Academic Pediatrics

Overview

2010-07-01

The Family-Centered Medical Home: Specific Considerations for Child Health Research and Policy

2010-06-07

Since the initial conceptualization of the medical home in the 1960s and 70s in pediatrics, its definition and principles have evolved. The addition of clinicians in family medicine and internal medicine, policymakers, payer groups, and consumer groups to medical home study and implementation has given tremendous positive momentum to the movement to create patient- and family-centered medical homes for children, adolescents and adults. While there is a great deal of similarity between medical home concepts and models for the care of adults and children, some principles should be emphasized in child and adolescent health, and a few health concepts are unique. These have important implications for how child-relevant research and policy related to the medical home should be promoted. This paper describes perspectives on the primary care medical home from the standpoint of child and adolescent health.

Medicine Safety Among Children and Adolescents

Laura P. Shone, H. Shonna Yin, Michael S. Wolf — 2010-07-01

An increasing number of studies have documented problems with the safe use of prescription and nonprescription or over-the-counter (OTC) medicines among children and adolescents. Specifically, risks include potential errors by caretakers in administering prescription and OTC medicines to children, as well as unintended exposure of children and teens to medicines that are not intended for them. Children 18 years of age and younger make over 70 000 emergency visits each year for medication overdoses whereas adolescents are vulnerable to harm from both unintended and deliberate misuse of medicines. Of particular concern are opioids, prescription pain medicines, psychotherapeutic agents, and acetaminophen. In addition, there is an ever-increasing potential for future risks as medication indications expand, safety concerns become newly identified, and prescription drugs shift to OTC availability.

The Association of Pediatric Program Directors’ Strategic Plan: An Opportunity for Transformational Change

Ann E. Burke, Susan Guralnick, Patricia Hicks — 2010-06-10

In late February 2010, the leadership of the Association of Pediatric Program Directors (APPD) assembled key representatives of the pediatric undergraduate medical education and graduate medical education community to develop a new APPD strategic plan, a road map that could potentially transform pediatric medical education. This collaborative process included past and present leaders of APPD and current leaders of the Academic Pediatric Association (APA); the dialogue served to inform our understanding of history, where we are now, and consider what we might want to explore. It is unusual for strategic planning to take place in the presence of others outside an organization, but within the same field. However, the APPD board felt that the inclusion of all key stakeholders was critical to our deliberations and would allow us to learn and grow from the valuable contributions of many current and past leaders in pediatric medical education. In addition to the APPD leaders and representatives, others present for the 2-day proceedings were Gail McGuinness, APPD member and executive vice president of the American Board of Pediatrics (ABP); Janet Serwint, president elect of the APA and an associate program director; Ted Sectish, a past president of the APPD and director of the Federation of Pediatric Organizations; Jerry Woodhead, president elect of the Council on Medical Student Education in Pediatrics; Jim Bale, incoming chair of the Council of Pediatric Subspecialties; Carol Carraccio, director of the Initiative for Innovation in Pediatric Education (IIPE) and the Milestones Project; and Hilary Haftel, director of the Longitudinal Educational Assessment Research Network (LEARN). The complement of other talented individuals present represented a broad sweep of pediatric medical education.

Leaving the Cove

Marjorie S. Rosenthal — 2010-07-01

It is time for us to leave the Cove. When my husband, Amal, died suddenly in a car crash, my daughters Elina and Maya were very young—7 weeks and 2½ years old. For 4 of the past 5 years, we have been going to the Cove, a grieving meeting two Sunday nights a month. At first I thought I didn't need it. “I can do this.” I knew the stages of grief and said, “The three of us will get through this.” And I shared Groucho Marx's attitude toward joining groups: I didn't want to belong to a club that accepted people like me as members. Amal and I had almost codified this thinking as a part of who we were when discussing why we would not take prenatal birthing classes. After he died, though, I found myself desperate enough to try anything I thought might stem the tide of sadness and loss for me and my girls.

Evaluation of Consumer Medical Information and Oral Liquid Measuring Devices Accompanying Pediatric Prescriptions

Lorraine S. Wallace, Amy J. Keenum, Jennifer E. DeVoe — 2010-06-04

Objectives: The aim of this study was to assess supplementary materials accompanying 2 commonly prescribed pediatric medications, including the following: 1) readability and layout characteristics of pharmacy-generated consumer medical information (CMI); and 2) types and features of oral liquid measuring devices (OLMDs) provided.Methods: We filled the same two prescriptions (prednisolone and amoxicillin) at 20 pharmacies (national grocery store chain [n = 1], regional grocery store chains [n = 4], national pharmacy chains [n = 3], national superstore chains [n = 3], and independently owned [n = 9]) across three states (Colorado, Georgia, and Tennessee). We evaluated readability, using both the Flesch-Kincaid (FK) formula and McLaughlin's Simplified Measure of Gobbledygook (SMOG), and text point size of pharmacy-generated CMI. We also assessed whether an OLMD (oral syringe, dropper, or cylindrical spoon) was included with each prescription and recorded the largest marked dose (in mL).Results: Three pharmacies did not provide any type of CMI for either medication. Therefore, CMI was reviewed for 34 prescriptions. Reading grade levels of CMI averaged 9.6 ± 1.9 (range, 5.3–11.7) using the FK and 11.2 ± 2.6 (range, 6–14) based on the SMOG. Average text font size of CMI was 9.8 ± 1.9 (range, 6–12). Although 32 (80%) prescriptions included an OLMD (oral syringe [n = 20], cylindrical spoon [n = 7], and dropper [n = 5]), close to one third (31.3%) would require multiple measurements to attain prescribed dosages.Conclusions: Many of the supplemental materials accompanying the prescriptions filled in this study were suboptimal; CMI was written at reading levels exceeding that of many parents, and the largest marked dose on each OLMD varied substantially. Physicians should be cognizant of the shortcomings of supplemental materials included with many medications, whereas pharmacies should strive to provide understandable CMI (ie, written at or below sixth-grade reading level) and suitable OLMDs (ie, requiring only one measurement of medication) to promote proper medication use.

Knowledge Gaps and Misconceptions About Over-the-Counter Analgesics Among Adolescents Attending a Hospital-Based Clinic

2010-06-10

Objectives: Although many adolescents use over-the-counter (OTC) analgesics, their knowledge about these drugs is unclear. This study evaluates misconceptions and knowledge gaps about OTC side effects, risks, and interactions among adolescents attending a hospital-based clinic.Methods: Adolescents aged 14 to 20 years presenting to an outpatient clinic were surveyed using a computer-administered instrument. Participants answered questions regarding their use of specific OTC medications and knowledge of side effects, risks, and interactions of these drugs. A summary score of percent correct answers on knowledge questions was created, and univariate and multivariate statistical techniques examined differences between groups.Results: Ninety-six adolescents completed the survey. Most (78%) adolescents had used OTC medications in the previous month. The most frequently reported OTC medications used were analgesics, including ibuprofen (46%), and Tylenol (45%); acetaminophen ingestion was reported by 15% of respondents. Although 35% reported knowing what acetaminophen is, 37% of these did not correctly identify acetaminophen and Tylenol as the same medication. The average overall knowledge score was 44%. In regression models including demographics, and OTC product use, older adolescents had higher overall average knowledge scores. Hispanic teens had less reported use and lower knowledge scores than adolescents of other race/ethnicities.Conclusions: Most adolescents use OTC analgesics, but many are confused about generic and brand name forms. There were also significant knowledge gaps about OTC use, side effects, and contraindications, especially for acetaminophen. Clinicians should be aware of the potential for OTC medication misuse by adolescent patients.

Using Pharmacy Data to Screen for Look-Alike, Sound-Alike Substitution Errors in Pediatric Prescriptions

William T. Basco, Myla Ebeling, Thomas C. Hulsey, Kit Simpson — 2010-06-14

Objective: The aim of this study was to pilot test a screening approach to detect potential look-alike, sound-alike (LASA) errors in pediatric outpatient prescriptions.Method: Medicaid pharmacy claims from one state were reviewed. From a list of LASA drug pairs, we identified candidate pairs meeting the following criteria: 1) one drug was commonly prescribed in children; 2) the paired drug was uncommonly prescribed for children; and 3) both drugs were available as oral preparations only, resulting in 11 LASA pairs. We identified patients who usually received one drug in a pair, then presented with a first dispensing of the paired drug, representing a “screening alert” for potential LASA error. We determined a “true error” as any patient who triggered a screening alert, received only one dispensing of the paired drug in the subsequent 6 months, and had no diagnoses supporting the dispensing of the paired drug.Results: Among the 22 test drugs, there were 1 420 091 prescriptions to 173 005 subjects. There were 395 screening alerts generated, representing a screening alert frequency of 0.28 screening alerts per 1000 prescriptions. We identified 43 true LASA errors. In the dataset, the overall LASA error rate is estimated to be approximately 0.00003%, or 0.03 LASA errors per 1000 prescriptions.Conclusion: Prescription dispensing patterns can be used to screen for LASA errors in pediatric prescriptions. The rates of pediatric LASA errors appear to be much lower than other types of pediatric medication errors and may be best addressed by automated processes.

Characteristics Associated With Low Self-Esteem Among US Adolescents

2010-06-07

Objective: Low self-esteem in adolescents has been associated with a number of risk and protective factors in previous studies, but results have been mixed. Our objective was to examine characteristics associated with low self-esteem in a large national sample of young adolescents.Methods: We conducted a population-based correlational study. A sample of 6522 adolescents aged 12 to 16 years was surveyed by phone as part of a national study of media and substance use. Self-esteem was measured with 3 questions that assessed global self-worth and physical appearance. Multivariate logistic regression was used to examine the relationship between self-esteem and sociodemographics, child personality characteristics, weight status, daily TV time, parenting style, school performance, and team sports participation. Interactions among gender, race, and weight status were examined.Results: In multivariate analysis, female gender, Hispanic race, overweight and obesity, sensation seeking, rebelliousness, and daily TV time were each independently associated with lower self-esteem. Teens of black race, with higher parental responsiveness and demandingness, better school performance, or involvement in team sports were less likely to report low self-esteem. Black females were at lower risk and Hispanic males were at higher risk for low esteem than peers of similar gender of other races.Conclusions: Low self-esteem was associated with a number of modifiable risk factors, including obesity, TV time, team sports participation, school performance, and parenting style, that should be discussed with teens and parents at health supervision visits. Further research examining race and gender-specific factors that serve to moderate risk for poor self-esteem in adolescents is warranted.

Risky Health Behaviors Among Mothers-to-Be: The Impact of Adverse Childhood Experiences

2010-07-01

Objectives: Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to assess the influence of ACEs on risky health behaviors among mothers-to-be and determine whether a dose response occurs between ACEs and risky behaviors.Methods: A prospective survey of women attending health centers was conducted at the first prenatal care visit, and at 3 and 11 months postpartum. Surveys obtained information on maternal sociodemographic and health characteristics, and 7 ACEs prior to age 16. Risky behaviors included smoking, alcohol use, marijuana use, and other illicit drug use during pregnancy.Results: Our sample (N = 1476) consisted of low-income (mean annual personal income, $8272), young (mean age, 24 years), African American (71%), single (75%) women. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Nearly three fourths (72%) had one or more ACEs. There was a higher prevalence of each risky behavior among those exposed to each ACE than among those unexposed. The exception was alcohol use during pregnancy, where there was not an increased risk among those exposed when compared with those unexposed to witnessing a shooting or having a guardian in trouble with the law or in jail. The adjusted odds ratio for each risky behavior was >2.5 for those with >3 ACEs when compared with those without.Conclusions: ACEs were associated with risky health behaviors reported by mothers-to-be. Greater efforts should target the prevention of ACEs to lower the risk for adverse health behaviors that have serious consequences for adults and their children.

Is Developmental and Behavioral Pediatrics Training Related to Perceived Responsibility for Treating Mental Health Problems?

2010-05-31

Objective: The aim of this study was to investigate training in developmental and behavioral pediatrics (DBP) for graduating residents, their competencies in diagnosing and treating child mental health (MH) problems, and whether the amount of DBP training and/or perceived competencies are associated with perceived responsibility for treating 3 MH problems.Methods: Data were collected from 636 residents who completed the American Academy of Pediatrics's 2007 Graduating Residents Survey. The survey included questions on training and self-rated competencies in multiple MH skill areas and perceived responsibility for identifying and treating/managing children's MH problems. Weighted multivariable logistic regression analyses examined associations between training, competencies, and perceived responsibility for treating/managing attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression.Results: Ninety percent of respondents completed a DBP rotation, with 86% reporting >3 to 4 weeks of training. Duration of DBP rotation was related to training and perceived competencies in MH skill areas, and nearly all residents who reported high competencies were trained in those skill areas. However, <50% reported their competencies as “very good” or “excellent.” Residents with training and high competency in dosing with medications were most likely to agree that pediatricians should be responsible for treating/managing ADHD, anxiety, and depression.Conclusions: DBP training is highly associated with self-rated MH competencies, and highly assessed competencies are related to perceived responsibility for treating/managing common MH problems; yet 14% of graduating residents have <3 to 4 weeks of DBP training. These results argue for providing more high-quality educational experience with proven effectiveness to produce confident pediatricians who will be more responsive to identifying and treating MH problems of their patients.

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

Lauren Chernick, Martin Pusic, Heather Liu, Hector Vazquez, Maria Kwok — 2010-06-01

Objective: 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.Methods: 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.Results: 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 α = .80. Interrater reliability was high (κ = 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.Conclusions: 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.

Small Numbers Limit the Use of the Inpatient Pediatric Quality Indicators for Hospital Comparison

Naomi S. Bardach, Alyna T. Chien, R. Adams Dudley — 2010-07-01

Objective: The aim of this study was to determine the percentage of hospitals with adequate sample size to meaningfully compare performance by using the Agency for Healthcare Research and Quality (AHRQ) pediatric quality indicators (PDIs), which measure pediatric inpatient adverse events such as decubitus ulcer rate and infections due to medical care, have been nationally endorsed, and are currently publicly reported in at least 2 states.Methods: We performed a cross-sectional analysis of California hospital discharges from 2005–2007 for patients aged <18 years. For 9 hospital-level PDIs, after excluding discharges with PDIs indicated as present on admission, we determined for each PDI the volume of eligible pediatric patients for each measure at each hospital, the statewide mean rate, and the percentage of hospitals with adequate volume to identify an adverse event rate twice the statewide mean.Results: Unadjusted California-wide event rates for PDIs during the study period (N = 2 333 556 discharges) were 0.2 to 38 per 1000 discharges. Event rates for specific measures were, for example, 0.2 per 1000 (iatrogenic pneumothorax in non-neonates), 19 per 1000 (postoperative sepsis), and 38 per 1000 (pediatric heart surgery mortality), requiring patient volumes of 49 869, 419, and 201 to detect an event rate twice the statewide average; 0%, 6.6%, and 25%, respectively, of California hospitals had this pediatric volume.Conclusion: Using these AHRQ-developed, nationally endorsed measures of the quality of inpatient pediatric care, one would not be able to identify many hospitals with performance 2 times worse than the statewide average due to extremely low event rates and inadequate pediatric hospital volume.

Use of a Pediatrician Toolkit to Address Parental Perception of Children's Weight Status, Nutrition, and Activity Behaviors

2010-05-31

Background: Communication of children's weight status and targeted counseling by pediatricians may change parental perceptions or child dietary and physical activity behaviors. The aim of this study was to determine whether accuracy of parental perception of children's weight status and reports of related behaviors changed following a brief pediatrics resident intervention.Methods: Parents (N = 115) of children aged 4 to 12 years enrolled in Medicaid completed baseline questionnaires with providers about prior communication of weight status and/or body mass index (BMI), perceptions of their children's weight, and children's dietary and physical activity behaviors, and children were weighed and measured. Trained residents used a toolkit to communicate weight status to parents (via color-coded BMI charts) and counseled about mutually chosen healthy behaviors. Questionnaires were repeated at 1 and 3 months, and measurements were repeated for children with BMI ≥85%.Results: At baseline, 42% of parents of overweight children believed their children were at healthy weight. Most (n = 96; 83%) parents completed 1-month questionnaires, and 56% completed 3-month follow-up questionnaires. Improvements in fruit and vegetable consumption, sweet drinks, unhealthy snacks, frequency of restaurant food, lower-fat milk, and screen time occurred among both overweight and healthy weight children. There were also increases in discussions with providers about weight/BMI and parental accuracy of overweight assessment.Conclusions: Parent accuracy of weight status and short-term childhood dietary and physical activity behavior changes improved following resident pediatrician use of a toolkit to support communication of weight status and counseling. Further research needs to determine whether accurate parental perception motivates improved behavior change or healthier BMI trajectories.

1. Validation of an Evidence-Based Medicine (EBM) Critically Appraised Topic

Hans B. Kersten, Erin Giudice, John G. Frohna — 2010-07-01

ACGME requirements for residency and fellowship training mandate the teaching and evaluation of competence in evidence-based medicine (EBM). Many residency programs now require an EBM project, such as the creation and presentation of a Critically Appraised Topic (CAT) to demonstrate these skills. However, there are few validated tools available to assess EBM skills among residents, and there is no known valid and reliable tool to assess residents' ability to develop and present an EBM CAT.

2. Educational Implications and Sleep and Fatigue Implications of the 2008 Proposed Work Hour Regulations: Pilot Studies

2010-07-01

In 2008, the Institute of Medicine published recommendations for resident duty hour rules intended to enhance sleep, safety, and resident supervision. There is no data that addresses the feasibility of implementing the new rules or their effects on residents' education, sleep and fatigue.

3. Reliability and Validity of a New Multisource Feedback Evaluation Tool (Peds360) for Residents

Su-Ting T. Li, Jamal Abedi, Daniel C. West — 2010-07-01

While multisource feedback evaluations (MSF) may be one of the best ways to evaluate a resident's professionalism (Prof) and interpersonal and communication skills (ICS), the validity and reliability of MSF in pediatric residents is unknown.

4. Recruitment of Diverse Housestaff in Pediatrics: Strategies for Success

Shaquita L. Bell, Heather A. McPhillips, Richard P. Shugerman — 2010-07-01

Increasing the minority pediatric workforce is of the utmost importance. At the University of Washington, a resident-led, faculty-supported diversity committee has been in place for eight years. In that time period, the committee has been awarded a funded sub-internship program through local grants and has refined unique recruiting strategies to increase the enrollment of minority residents.

5. Pediatric Resident-as-Teacher Curriculum: A National Survey of Existing Programs and Future Needs

2010-07-01

Residents assume significant teaching responsibilities and, over the last 30 years, Residents as Teachers (RAT) programs have been reported in the literature. Currently LCME and ACGME requirements mandate this curriculum. We report results of a nationwide survey of Pediatric residency programs describing curricula of existing RAT programs. 106 of 172 (62%) Pediatric program directors (PDs) completed our survey. 13% of responding programs do not have a formal RAT curriculum and over 50% allocate 10 hours or less to this teaching throughout a three year residency training program. The primary teaching modalities in programs with curricula are lectures (78%) and workshops (66%). Content areas include feedback, inpatient teaching, communication skills, case-based teaching, role modeling, evaluation, leadership skills, one minute preceptor, teaching/learning styles, professionalism, and small group teaching. 64% of PDs also use direct observation of residents in clinical settings as an opportunity for skills practice for their residents. Whereas 63% of programs report evaluating their curricula, only 27% perceive their program to be either very or extremely effective. Overall, the vast majority of respondents (95%) express interest in a national RAT curriculum, most indicating web-based modules as the preferred method for dissemination. This survey demonstrates that despite a national mandate for resident teaching programs, there are still programs without curricula to address this. The majority of programs with curricula consider them only moderately effective. Our survey indicates that a wealth of curricular material exists across residency programs nationally; these materials offer a variety of content and methods of evaluation (of both the curricula and resident performance) that could be disseminated, perhaps using web-based modules, to complement existing RAT curricula and aid programs without curricula. Establishing a national RAT curriculum would offer PDs resources to meet educational mandates and the ability to tailor programs to best fit the needs of their own programs.

6. Ethics and Professionalism Education for Pediatric Residents

Jennifer C. Kesselheim, Theodore Sectish, Steven Joffe — 2010-07-01

Competency in confronting dilemmas related to ethics and professionalism can develop over time with teaching efforts during residency training. We surveyed directors of pediatric residency training programs (N = 187) to explore the teaching and assessment strategies used to ensure learning in ethics and to comply with the ACGME core competency of Professionalism.

7. Impact of a Teaching Rotation on Residents' Attitudes Toward Teaching: A 5-Year Study

Khanh-Van T. Le-Bucklin, Aline Wong, Rebecca Hicks — 2010-07-01

Residents spend a large part of their training teaching medical students and other residents. Recognizing the tremendous role that residents play in medical education, many residency programs have instituted formal instruction on teaching. A prior study using open-ended interview questions found a qualitative improvement in residents' enthusiasm for teaching after participation in a teaching curriculum. This 5-year study was conducted to quantitatively evaluate the impact of a teaching rotation on residents' attitudes toward teaching.

8. Reading Program Success on In-Training and Certifying Exam Scores

Ryan S. Bode, Grace L. Caputo — 2010-07-01

The pass rates of the General Pediatric Certifying Exam are a publicly shared outcome measure of ACGME accredited pediatric residency programs. The annual In-Training Exam is the best predictor of eventual success on the certifying exam. On average, residents gain 100 points per year on the In-Training exam with a score of 410 needed to pass the certifying exam. In an effort to better prepare our residents for passing boards, in 2006, we developed a reading program that was mandatory based on the results of the individual's In-Training Exam: PL1 scores <100, PL2 scores <200, and PL3 scores <350. The reading program consisted of the following: 1) Regular meetings with program director to review and track progress; 2) Complete 25 PREP questions on Pedialink per month. For PL'3s, 50 questions per month; 3) Complete weekly on-line “Case of the Week”; 4) Conference attendance >70%; 5) Commitment to read on every patient; 6) For PL3's, read “Pediatrics in Review” monthly, complete questions and submit 10 learning points; and 7) PL3's encouraged to take a Board Review course at the completion of residency. Over a two year period, the average PL1 In-Training exam score was 147 (42 residents). Within the same cohort, as PL2's the average score increased to 277 - an increase of 130. Average PL2 score over this 2 year period was 282 (40 residents) increasing to 362 as PL3's - an increase of 80. Over this 2 year period, 25 residents were on the reading program with average score increase of 156. 57 residents were not on the reading program with an average score increase of 84. Using a paired t test to compare the impact of the reading program on the means between each individual class revealed statistically significant results: t = 5.5869, df = 3, p = 0.0113. In addition, from 1999-2006, prior to the reading program, our General Pediatric Certifying Exam first time pass rate was 92% (101/110). From 2007-2008, this has increased to 94% (30/32). A structured reading program, specifically using PREP questions, is successful at increasing In-Training Exam scores and first time pass rates on the General Pediatric Certifying Exam.

9. Delivery Room Education During a NICU Rotation Improves Resuscitation Skills

Amy Wood, Cassidy A. Delaney, Adam A. Rosenberg, James S. Barry — 2010-07-01

Neonatal resuscitation skills are usually developed through neonatal resuscitation program (NRP) education and during residency through apprenticeship roles, experience and repetition.

10. Compliance with Resident Physician Duty Hour Regulations: A 16-Week Observational Study at the Women and Children's Hospital of Buffalo, New York

Lorna K. Fitzpatrick, Joyce J. Lee — 2010-07-01

Resident physician duty hour restrictions remain a contentious issue in Graduate Medical Education. Limitations have arisen in response to concerns that resident fatigue adversely affects patient safety, resident safety, and resident education. These regulations emphasize efforts to promote compliance and resident education within the constraints of limited duty hours. Our specific goals include: 1) to objectively assess overall compliance with ACGME or NYS Health Code 405 duty hour regulations among pediatric residents at our institution; 2) to identify the number and severity of violations; and 3) to recognize resident assignments that are particularly prone to violations.

11. Resident Perceptions of Barriers to Compliance with Work Hour Regulations

Lorna K. Fitzpatrick, Danielle L. Bonnevie, Joyce J. Lee, Bree C. Kramer — 2010-07-01

Resident work hour limitations have been mandated by the ACGME since 2003. A prior study by SUNY Buffalo pediatric residents showed 141 work hour violations in 1,645 assessed shifts. Violations were committed by 79.6% of residents studied.

12. Successful Self-Directed Life-Long Learning in Medicine: A Conceptual Model Derived from Qualitative Analysis of a National Survey of Pediatric Residents

Su-Ting T. Li, Debora A. Paterniti, John Patrick T. Co, Daniel C. West — 2010-07-01

Self-directed lifelong learning is recognized as an integral component of medical professionalism, yet how best to encourage its development during clinically intensive training is unknown. We developed a model for successful self-directed learning by analyzing qualitative data from a national survey of residents collected in 2008-2009.

13. Assessing ‘Centeredness’ of Pediatric Residents Prior to a New Curriculum

Keith J. Mann, Sheryl A. Chadwick, Deedra J. Miller, Sarah C. Petersen — 2010-07-01

The Patient-Practitioner Orientations Scale (PPOS) measures physicians' attitudes towards the doctor-patient relationship on a scale ranging from patient- to physician/disease-centered. We aim to document a baseline measure of centeredness in pediatric interns, and compare that baseline to third year residents, prior to implementing a patient- and family-centered curriculum.

14. A Quality Improvement (QI) Project to Decrease Pages During Resident Conferences

Keith J. Mann, Mary Hamm, Lory Harte — 2010-07-01

1) Identify the volume and character of the pages that disrupt residents during noon conference; and 2) Decrease non-urgent pages during noon conferences by 75% within 6 months.

15. Applying Lean Initiatives to Inpatient Rounds to Improve Discharge Delays

2010-07-01

The Pediatric RRC's system-based practice requirement calls for residents to participate in quality improvement projects aimed at identifying opportunities in patient care and hospital processes. Resident feedback in our program suggests that the lack of standardization of inpatient rounds and multidisciplinary care coordination hampers efficiency in executing patient care duties, such as discharges. This leaves them less time for educational activities and self-directed learning.

16. Obesity and Overweight - Do Resident Physicians Recognize and Document in an at Risk Population?

Sarah Yount, Kerry Sease — 2010-07-01

The rapid increase in obesity and overweight children in the general pediatric population is a significant concern for practicing pediatricians. A recent press release sponsored by the Piedmont Healthcare Foundation found 41% of Greenville County youth overweight or obese - above the SC state rate 31.5% and the National rate 28.8%. Knowing the associated morbidity and mortality of obesity, development of a protocol to identify and treat an at risk population at the Center for Pediatric Medicine (CPM) was felt necessary. A quality improvement project following the PDSA (Plan-Do-Study-Act) cycle was started to discern if a difference was being made in the at risk patients at CPM.

17. Scoliosis Screening in Med-Peds Clinic: Back to Basics

Lisa Nguyen, Aimee Chung, Suzanne Woods, Jane Trinh — 2010-07-01

Appropriate screening for scoliosis can lead to early detection and prevent future morbidity. Specific screening recommendations vary. The AAP recommends if screening is undertaken, females should be screened twice at ages 10 and 12, and boys once, at age 13 or 14. We found that residents in our Med-Peds clinic are unaware of the recommendations and are not comfortable with scoliosis screening.

18. A Quality Improvement Project to Enhance Pediatric Resident Medical Record Documentation

Hai Jung H. Rhim, Avni Bhalakia, Luis Umana, David Fagan — 2010-07-01

The Accreditation Council for Graduate Medical Education (ACGME) requires residents to participate in a quality improvement project. Participation in QI projects especially when resident driven may provide an opportunity to address one or more of the six ACGME core competencies.

19. Improving Adolescent Gynecologic Care and Contraceptive Counseling: A Resident QI Project

Stephanie de Wit, Jennifer Cameron, Kristy Healy, Esther Liu, Lynn Garfunkel — 2010-07-01

Participation in a mandatory workshop early in the R2 year provided a basic understanding of quality and improvement. During the R2 and R3 years, ongoing project development and implementation greatly impacted adolescent primary care in a resident continuity clinic. The Concern: High rates of adolescent pregnancy and sexually transmitted infections (STI) which exceed national averages in our clinic population. Potential solution: Improve STI screening and contraceptive counseling. Problem: Does our clinic systematically provide “best practice” for adolescent girls? Using the PDSA cycle we learned how our practice differed from ideal practice and then implemented changes to eliminate the gap between current practice and ideal practice. PLAN: Evaluate care and counseling of a group of adolescent girls. We conducted a chart review of well-child visits for girls ages 15-19. DO: After development of a chart review tool, we assessed 100 charts: 1. Was a Sexual History (SH) documented? 2. Were sexually active (SA) adolescent girls screened for STIs, including gonorrhea, Chlamydia, and HIV? 3. Were SA adolescent girls offered contraception? 4. Were SA adolescent girls offered Emergency Contraception (EC)? STUDY: 93% had SH documented; 50% were SA and of those, 46% were screened for gonorrhea and Chlamydia; 30% were offered HIV testing; 74% were offered contraception; 6% were offered emergency contraception. SH documentation met standards; however we wanted to increase STI screening and EC discussion. ACT: Findings were presented to faculty, residents and nurse practitioners at pre-clinic conferences. The electronic medical record template was modified with prompts for STI screening and EC. A second chart review after provider education and implementation of the new template showed higher HIV screening rates (40%), and improved contraception (81%) and EC (24%) management. Given the large adolescent female population served by our clinic, improving our practice will hopefully impact STI and teen pregnancy rates. Offering better care to our patients with a relatively simple process helped us appreciate the value of QI.

Editorial Board

2010-07-01

Academic Pediatrics

Overview

The Family-Centered Medical Home: Specific Considerations for Child Health Research and Policy

Medicine Safety Among Children and Adolescents

The Association of Pediatric Program Directors’ Strategic Plan: An Opportunity for Transformational Change

Leaving the Cove

Evaluation of Consumer Medical Information and Oral Liquid Measuring Devices Accompanying Pediatric Prescriptions

Knowledge Gaps and Misconceptions About Over-the-Counter Analgesics Among Adolescents Attending a Hospital-Based Clinic

Using Pharmacy Data to Screen for Look-Alike, Sound-Alike Substitution Errors in Pediatric Prescriptions

Characteristics Associated With Low Self-Esteem Among US Adolescents

Risky Health Behaviors Among Mothers-to-Be: The Impact of Adverse Childhood Experiences

Is Developmental and Behavioral Pediatrics Training Related to Perceived Responsibility for Treating Mental Health Problems?

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

Small Numbers Limit the Use of the Inpatient Pediatric Quality Indicators for Hospital Comparison

Use of a Pediatrician Toolkit to Address Parental Perception of Children's Weight Status, Nutrition, and Activity Behaviors

1. Validation of an Evidence-Based Medicine (EBM) Critically Appraised Topic

2. Educational Implications and Sleep and Fatigue Implications of the 2008 Proposed Work Hour Regulations: Pilot Studies

3. Reliability and Validity of a New Multisource Feedback Evaluation Tool (Peds360) for Residents

4. Recruitment of Diverse Housestaff in Pediatrics: Strategies for Success

5. Pediatric Resident-as-Teacher Curriculum: A National Survey of Existing Programs and Future Needs

6. Ethics and Professionalism Education for Pediatric Residents

7. Impact of a Teaching Rotation on Residents' Attitudes Toward Teaching: A 5-Year Study

8. Reading Program Success on In-Training and Certifying Exam Scores

9. Delivery Room Education During a NICU Rotation Improves Resuscitation Skills

10. Compliance with Resident Physician Duty Hour Regulations: A 16-Week Observational Study at the Women and Children's Hospital of Buffalo, New York

11. Resident Perceptions of Barriers to Compliance with Work Hour Regulations

12. Successful Self-Directed Life-Long Learning in Medicine: A Conceptual Model Derived from Qualitative Analysis of a National Survey of Pediatric Residents

13. Assessing ‘Centeredness’ of Pediatric Residents Prior to a New Curriculum

14. A Quality Improvement (QI) Project to Decrease Pages During Resident Conferences

15. Applying Lean Initiatives to Inpatient Rounds to Improve Discharge Delays

16. Obesity and Overweight - Do Resident Physicians Recognize and Document in an at Risk Population?

17. Scoliosis Screening in Med-Peds Clinic: Back to Basics

18. A Quality Improvement Project to Enhance Pediatric Resident Medical Record Documentation

19. Improving Adolescent Gynecologic Care and Contraceptive Counseling: A Resident QI Project

Editorial Board

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