Third-year Pediatric Residents Research Articles

Development and Implementation of a Pediatric Pulmonary-Focused Active Learning Curriculum.

During the pediatric pulmonary rotation, trainees reported that while the clinical experience was robust, they desired more structured didactic sessions. Self-paced online modules can be an alternative but equally effective teaching tool. Multiple studies demonstrate the benefits of e-learning in medical education. Four interactive, case-based, e-learning modules on asthma, chronic cough, tracheostomy, and obstructive sleep apnea were created and piloted to pediatric residents and medical students in the pediatric pulmonology elective at the University of California, San Francisco and Oakland campus. Modules incorporated videos with experts, images, and multiple-choice questions to enhance learning. The modules were distributed via email on their first day of the rotation and were completed virtually by the trainees during their rotation. Progress was evaluated from December 2021 to July 2022 using pre- and postcourse questions assessing knowledge acquisition and decision-making skills. A total of 22 participants took part in the elective and completed the modules to varying degrees. This group included six fourth-year medical students and three first-year, five second-year, and eight third-year pediatric residents. Data showed an improvement in posttest scores across all four modules, ranging from 9% to 21%, with a large improvement in the obstructive sleep apnea module and a small improvement in the chronic cough module. Trainees reported that the modules supplemented and increased their knowledge base. Knowledge about managing common pulmonary conditions is critical for general pediatricians. Self-paced online modules are well accepted by trainees and are effective in improving knowledge and medical decision-making.

Communication of medical errors in a simulated clinical scenario. Experience with a pediatric residency group.

To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing. Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient's father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing. Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son's health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88). We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents' self-perception of error management was regular and not modified by the debriefing.

Pediatric Residents' Perceptions of a Point-of-Care Ultrasound Collaboration With Emergency Medicine.

Background Pediatric residencies expanding their point-of-care ultrasound (POCUS) education face barriers, including a lack of established curriculum and qualified educators. Prior studies report partnerships between pediatrics and pediatric emergency medicine (PEM); however, many non-PEM emergency medicine (EM) physicians with POCUS fellowship training also have experience with pediatric POCUS and represent an alternate educational partner. Objectives To improve pediatric residents' POCUS skills through collaborative education with EM and evaluate perceptions of the teaching format and instructors. Methods First through third-year pediatric residents attended a half-day didactic and hands-on session about renal, lung, and musculoskeletal (MSK) POCUS. These educational sessions were led by EM faculty with POCUS fellowship training and assisted by EM residents. Post-session surveys were administered to pediatric residents to assess prior POCUS experience, changes in confidence in acquiring and interpreting renal, lung, and MSK POCUS images, and opinions about the educational format. Statistical analyses of the post-session survey data were performed using SPSS. Results Thirty-nine pediatric residents attended the session and completed the survey of 45 total residents in the program (86.7%), with 89.7% completing 10 or fewer POCUS studies. Residents' comfort level with performing lung POCUS increased from 5.1% to 82.1% (p< .001), renal POCUS from 10.3% to 76.9% (p< .001), and MSK POCUS from 7.7% to 84.6% (p< .001). 87.2% rated the educational format as effective, and 94.9% (37/39) rated emergency medicine faculty as 'very effective' in providing ultrasound education relevant to the practice of pediatrics. Conclusion Pediatric resident POCUS education taught by EM faculty with POCUS fellowship training was well-received by pediatric residents and significantly improved confidence in acquiring and interpreting POCUS.

Using a Limerick Writing Contest to Address Residency and Career Stress and Foster Connection Among Pediatric Residents Approaching Graduation.

As third-year pediatric residents prepare to graduate, they commonly navigate uncertainty around “ending” residency life and transitioning to new professional settings.1 Residents graduating in summer 2021 faced additional emotional challenges in career preparation due to coronavirus-19.2 Our residency program therefore sought to deliver a wellness activity to address residency and career stressors specific to the 2021 graduating class during a previously planned professional development session focusing on career transition.

A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study.

BackgroundBehavioral health disorders have steadily increased and been exacerbated by the COVID-19 pandemic. Though behavioral health disorders can be successfully mitigated with early implementation of evidence-based parent management strategies, education for pediatric residents on behavioral health anticipatory guidance has been limited to date, with training challenges compounded by the physical distancing requirements of the COVID-19 pandemic. Virtual reality (VR) simulations provide an opportunity to train residents on this complex competency by allowing deliberate practice of necessary skills while adhering to current social distancing guidelines.ObjectiveThis study explored the usability of a VR-based behavioral health anticipatory guidance curriculum for pediatric residents.MethodsThis mixed methods study included 14 postgraduate third-year pediatric residents who completed the behavioral health anticipatory guidance VR curriculum. Residents completed the MEC Spatial Presence Questionnaire to assess immersion in the virtual environment. Semistructured interviews were used to elucidate residents’ perspectives on the curriculum’s content and format. The interviews were analyzed using conventional content analysis.ResultsQuantitatively, residents reported a high degree of immersion, spatial presence, and cognitive involvement. Most residents (11/14, 79%) agreed or strongly agreed that it seemed as though they took part in the action of the simulation. Qualitatively, two themes emerged from the data: (1) the curriculum expands behavioral health anticipatory guidance and motivational interviewing knowledge and skills and (2) VR technology is uniquely positioned to develop competence. These themes revealed that the curriculum expanded their current level of knowledge and skill, addressed training gaps, and was applicable to all residents. Additionally, residents experienced VR as immersive, feasible, realistic to the clinic setting, and a safe space to practice and learn new skills.ConclusionsPilot data indicates that VR may be an effective tool to teach pediatric residents behavioral health anticipatory guidance, meeting a current gap in medical education training. This VR curriculum is particularly relevant in the context of the COVID-19 pandemic given the increased behavioral health concerns of families.

“Still Caring for the Family”: Condolence Expression Training for Pediatric Residents

ContextInsufficient communication from the medical team following a child's death may compound parental grief. Pediatric residents care for children who die, yet the landscape of condolence expression education within residency programs has not been studied. ObjectivesThe objective of this study was to evaluate pediatric residents’ levels of experience and comfort with condolence expression and to assess their needs and desires for training in condolence expression. MethodsA cross-sectional, mixed-methods survey was developed by palliative care clinicians in collaboration with bereaved parents. In 2020, following pilot testing, an electronic survey measuring resident experience with, comfort with, and training on condolence expression was distributed to 202 third-year pediatric residents across 17 Accreditation Council for Graduate Medical Education-accredited programs representing varying sizes and geographic regions. ResultsTen percent of pediatric residents surveyed reported having training on condolence expression. Almost all residents considered condolence expression to be beneficial for bereaved families and most for clinicians, too, yet very very few had formally expressed condolences in their roles as physicians: 83.1% had never written a condolence letter; 85% had never made a condolence phone call; and 90.5% had never attended a memorial event. Commonly reported barriers to condolence expression included lack of experience and training, as well as concern about upsetting families. ConclusionsPediatric residents lack comfort with and training in condolence expression and desire education to address these gaps. These findings should inform development and investigation of educational resources and training opportunities for residents to learn and practice compassionate provision of condolences to grieving families.

Usability Evaluation of the Novel Smartphone Application, HPV Vaccine: Same Way, Same Day, Among Pediatric Residents.

Scalable, deliberate practice training strategies to administer evidence-based recommendations are necessary to improve human papillomavirus (HPV) vaccination rates. We sought to characterize resident clinicians' perceptions regarding the usability of the HPV Vaccine: Same Way, Same Day smartphone application (app). Usability, a critical aspect of digital programs to promote behavior change, was evaluated. Fifteen third-year pediatric residents were recruited to complete a usability evaluation of the HPV Vaccine: Same Way, Same Day app, which includes simulated role-play scenarios in which users interact, as a pediatrician avatar, with an animated parent hesitant to accept the vaccine for her child. The app provides information about the vaccine and utilizes deliberate practice, a purposeful and systematic approach to improve performance, to teach evidence-based vaccine recommendation practices, including motivational interviewing skills. Data were derived from in-depth, semistructured interviews with pediatric residents. We used a constructivist general inductive approach to illuminate perspectives via inductive coding and pattern identification. Garrison's theoretical construct on self-directed learning was used to cluster themes into conceptual categories. We classified interview data in 3 conceptual categories: self-management, internal monitoring and motivational principles. Residents described the app as interactive, easy to use, succinct, informative, engaging, and practical. All residents would recommend the HPV Vaccine: Same Way, Same Day app to a colleague. Residents suggested adding more complex cases for future iterations. From their perspective, pediatric residents reported that an app using deliberate practice principles has the potential to inform and advance providers' counseling skills regarding the HPV vaccine.

Scholarly Activity Training During Residency: Are We Hitting the Mark? A National Assessment of Pediatric Residents

ObjectiveParticipation in scholarly activity (SA) is an Accreditation Council for Graduate Medical Education requirement. Our previous research with program directors (PDs) suggests that pediatric SA training is variable and suboptimal. To help programs better meet requirements, our objective was to understand the resident perspective regarding SA training, including factors associated with satisfaction and productivity. MethodsWe conducted cross-sectional surveys of second- and third-year pediatric residents and PDs at 22 diverse programs in 2016. Surveys assessed resident demographics, career intentions, program characteristics, beliefs, barriers, satisfaction, and productivity, defined as SA accepted at a regional or national meeting, for publication, or grant funding. Data were analyzed using descriptive statistics and multivariable logistic regression. ResultsA total of 464 (60.2%) of 771 residents and 22 PDs (100%) responded. Most residents believed that residents should participate in SA (n = 380, 81.9%). However, only 37.9% (n = 175) were extremely or very satisfied with their training. Residents who reported that training to conduct research (adjusted odds ratio [AOR] = 1.9, 95% confidence interval [CI] 1.1–3.5), availability of a research curriculum (AOR = 1.9, 95% CI 1.2–3.1), and adequate faculty mentorship (AOR = 2.5, 95% CI 1.6–4.1) were not barriers were more satisfied. Protected time was associated with satisfaction (AOR = 1.7, 95% CI 1.1–2.7). A total of 43.8% of residents (n = 203) were productive. Productivity was associated with future plans to conduct research (AOR = 3.3, 95% CI 2.1–5.1). ConclusionsResidents believe SA training is important. Dedicated program infrastructure, protected time, and adequate mentorship appear to be crucial to improving quality perceptions.

Using an Audience Response System Smartphone App to Improve Resident Education in the Pediatric Intensive Care Unit.

In the Pediatric Intensive Care Unit (PICU), most teaching occurs during bedside rounds, but technology now provides new opportunities to enhance education. Specifically, smartphone apps allow rapid communication between instructor and student. We hypothesized that using an audience response system (ARS) app can identify resident knowledge gaps, guide teaching, and enhance education in the PICU. Third-year pediatric residents rotating through the PICU participated in ARS-based education or received traditional teaching. Before rounds, experimental subjects completed an ARS quiz using the Socrative app. Concomitantly, the fellow leading rounds predicted quiz performance. Then, discussion points based on the incorrect answers were used to guide instruction. Scores on the pre-rotation test were similar between groups. On the post-rotation examination, ARS participants did not increase their scores more than controls. The fellow’s prediction of performance was poor. Residents felt that the method enhanced their education whereas fellows reported that it improved their teaching efficiency. Although there was no measurable increase in knowledge using the ARS app, it may still be a useful tool to rapidly assess learners and help instructors provide learner-centered education.

Competent for Unsupervised Practice: Use of Pediatric Residency Training Milestones to Assess Readiness.

To describe clinical skills progression during pediatric residency using the distribution of pediatric milestone assessments by subcompetency and year of training and to determine reasonable milestone expectations at time of graduation. Multi-institutional cohort study of the milestones reported to the Accreditation Council for Graduate Medical Education for all 21 pediatric subcompetencies. Most subcompetencies were measured using five milestone levels (1 = novice, 2 = advanced beginner, 3 = competent, 4 = proficient, 5 = master); 3 subcompetencies had only four levels defined. Milestone assessments for 2,030 pediatric residents in 47 programs during academic year 2013-2014 were obtained. There was significant variation in end-of-year milestone ratings for residents within each level of training, which decreased as training level increased. Most (78.9%; 434/550) graduating third-year pediatric residents received a milestone rating of ≥ 3 in all 21 subcompetencies; fewer (21.1%; 116/550) received a rating of ≥ 4 in all subcompetencies. Across all training levels, professionalism and interpersonal communication skills were rated highest; quality improvement was rated lowest. Trainees entered residency with a wide range of skills. As they advanced, skill variability within a training level decreased. Most graduating pediatric residents were still advancing on the milestone continuum toward proficiency and mastery, and an expectation of milestone ratings ≥ 4 in all categories upon graduation is unrealistic; milestone ratings ≥ 3 upon graduation may be more realistic. Understanding current pediatric residents' and graduates' skills can help to identify key areas that should be specifically targeted during training.

Transition to Pediatric Practice: A Residency Elective Experience to Prepare Senior Pediatric Residents for General Pediatric Primary Care.

Transition to practice (TTP), while impactful in other specialties, has been minimally studied and rarely offered in pediatric training residency programs. This pediatric TTP elective is designed to provide a glimpse into the world of a primary care pediatrician to residents who are interested in pursuing a career in primary care. During this elective residents hone their outpatient diagnostic skills by participating in a variety of clinical patient encounters; this is supplemented with selectives, learner-chosen supplemental educational activities that aim to help fulfill a resident's self-identified learning goals. This TTP experience was developed for third-year pediatric residents who are planning on entering primary care. The course is organized and facilitated by a general pediatric faculty member with an administrative assistant. This TTP elective was evaluated highly by pediatric residents; the overall score of its effectiveness, rated by residents who participated in the elective, was 4.5-5.0 out of 5.0. Following completion of this TTP elective, residents demonstrated an overall improvement in outpatient procedural opportunities and self-reported competence for routine outpatient procedures. In addition, residents demonstrated an overall improvement in office-visit billing practices. The 4-week rotation format maximizes the number of general pediatric outpatient clinical experiences and individualized learning selectives.

Physicians' perceptions of mobile technology for enhancing asthma care for youth.

This study assessed physicians' receptivity to using mobile technology as a strategy in patient care for adolescents with asthma. Understanding physicians' perceived barriers and benefits of integrating mobile technology in adolescents' asthma care and self-management is an initial step in enhancing overall patient and disease outcomes. We conducted in-depth interviews with second- and third-year pediatric residents and attending physicians who oversee pediatric residents in training (N = 27) at an academic medical center in the southeastern United States. We identified both benefits from and barriers to broader use of mobile technologies for improving asthma outcomes in adolescents. Resident physicians demonstrated greater readiness for integrating these technologies than did attending physicians. Prior to adoption of mobile technologies in the care of adolescent asthma patients, barriers to implementation should be understood. Prior to widespread adoption, such systems will need to be evaluated against traditional care for demonstration of patient outcomes that improve on the current situation.

Development of learning objectives and a validated testing tool for management of pediatric mechanical ventilation*.

Graduate medical education is shifting toward an outcome-based paradigm, where physicians are evaluated for competency using well-defined criteria. Our aim was to learning objectives and a testing tool to assess competency in the management of mechanical ventilation for infants, children, and adolescents and to verify that the test was reliable and valid. Prospective reliability and validity study. Large, university-affiliated academic hospital. Sixty-one total subjects from five different academic centers divided into three groups of varying experience. The groups were second- and third-year pediatric residents (Novice), second- and third-year pediatric critical care fellows (Advanced), and pediatric critical care faculty (Expert). None. Ten learning objectives considered important for the management of pediatric mechanical ventilation were developed from expert opinion and current evidence. Based on these objectives, a 35-question multiple choice, knowledge- and case-based test was created. Content validity was achieved by consensus of three experts in pediatric critical care medicine evaluating whether the questions reflected the learning objectives and the responses were consistent with current practice and evidence-based medicine. The test was then administered to the three groups to establish construct validity. The "Novice" group scored a mean of 34.6% (95% CI, 28-41%), the "Advanced" group a mean of 59.4% (95% CI, 53-65%), and the "Expert" group a mean of 74.8% (95% CI, 69-80%), with p less than 0.01 for all comparisons. As determined by Hoyt's analysis, the reliability coefficient was 0.89, reflecting excellent reliability. This is the first description of specific learning objectives for management of pediatric mechanical ventilation and the first validated and reliable testing tool for assessing knowledge. This tool could be used by fellowship programs to assess fellow competency and identify knowledge gaps in this area prior to completion of training. Further work must be done to determine the criteria for determination of competency.

Learning to Deliver Care in a Medical Home

We used online structured reflection to improve residents' understanding of care delivery in the medical home. Third-year pediatric residents participated in an online curriculum on delivering effective, patient-centered primary care in the medical home to children with special health care needs. Residents were prompted to respond to questions designed to stimulate reflection. We qualitatively assessed their responses, graded their depth of reflection, and provided structured feedback. Residents identified aspects of their practice consistent with medical home principles. Depth of reflection increased over time. Residents realized they needed to better understand families' financial, emotional, and social needs and increase families' involvement in care planning. Residents identified systems issues and practice changes to improve care delivery. Online reflective writing with feedback is a powerful strategy to improve residents' learning. Residents identified and began to make practice changes to provide patient-centered care in a medical home.

Pediatric Resident Education in Quality Improvement (QI): A National Survey

ObjectiveTo assess pediatric residents' perceptions of their quality improvement (QI) education and training, including factors that facilitate learning QI and self-efficacy in QI activities. MethodsA 22-question survey questionnaire was developed with expert-identified key topics and iterative pretesting of questions. Third-year pediatric residents from 45 residency programs recruited from a random sample of 120 programs. Data were analyzed by descriptive statistics, chi-square tests, and qualitative content analysis. ResultsRespondents included 331 residents for a response rate of 47%. Demographic characteristics resembled the national profile of pediatric residents. Over 70% of residents reported that their QI training was well organized and met their needs. Three quarters felt ready to use QI methods in practice. Those with QI training before residency were significantly more confident than those without prior QI training. However, fewer than half of respondents used standard QI methods such as PDSA cycles and run charts in projects. Residents identified faculty support, a structured curriculum, hands-on projects, and dedicated project time as key strengths of their QI educational experiences. A strong QI culture was also considered important, and was reported to be present in most programs sampled. ConclusionsOverall, third-year pediatric residents reported positive QI educational experiences with strong faculty support and sufficient time for QI projects. However, a third of residents thought that the QI curricula in their programs needed improvement, and a quarter lacked self-efficacy in conducting future QI activities. Continuing curricular improvement, including faculty development, is warranted.

Assessing Residents’ Written Learning Goals and Goal Writing Skill

To provide validity evidence for use of the Learning Goal Scoring Rubric to assess the quality of written learning goals and residents' goal writing skills. This two-part study used the rubric to assess University of Colorado third-year pediatric residents' written learning goals to obtain validity evidence. In study 1, five raters independently scored 48 goals written in 2010-2011 and 2011-2012 by 48 residents, who also responded to the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). In study 2, two raters independently scored 48 goals written in 2011-2012 by 12 residents. Intraclass correlation coefficients (ICCs) assessed rater agreement to provide evidence for response process. Generalizability theory assessed internal structure. Independent-samples Mann-Whitney U tests and correlations assessed relationship to other variables. Content was matched to published literature and instructional methods. The ICC was 0.71 for the overall rubric. In study 1, where the generalizability study's (G study's) object of measurement was learning goals, the phi coefficient was 0.867. In study 2, where the G study's object of measurement was the resident (goal writing skill), the phi coefficient was 0.751. The total mean score of residents with goal writing training was significantly higher than that of those without (7.54 versus 4.98, P < .001). Correlation between goal quality and JeffSPLL score was not significant. Investigators agreed that the content matched the published literature and instructional methods. Preliminary validity evidence indicates that this scoring rubric can assess learning goal quality and goal writing skill.

P-350 - Training Resident Physicians in Pediatric Psychopharmacology for ADHD

Children and adolescents experience significant emotional disorders and the prevalence of these conditions is notable. There is a dearth of pediatric mental health care professionals in the U.S., and among those professionals available, geographic and reimbursement limitations restrict access to the care. Primary health care providers are being encouraged to provide some of the identification and care management to offset this access problem. Expand clinical skills of pediatric providers through enhanced training of residents in the use of psychopharmaceuticals for the most common psychiatric diagnosis in U.S. children (ADHD). Second- and third-year pediatric residents attended an intensive 10-hour training in pediatric psychopharmacology for ADHD in 2010. The curriculum was based on a well-established 3-day program that teaches primary care clinicians the elements of guideline-level care for common behavioral health conditions. The program included pre- and post- training assessment of resident knowledge of current practice guidelines for ADHD and intention to use them. Special attention was given to proper use of screening instruments, diagnostic scales, treatment options, importance of medication options and increased frequency of visits during drug initiation and titration of dosages, and obstacles to implementation. Results showed significant and sometimes large post-training increases in intentions to use medication therapies, systematic progression through stimulant and non-stimulant alternatives, parent and teacher symptom rating scales throughout treatment, and side effect scales during dose titration. A one-day enhanced training program improved knowledge of, attitudes toward, and intention to use guidelines of care for youth with ADHD.

Do Medical Professionalism and Medical Education Involve Commitments to Political Advocacy?

To the Editor: We wish to present a different perspective of advocacy education from that in Dr. Huddle's1 article. To medical educators, advocacy is not equal to political action or involvement in politics. Instead, advocacy education seeks to foster an awareness of the world around a patient beyond the four walls of the clinic. At the crux of this debate is the need to recognize the social determinants of health—the economic and social conditions that shape the health of individuals and communities. This means acknowledging the new understanding of health in which environmental, social, behavioral, physical, and economic factors contribute significantly to the health and well-being of patients. Physicians must address the problems facing adults and children in the 21st century by influencing these critical determinants of health and well-being. To do so, physicians must successfully merge their traditional clinical skills with public health, population-based approaches to practice and advocacy. Current trainees are too familiar with scenarios in which a simple prescription is not sufficient to treat a patient's problems. Not only does an obese 12-year-old girl need antihypertensives to treat high blood pressure, but she will also need dietary and lifestyle modifications that could potentially save her life. Therefore, for trainees it is a natural extension of this broader approach to recognize the lack of safe places for children to play and exercise, the lack of quality choices of food in school cafeterias, and the challenges for lower-income children to access quality health care. Thus, it is vital that trainees learn that intervening at the population level to support local initiatives or to advocate the passage of legislative bills to improve these and related conditions is an appropriate function of a physician on behalf of his or her patients. Here at UCLA, we have had a Community Health and Advocacy Training program for over 10 years. Our curriculum includes 12 weeks of specialized rotations, a community-based continuity clinic, longitudinal community projects, and a dinner seminar series featuring guest speakers from the community. We have also participated in a statewide coalition of 13 pediatric residency programs focused on developing and sharing curricula for community pediatrics and child advocacy. Since 2003, we have had a one-month legislative and media advocacy rotation for third-year pediatric and med-peds residents in this program. During this month, residents are empowered to use their roles as physicians in society to improve the social and environmental conditions in which their patients live, with the goal of ultimately improving patient health and quality of life. Not only do these educational experiences fulfill “requirements” by the Accreditation Council for Graduate Medical Education, but we believe that this training also produces better doctors who are able to care for populations of patients and address the health needs of Americans in the 21st century. Alice A. Kuo, MD, PhD Director, Community Health and Advocacy Training (CHAT) Program and Combined Internal Medicine and Pediatrics Residency Program, David Geffen School of Medicine at UCLA, Los Angeles, California; [email protected]. Lisa Arcilla, MD Adrian Castro, MD Leian Chen, MD Bianca Edison, MD John Huang, MD, MPH Kiran Mitha, MD Melissa Orkin, MD Zarin Tejani, MD Diana Tu, MD Joanna Yeh, MD UCLA CHAT, class of 2011 Mridula Watt, MD Lindsay Wells, MD UCLA CHAT, class of 2012 Ryan J. Coller, MD Alma D. Guerrero, MD, MPH Wendy M. Slusser, MD, MS UCLA CHAT faculty

A Pediatrics-Based Instrument for Assessing Resident Education in Evidence-Based Practice

The principles of evidence-based practice (EBP) are a mandated component of the pediatric residency curriculum; however, a pediatrics-based assessment tool validated with pediatric residents does not exist. We designed an assessment instrument composed of items in 4 categories: 1) demographics; 2) comfort level; 3) self-reported practice of EBP; and 4) EBP knowledge. This last section required participants to identify best evidence and most appropriate study design by using pediatric-based scenarios, develop searchable questions, and use existing published research to address diagnostic and treatment issues. Four groups completed the instrument: preclinical medical students (MS-2), incoming pediatric interns (PGY-1), incoming second- and third-year pediatric residents (PGY2-3), and expert tutors (expert). We determined internal consistency, interrater reliability, content validity, item difficulty, and construct validity. Fifty-six subjects completed tests (MS-2, n = 13; PGY-1, n = 13; PGY2-3, n = 22; expert, n = 8). Internal reliability was good, with Cronbach's alpha = .80. Interrater reliability was high (kappa = 0.94). Items were free of floor or ceiling effects. Comfort level and self-reported practice of EBP increased with expertise level and prior EBP experience (P < .01). Scores on the knowledge section (out of 50 +/- SD) rose with training level (MS-2: 14.8 +/- 5.7; PGY-1: 22.2 +/- 3.4; PGY2-3: 31.7 +/- 6.1; experts: 43 +/- 4.0; P < .01). Scores also correlated with prior EBP education. We have developed a reliable and valid instrument to assess knowledge and skill in EBP taught to pediatric residents. This instrument can aid pediatric educators in monitoring the impact of the EBP curriculum.

Does Quality of Primary Care Vary by Level of Training in Pediatric Resident Continuity Practices?

The aim of this study was to compare parental perception of quality of care provided by first- versus third-year pediatric residents who served as their children's primary care providers. The Parents' Perception of Primary Care (P3C) survey was administered to all parents who identified a pediatric resident as a primary care provider at 19 Continuity Research Network (CORNET) sites. Parent survey scores were compared between those identifying first-year pediatric residents (PL-1) versus third-year pediatric residents (PL-3) as care providers by using t tests and linear regression modeling, as well as item-specific chi-square analysis and logistic regression. Comparing the responses of the 347 parents who identified a PL-3 resident and the 360 parents who identified a PL-1 resident as their child's primary care provider, those who identified a PL-3 resident rated their childrens overall care higher, with a mean score of 79.2 (95% confidence interval [95% CI] 77.5-80.8) as compared to 75.9 (95% CI 74.4-77.3); P < .05. This disparity was primarily due to differences in the longitudinal continuity domain. Comparisons of the other domains of communication, comprehensiveness, access, contextual knowledge, and coordination showed no statistically significant differences between the 2 groups. Parents rated PL-3 residents as having greater knowledge in behavioral counseling and coordination with schools than PL-1 residents. Parents rated residents at both training levels very highly for the quality of care provided. PL-3 residents had higher longitudinal continuity scores and were perceived to have greater knowledge about behavioral counseling and coordination of care with schools. Further research will need to elucidate strategies to improve earlier resident acquisition of coordination and behavior management skills.