Exploring the Educational Value of Patient Feedback: A Qualitative Analysis of Pediatric Residents' Perspectives
2017; 17 (1): 4-8
Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships.
2017; 140 (1)
A Novel Pediatric Residency Coaching Program: Outcomes After One Year.
Academic medicine : journal of the Association of American Medical Colleges
Pediatric Hospital Medicine (PHM) is an emerging field in pediatrics and one that has experienced immense growth and maturation in a short period of time. Evolution and rapid expansion of the field invigorated the goal of standardizing PHM fellowship curricula, which naturally aligned with the field's evolving pursuit of a defined identity and consideration of certification options. The national group of PHM fellowship program directors sought to establish curricular standards that would more accurately reflect the competencies needed to practice pediatric hospital medicine and meet future board certification needs. In this manuscript, we describe the method by which we reached consensus on a 2-year curricular framework for PHM fellowship programs, detail the current model for this framework, and provide examples of how this curricular framework may be applied to meet the needs of a variety of fellows and fellowship programs. The 2-year PHM fellowship curricular framework was developed over a number of years through an iterative process and with the input of PHM fellowship program directors (PDs), PHM fellowship graduates, PHM leaders, pediatric hospitalists practicing in a variety of clinical settings, and other educators outside the field. We have developed a curricular framework for PHM Fellowships that consists of 8 education units (defined as 4 weeks each) in 3 areas: clinical care, systems and scholarship, and individualized curriculum.
View details for DOI 10.1542/peds.2017-0698
View details for PubMedID 28600448
Subacute Sclerosing Panencephalitis: The Foothold in Undervaccination
JOURNAL OF PEDIATRICS
2016; 179: 259-262
The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement.The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback.Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before.Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.
View details for DOI 10.1097/ACM.0000000000001825
View details for PubMedID 28700460
The Current State of Pediatric Hospital Medicine Fellowships: A Survey of Program Directors
JOURNAL OF HOSPITAL MEDICINE
2016; 11 (5): 324-328
Subacute sclerosing panencephalitis (SSPE) is a fatal complication of measles infection. We present a case of a fully vaccinated 3-year-old boy who was diagnosed with and treated for autoimmune encephalitis before arriving at a diagnosis of SSPE. We discuss the challenges of diagnosing SSPE in developed countries.
View details for DOI 10.1016/j.jpeds.2016.08.051
View details for Web of Science ID 000390027100051
View details for PubMedID 27634625
A Strategic Approach to Implementation of Medical Mentorship Programs.
Journal of graduate medical education
2016; 8 (1): 68-73
Pediatric hospital medicine (PHM) fellowship programs have grown rapidly over the last 20 years and have varied in duration and content. In an effort to standardize training in the absence of a single accrediting body, PHM fellowship directors now meet annually to discuss strategies for standardizing and enhancing training.To explore similarities and differences in curricular structure among PHM fellowship programs in an effort to inform future curriculum standardization efforts.An electronic survey was distributed by e-mail to all PHM fellowship directors in April 2014. The survey consisted of 30 multiple-choice and short-answer questions focused on various curricular aspects of training developed by the authors.Twenty-seven of 31 fellowship programs (87%) responded to the survey. Duration of most programs was 2 years (63%), with 6, 1-year programs (22%) and 4 (15%) 3-year programs making up the remainder. The average amount of clinical time among programs was 50% (range approximately 20%-65%). In addition to general inpatient pediatric service time, most programs require other clinical rotations. The majority of programs allow fellows to bill independently for their services. Most programs offer certificate courses, courses for credit or noncredit courses, with 11 programs offering masters' degrees. Twenty-one (81%) programs provide a scholarship oversight committee for their fellows. Current fellows' primary areas of research are varied.Though variability exists regarding program length, clinical composition, and nonclinical offerings, several common themes emerged that may help inform the development of a standard curriculum for use across all programs. This information provides a useful starting point if pediatric hospital medicine obtains formal subspecialty status. Journal of Hospital Medicine 2016;11:324-328. © 2016 Society of Hospital Medicine.
View details for DOI 10.1002/jhm.2571
View details for Web of Science ID 000380039600002
View details for PubMedID 27042818
Training Health Care Professionals for 21st-Century Practice: A Systematic Review of Educational Interventions on Chronic Care
2015; 90 (11): 1561-1572
Mentors influence medical trainees' experiences through career enhancement and psychosocial support, yet some trainees never receive benefits from involved mentors.Our goals were to examine the effectiveness of 2 interventions aimed at increasing the number of mentors in training programs, and to assess group differences in mentor effectiveness, the relationship between trainees' satisfaction with their programs given the presence of mentors, and the relationship between the number of trainees with mentors and postgraduate year (PGY).In group 1, a physician adviser funded by the graduate medical education department implemented mentorships in 6 residency programs, while group 2 involved a training program with funded physician mentoring time. The remaining 89 training programs served as controls. Chi-square tests were used to determine differences.Survey responses from group 1, group 2, and controls were 47 of 84 (56%), 34 of 78 (44%), and 471 of 981 (48%, P = .38), respectively. The percentages of trainees reporting a mentor in group 1, group 2, and the control group were 89%, 97%, and 79%, respectively (P = .01). There were no differences in mentor effectiveness between groups. Mentored trainees were more likely to be satisfied with their programs (P = .01) and to report that faculty supported their professional aspirations (P = .001). Across all programs, fewer first-year trainees (59%) identified a mentor compared to PGY-2 through PGY-8 trainees (84%, P < .001).A supported mentorship program is an effective way to create an educational environment that maximizes trainees' perceptions of mentorship and satisfaction with their training programs.
View details for DOI 10.4300/JGME-D-15-00335.1
View details for PubMedID 26913106
View details for PubMedCentralID PMC4763391
Caring for Children With Medical Complexity: Challenges and Educational Opportunities Identified by Pediatric Residents
2015; 15 (6): 621-625
Caring for Children With Medical Complexity: Challenges and Educational Opportunities Identified by Pediatric Residents.
2015; 15 (6): 621-625
To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care.A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner's chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller's classification of clinical competence was used to assess the quality of learner achievements for each educational intervention.A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner's CCM and showed high-level learner competence according to Miller's classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives.The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.
View details for DOI 10.1097/ACM.0000000000000773
View details for Web of Science ID 000363973300032
View details for PubMedID 26039140
Outcomes of a Randomized Controlled Educational Intervention to Train Pediatric Residents on Caring for Children With Special Health Care Needs
2015; 54 (7): 659-666
High-quality care for children with medical complexity (CMC) is in its infancy. Residents have the opportunity to view care for CMC with a fresh perspective that is informed by their work across diverse health care settings and significant time spent at the bedside. This study aimed to identify the challenges and potential solutions for complex care delivery and education from their perspectives.We conducted three 60-minute focus groups with a purposeful sample of residents and recent graduates at a US tertiary-care medical center. Data were transcribed verbatim, and themes were identified using an iterative approach and modified grounded theory.Sixteen participants identified 4 major challenges to caring for CMC: 1) lack of care coordination; 2) complex technology management; 3) patients' pervasive psychosocial needs; and 4) lack of effective health care provider training. Participants identified 3 solutions: 1) greater integration of primary care providers; 2) attention to psychosocial needs through shared decision making; and 3) integration of longitudinal patient relationships into provider training. We found that residents who experienced longitudinal relationships with CMC felt more efficacious and better equipped to handle challenges of caring for CMC as a result of their broader understanding of patients' priorities and of their role as providers.Residents recognize important challenges and offer thoughtful solutions to caring for CMC. Although multiple solutions exist, formal integration of longitudinal patient experiences into residency training may better prepare residents to understand patient priorities and identify when their own attitudinal changes can guide them into more efficacious roles as providers.
View details for DOI 10.1016/j.acap.2015.08.004
View details for PubMedID 26409304
Continuing education needs of pediatricians across diverse specialties caring for children with medical complexity.
2015; 54 (3): 222-227
Objective. To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). Methods. Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. Results. Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. Conclusion. SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease.
View details for DOI 10.1177/0009922814564050
View details for Web of Science ID 000354656600008
View details for PubMedID 25561698
Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis.
2015; 15 (1): 61-68
Objective. Care for children with medical complexity (CMC) relies on pediatricians who often are ill equipped, but striving to provide high quality care. We performed a needs assessment of pediatricians across diverse subspecialties at a tertiary academic US children's hospital about their continuing education needs regarding the care of CMC. Methods. Eighteen pediatricians from diverse subspecialties were asked to complete an online anonymous open-ended survey. Data were analyzed using modified grounded theory. Results. The response rate was 89% (n = 16). Of participants, 31.2% (n = 5) were general pediatricians, 18.7% (n = 3) were hospitalists, and 50% (n = 8) were pediatric subspecialists. Pediatricians recognized the need for skills in care coordination, giving bad news, working in interprofessional teams, and setting goals of care with patients. Conclusions. Practicing pediatricians need skills to improve care for CMC. Strategically incorporating basic palliative care education may fill an important training need across diverse pediatric specialties.
View details for DOI 10.1177/0009922814564049
View details for PubMedID 25561699
Pediatric discharge content: a multisite assessment of physician preferences and experiences.
2014; 4 (1): 9–15
Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement.We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes.Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care.This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives.
View details for DOI 10.1016/j.acap.2014.07.004
View details for PubMedID 25444655
A 6-Year-Old Girl with Extensive Bullous Skin Lesions
2012; 41 (6): 229-231
Streptococcal pyomyositis of the psoas - Case reports and review
PEDIATRIC EMERGENCY CARE
2006; 22 (4): 250-253
Professional medical societies endorse prompt, consistent discharge communication to primary care providers (PCPs) on discharge. However, evidence is limited about what clinical elements to communicate. Our main goal was to identify and compare the clinical elements considered by PCPs and pediatric hospitalists to be essential to communicate to PCPs within 2 days of pediatric hospital discharge. A secondary goal was to describe experiences of the PCPs and pediatric hospitalists regarding sending and receiving discharge information.A survey of physician preferences and experiences regarding discharge communication was sent to 320 PCPs who refer patients to 16 hospitals, with an analogous survey sent to 147 hospitalists. Descriptive statistics were calculated, and χ(2) analyses were performed.A total of 201 PCPs (63%) and 71 hospitalists (48%) responded to the survey. Seven clinical elements were reported as essential by >75% of both PCPs and hospitalists: dates of admission and discharge; discharge diagnoses; brief hospital course; discharge medications; immunizations given during hospitalization; pending laboratory or test results; and follow-up appointments. PCPs reported reliably receiving discharge communication significantly less often than hospitalists reported sending it (71.8% vs 85.1%; P < .01), and PCPs considered this communication to be complete significantly less often than hospitalists did (64.9% vs 79.1%; P < .01).We identified 7 core clinical elements that PCPs and hospitalists consider essential in discharge communication. Consistently and promptly communicating at least these core elements after discharge may enhance PCP satisfaction and patient-level outcomes. Reported rates of transmission and receipt of this information were suboptimal and should be targeted for improvement.
View details for DOI 10.1542/hpeds.2013-0022
View details for PubMedID 24435595
We present two unusual cases of pyomyositis of the psoas muscle caused by Group A beta-hemolytic streptococcus (GABHS) in children presenting with fever, emesis and leg pain. Pyomyositis secondary to GABHS is rare in children and cases involving the psoas muscle have not been previously reported. In our discussion, we review the epidemiology, presentation, diagnosis and treatment of GABHS psoas myositis in comparison with staphylococcal pyomyositis. Prompt recognition of the signs and symptoms of GABHS psoas pyomyositis is essential for treatment of this life-threatening infection.
View details for Web of Science ID 000237260600010
View details for PubMedID 16651916