A BPA survey of recently appointed consultants.

A postal survey of recently appointed consultant paediatricians was undertaken to determine whether they perceived their training had adequately equipped them for their current job. The response rate was 69% (207/299). After excluding replies from consultants trained outside the UK the analysis was carried out on 167 replies. Trainees held a mean 5.2 posts during general and higher professional training, necessitating a mean 1.8 house moves. Altogether 82% felt moves were beneficial to training but 46% found moves 'very disruptive' to family life. Only 12% of district general hospital and 22% of teaching hospital senior registrars took two research sessions a week. Supervision and training in research was absent or poor for more than 60%; 24% felt major changes and 55% moderate changes were needed to current training. Training in non-clinical skills was particularly in demand and a curriculum for both trainers and trainees with regular appraisals is required. Research at senior registrar level needs review and educational methods improved to achieve better training in a shorter period.     

Postgraduate training in paediatrics: Analysis of deficiencies as perceived by paediatricians

Abstract A listing of all general paediatricians in the country was obtained from the directory of members of the Australian College of Paediatrics. Each of the 287 paediatricians identified was sent a questionnaire requesting information about morbidity patterns of patients seen in their practices and their views regarding paediatric training. The response rate was 80.9%. Half the respondents had been in practice for 10 years or less, while two-thirds practised in a capital city. Respondents rated their training in each of 10 organic specialty areas, on average, as having been appropriate. However, when given a listing of nine areas related to child development and behaviour, chronic disease and counselling, 70% rated training in these areas as having been inadequate; this figure was even higher for recent graduates. Less than one-third had formal training in developmental, behavioural and community paediatrics; the remaining two-thirds of respondents acquired their knowledge by clinical experience, books or journals, professional contacts or meetings. This was despite the fact that almost 80% of respondents felt that practical experience was not an adequate substitute for formal training in developmental and behavioural paediatrics. There was an encouraging trend for paediatricians who had been in practice for 10 years or less to have had training in these areas, although the number was still less than half. Almost 90% of respondents felt that changes were needed in paediatric training to equip trainees for general paediatric practice, while 62% of respondents were of the opinion that the present FRACP training system mitigated against appropriate training for general paediatrics. Ninety-three per cent of respondents agreed that paediatricians had a major role to play in the management of children with problems of development and behaviour. Respondents made a large number of pertinent comments regarding perceived deficiencies in their training. These data are discussed in terms of the need to address imbalances in training. It is suggested that steps need to be taken to address the conflict between hospital service and training needs, that more trainees should be exposed to experiences in ambulatory and community settings, and that it is important to consider the introduction of appropriate curricula in developmental and behavioural paediatrics into Australian training programmes.     

Postgraduate training in paediatrics: analysis of deficiencies as perceived by paediatricians

A listing of all general paediatricians in the country was obtained from the directory of members of the Australian College of Paediatrics. Each of the 287 paediatricians identified was sent a questionnaire requesting information about morbidity patterns of patients seen in their practices and their views regarding paediatric training. The response rate was 80.9%. Half the respondents had been in practice for 10 years or less, while two-thirds practised in a capital city. Respondents rated their training in each of 10 organic specialty areas, on average, as having been appropriate. However, when given a listing of nine areas related to child development and behaviour, chronic disease and counselling, 70% rated training in these areas as having been inadequate; this figure was even higher for recent graduates. Less than one-third had formal training in developmental, behavioural and community paediatrics; the remaining two-thirds of respondents acquired their knowledge by clinical experience, books or journals, professional contacts or meetings. This was despite the fact that almost 80% of respondents felt that practical experience was not an adequate substitute for formal training in developmental and behavioural paediatrics. There was an encouraging trend for paediatricians who had been in practice for 10 years or less to have had training in these areas, although the number was still less than half. Almost 90% of respondents felt that changes were needed in paediatric training to equip trainees for general paediatric practice, while 62% of respondents were of the opinion that the present FRACP training system mitigated against appropriate training for general paediatrics.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pediatric Emergency Medicine Fellowship survey: 1991-1992.

This study was designed to determine the general characteristics, training expectations, and career goals of those individuals entering Pediatric Emergency Medicine Fellowships in 1992 through the NRMP Pediatric Emergency Medicine Match. A 20-item questionnaire was developed and sent to those individuals who successfully obtained fellowship positions through the 1991-1992 Match. All of the respondents will have completed a formal pediatric residency program, and 90% will have completed their residency since 1990. Eighty-eight percent of the respondents have not completed formal postgraduate training other than a pediatric residency, and none of the respondents were from training programs in emergency medicine. Ninety percent of the respondents are planning on two years of training, while 10% are either entering a three-year program or planning an optional third year. Ninety-four percent of the individuals who responded had not applied for Pediatric Emergency Medicine Fellowships in the past, but, while many of the individuals were concerned about obtaining a position, only 6% applied for a fellowship in an alternative field. If the respondents had not obtained positions this year, 79% felt that they would have reapplied next year. When asked why they are pursuing a Pediatric Emergency Medicine Fellowship, 85% listed opportunities in clinical medicine as their primary reason, while 10% claimed that research opportunity was the most important factor. When their fellowships are completed, 77% hope to practice at a university-based children's hospital, and 10% hope to practice at a private children's hospital.(ABSTRACT TRUNCATED AT 250 WORDS)     

A study of bereavement care after a sudden and unexpected death

Bereaved parents' perceptions of care after the sudden, unexpected death of their child (from 1 week to 12 years), and the care that was or could be offered by statutory and voluntary agencies, was assessed in 11 health districts in seven regions of England and Wales. In these 11 districts, 185 families were identified who met the criteria of the study. Permission to contact these families was given by only 72 general practitioners. Of these, 42 families responded (58%). Sudden infant death syndrome accounted for 43% of the deaths. The results from postal questionnaires sent to both parents showed that hospital care was perceived as good on the whole, although parents would like more choices. Most parents felt that community care was inadequate, leaving many feeling isolated. In contrast, questionnaires from health visitors and general practitioners in the same health districts showed that they believed that they were the most appropriate professionals to give follow up care, but as there were few policies to guide them and little training provided, felt unable to offer support.     

The 2011 ACGME Standards: Impact Reported by Graduating Residents on the Working and Learning Environment

ObjectiveChanges in Accreditation Council for Graduate Medical Education (ACGME) requirements, including duty hours, were implemented in July 2011. This study examines graduating pediatrics residents' perception of the impact of these standards.MethodsA national, random sample survey of 1000 graduating pediatrics residents was performed in 2012; a total of 634 responded. Residents were asked whether 9 areas of their working and learning environments had changed with the 2011 standards. Three combined change scores were created for: 1) patient care, 2) senior residents, and 3) program effects, with scores ranging from −1 (worse) to 1 (improved). Respondents were also asked about hours slept and perceived change in hours slept.ResultsMost respondents felt that several areas had worsened, including continuity of care and senior resident workload, or not changed, including supervision and sleep. Mean change scores that included all study variables except those related to sleep all showed worsening: patient care (mean −0.37); senior residents (mean −0.36), and program effects (mean −0.06) (P < .01). Respondents reported a mean of 6.7 hours of sleep in a 24-hour period, with the majority (71%) reporting this amount of sleep has not changed with the 2011 standards.ConclusionsIn the year after implementation of the 2011 ACGME standards, graduating pediatrics residents report no changes or a worsening in multiple components of their working and learning environments, as well as no changes in the amount of sleep they receive each day.     

A study of bereavement care after a sudden and unexpected death.

Bereaved parents'' perceptions of care after the sudden, unexpected death of their child (from 1 week to 12 years), and the care that was or could be offered by statutory and voluntary agencies, was assessed in 11 health districts in seven regions of England and Wales. In these 11 districts, 185 families were identified who met the criteria of the study. Permission to contact these families was given by only 72 general practitioners. Of these, 42 families responded (58%). Sudden infant death syndrome accounted for 43% of the deaths. The results from postal questionnaires sent to both parents showed that hospital care was perceived as good on the whole, although parents would like more choices. Most parents felt that community care was inadequate, leaving many feeling isolated. In contrast, questionnaires from health visitors and general practitioners in the same health districts showed that they believed that they were the most appropriate professionals to give follow up care, but as there were few policies to guide them and little training provided, felt unable to offer support.     

Exclusive enteral nutrition for children with Crohn's disease: Use in Australia and attitudes of Australian paediatric gastroenterologists

Aim:   Although available data support a role for exclusive enteral nutrition (EEN) in children with Crohn's disease (CD), use of this therapy varies. The aim of this study was to define the patterns of use of EEN across Australia and to better understand the reasons for this variation.
Methods:   Using an existing email network, Australian paediatric gastroenterologists were asked to provide details of their attitudes towards, and use of, EEN in children. A questionnaire was designed to direct responses, with regard to use of EEN, to current EEN protocols and patterns of use.
Results:   Twenty-one replies were received (58% response). Although 12 respondents felt that EEN was an appropriate therapy for CD, only 8 regularly used EEN for their patients. Usage varied between states and within units. Current use was related to practitioners' experiences of EEN during their gastroenterology training. The concerns of those who did not recommend EEN included compliance, cost and resource demands. The doctors who recommend EEN reported that family support, team approach and disease location were important factors for a positive outcome from EEN. Current protocols varied in terms of type of formula, length of therapy and use of concurrent medications.
Conclusions:   Variations in care were illustrated across these paediatric gastroenterologists. Practitioners have many reasons and concerns about the use of EEN: these impede the wider use of EEN for paediatric CD. More consistent protocols for the use of EEN and an improved understanding of the mechanisms of EEN could lead to enhanced use of this therapy.     

Medical students�� views on selecting paediatrics as a career choice

Despite increasing numbers of UK medical students, the number of trainees selecting paediatrics as their specialty choice has decreased. Previous studies show that most students will choose their ultimate career during undergraduate training. We therefore explored the views of students in the final year at Birmingham University about a career in paediatrics. Students completed a 27-item questionnaire during the penultimate week of their paediatric clerkship (PC) and 97% responded (127/131). Prior to the PC, 29% (37/127) of students had considered a career in paediatrics, rising to 50% (63/127) after the PC (p < 0.001). Students felt that paediatricians were enthusiastic and keen on teaching, and the ward working atmosphere was good. However, students perceived paediatrics as a difficult specialty with high competition for training posts. Students felt their paediatric experience was too limited and advice was needed on paediatric careers early in undergraduate training. This study confirmed that focusing on improving the PC is not sufficient if we are to inspire medical students to consider a career in paediatrics. Exposure to the specialty is needed from year 1 of undergraduate training along with career advice to dispel current myths about specialty training. Students would then be able to make more informed career decisions.     

Pediatric resident management of the young febrile child

Identifying the febrile child at risk for serious illness continues to challenge physicians, especially since conflicting guidelines exist for identification and management. This situation poses a special problem for the pediatrician-in-training. In this study the 35 PL-1, P1-2, and PL-3 pediatric house staff of a university-affiliated hospital were surveyed by written questionnaire regarding their practices in dealing with children of less than two years with rectal temperature above 101 degrees F (38.3 degrees C). Uniform replies were received from all house staff concerning the significance of patient age, degree of fever, and laboratory data, although there were some differences of opinion regarding the importance of specific data. All three resident levels tended to reduce the number of laboratory tests obtained as patient age increased, with emphasis placed on clinical impression of illness in assessing the older febrile child. Although the house staff indicated that they were satisfied with their handling of the febrile child, the PL-3s were only marginally more satisfied than the PL-1s and PL-2s. In general, the house staff had most confidence in handling the patient under three months of age, for whom it was generally felt that extensive laboratory evaluations and active management were indicated. The perception of the need for a formal protocol was also greatest for this youngest age group and decreased in importance with age.     

Education and training in the paediatric senior house officer grade: analysis of RCPCH hospital/child health visits reports, 1997-2001

Methods: Retrospective audit of visits reports (1997–2001) against the RCPCH criteria for general professional training. Hospital and/or community child health departments who were responsible for training paediatric senior house officers were visited to assess whether RCPCH criteria of education were being met. Follow up visits were undertaken where limited education and training approval was given. Reports were received from 214 of 242 (88%) hospital and/or community based departments in England, Wales, and Northern Ireland. Results: Satisfactory achievement of the 12 training criteria by departments varied widely: 39–95% (median 66%) achieved. Follow up visits reported significant improvements in most departments. Criteria which departments struggled to achieve reasonable standards were: (1) ensuring SHOs were performing educationally appropriate duties (39% achieved); and (2) satisfactory outpatient experience (41% achieved). Twenty four per cent of hospital based departments did not have a paediatrician with 12 months or more experience of paediatrics resident on call. Conclusions: The visiting process highlighted areas of good practice, encouraged change to meet the criteria, and recommended increased resources and staffing where necessary to improve training and hence the service. The need for continuing approval for education and training in these departments encouraged significant efforts on the part of trainers and managers to meet the requirements, and consequently the quality of service to children has been enhanced.     

The status of academic general pediatrics: no longer endangered?

Our study objective was to assess the current state of general academic pediatrics in the United States. A confidential survey of division directors was conducted. At the beginning and end of the survey period, programs were called to verify the director's name. Of 199 divisions surveyed, 119 were returned. The number of physician and nonphysician division faculty has grown from a mean of 12.1 (+/-8.2) and 1.7 (+/-1.8), respectively, 5 years ago to 15.6 (+/-11.7) and 2.1 (+/-2.6). Over a 15- to 18-month period, 21% of programs had a change in division director leadership. Over 90% of divisions rated the clinical care and education missions as "very important," with research and advocacy thus rated by 29% and 50%. Ninety-five percent of divisions have primary responsibility for residency continuity clinics, 51% residency program, and 64% medical student clerkship. The mean number of annual outpatient visits was 29,821 (26,487). Academic general pediatrics divisions have grown and play a large role in clinical care, education, and research at their institutions. There is a need for continued focus on recruitment, fellowship training, faculty development, and leadership development. Although these divisions are now well established, many continue to feel "endangered" because of funding uncertainties in supporting their missions.     

Education and training in the paediatric senior house officer grade: analysis of RCPCH hospital/child health visits reports, 1997-2001.

AIMS: To review the process and outcome of education and training visits to paediatric departments by the RCPCH. METHODS: Retrospective audit of visits reports (1997-2001) against the RCPCH criteria for general professional training. Hospital and/or community child health departments who were responsible for training paediatric senior house officers were visited to assess whether RCPCH criteria of education were being met. Follow up visits were undertaken where limited education and training approval was given. Reports were received from 214 of 242 (88%) hospital and/or community based departments in England, Wales, and Northern Ireland. RESULTS: Satisfactory achievement of the 12 training criteria by departments varied widely: 39-95% (median 66%) achieved. Follow up visits reported significant improvements in most departments. Criteria which departments struggled to achieve reasonable standards were: (1) ensuring SHOs were performing educationally appropriate duties (39% achieved); and (2) satisfactory outpatient experience (41% achieved). Twenty four per cent of hospital based departments did not have a paediatrician with 12 months or more experience of paediatrics resident on call. CONCLUSIONS: The visiting process highlighted areas of good practice, encouraged change to meet the criteria, and recommended increased resources and staffing where necessary to improve training and hence the service. The need for continuing approval for education and training in these departments encouraged significant efforts on the part of trainers and managers to meet the requirements, and consequently the quality of service to children has been enhanced.     

Paediatric medical outpatients: are all those reviews necessary?

The value of and need for paediatric outpatient review attendance as perceived by parents, children, consultants, and general practitioners (GPs) were assessed. One hundred and ninety one parents of 239 children over 7 years of age undergoing review were randomly selected for a semistructured interview. For each parent interviewed, an audit questionnaire was completed after case note review by another paediatrician. A random sample of the patients' GPs was surveyed by postal questionnaire. Twenty per cent of parents and 26% of GPs felt that the GP could care for the child as well as or better than the hospital, whereas only 6% of consultants felt this to be so. Regarding future attendance of the child at the hospital, 48% of parents and 32% of GPs felt the child could either be discharged or seen when parents were worried, whereas consultants felt 24% of patients should have been discharged.     

Paediatric medical outpatients: are all those reviews necessary?

The value of and need for paediatric outpatient review attendance as perceived by parents, children, consultants, and general practitioners (GPs) were assessed. One hundred and ninety one parents of 239 children over 7 years of age undergoing review were randomly selected for a semistructured interview. For each parent interviewed, an audit questionnaire was completed after case note review by another paediatrician. A random sample of the patients' GPs was surveyed by postal questionnaire. Twenty per cent of parents and 26% of GPs felt that the GP could care for the child as well as or better than the hospital, whereas only 6% of consultants felt this to be so. Regarding future attendance of the child at the hospital, 48% of parents and 32% of GPs felt the child could either be discharged or seen when parents were worried, whereas consultants felt 24% of patients should have been discharged.     

Violence against trainee paediatricians.

BACKGROUND: Much research has looked at the extent of violence against doctors, but this has been restricted mainly to psychiatry, general practice, and accident and emergency. AIMS: To assess the level of violence against trainee paediatricians. METHODS: A telephone questionnaire was addressed to 25 specialist registrars/senior registrars/senior SHOs in each of three regions in the UK: Northern Ireland, South Thames, and North West England. RESULTS: Sixty eight of 75 (90.7%) trainee paediatricians had been exposed in at least one circumstance to a violent incident, 47 of which incidents (62.3%) had occurred in the past year. Thirty one (41%) had suffered threats on at least one occasion. Although only 5.3% of the interviewees had been victims of actual physical assault, more than 10% said that an attempted assault had taken place. Most of the doctors who had experienced a violent episode (41/68) worried about the incident after return from work and yet only one was offered any counselling. Only nine (13.2%) had ever formally reported an incident to hospital management. Less than 10% of those questioned had received any formal training in the management of violent people, although 99% thought this would be a good idea. CONCLUSIONS: Paediatric trainees are involved in high risk situations at work (for example, child protection and casualty) which frequently result in exposure to violence. Very few report these incidents officially, but often underplay them. More attention should be given to the training and counselling needs of paediatric trainees.     

Evaluation of a pediatric palliative care educational workshop for oncology fellows

BACKGROUND: Recent efforts have focused on improving pediatric palliative care to relieve physical and psychological suffering throughout the course of illness, as well as to improve care at the end-of-life (EOL). One area of attention has been medical training, as healthcare providers have often reported feeling ill-equipped to manage EOL issues. As a pilot study, we developed and evaluated a daylong educational workshop on pediatric palliative care for oncology fellows. PROCEDURE: Fellows (N = 32) from 20 hospitals participated in one of two workshops covering palliative care topics, such as pain/symptom management, communication, ethics, and bereavement. Training, knowledge, behavior, and attitudes regarding pediatric palliative care were assessed before the workshop, and knowledge was re-assessed immediately afterwards. RESULTS: Fellows reported a general lack of training in EOL care, and only 41% rated their education as at least "somewhat" adequate. Colleagues and personal experience were more often sources on EOL care, rather than formal classes or textbooks. Although fellows reported open attitudes toward palliative care, such as involving adolescents in decision-making, only half felt comfortable in the presence of a dying person. Fewer than half felt comfortable providing EOL care, managing families' expectations, or knowledgeable enough to discuss hospice with patients/families. Following the workshop, knowledge of palliative care increased significantly from 75 to 85% correct. CONCLUSIONS: Fellows reported open beliefs about palliative care, but acknowledged weaknesses in their training and level of competence. The workshop showed efficacy in improving knowledge, but additional research is needed to evaluate larger educational initiatives and their long-term impact on clinical services and family satisfaction.     

General practitioners'' attitudes to child injury prevention in the UK: a national postal questionnaire.

OBJECTIVE: To survey the level of interest and involvement in child injury prevention among general practitioners and their practice teams, and to identify factors associated with current interest. DESIGN: Postal survey of a random sample of United Kingdom (UK) medical practitioners. SETTING: Medical practices throughout the UK. SUBJECTS: 957 general practitioners (50% of the total sample) who responded to the survey questionnaire. OUTCOMES: Answer to questions about role in injury prevention. RESULTS: Despite a response rate of only 50%, this study is the largest to examine the role of general practitioners in child injury prevention. Seven hundred and twenty five (77%) of the respondents considered injury prevention to be part of the general practitioner's role, but only 260 (28%) felt that they did enough in this area. Time was cited as the most significant limiting factor. Women doctors, rural practitioners, members of the Royal College of General Practitioners, and doctors with previous personal experience of serious accidents all had more positive attitudes to injury prevention as a routine part of their activities (p < 0.05). Practices providing first aid training for staff were also associated with an interest in injury prevention. The most appropriate times for offering prevention advice were thought to be during child health surveillance clinics and during treatment of an accident. CONCLUSIONS: Awareness about injury prevention opportunities might be improved by emphasising the roles of individual team members and by better addressing the training needs of the whole team.     

Discussing withdrawing and withholding of life-sustaining medical treatment in a tertiary paediatric hospital: a survey of clinician attitudes and practices

Aim:   To better understand current attitudes and practices relating to discussions concerning the withholding and withdrawing of life-sustaining medical treatment (WWLSMT) among medical staff in the paediatric setting.
Methods:   An anonymous online survey of paediatricians (senior medical staff – SMS) and paediatric trainees (junior medical staff – JMS) likely to be involved in the care of children with life limiting illness.
Results:   A total of 162 responses were obtained (response rate 42%). SMS indicated feeling more comfortable with their abilities to discuss WWLSMT than JMS. Barriers to discussing WWLSMT were numerous and included clinician concerns about family readiness for the discussion, prognostic uncertainty, family disagreement with the treating team regarding the child's prognosis/diagnosis and concerns about how to manage family requests for treatments that are not perceived to be in the child's best interests. Fifty-eight per cent of JMS and 35.8% of SMS reported receiving no specific communication training regarding WWLSMT. Most learned through experience and by observing more senior colleagues. There was a high level of support for additional training in this area and for the provision of resources such as discussion guidelines and a structured form for documenting the outcomes WWLSMT discussions.
Conclusion:   The majority of JMS feel less comfortable with their abilities to facilitate these discussions than their senior colleagues. The results of this study suggest that although confidence correlates with experience, junior and senior clinicians are eager to improve their skills through ongoing professional development and the provision of resources. The education needs of JMS and SMS appear to be different.     

Pediatric jeopardy may increase residents' medical reading.

OBJECTIVE: To describe the implementation of a monthly pediatric jeopardy educational intervention (pediatric jeopardy) designed to increase resident reading. METHODS: Pediatric jeopardy, based on the game show JEOPARDY!, was implemented in a pediatric residency training program in September 1997. The questions were derived from the current issues of Pediatrics in Review, Pediatrics, and Pediatrics Review and Education Program. Three residents from each training level competed in teams. Residents' reading habits were briefly surveyed in May 1998 using a 23-item questionnaire. RESULTS: Pediatric jeopardy was implemented and has been continued because both residents and faculty members believed it is a valuable part of the overall residency training program. Some format changes have occurred since the initial implementation of the program. Residents are seen with journals throughout the month, and they speak positively about this conference. The questionnaire response rate was 89.2%. Residents self-reported reading an average of 350 minutes per month (5.8 hours) in May 1998. Residents reported that they felt that this program increased their knowledge, motivated them to read, and should be used in other residency training programs. CONCLUSION: Implementation of pediatric jeopardy may increase the amount of overall medical reading reported by the pediatric residents. Pediatric residents reported reading an average of 350 minutes per month. Residents felt this educational intervention was of significant educational value to them personally and should be used in other residency training programs.