Pediatric Resident Attitudes Research Articles

Exploring Pediatric Resident Attitudes and Preferences for Board Exam Preparation.

ObjectiveThe American Board of Pediatrics Certifying Exam (ABP CE) is a high stakes exam and is important for employment and fellowship opportunities in pediatrics. Although research has suggested interventions which may improve scores, little research has focused on resident perception of preparation for the ABP CE. In this study, we aimed to better define pediatric residents’ attitudes and preferences regarding preparation for the ABP CE.MethodsPediatric residents from one residency program were invited to participate in focus groups to discuss their attitudes and preferences on board exam preparation for the ABP CE. Focus groups were audio recorded and transcribed. Conventional content analysis was used to analyze qualitative data. From the transcripts, authors developed codes through an iterative process, which were then organized into categories. These categories were then grouped into themes.ResultsNineteen residents participated in three focus groups. Focus group transcription analysis resulted in 49 codes, which were sorted into 26 categories. The categories were then grouped into four key themes: 1) the ABP CE is not immediately important early in residency; 2) more personalized guidance is preferred; 3) consistent board preparation focus from the residency program is valued; 4) learning format is important.ConclusionsResidents believe preparation for the ABP CE increases in importance as they progress through residency, and they desire more personalized, consistent, and structured focus from their training program related to ABP CE preparation. Attention to these perceptions can help guide pediatric residency program leadership in developing effective board exam preparation strategies and curricula for their residents.

Pediatric Resident Attitudes Toward Inpatient Immunization of Children and Adolescents: Highlighting Differences in Human Papillomavirus Vaccination.

Over a decade after its debut, human papillomavirus (HPV) vaccine coverage remains suboptimal. The inpatient setting presents a largely unexplored opportunity to increase vaccination rates. This study aims to describe pediatric resident attitudes toward inpatient immunization and compare differences by vaccine, in particular HPV. An anonymous survey of beliefs and practices regarding inpatient vaccines was distributed to pediatric resident physicians at a single freestanding urban children’s hospital in September 2017. A total of 58 surveys were collected (64% response rate). We found that pediatric residents were more likely to report that they never or rarely discuss the HPV vaccine during hospitalization compared with the primary childhood series (P = .001), Tdap (P = .02), and the influenza vaccine (P < .001), and rarely offer the HPV vaccine during hospitalization compared with childhood vaccines (P = .003) and influenza (P = .001). This suggests that provider hesitancy still exists for the HPV vaccine, presenting opportunities for further education and inpatient interventions.

Pediatric Resident Attitudes and Practice Regarding Advocacy Pre- and Post-Implementation of an Innovative Advocacy Curriculum (Research Abstract)

In 2016, The American Academy of Pediatrics released a policy statement on poverty and child health, urging pediatricians to screen for social determinants of health (SDH) during patient encounters. However, training pediatricians to advocate for their patients by recognizing and addressing SDH, and engaging in individual, community and legislative advocacy is currently lacking in medical education. In July 2015, we implemented an innovative advocacy curriculum at our residency program.

Pediatric Resident Attitudes and Knowledge of Critical Congenital Heart Disease Screening.

This study aimed to understand the knowledge, attitudes and confidence level related to critical congenital heart disease (CCHD) screening among pediatric residents. Pediatric residents were assessed via an anonymous survey related to CCHD guidelines and procedures as set out by the New York State Department of Health. The survey was emailed to pediatric residents at a large academic institution. A teaching intervention was performed after the initial survey, which was followed by an identical after-intervention survey. Forty-two residents responded to the pre-intervention survey (n=42), and forty post-intervention (n=40). The mean composite knowledge score was 76% pre-intervention and 92% post-intervention, p<.001. Pre-intervention only 12% of the respondents could answer all the questions correctly which increased to 60% post-intervention. Confidence among residents regarding guidelines increased from 38 to 95% post-intervention, p<.001. There was a positive correlation between the residents who felt confident of the guidelines and who answered correctly, r=.514, p<.001, n=82. There was no significant difference between knowledge, attitudes or confidence level scores by year of training or the gender of the residents. Our study demonstrated a significant gap of knowledge among residents related to CCHD screening mandated by New York State health law. There was also a corresponding lack of confidence demonstrated by the residents in the guidelines. These data suggest that residents would benefit from further education on the proper implementation of a CCHD screening program. Further multicenter studies are warranted to assess similar gaps in other residency training programs in New York and wherever these screenings guidelines have been adopted.

A Survey of Resident Attitudes on Billing and Coding Education

INTRODUCTION: Billing and coding (B&amp;C) are important aspects of medical practice that many feel are taught inadequately during residency. In addressing this deficiency, residency programs must determine when and how to teach B&amp;C. Some programs teach through informal methods or direct their education only towards senior residents and/or certain career paths. Is this approach ideal? This study evaluated pediatric resident attitudes towards formal B&amp;C education, by post graduate year (PGY), and career plans. METHODS: A survey was distributed to residents before and after implementation of a novel, formal curriculum teaching B&amp;C. General linear models were calculated to look at differences over time of all residents and by PGY levels and future career plans. RESULTS: Among all residents, there was no change in the highly positive attitudes towards Learning is Important, Valuable Use of Time, or Want a Formal Curriculum. Perceived Knowledge increased significantly and Need to Know More decreased significantly. There were no differences between PGY levels or career plans with all years valuing and wanting education. PGY-3s scored higher than PGY-1s and PGY-2s with Perceived Knowledge. CONCLUSION: This study demonstrated a strong, equal amount of interest in the formal education of B&amp;C across all residents, regardless of training year and/or career plans. Pediatric residencies should consider implementing formal education on B&amp;C to all residents. Pediatric resident attitudes towards billing and coding education can be used to guide the curriculum.

Fellows as teachers: a model to enhance pediatric resident education

ObjectivePressures on academic faculty to perform beyond their role as educators has stimulated interest in complementary approaches in resident medical education. While fellows are often believed to detract from resident learning and experience, we describe our preliminary investigations utilizing clinical fellows as a positive force in pediatric resident education. Our objectives were to implement a practical approach to engage fellows in resident education, evaluate the impact of a fellow-led education program on pediatric resident and fellow experience, and investigate if growth of a fellowship program detracts from resident procedural experience.MethodsThis study was conducted in a neonatal intensive care unit (NICU) where fellows designed and implemented an education program consisting of daily didactic teaching sessions before morning clinical rounds. The impact of a fellow-led education program on resident satisfaction with their NICU experience was assessed via anonymous student evaluations. The potential value of the program for participating fellows was also evaluated using an anonymous survey.ResultsThe online evaluation was completed by 105 residents. Scores were markedly higher after the program was implemented in areas of teaching excellence (4.44 out of 5 versus 4.67, p<0.05) and overall resident learning (3.60 out of 5 versus 4.61, p<0.001). Fellows rated the acquisition of teaching skills and enhanced knowledge of neonatal pathophysiology as the most valuable aspects of their participation in the education program. The anonymous survey revealed that 87.5% of participating residents believed that NICU fellows were very important to their overall training and education.ConclusionsWhile fellows are often believed to be a detracting factor to residency training, we found that pediatric resident attitudes toward the fellows were generally positive. In our experience, in the specialty of neonatology a fellow-led education program can positively contribute to both resident and fellow learning and satisfaction. Further investigation into the value of utilizing fellows as a positive force in resident education in other medical specialties appears warranted.

Pediatric Resident Attitudes Toward Caring for Children with Severe Disabilities

To survey pediatric residents' attitudes toward caring for children with severe disabilities. A cross-sectional survey of residents in a university-affiliated pediatric residency program between October and December 2005. Residents were asked to complete a newly designed, 13-item survey. For each item, participants selected the degree to which they did or did not agree with a statement about disabilities or caring for children with severe disabilities. Fifty-five (43%) of 129 eligible residents participated. Eighty-nine percent felt that caring for children with severe disabilities was as rewarding as caring for other children. Ninety-two percent felt that there is a societal responsibility to care for such children; 98% felt families of children with disabilities love their children as much as other families. Two-thirds (66%) admitted frustration related to caring for children who cannot be cured or function independently, and 71% questioned the aggressive treatment of such children. Residents in their second and third postgraduate years were more likely to question the aggressive treatment compared with their junior colleagues. Although pediatric residents had positive attitudes toward children with severe disabilities, emotional and moral tensions did arise around their care.

Pediatric Resident Attitudes About Technologic Support of Vegetative Patients and the Effects of Parental Input—A Longitudinal Study

To evaluate the change over time of attitudes about withdrawal of care from hopelessly ill children among a cohort of pediatric residents. Prospective data collection via surveys. A pediatric residency program in a children's hospital. Pediatric residents beginning training in 1987 and 1988; 29 residents completed the study. Study participants completed a structured case-oriented questionnaire yearly from June 1988 through the completion of their residency training. The withholding of vasoactive agents or cardiopulmonary resuscitation, and the withdrawal of intravenous fluids, nutrition, or mechanical ventilation were the specific therapeutic options presented for a patient in a persistent vegetative state. The effects of time (further training) and parental wishes on resident decisions were assessed. No resident wanted to provide intensive care to a child in a persistent vegetative state who was in respiratory failure; all residents would withhold vasoactive agents and CPR from such a child. At the conclusion of training, most (97%) would withdraw mechanical ventilation. A minority would withdraw intravenous (IV) fluids (41%) or nutrition (35%). Residents became more willing to withdraw IV fluids from these patients (0/16 vs 6/16; P = .03) and to withhold or withdraw therapies in general (P = .03) over the course of their training. All of this change occurred over the first year of training. Parental wishes altered treatment plans for these patients significantly, both when parents desired additional treatment (P < .0001), and when parents wanted treatment stopped (P = .04). The residents' level of training had no effect on responses to parents' therapeutic requests. Although exposure to level of care issues occurs throughout pediatric residency training, almost all changes in trainees' attitudes occur during the first year. Efforts to promote effective learning and coping should be concentrated in this period.