Academic Pediatrics

Overview

2010-03-01

The Wisdom, the Will, and the Wallet: Leadership on Behalf of Kids and Families

Tina L. Cheng — 2010-03-01

It has been a genuine pleasure to serve as the president of the Academic Pediatric Association (APA). The APA plays a critical leadership role in setting the agendas that shape clinical care, education, research, and advocacy on behalf of kids and families. Today, I wanted to reflect on leadership lessons I have learned and relate them to the challenges we face to improve the health and well-being of children and families. I refer to these challenges as “the wisdom,” “the will,” and “the wallet.”

Child Health Care Disparities: Findings from the Annual Report on Children's Health Care

Lee M. Pachter — 2010-03-01

The annual report on child health appears in this issue of Academic Pediatrics, and its focus this year is on health care disparities. Child health and health care disparities can be defined as an inequitable difference in health or health care that is based on demographic characteristics such as race, ethnicity, generational status, socioeconomic position, or geography. For these differences to be labeled as disparities, they must be inequitable, systematic, and potentially avoidable. The current article, which reports on analyses culled from the Medical Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP), breaks down child health care quality indicators on the basis of race/ethnicity, income, and insurance status, and thus it provides an interesting look at the interactions among these distinct but interrelated categories.

Celebrating Education and Building the Community of Pediatric Educators

Maryellen E. Gusic — 2010-03-01

The inclusion of 5 educational articles in this issue of Academic Pediatrics allows us to highlight the work of pediatric educators. It also provides us with the opportunity to reiterate the principles that guide our review of educational articles and to announce our desire to serve as a venue for the dissemination of scholarly work from across the continuum of education.

The Next Phase of Pediatric Residency Education: The Partnership of the Milestones Project

Jerry L. Rushton, Patricia J. Hicks, Carol L. Carraccio — 2010-03-01

We are at a crossroads in medical education. In the wake of the Institute of Medicine duty hours report, the health care reform debate, and concerns of patient safety, policymakers and the public are demanding a response. The American Board of Pediatrics, the Accreditation Council of Graduate Medical Education (ACGME), the Association of Pediatric Program Directors (APPD), and other organizations are working together to position pediatrics to meet these demands and keep the public trust for excellence in the care of children.

Sounds of a Code

Stephanie K. Neumayer — 2010-03-01

Yesterday I was jeopardized to take call in the pediatric intensive care unit (PICU). Two words I will never forget. Jeopardy. PICU. Yuck. I've been there before, but this call was different, thus the need to put it down in writing as I sit at my computer on the floor of my living room.

Annual Report on Health Care for Children and Youth in the United States: Racial/Ethnic and Socioeconomic Disparities in Children's Health Care Quality

2010-03-01

Objective: The aim of this study was to explore the joint effect of race/ethnicity and insurance status/expected payer or income on children's health care quality.Methods: The analyses are based on data from a nationally representative random sample of children in the United States in 2004 and 2005 from the Medical Expenditure Panel Survey (MEPS) and pediatric hospitalizations from a nationwide sample of hospitals in 2005 from the State Inpatient Databases disparities analysis file from the Healthcare Cost and Utilization Project (HCUP). We provide estimates of differences in race/ethnicity within income and insurance/expected payer categories on key pediatric quality indicators to provide a more nuanced understanding of disparities in care for children. Our indicators of quality cover several domains from the Institute of Medicine report, including effectiveness, patient centeredness, timeliness, and patient safety.Results: Across a broad set of 23 quality indicators, findings indicate that racial/ethnic disparities vary by income levels and types of insurance. Key highlights include the finding that racial/ethnic differences within income or insurance/payer groups are more pronounced for some racial/ethnic groups than others. Hispanic children followed by Asian children had worse quality than whites as measured by the majority of quality indicators. Exceptions included rates of admissions for diabetes, admissions for gastroenteritis, accidental puncture during procedures, and decubitus ulcers. Many indicators showed less than ideal quality for all subgroups of children, even whites with private insurance.Conclusions: The extensive findings in this report make clear that patterns of racial/ethnic disparity vary by income and insurance/expected payer subgroup. However, disparities in quality are not similar across all measures of quality, and strategies to address these disparities need to be designed with these nuances in mind.

Continuity of Care in Fixed-Day Versus Variable-Day Resident Continuity Clinics

Carlos F. Lerner, Peter J. Chung — 2010-03-01

Objective: Since the introduction of resident work-hour standards, pediatric residency programs have struggled to preserve robust continuity clinic experiences. Many programs have resorted to more flexible approaches to resident scheduling. We know little regarding the impact of such changes. We compared 2 continuity clinic scheduling models: a traditional fixed-day clinic and a variable-day clinic in which resident clinic days vary each week to accommodate resident schedules.Methods: The setting for our study was a large university resident continuity clinic. We analyzed 111 resident schedules and 1113 visits by children aged younger than 1 year during 2 periods: July 2007 to December 2007, when residents were scheduled by using a variable-day clinic model, and July 2008 to December 2008, when a fixed-day model was used. We compared the number of clinic sessions per resident and continuity of care. We used the usual provider of care definition of continuity: the proportion of visits in which a patient is seen by his or her primary resident. A multivariable logistic regression was used to model the relationship between patient continuity of care and clinic structure (fixed-day vs variable-day), resident level, patient age, and appointment type.Results: The number of clinics per resident during a 6-month period was higher using variable-day scheduling (19.6 vs 16.2; P < .01), whereas continuity of care was lower (0.54 vs 0.61; P = .01) In the multivariate model, continuity of care was significantly higher under the fixed-day model (odds ratio 1.40; P < .01).Conclusions: Scheduling residents for continuity clinic on variable days results in lower patient continuity of care despite increased resident time in clinic.

Factors Associated with Successful Self-Directed Learning Using Individualized Learning Plans During Pediatric Residency

Su-Ting T. Li, Daniel J. Tancredi, John Patrick T. Co, Daniel C. West — 2010-03-01

Objective: The aim of this study was to determine whether resident or program characteristics are associated with effective self-directed learning of residents.Methods: A cross-sectional survey of pediatric and medicine/pediatric residents and program directors from a nationally representative sample of residency programs was conducted. Self-directed learning efficacy was measured by resident-reported progress on learning goals from their most recent individualized learning plan (ILP). Multilevel linear regression models were used to analyze the relationship between learner and program characteristics and self-directed learning efficacy of residents.Results: All program directors of participating programs (N = 46) completed the survey; the response rate from residents was 57% (992/1739). At the time of the survey, 78% of residents had previously written an ILP. Most residents achieved moderate self-directed learning efficacy. The most important factors associated with greater self-directed learning efficacy included using a system to track one's own progress in achieving learning goals, higher score on a propensity toward lifelong learning scale, and reporting greater confidence in self-directed learning abilities. Program characteristics, including program-level support for ILPs, had little or mixed association with resident self-directed learning efficacy.Conclusions: The most important factors associated with effective self-directed learning were resident characteristics. Our findings imply that residency programs should invest their limited resources in curricula that help residents develop measurable goals and systems for tracking progress toward goal attainment. Since propensity toward lifelong learning was an important factor, medical schools and residency training programs should enhance their efforts to develop this characteristic in learners.

Effectiveness of an Online Pediatric Primary Care Curriculum

Raymond C. Baker, Melissa Klein, Zeina Samaan, Kadriye Lewis — 2010-03-01

Objective: The aim of this study was to evaluate the effectiveness of a supplementary online pediatric primary care (PPC) curriculum in reaching pediatric residents and increasing knowledge in selected primary care topics.Methods: We conducted a nonrandomized, controlled, pre-test/post-test study comparing an online PPC curriculum supplement with the traditional formal, conference-based curriculum alone, both with identical content. We compared 2 groups of first-year categorical pediatric residents from 2 successive years: one group (from 2006–2007) was offered the online curriculum supplement (study group) and one (2005–2006) was not (control group). Comparisons were made using the following: 1) pre-testing and post-testing of knowledge; and 2) monitoring of attendance at the formal conferences and accessing the online curriculum.Results: The control group of 33 residents and the study group of 34 residents were similar with respect to gender, age, and first-year in-training exam scores. In the first quarter of the year, 93% (mean) of the study group accessed the online curriculum; 43% accessed it in the last quarter of the year. For the same time periods, 33% and 30% of all of the residents (intervention and control groups combined) attended the noon conferences. The pre-test and post-test scores of the study group showed a significant increase (P < .001), and the post-test score comparison of study versus control group was also significant (P = .035). There were no significant differences in the in-training exam scores between the 2 groups for exams given at the beginning of their second year.Conclusion: An online PPC curriculum is an effective supplement to traditional resident education and reaches a significantly larger number of residents compared with the traditional conference-based format.

PHACES (Photographs of Academic Clinicians and Their Educational Status): A Tool to Improve Delivery of Family-Centered Care

Robert A. Dudas, Hanna Lemerman, Michael Barone, Janet R. Serwint — 2010-03-01

Objective: The aim of this study was to determine if an information sheet containing photographs and explanations of the training level of medical providers could enhance a parent's ability to identify their child's providers and whether this would impact parental attitudes toward trainee involvement and patient satisfaction.Methods: This was a prospective, mixed methods study of parent-child dyads admitted to an academic general pediatric inpatient service. The intervention group received a photo information sheet (Photographs of Academic Clinicians and Their Educational Status [PHACES] tool) consisting of passport-sized photos of the medical team along with information regarding their training. Parents were asked to name their child's providers, were surveyed about their attitudes toward trainees, participated in a brief, semistructured interview and completed the patient satisfaction questionnaire (ABIM-PSQ).Results: Comparing intervention with control parents, 40 of 49 (82%) versus 19 of 51 (37%) were able to name at least one provider (adjusted odds ratio 8.0; P < .01). Parents who received the intervention were more likely to correctly match the face with the name of the medical student (67% vs 14%; P < .01) and attending (80% vs 24%; P < .01). Parents who received the intervention were more likely to report acceptance of the involvement of medical students and house staff as well as an improved understanding of their roles. Parents who received the intervention scored higher on the ABIM-PSQ (mean 48.3 vs 45.4; P = .008).Conclusions: An information sheet containing the photographs of health care providers along with an explanation of their training improves recognition of the health care team members, improves acceptance of trainee involvement, and improves satisfaction with care delivered by physicians in training.

Peer-Facilitated Virtual Action Learning: Reflecting on Critical Incidents During a Pediatric Clerkship

Margaret M. Plack, Maryanne Driscoll, Maria Marquez, Larrie Greenberg — 2010-03-01

Objectives: Action learning (AL) facilitates reflection, critical thinking, and learning while solving real-world problems. Virtual AL is an asynchronous collaborative process that encourages students to analyze their critical incidents and learn from these experiences. The researchers sought to: 1) determine whether medical students engaged in peer-facilitated virtual action learning (VAL) demonstrated reflection and critical thinking around complex issues during their pediatric clerkship; and 2) identify challenges students face during their clerkships.Methods: Seventy clerkship students were introduced to reflection and participated in VAL by using an electronic discussion board. Each posted 1 critical incident and group members responded with thought-provoking questions and comments to facilitate reflection and analysis. Weekly, students who posted incidents revisited their incidents, pondered the questions posed, and wrote essays summarizing their reflections and insights gained. Data were analyzed using qualitative methods.Results: Seventy incidents, 210 responses, and 70 revised incidents/essays were analyzed. Outcomes included broadened perspectives (44/70), questioned assumptions (12/70), and reconfirmed thinking (14/70). Content themes included communication, role identification, medical treatment concerns, and limited voice and power.Conclusions: Most of the students engaged in VAL demonstrated reflection on complex clinical issues. Themes portrayed struggles encountered and exposed issues in the hidden curriculum, suggesting a lack of voice and power that may lead to missed learning opportunities. Discussion threads offered the clerkship director insights into the overall student experience to improve future clerkship experiences.

Editorial Board

2010-03-01

Academic Pediatrics

Overview

The Wisdom, the Will, and the Wallet: Leadership on Behalf of Kids and Families

Child Health Care Disparities: Findings from the Annual Report on Children's Health Care

Celebrating Education and Building the Community of Pediatric Educators

The Next Phase of Pediatric Residency Education: The Partnership of the Milestones Project

Sounds of a Code

Annual Report on Health Care for Children and Youth in the United States: Racial/Ethnic and Socioeconomic Disparities in Children's Health Care Quality

Continuity of Care in Fixed-Day Versus Variable-Day Resident Continuity Clinics

Factors Associated with Successful Self-Directed Learning Using Individualized Learning Plans During Pediatric Residency

Effectiveness of an Online Pediatric Primary Care Curriculum

PHACES (Photographs of Academic Clinicians and Their Educational Status): A Tool to Improve Delivery of Family-Centered Care

Peer-Facilitated Virtual Action Learning: Reflecting on Critical Incidents During a Pediatric Clerkship

Editorial Board

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