 states that care of patients with B/MH concerns requires that a pediatrician be competent in (1) identifying and managing common B/MH issues; (2) referring and comanaging … Address correspondence to Sue E. Poynter, MD, MEd, Pediatric Residency Training Program, Cincinnati Children’s Hospital Medical Center, MLC 5018, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: sue.poynter{at}cchmc.org

1176 Survey Of Knowledge Of Pediatric Trainees Regarding Obstructive Sleep Apnea In Children

Abstract Introduction Obstructive sleep apnea (OSA) causes significant morbidity in children. Very few studies were conducted among pediatricians regarding sleep and sleep disorders in children and adolescents. They demonstrated significant gaps in knowledge in the recognition and management of OSA. Methods We conducted a survey among the pediatric residents in the screening and diagnosis of OSA. The survey consist of 15 questions related to OSA in children. It aimed at identifying gaps in their knowledge and educating them accordingly. Following the survey, core lectures were included in the pediatric curriculum which aimed at educating them with the causes, diagnosis, management and sequelae of untreated OSA. Results 37 pediatric residents took part in the survey. They were from first, second and third year of the pediatric residency training program respectively in an university hospital. 45% of them belong to the first year, 29% of them belong to the second year and 24% of them belong to the third year of training.Only a quarter of them had completed rotations in Pediatric Pulmonology for at least two weeks at the time of the survey. Three questions related to identifying at risk groups, four questions related to identification of the signs and symptoms, and three questions related to the diagnostic criteria and five questions related to the treatment and follow up of OSA. 46% of the residents accurately answered the questions related to screening and identifying children at risk of OSA. 57% of them identified the signs and symptoms of OSA in children.41% of them answered the questions related to diagnosis appropriately and 49% had correct responses for the questions related to treatment of OSA and follow up. Conclusion Less than 50% of the pediatric trainees could accurately identify the at risk groups and symptoms of OSA. These pediatric trainees who are future pediatricians form the referral source for children with OSA and educating them is vital.This reemphasizes the need for the pediatric training programmes to include mandatory training modules related to Pediatric sleep disorders, OSA in particular in the pediatric core curriculum. Support None

Racial, Ethnic, and Gender Diversity in Pediatric Anesthesiology Fellowship and Anesthesiology Residency Programs in the United States: Small Reservoir, Leaky Pipeline.

The critical question of racial and gender diversity in pediatric anesthesia training programs has not been previously explored. The primary objective of this study was to evaluate trends by race/ethnicity and gender in pediatric anesthesiology fellowship training programs in the United States for the years 2000 to 2018. Demographic data on pediatric anesthesiology fellows and anesthesiology residents were obtained from the self-reported data collected for the Journal of the American Medical Association's annual report on Graduate Medical Education for the years 2000 to 2018. Diversity was assessed by calculating the proportions of trainees per year by gender and racial/ethnic groups in pediatric anesthesiology fellowship and anesthesiology residency programs. Logistic regression equations were developed to estimate the annual growth rate of each racial/ethnic groups. The number of pediatric anesthesiology fellows increased from 57 trainees in 2000-2001 to 202 in 2017-2018 at an average rate of 9 fellows per year (95% confidence interval [CI], 8-10). These increases were primarily due to white trainees (54.4%-63.4%) as the proportions of black (7.0%-4.5%), Asian (26.3%-21.3%), and other minority (12.3%-10.9%) trainees have remained low. The number of anesthesiology residents increased from 3950 trainees in 2000-2001 to 5940 in 2017-2018 at an average rate of 99 residents per year (95% CI, 88-111). Within all anesthesiology trainees, these increases were due to white trainees (55.7%-61.3%) as the proportion of black (5.0%-6.0%), Asian (25.8%-24.1%), and other minority trainees (8.2%-8.5%) has remained fairly constant over the time period. Despite the overall lower proportion of female anesthesiology residents (range: 27.0%-37.5%), a steady increase in the number of women in pediatric anesthesiology fellowship programs has reversed the gender imbalance in this population as of 2010. While historic gains have been made in gender diversity in pediatric anesthesiology, there is persistent underrepresentation of black and Hispanic trainees in pediatric anesthesiology. It appears that their low numbers in anesthesiology residency programs (the reservoir) may be partly responsible. Efforts to increase ethnic/racial diversity in pediatric anesthesiology fellowship and anesthesiology residency training programs are urgently needed.

The development and implementation of a training program for pediatric dentistry residents working with patients diagnosed with ASD in a special needs dental clinic.

Oral health care is the most prevalent unmet health care need among all U.S. children age 17 and under in the U.S., and this includes those with special health care needs (SHCN). Children with SHCN experience unique barriers to receiving oral care including challenging behaviors, inadequate insurance coverage, and a lack of trained dentists. Despite the need for specialized training to successfully provide dental care to children with SHCN, few dental programs offer the necessary educational preparation. The Nova Southeastern University College of Dentistry was funded by the Health Resources and Services Administration to prepare pediatric and Advanced Education in General Dentistry (AEGD) dental residents in the care of children, adolescents, and adults with SHCN. The purpose of this paper is to describe the didactic and clinical training program and to provide data on the program's impact.

The Waiting Room: A Space for Self-Expression in the Pediatric Primary Care Setting.

In The Poetics of Space , Gaston Bachelard1 characterizes the house as “one of the greatest powers of integration for the thoughts, memories and dreams of mankind...Life begins well, it begins enclosed, protected, all warm in the bosom of the house.” As medical students, it was often difficult to feel a sense of belonging as we transitioned between rotations throughout our core clinical year. During this time of frequent change, we felt most at home in the Charles B. Rangel Community Health Center in Harlem (hereafter, Rangel), which provides care to a Medicaid-insured, predominantly African American and Hispanic population. As members of the Daniel Noyes Brown Scholars Program, a program within the medical school that seeks to expose students to primary care models and mentors, we were uniquely fortunate to enjoy a longitudinal experience at Rangel, making it a space where we felt safe and connected to the staff and patient community. We hoped to make the space that had become our professional home into an inviting and comfortable medical home for patients and families. When thinking about how best to enhance the medical home model, we thought it might be interesting to examine the physical design of the clinic itself because of our shared interest in narrative medicine and the therapeutic potential of art and architecture.2 Although the field of narrative medicine emphasizes the power of stories and the importance of listening in … Address correspondence to Anoushka A. Sinha, MD, MS, Pediatric Residency Training Program, Columbia University Irving Medical Center, 630 W 168th St, CHN-517, New York, NY 10032. E-mail: as4531{at}cumc.columbia.edu

Are Stethoscopes, Coats, and Pagers Potential Sources of Healthcare Associated Infections?

We conducted a study to determine the rate of bacterial colonization of stethoscopes, coats, and pagers of residents at a pediatric residency training program as compared to that of badges, sleeves, and pagers of non-patient care staff (control group). Among 213 cultures obtained from 71 residents, 27 potential pathogens were isolated from 22 residents (27/213, 12.7%) as compared to 10 potential pathogens out of 162 samples obtained from 54 control participants (10/162, 6.2%) (P = .0375). The most common pathogen isolated from residents and control participants was methicillin sensitive Staphylococcus aureus (MSSA). The source of positive cultures among the residents was the stethoscope (8/22, 36.3%), pager (8/22, 36.3%), and coat sleeve (11/22, 50%). The rates of colonization with potential pathogens were higher among residents than control participants and about 12% of residents’ stethoscopes, coats and pagers were colonized with bacterial pathogens. These are potential sources of nosocomial transmission of pathogenic organisms.

Pediatric residents' perceptions of the impact of the 24-hour on-call system on their well-being and education and patient safety. A national survey.

Objectives:To examine pediatric residents’ perceptions of the 24-hour in-hospital shift and its impact on their well-being and education and patient safety.Methods:A cross-sectional survey conducted with residents enrolled in pediatric residency programs across Saudi Arabia in February 2017 at the Saudi Commission For Health Specialties, Riyadh Saudi Arabia. We designed a self-administered questionnaire that was distributed using the Saudi Commission for Health Specialties E-mail groups. A 4-point Likert-type scale was used to rank the residents’ responses; and the relative importance index (RII) approach was used to analyze the relative contribution of each indicator to its main theme.Results:A total of 314 residents participated in the survey (response rate, 30%). Of these, 168 (53.6%) were females. When asked about their preferences regarding the 24-hour on-call system, 286 residents (91.1%) preferred not to continue with this system. Residents ranked several indicators that they perceived as a negative impact due to the 24-hour on-call system. The first ranked indicator was missing academic activities and elective rotations post-call (mean 3.10 [standard deviation 1.25], RII 90.94%), and the second was decreased performance and decision-making skills during night duty (mean 3.51 [standard deviation 1.0], RII 88.11%).Conclusion:We found that the 24-hour on-call system negatively impacts residents’ well-being and education and patient care. Pediatric residency training programs in Saudi Arabia should consider resident duty hour reform and evaluate new on-call models to improve resident well-being and training, as well as patient care.

79. RESIDENT AUTONOMY: ARE ATTENDINGS AROUND TOO MUCH?

Background According to guidelines from the ACGME, residents must demonstrate progressive autonomy over the course of training that affords them the ability to act in a supervisory role under faculty guidance in preparation for independent practice. As adult learning theory supports, autonomy within a supportive climate can have a significant impact in motivating learners to expand their knowledge base and practice methods. We created a needs assessment survey to help obtain information regarding the current opinions surrounding autonomy within our own residency program. Objective We sought to determine residents’ perception of autonomy during their pediatric residency training with a secondary objective of preliminary assessment for an attending-less rounding experience to address autonomy and supervisory elements within the residency curriculum. Methods In 2018, graduating PGY3 Pediatric residents and PGY4 combined Internal Medicine/Pediatric residents were electronically sent an anonymous novel survey. The questions focused on overall level of supervision as well as how valuable they would find rounding without an attending in terms of building their own autonomy. Numerical responses were collected for statistical interpretation. Results We obtained surveys from 33/36 graduating residents within their final month of residency training. Respondents reported a mean value of 72/100 (Scale: 0/100 = significantly unsupervised, 50/100 adequately supervised, 100/100 significantly over-supervised) when asked about their level of supervision on pediatric services. This cohort also reported a mean value of 82.42/100 and 83.27/100 when asked how valuable and how enjoyable, respectively, attending-less rounding on our Hospitalist service would be for resident autonomy. Conclusions Clinical settings within pediatric residency training programs can find it hard to balance autonomy given the extrinsic forces that are present. However, our residents demonstrate a perception of being over-supervised and support creating space for greater decision-making responsibilities and increased autonomy through revised inpatient service structure.

Controlling the Crowd: Balancing Patient Care and Education in Pediatric Palliative Care

Background: It has been demonstrated in the literature that in medical school and pediatric residency training programs, exposure to end of life management and palliative conversations are limited. As a result, many learners finish their training feeling underprepared for patient encounters that may require primary palliative care skills. As such, elective experiences in pediatric palliative care can be a valuable experience. …

Training Residents in the Early Identification of Anxiety Disorders: Feasibility and Preliminary Efficacy of a Novel Training Program.

Pediatric anxiety disorders are highly prevalent, but tend to go undetected as pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of child anxiety disorders. The novel training was completed in a group-based format or via an online, asynchronous training program. Pediatric residents from 2 residency programs (n = 63) participated and completed pre- and posttraining surveys evaluating attitudes about previous training, knowledge about child anxiety, perceived evaluation skills, and responses to clinical vignettes. Most residents (81%) reported they did not receive enough prior training in the presentation of anxiety disorders in young children. Residents' knowledge and perceived evaluation skills increased posttraining. On the vignette-based assessment, residents demonstrated increased sensitivity with regard to interference, diagnosis, and referral urgency. Despite some challenges with participation, results provide preliminary evidence that brief training programs could be an effective way to improve resident education.

Medical Librarians may be Underutilised in EBM Training within Pediatric Resident Programs

A Review of: &#x0D; Boykan, R., &amp; Jacobson, R. M. (2017). The role of librarians in teaching evidence-based medicine to pediatric residents. Journal of the Medical Library Association, 105(4), 355-360. https://doi.org/10.5195/jmla.2017.178&#x0D; Abstract&#x0D; Objective – To identify the use and role of medical librarians in pediatric residency training, specifically in the teaching of evidence-based medicine (EBM) to medical residents. This research also aims to describe current strategies used for teaching evidence-based medicine in pediatric residency training programs.&#x0D; Design – Web-based survey.&#x0D; Setting – Pediatric residency programs within the United States of America.&#x0D; Subjects – 200 members of the Association of Pediatric Program Directors (APPD).&#x0D; Methods – The 13-question, web-based survey used multiple choice and short answer questions to ask how pediatric residency programs used medical librarians. The survey collected demographic information such as program name, geographic region, and program size. Where respondents indicated their programs utilised librarians, the survey asked about their specific role, including involvement in EBM curricula. For respondents who indicated their programs did not use librarians, the survey asked about their reasons for not doing so, and to describe their EBM curricula. Researchers used SPSS software to analyse the quantitative data.&#x0D; Main Results – Overall 91 (46%) APPD-member program directors responded to the online survey. Of these, 76% of program directors indicated a formal EBM curriculum in their residency programs. Medical librarians were responsible for teaching EBM in 37% of responding pediatric programs. However, only 17% of responding program directors stated that medical librarians were involved in teaching EBM on a regular basis. The EBM skills most commonly taught within the pediatric residency programs included framing questions using PICO (population, intervention, comparator, outcome), searching for relevant research literature, and critical appraisal of studies. The strategies reported as most effective for teaching EBM in pediatric residency training programs were journal clubs, regular EBM conferences or seminars, and ‘morning reports.’&#x0D; Conclusion – The study concluded that medical librarians may be important in the teaching of EBM in pediatric residency programs, but are likely underutilised. The librarian might not be seen has having a significant role in forums such as journal clubs, despite these being a predominant venue for EBM teaching. The authors recommend that program directors and faculty work together to better integrate medical librarians’ expertise into clinical teaching of EBM.