Pediatric Residents Research Articles

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.

Development and Validation of a Trauma-Informed Care Communication Skills Assessment Tool

BackgroundTrauma-informed care (TIC) is growing in medical education as health care systems recognize trauma’s impact on health outcomes. TIC acknowledges and responds to the effects of trauma on physical, psychological, and emotional health. As TIC trainings are developed and delivered to health care professionals across the learner continuum, curricula need evaluation beyond learner satisfaction and knowledge to better assess changes in skills. We developed the Gap Kalamazoo Communication Skills Assessment Form for Trauma-Informed Care (GKCSAF-TIC) to evaluate pediatric trainees' communication skills in TIC. We describe the development and validity evidence of the GKCSAF-TIC in assessing pediatric residents' TIC skills during standardized patient encounters. MethodsWe developed and implemented the TIC communication skills assessment tool in a one-year prospective cohort study involving pediatric residents. We conducted simulated patient encounters conducted before and after TIC training, with two pediatric faculty attendings assessing each encounter. We gathered validity evidence using Messick’s framework, focusing on content, response process, internal structure, and relationship with other variables. ResultsWe analyzed 57 standardized patient encounters with 33 pediatric interns, including 23 pre-post matched pairs. The development process and rater training supported content and response process validity. Internal consistency, measured by Cronbach’s alpha, ranged from 0.93 to 0.96, while inter-rater reliability, measured by intraclass correlations, ranged from 0.80 to 0.83. There was a significant improvement in scores from pre-training to post-training (3.7/5 to 4.05/5; P < 0.05). ConclusionThe GKCSAF-TIC demonstrated strong preliminary validity and offers educators a valuable means to assess and provide formative feedback to pediatric trainees about TIC.

Evaluating the Novel Use of Unmanned Video Objective Structured Clinical Examination Stations in Pediatric Resident Training: Results and Insights

Abstract Background: Objective structured clinical examination (OSCE) is vital in assessing medical trainees’ clinical competence. Unlike the traditional resource-intensive OSCE, video-based OSCE has advantages like asynchronous assessment and more immediate feedback. However, their applicability and effectiveness in pediatric residency training are less explored. This study aims to evaluate the feasibility and outcomes of using unmanned video OSCE stations in pediatric residency training. Materials and Methods: A cross-sectional study was conducted with 79 pediatric residents participating in OSCE mock stations. Video clips showing real-life clinical scenarios were played. Residents then responded electronically to scenario-related multiple-choice questions. Descriptive statistics were employed to analyze residents’ responses to multiple-choice questions. Results: In a study of 79 physicians, the majority were female (63.3%) and under 34 years old (62%), with most receiving their training outside Riyadh (79.7%). Their clinical understanding, assessed through a nonmanned OSCE video, varied: 16.5% accurately diagnosed spinal muscular atrophy in infants, while 48.1% correctly identified laryngomalacia in 2-month-olds. The average knowledge score was 2.89 out of 7, with a standard deviation of 1.19. Notably, 43% answered three scenarios correctly. Analysis showed no significant correlation between the physicians’ gender, age, or training location and their knowledge scores, indicating diverse expertise levels irrespective of these demographic factors. Conclusion: Unmanned video OSCE stations show promise in enhancing pediatric residency training assessments by providing instant feedback and streamlining the evaluation process. However, challenges and the need for targeted interventions should be considered. Future research should focus on refining technology integration and assessing long-term impacts on residents’ clinical skills and patient care outcomes. Ensuring the privacy and security of video recordings is essential in this technologically evolving landscape.

Educational Needs of Pediatric Surgery Residents

Educational Needs of Pediatric Surgery Residents

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.

Improving Completion Rates for Autism Screening - A Quality Improvement Project

Introduction: Autism spectrum disorder (ASD) may be the most well-known and most studied neurocognitive disorder responsible for developmental delay. The medical community, in response to the noted increase in prevalence, emphasized the importance of routine screenings at 18 months and 24 to 30 months of age. Ascension St. John Children’s Hospital Resident Clinic utilizes the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) or MCHAT for short, validated for ages 16 through 30 months. It was noted that screening is frequently missed or undocumented. Because of the need for timely diagnosis and intervention, these missed opportunities can be costly for children and their families. Purpose: To improve compliance with the American Academy of Pediatrics’ (AAP) recommendation to screen all children for ASD at 18 and 24 months of age. Methods: An educational lecture was provided to the pediatric residents to screen all children in the above age group being seen for a well-child visit. A visual reminder red pen mark was also applied to eligible patient charts as they were checked in. Baseline completion rates in two three month periods, one year before and three months after the intervention, were compared. Results: A total of 337 charts were reviewed with similar baseline characteristics between pre- and post-intervention groups. Overall MCHAT completion rates were lower after the intervention: 64% pre- vs. 49% post-intervention (p &lt;0.05). Subgroup analysis of visits where screening was directly indicated (excluding ages 16-17 months, &gt;24 month olds where a screen was already passed at a 24 month well visit, or children already diagnosed with autism, n = 281), had similar completion rates (67.5% and 64.5% respectively, p = 0.59). Conclusion: MCHAT completion did not improve after the combined intervention of a single, in-person lecture and visual reminder chart marking.

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.

Knowledge and skills of pediatric residents in managing pediatric foreign body airway obstruction using novel airway clearance devices in Spain: A randomized simulation trial

AimRecent emergence of airway clearance devices (ACDs) as a treatment alternative for foreign body airway obstructions (FBAO) lacks substantial evidence on efficacy and safety. This study aimed to assess pediatric residents’ knowledge and skills in managing a simulated pediatric choking scenario, adhering to recommended protocols, and using LifeVac© and DeCHOKER© ACDs. MethodsRandomized controlled simulation trial, in which 60 pediatric residents from 3 different hospitals (median age 27 [25.0–29.9]; 76.7% female) were asked to solve an unannounced pediatric simulated choking scenario using three interventions to manage (randomized order): 1) following the recommended protocol of the European Resuscitation Council (encouraging to cough or combination of back blows and abdominal thrusts); 2) using LifeVac©; and 3) using DeCHOKER©. A Little Anne QCPR™ manikin (Laerdal Medical) was used. The variable compliance rate (%) was calculated according to the correct/incorrect execution of the steps constituting the proper actions for each test. ResultsParticipants demonstrated a correct compliance rate only ranging between 50–75% in following the recommended protocol for managing partial FBAO progressing to severe. Despite unfamiliarity with the ACDs, pediatric residents achieved rates between 75% and 100%, with no significant difference noted between the two devices (p = 0.173). Both scenarios were successfully resolved in under a minute, with LifeVac© demonstrating a significantly shorter response time compared to DeCHOKER© (39.2 [30.4–49.1] vs. 45.1s [33.7–59.2], p = 0.010). ConclusionsOnly a minority of pediatric residents were able to adhere to the recommended FBAO protocol, whereas 70% of them were able to adequately use the ACDs. However, since a significant proportion could not, it seems that ACDs themselves do not address all issues.

Impact of a Novel Structured Transfusion Medicine Curriculum on Pediatric Residents’ Knowledge and Self-Reported Confidence Levels

Impact of a Novel Structured Transfusion Medicine Curriculum on Pediatric Residents’ Knowledge and Self-Reported Confidence Levels

Put Yourself out There! A Strategy for Effective Self-Promotion in Academic Medicine.

Trainees and faculty in academic medicine often struggle with self-promotion. Barriers may be more formidable for women and other groups underrepresented in medicine. Experience-based stories illustrating personal strengths are preferable when engaging in self-promotion activities. We developed a 90- to 120-minute workshop utilizing approaches such as iterative journaling and peer discussion to teach the development of problem-action-result (PAR) stories for self-promotion efforts in interviews and written applications to new positions. Participants provided Likert-scale (1 = strongly disagree, 5 = strongly agree) and free-response evaluations, which we analyzed for workshop strengths and areas for improvement. We presented the workshop in person to 28 pediatric residents and subsequently to 22 residents, fellows, and faculty at an in-person national meeting. Sixty-one percent of the resident group and 100% of the national workshop group completed the evaluation. Both groups reported high satisfaction with the workshop's format (M = 4.7) and content (M = 4.7) and indicated intention to use the skills learned (M = 4.7). Strengths included the PAR format, interactivity, journaling, opportunity for reflection, and tips for interviewing and writing. Areas to improve included offering the workshop earlier in the academic year and providing more written examples of PAR stories. This workshop used strategies of personal reflection, journaling, and peer feedback to help participants understand behavior-based recruiting practices and the PAR framework as a strategy for successful self-promotion. Learners can use these strategies to develop greater confidence and efficacy and to address barriers to effective self-promotion they encounter.

La especialidad de Pediatría sigue teniendo interés para los residentes

Introduction: the objective of our work as to analyse the interest of residents who begin their training in the specialty of paediatrics and its specific areas, based on the order in which open residency spots were filled throughout the years. Methodology: analysis of data obtained from the register of the medical intern resident (MIR) selection process in the past 9 years, current paediatrician positions in the National Health System and a study on the projected need for medical specialists in 2021-2035. Results: in the last nine years, there has been an increase in the number of available spots from 392 to 501. Since more spots are available now, the last one is, as expected, filled later in the selection process. Thus, the delay in spot allocation has been of 49%, but if the number of spots had not increased, it would have been of 17%. The number of candidates who could not choose paediatrics because all residency spots had been filled when their turn arrived increased by 28% from 2703 to 3469. Given that the rate of transfer or attrition in the paediatrics residency programme is minimal, it would be possible to offer more spots, as they would be filled appropriately. Most job openings in paediatrics are in primary care (65%) followed by hospital-based paediatric care (35%). Conclusions: paediatrics continues to be an appealing speciality for candidates to MIR training. If more MIR spots were offered, more residents would choose the paediatrics specialty. Given that most job opportunities are ins primary care, training in this setting should be reinforced in the MIR programme.

Pediatric ultrasound practice in Italy: an exploratory survey

BackgroundThe aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide.MethodsA questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022.ResultsThere were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%).ConclusionsDespite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.

Our New Normal: Pediatric Nurse Residents' Experiences with Transition to Practice during the COVID-19 Pandemic.

This phenomenological qualitative study examined the lived experience of pediatric nurse residents' transition to practice during the COVID-19 pandemic. The purposive sample included nine pediatric nurses, participating in a nurse residency program, who entered the nursing profession during the first year of the pandemic. The setting was a free-standing, Magnet-recognized, pediatric academic medical center in the Northeastern U.S. Individual interviews were audio recorded and transcribed. Narratives were analyzed using a hermeneutic phenomenological approach. Five themes emerged from the data: Our New Normal; The Rules Keep Changing; I'm Not Ready for This (transition to practice); The Toll of COVID; and Shattered Family-Centered Care. Sub-themes emerged in The Toll of COVID theme: COVID and the Nursing Care Environment, Emotional Toll of COVID, Burnout: A Universal Truth, and The Pandemic within the Pandemic. The nurse residents' narratives uncovered the essence of their uncertainty, sorrow, growth, and resilience. Through the eyes of pediatric nurse residents, this study illuminated the experiences of these novices as they entered the nursing profession amid a pandemic.

A national virtual job search series for neonatal-perinatal medicine fellows

BackgroundA standardized approach to prepare trainees for the job search has not been described. The objective of this study was to describe and evaluate an educational series on the job search for Neonatal-Perinatal Medicine (NPM) fellows and identify participants’ job search knowledge gaps.MethodsDuring the 2020–2021 academic year, we created a virtual, seven-part job search series for NPM fellows that required no funding. The series has been repeated annually. We use REDCap surveys to register participants, collect baseline/demographic information, and evaluate the series’ impact at the beginning and end of the job search timeline.ResultsIn the 2021–2022 academic year, 290 individuals registered for the series, and 89% completed the baseline/demographic survey. The majority were NPM fellows (89%). Early career neonatologists, NPM hospitalists, and pediatric residents also utilized the series (11%). Less than 25% reported being “knowledgeable” or “very knowledgeable” of core job search components, including the timeline of the job search, contract negotiation, and the general roles and responsibilities of junior faculty. Of those who completed the final job search survey and underwent a job search (60%, 97 of 162), the majority (86%) felt that career planning during training was stressful and believed that job search preparation should be structured into the NPM fellowship curriculum (81%). Many felt that the Job Search Series was helpful in elucidating components of the job search.ConclusionsWe identified several knowledge gaps in NPM fellows’ understanding of how to find, prepare for, and negotiate their first post-training job. We strongly believe these knowledge gaps are not unique to NPM fellows and that all graduate medical education trainees would benefit from a similar, easy-to-implement, no-cost series.

Research Training and Scholarly Activity during General Pediatric Residency in Canada

Research Training and Scholarly Activity during General Pediatric Residency in Canada

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.

Effect of citizenship status on access to pediatric liver and kidney transplantation

Transplantation of non-US citizen residents remains controversial. We evaluate national trends in transplant activity among pediatric noncitizen residents (PNCR). Pediatric liver and kidney transplant data were obtained from the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. Data on transplanted organs, region, waitlist additions, procedures, and citizenship status were analyzed from 2012-2022. Rates of PNCR transplantation activity were compared with population rates from the US Census Bureau. On average, 713 ± 47 pediatric liver and 1039 ± 51 kidney patients were added to the waitlist, with 544 ± 32 liver and 742 ± 33 kidney transplants performed annually. Of these, PNCR comprised 1.5% and 3.3% of liver and kidney waitlist additions and 1.5% and 2.9% of liver and kidney transplant procedures, respectively. There were no significant changes in waitlist or transplant activity nationwide over the study period. There was a significant geographic variation in the percentage of waitlist additions and transplants across the United Network for Organ Sharing regions among the PNCR for liver and kidney transplantation. This is the first study to evaluate national trends in transplantation activity among PNCRs. The significant regional variation in transplantation activity for PNCR may suggest multilevel structural and systemic barriers to transplant accessibility.

Teaching Short, Practical Resilience Tools to Pediatric Residents: Evaluation of a Resiliency Training Program

Teaching Short, Practical Resilience Tools to Pediatric Residents: Evaluation of a Resiliency Training Program

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.

Educational Intervention for Pediatricians on Research and Resources for Moms with Postpartum Depression

Postpartum depression (PPD) is a serious condition that affects 13-19% of mothers who previously had postpartum blues. The American Academy of Pediatrics recommends that mothers receive screening for PPD at their infant’s well-child visits during months 1, 2, 4, and 6. The purpose of this intervention was to host an informational session for pediatric residents regarding current research and local/national resources for women with postpartum depression. We hypothesize that by doing this session, there will be a notable increase in the knowledge learned. The session was held at the Orlando Health Arnold Palmer Hospital for Children. Residents were given a pre-survey, a presentation, and then a post-survey immediately after. All surveys were online and given via Qualtrics. The presentation consisted of background information on postpartum depression, local specialists on maternal mental health, research supporting telemedicine, exercise, social interactions, and expressive writing as evidence-based methods to improve symptoms, and local/national resources for each respective field. Descriptive statistical analysis was used to analyze the differences in our pre-survey data versus. post-survey data. In comparing the pre to post-survey responses, an overall average of an 87% increase in knowledge occurred. Overall it was noted that all residents gained a better understanding of resources nationally and in the local community. Although limited by our sample size, N&lt;14, our study concluded that the residents who attended our session were able to screen and diagnose postpartum depression and were able to provide local resources to mothers. We were able to accept our hypothesis that creating an educational intervention where current research and resources regarding support for women with PPD is synthesized and presented to pediatricians, their knowledge on available tools accessible to mothers will increase.