Development of a Bright Futures curriculum for pediatric residents.

OBJECTIVE: To develop a standardized case-based curriculum for pediatric residents on child growth, development, behavior, and adolescent medicine that incorporates the Bright Futures health supervision guidelines. DESIGN: This project included a needs assessment, development of a list of important topics, writing and revising of standardized cases, formative evaluation of cases, and efficacy pilot testing of 2 cases. SETTING: A large pediatric teaching hospital continuity clinic. PARTICIPANTS: Pediatric residents, fellows, and faculty. INTERVENTIONS: Preparation of standardized cases, facilitator training, and resident-led teaching conferences. OUTCOME MEASURES: Learner and facilitator evaluation forms and two 10-item diagnostic skills assessments. RESULTS: During the project, faculty-fellow teams wrote 29 case-teaching modules. All participants gave high ratings to cases, and resident facilitators reported increased comfort with the case discussion method. Resident learners' ability to accurately interpret developmental screening tests and growth charts improved following sessions on those topics. CONCLUSIONS: Further evaluation is required, but these standardized cases appear promising for teaching pediatric residents. The curriculum is now freely available to faculty nationwide.     

International child health electives for pediatric residents

BACKGROUND: International child health (ICH) electives can strengthen the skills and shape the values of pediatric residents. Much can be learned from the literature on ICH electives during medical school. Yet there is little published information regarding ICH electives during residency, nor do educational guidelines for such electives exist. OBJECTIVES: To describe existing ICH electives among pediatric residency programs and to develop guidelines for ICH electives during residency training. PARTICIPANTS AND METHODS: A survey of 248 pediatric residency programs in the United States, Canada, and Puerto Rico was conducted in November 1995. Consensus guidelines were developed by the executive committee of the American Academy of Pediatrics (AAP) Section on International Child Health. Consensus was achieved via full agreement among the 11 committee members. RESULTS: Survey response rate was 65%. International child health electives were offered by 25% of respondents. Most had no formal educational structure. An additional 42% of respondents indicated interest in ICH electives and requested more information. The AAP consensus guidelines for ICH electives focus on 4 principles: prerequisites, preceptorship, preparation, and evaluation. The guidelines are based on a conceptual framework that emphasizes reciprocity and continuity. CONCLUSIONS: While only 25% of pediatric residency programs currently offer ICH electives, many more express an interest in doing so. Educational structure for such electives is important and lacking. The AAP consensus guidelines provide a template for meaningful ICH experiences during pediatric residency. These guidelines may be applicable to other specialties as well.     

Teaching pediatric residents about child maltreatment

Child maltreatment is a growing problem faced by pediatricians; however, there are many deficiencies in pediatricians' relevant knowledge and skills. Residency programs typically have included limited teaching in the area of child maltreatment. Fifty pediatric residents participated in an evaluation of a model educational course in child maltreatment developed by an interdisciplinary faculty. The course resulted in significant short-term improvements in knowledge and skills as well as a greater sense of competence in managing cases of child maltreatment. The importance of teaching pediatric residents about the "new morbidity" is discussed.     

Pediatric residents buckle up: a child safety seat training program for pediatric residents.

OBJECTIVES: To assess the effectiveness of supervised installation of child safety seats (CSSs) as a teaching tool for pediatric residents and to evaluate acceptance of this hands-on learning experience. METHODS: Pediatric residents were divided into an intervention group and a control group. All residents completed an initial questionnaire regarding knowledge about CSS use. The intervention group listened to a CSS lecture, viewed a video, and installed CSSs under the supervision of certified CSS technicians. The control group received no intervention. A second questionnaire was administered to all residents. We compared the knowledge gained since the initial questionnaire. The intervention group answered questions regarding their acceptance of this learning experience. RESULTS: Sixty-one residents participated in the study. Most residents had never installed a CSS and felt uncomfortable with their CSS knowledge. The percentage of the intervention group that received a passing score for knowledge increased from 3% initially to 97% on the posttest (P <.001). There was no change in the passing rate of the control group. The intervention group rated the CSS installation session as extremely helpful. CONCLUSION: A hands-on educational program can be an effective, well-accepted method for increasing pediatric residents' knowledge about CSS use.     

Toward the development of advocacy training curricula for pediatric residents: a national delphi study.

BACKGROUND: Training in child advocacy is now required in pediatric residency program curricula. No national consensus exists regarding the content of such advocacy training. OBJECTIVE: To identify an operational definition of advocacy, as well as knowledge, skills, and attitude objectives for advocacy training in pediatric residency programs. METHODS: Professionals experienced in pediatric advocacy and training (n = 53) were invited to participate in a sequence of surveys to define the content of a pediatric residency advocacy curriculum that would result in acquisition of appropriate knowledge, skills, and attitudes related to advocacy for children. Three rounds of surveys were distributed, collected, and analyzed using a modified Delphi technique, in which the results from an antecedent survey were used to refine responses in a subsequent survey. RESULTS: Participants (n = 36), comprising a group of experienced leaders with diverse training and experience in child advocacy and resident education, created a consensus definition for advocacy. They initially identified 179 possible objectives for advocacy curricula. Through the iterative process of the Delphi technique, 32 of those objectives were identified as necessary for inclusion in a child advocacy curriculum for pediatric residents. CONCLUSIONS: Using a modified Delphi technique, a group of experienced leaders in pediatric advocacy were able to reach consensus on an operational definition of child advocacy and a set of objectives for a resident advocacy curriculum. Programs may use these findings to assist in developing an advocacy curriculum based on their own faculty assets and community resources.     

A block rotation in community health and child advocacy: improved competency of pediatric residency graduates.

CONTEXT: Despite increasing recognition of the importance of community health and child advocacy activities by pediatricians, residency programs have had little experience providing this education. There are no known reports examining the effects of such training on residency graduates. OBJECTIVE: To determine whether a program for educating residents in community health and child advocacy, Pediatric Links With the Community (PLC), improved attitudes and competencies of residency graduates. DESIGN: Survey of all graduates of the Rochester Pediatric Residency Program from 1991-2001. Graduates before institution of PLC (pre-PLC) were compared with graduates after institution of PLC (post-PLC). PARTICIPANTS: A total of 137 (81%) of 169 graduates participated; 78 (85%) of 92 were in the pre-PLC group and 59 (77%) of 77 were in the post-PLC group. INTERVENTION: PLC provides all pediatric residents with a 2-week rotation working with multiple community-based organizations. OUTCOME MEASURES: Differences between pre-PLC and post-PLC graduates in self-reported attitudes and competencies in multiple community health and child advocacy activities on 4-point Likert scales. RESULTS: The pre-PLC and post-PLC groups' attitudes toward community health activities were equally positive (3.4 vs 3.5, P =.08). The post-PLC group rated its competency higher in 8 of 12 activities (P <.05); its overall rating of competency was also higher (2.8 vs 2.3, P <.001). CONCLUSIONS: Although all pediatricians surveyed had positive attitudes toward community health and child advocacy activities, those who participated in PLC had higher self-perceived competency in most activities. Residency training programs can increase graduates' competence in community health skills.     

Teaching developmental pediatrics to pediatric residents: effectiveness of a structured curriculum

A national Task Force on Developmental Pediatrics was convened in 1979 to produce a curriculum for pediatric residents pertaining to the detection, assessment, and management of children with atypical development. During a 2-year period, the task force developed a structured curriculum composed of specific goals, educational objectives, and matched learning activities that identified and described the basic knowledge, skills, and attitudes of developmental pediatrics to be acquired during a pediatric residency. Subsequently, the curriculum was implemented and evaluated in 11 pediatric programs with a developmental pediatrics rotation. On a seven-point subjective scale, the mean resident (n = 64) rating of the curriculum's usefulness was 6.0 and of their perceived competence in the skills of developmental pediatrics was 5.2; the mean percent of this competence attributed to the curriculum-based rotation was 56.6. On an objective case management test, residents who used the curriculum scored significantly (P less than .005) higher than those who did not. These results suggest the efficacy of structured curricula in pediatric resident education.     

Addressing behavioral health issues during well child visits by pediatric residents

The study examined practices by pediatric residents (n = 61) concerning psychosocial care during well child visits. A random sample (n = 719) of well child visits was selected, and a medical record review was conducted. Results suggested that a behavioral health issue was discussed in 38% of the cases. The most frequent type of problem discussed involved a medical component, while problems with mood were rarely discussed (<1%). Residents treated 67% of the cases and referred 20% of the cases with behavioral health concerns. Logistic regression suggested that residents were significantly more likely to treat medically focused problems (P = 0.05), but more likely to refer children with social/environmental or learning problems (P = 0.05). Results suggested the need for further training in recognition of internalizing disorders.     

Evaluation and comparison of a 1-month versus a 2-week community pediatrics and advocacy rotation for pediatric residents

This prospective study was conducted to assess the effects of a 4-week community pediatrics and advocacy rotation with a unique project (Curriculum A), a 2-week community pediatrics rotation with advocacy training and unique project throughout residency (Curriculum B), or no curriculum exposure on residents' attitudes, perceived competence, knowledge, and behaviors. A 27-item questionnaire was used to assess attitudes, competence, and knowledge. Examination of residents' patients' use of Early Intervention services during the 5-year period after curricula introduction assessed behaviors. Seventy percent of questionnaires distributed over several years were completed by 105 of 111 eligible residents. Residents exposed to Curriculum A or B demonstrated improved competence and knowledge but no significant increase in positive attitudes toward community pediatrics and advocacy. Residents' patients' use of Early Intervention services increased 65% during the 5-year period after curriculum introduction. No significant differences in outcome measures were observed between Curriculum A and Curriculum B.     

Career planning for pediatric residents

After having made decisions about college, medical school, and specialty training, some residents may delay consideration of their future career in pediatrics. Others, having decided what path they will pursue, are not clear as to what steps need to be taken to ensure that they approach their choice armed with the most appropriate and accurate information. Residents seek career choice information from various sources. For many, the resources may not be able to provide as complete information in all facets of career decision-making. An Internet accessible site for career planning for pediatric residents has been developed (). The advantages, beyond ease of access by all residents, are many, particularly the power of links to other Internet resources. In addition, a website provides the ability to rapidly update and add information, which is not feasible in printed form. career planning, pediatric residents, jobs, private practice, pediatric specialties.     

Home visits by pediatric residents. A valuable educational tool.

OBJECTIVE--To establish how many pediatric residency programs offer home visits, to assess the feasibility of making home visits as part of pediatric training, and to determine whether residents perceive home visits as worthwhile learning experiences. DESIGN--A questionnaire was mailed to all medical school pediatric departments in the United States and Puerto Rico to determine the prevalence of home visits during residency training. To study the feasibility of residents making home visits, a pilot program was instituted. PARTICIPANTS--Fourteen pediatric residents participated in the study. Each resident visited a house, trailer, apartment, or shelter for the homeless that was within a 20-minute radius from the medical center. To determine the educational value of home visits, each resident wrote a one-page report immediately on his or her return to the hospital. After about 6 months, all participating residents completed a questionnaire retrospectively evaluating their home visits. SELECTION PROCEDURES--Interns who were neither on-call nor postcall the day of the visits were invited to participate. Patients were selected because they were homebound (eg, ventilator-dependent), had missed follow-up appointments, or had transportation difficulties. RESULTS--Thirteen percent of the pediatric residency programs surveyed currently include home visits. In all 14 of the pilot visits, the home was located without difficulty and the patient was at home. In each case, the family welcomed the visit. All the pediatric residents believed that the home visit was a worthwhile learning experience. CONCLUSIONS--Although very few programs (13%) currently offer home visits as part of pediatric residency training, such visits are feasible within a large urban area. Residents are enthusiastic about seeing how and where their patients live, and consider home visits a worthwhile learning experience.     

Practice management training for pediatric residents

In 1986, a practice management training program was developed for pediatric house staff. In conjunction with this program, pediatric residents for the following 2 years completed questionnaires regarding their career goals, interests, and perceived competence in practice management. Postgraduate level-3 residents who completed the program felt more competent than postgraduate level-1 residents in all areas of practice management and were more likely to take an active role in managing their practice. There was a significant difference between postgraduate level-1 and level-3 residents who completed the program in several areas: feelings of overall competence in office management, choosing a practice location, office staff, appointment system, billing system, office computer, fee schedules, telephone management, and setting up an office laboratory. Exposure to a practice management program during residency training may better prepare future pediatricians for a successful practice.