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)     

Current trends in pediatric residency training

A spreading gap has developed between available pediatric level 1 positions and those filled through the National Resident Matching Program. To define which variables enhance a program's ability to match, we surveyed program directors of all categorical pediatric training programs. An 82% response rate showed that ability to match was positively associated with larger program size and offering of shared residency positions. A negative association was found between many benefits and ability to match. The call schedule and number of call-free elective months had no measurable effect. Factors that we were unable to investigate, such as geographic location and academic reputation, may also play a role. Our results emphasize the irrelevance of enhancing benefits as a way of making programs competitive. Our energies need to be directed at attracting junior medical students to a career in pediatrics rather than competing for fourth-year students applying to pediatric programs.     

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.     

Pediatric Resident Training in the Community Hospital Setting: A Survey of Program Directors

Background and ObjectiveThe role of a hospitalist differs in a community hospital (CH) compared to a university/children's hospital. Residents are required to practice in a variety of relevant clinical settings, but little is known about current trends regarding pediatric resident training in different hospital settings. This study explores CH rotations including their value for resident training, characteristics, benefits, and drawbacks. This study also seeks to define “community hospital.”MethodsAuthors conducted an online cross-sectional survey of pediatric residency program directors distributed by the Association of Pediatric Program Directors. The survey was developed and revised based on review of the literature and iterative input from experts in pediatric resident training and CH medicine. It assessed residency program demographics, availability of CH rotations, value of CH rotations, and their characteristics including benefits and drawbacks.ResultsResponse rate was 56%. CH rotations were required at 24% of residency programs, available as an elective at 46% of programs, and unavailable at 48% of programs. Residency program directors viewed these rotations as valuable for resident training. CH rotations were found to have multiple benefits and drawbacks. Definitions of “community hospital” varied and can be categorized according to positive or negative characteristics.ConclusionsResident rotations at a CH provide valuable learning opportunities with multiple potential benefits that should be weighed against drawbacks in the context of a residency program's curriculum. There are many characteristics that potentially distinguish CH from university/children's hospitals.     

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.     

The fellowship in pediatric neurosurgery.

Subspecialty training in pediatric neurosurgery has been a widely discussed topic over the past several years. This paper will discuss the rationale for subspecialization in neurosurgery, describe what makes pediatric neurosurgery unique as a subspecialty area of neurosurgery, and present a rationale for fellowship training in pediatric neurosurgery following the completion of a general residency in neurosurgery. The difference between fellowship and residency training is outlined, and the importance of integrating the fellowship with the neurosurgical training program is emphasized. Controversies regarding structure of the pediatric neurosurgical fellowship, 'certification' of the fellowship training, and issues of supply and demand are reviewed.     

Pediatric resident education about medical errors.

BACKGROUND: National organizations have called for patient safety curricula to help reduce the incidence of errors. Little is known about what trainees are taught about medical errors. OBJECTIVE: 1) To determine the amount and type of training that pediatric residents have about medical errors and 2) to assess pediatric chief resident knowledge about medical errors. METHODS: We surveyed chief residents from a national sample of 51 pediatric training programs by selecting every fourth program from the American Council on Graduate Medical Education list of accredited programs. The 21-item telephone survey was developed with patient safety specialists and piloted on several chief residents. It asked about patient-safety training sessions and awareness and knowledge about medical errors. RESULTS: The 51 chief residents helped teach 2176 residents, approximately one third of all pediatric residents. One third of programs had no lectures about medical errors and 23% did not have morbidity and mortality rounds. Sixty-one percent of respondents stated that outpatient medical errors were rarely discussed. Informal teaching was most often reported as the primary method for educating residents about medical errors. Although 58% of respondents did not know that a systemic change should be made in response to a medical error, 83% felt that residents are adequately trained to deal with a medical error. DISCUSSION: Pediatric resident education about medical errors varies widely. Attention by pediatric residency training programs to this important issue seems limited.     

The training of pediatric residents in the care of acutely ill and injured children

OBJECTIVES: To describe the current educational experience of pediatric residents in pediatric emergency care, to identify areas of variability between residency programs, and to distinguish areas in need of further improvement. DESIGN: A 63-item survey mailed to all accredited pediatric residency training program directors in the United States and Puerto Rico. SETTING AND PARTICIPANTS: Pediatric residency programs and their directors. MAIN OUTCOME MEASURES: Primary training settings, required and elective rotations related to the care of the acutely ill and injured child, supervision of care, procedural and technical training, and didactic curriculum in pediatric emergency medicine (PEM). RESULTS: One hundred fifty-three (72%) of 213 residency programs responded. One hundred nine (71%) were based at general or university hospitals, the remaining 44 (29%) were based at freestanding children's hospitals. Residents most commonly saw patients in pediatric emergency departments (54%), followed by acute care clinics (21%), general emergency departments (21%), and urgent care clinics (5%). The mean number of weeks of PEM training required was 11, but varied widely from 0 to 36 weeks. Forty programs (27%) required their residents to spend 4 or fewer weeks rotating in an emergency department setting. The best predictor of the number of weeks spent in emergency medicine was residency program size, with small programs requiring fewer weeks (7 weeks for small [1-8 postgraduate year 1 residents] vs 13 for medium [9-17 postgraduate year 1 residents] vs 15 for large [> or =18 postgraduate year 1 residents]). Pediatric surgery (18%), orthopedic (8%), anesthesia (6%), and toxicology (4%) rotations were rarely required. Ninety-two percent of the programs had 24-hour on-site attending physician coverage of the emergency department. Supervising physicians varied widely in their training and included PEM attendings and fellows, general emergency medicine attendings, and general pediatric attendings. Small programs were less likely to have PEM coverage (57% at small vs 95% at large) and more likely to have general emergency medicine coverage (79% at small vs 29% at large). Reported opportunities to perform procedures were uniformly high and did not differ by program size or affiliated fellowship. Residency program directors were uniformly confident in their residents' training in medical resuscitation, critical care, emergency care, airway management, and minor trauma. Thirty-seven percent of all respondents were not confident in their residents' training in major trauma. Most programs reported that they had a didactic PEM curriculum (77%), although the number of hours devoted to the lectures varied substantially. CONCLUSIONS: Wide variability exists in the amount of time devoted to emergency medicine within pediatric residency training curricula and in the training background of attendings used to supervise patient care and resident education. Nevertheless, pediatric residency training programs directors feel confident in their residents training in most topics related to PEM. Residents' training in major trauma resuscitation was the most frequently cited deficiency.     

Leadership Training in Pediatric Residency Programs: Identifying Content,Characterizing Practice,and Planning for the Future

ObjectivePhysicians serve as leaders in varying roles, but often with minimal dedicated training. Existing pediatric residency competencies may not completely describe all leadership skills that should be valued. We sought to identify a set of high-value leadership skills and evaluate current training in these skills in pediatric residency programs.MethodsA modified Delphi process was used to inform a national survey of pediatric residency program directors. Programs were asked to rate the perceived importance of identified leadership skills and the presence of dedicated teaching. Skills identified as extremely or quite important by ≥90% of respondents were classified as high-value.ResultsOur modified Delphi process generated 16 core leadership skills to evaluate. A total of 67/204 residency programs responded. Six skills were identified as high-value: managing time effectively, receiving feedback, communicating effectively through speaking, embodying professionalism, demonstrating emotional intelligence, and addressing conflict. Only 19% of responding programs reported providing dedicated teaching time for all high-value skills.ConclusionsDespite a high degree of national agreement among program directors about the importance of specific leadership skills, few pediatric residency programs dedicate time to teaching residents about these skills. The identified high-value leadership skills could help to inform future educational efforts.     

Teaching about schools during pediatric residency.

OBJECTIVE: Several published guidelines have suggested that primary care pediatricians include school issues as part of regular health supervision visits. Few residency training programs include systematic education about educational issues that affect children's lives and success in school. The goal of this study was to evaluate a short curriculum on Children In School that was included as part of the 2-month required rotation in developmental-behavioral pediatrics. METHODS: A questionnaire was designed to assess 1) pediatric residents' attitudes about the importance of making school issues part of their practice, 2) pediatric residents' self-perceived knowledge about central concepts, and 3) pediatric residents' self-perceived skills.Participants.-Twenty-one of the 22 pediatric residents in 1 training program completed the questionnaire at the beginning of their first residency year and again during the final 3 months of their third (last) year. RESULTS: Residents assessed that their knowledge and skills relating to children in school were increased consistently (P < .001). Because they considered pediatricians' responsibilities to help improve children's school success to be important even before the program, there was little opportunity for improvement in ratings of "importance" over time. CONCLUSIONS: A relatively short teaching module introduced in the context of the developmental-behavioral pediatrics rotation can improve residents' self-assessed skills and knowledge about children in school.     

Ten years of graduates evaluate a pediatric residency program

Ten years of graduates (1979 through 1988) from a pediatric residency program with a primary care track were surveyed for their perceived level of comfort gained in training for 28 different content/specialty areas of pediatrics and for their recommendations for increasing emphasis/time during residency for these areas. The response rate was 73%. The highest levels of comfort and fewest recommendations for increasing emphasis were for neonatal problems and health maintenance. The lowest perceived comfort levels and the most recommendations for increasing emphasis were for economics of pediatric practice and sports medicine/orthopedics. Graduates from the primary care track of the pediatric residency program expressed more comfort than did regular track graduates for some, but not all, areas of pediatrics emphasized in the primary care track program. Graduates of the first 5 years of study were not as comfortable with their training overall as were graduates from the most recent 5 years. This survey method and its results can provide useful information to medical educators faced with evaluation and revision of pediatric residency training programs.     

Demographic features and attitudes of program directors of combined internal medicine and pediatrics residencies

Combined residency training in internal medicine and pediatrics has proliferated greatly in the last ten years. This survey of program directors (N = 55) of such residency programs reports their personal and professional demographic characteristics as well as their perceptions about aspects of combined training. The directors were more often affiliated with Internal medicine (33 directors [60%]), 47 (85%) were men, their mean age was 44 years, they had been out of medical school for a mean of 19 years, the mean time served as program director was 2.6 years, and 32 (58%) had completed a fellowship. The programs had existed for an average of 4.2 years, the mean entering class size was 2.8 persons, and the mean number of graduates per program was 4.2. We report directors' perceptions of why students choose combined training, why the programs have proliferated, and how these residents differ from family medicine residents. We comment on curriculum design and the goals of combined internal medicine-pediatrics residency training programs.     

How are pediatric training programs preparing residents for practice?

The majority of pediatric residents continue to choose a career in practice on completion of their training. Despite knowing residents' career preferences, many training programs have focused on inpatient tertiary care at the expense of primary care. Perhaps this reflects service needs and the significant technology and extensive information resulting in the growth of pediatric subspecialties. To determine the spectrum of didactic and clinical experiences pediatric training programs offer residents to prepare them for managing a practice, we conducted a survey of pediatric training program directors in 1988. Although the majority of residency programs have a practice management curriculum, the number of hours devoted to this area is minimal. In addition, a significant number of residents are not experiencing a community office rotation. This survey indicates the need to develop a practice management curriculum if trainees are to be prepared for choosing the right career and for being competitive in practice.     

Telemedicine in Pediatric Training: A National Needs Assessment of the Current State of Telemedicine Education in Pediatric Training

PurposeTo describe the current state of telemedicine within pediatric training programs to inform development of a national telemedicine training curriculum for pediatric trainees.MethodsWe conducted an anonymous cross-sectional survey of pediatric residency (Fall 2020) and fellowship program directors (Spring 2021) on their current telemedicine practices in pediatric post-graduate training.ResultsForty-eight US pediatric residency programs (n = 48/198, 24%) and 422 fellowship programs completed the survey (n = 422/872, 48%); combined response rate 44% (n = 470/1070). Pre-COVID-19, 12% (n = 57/470) of programs surveyed reported using telemedicine in their training program, but during the pandemic 71% (n = 334/470) reported telemedicine use with trainees. Over 71% (n = 334/470) agreed that a formalized curriculum is important, yet 69% (n = 262/380) of programs reporting telemedicine use either did not have a curriculum or were unsure if one existed at their program. Respondents who were unsure/not likely to add a telemedicine curriculum and/or indicated that a telemedicine curriculum would not be important (52% n = 243/470), cited “time” (55%, n = 136/243) most frequently as a barrier.ConclusionsOur needs assessment indicates marked increase in use of telemedicine with trainees by respondent pediatric training programs, with fewer than 50% reporting a formalized training curriculum and most agreeing that a curriculum is important.     

The Development of a Pediatric Osteopathic Recognition Track

It is clear that graduates of osteopathic medical schools desire to maintain their Osteopathic Manipulative Medicine (OMM) and Osteopathic Principles and Practice (OPP) skills and mindset of their professional identity. In a recent survey, 68% of 1,523 third year osteopathic medical students indicated that it would be more appealing to attend a residency with osteopathic recognition, with more than half indicating this would play an important role in how they made their rank list. There are currently few options available to DO students that would like to maintain their OMM and OPP skills during pediatric residency programs, and with an increasing number of DO graduates each year, there may be a need to provide more opportunities for them. In this article we describe our pediatric Osteopathic Recognition Track, which has the goal of providing an appropriate level of osteopathic focused training to our small number of residents in the track (4 annually) while incorporating them fully into a large and very busy pediatric program. We use Bloom's taxonomy as the framework upon which to provide details about our approach.     

The pediatric program director. An analysis of the role and its problems

A questionnaire designed to elicit information about the work environment, knowledge, and stresses of pediatric residency program directors was mailed to the 235 member programs of the Association of Pediatric Program Directors (APPD). At the time that the 187 respondents (80% return rate) assumed responsibility for their training programs, many rated their knowledge of various aspects of residency program administration as "poor." The respondents indicated that a lack of time, the pressures of too many other academic responsibilities, and a fear of not "filling" all positions in the National Intern Matching Program created much personal stress. Most program directors felt that educational conferences designed to teach educational methods, and administrative skills, and provide technical information knowledge necessary for residency program supervision would be beneficial.     

The Pediatric Match Frenzy: An Overview and an Approach for Mentoring Medical Students

Applying for a pediatric residency position has become an increasingly stressful event and recently medical educators have described it as a “Match Frenzy.” Match statistics demonstrate increased competition for pediatric residency positions and a record number of applications. Faculty who mentor medical students are now challenged to counsel them through the intensified process and pediatric residency programs are now forced to navigate the rising number of applications. We define the Match Frenzy and its implications, review historical and current match statistics, and describe a data-driven approach to the problem. Through mitigating the frenzy surrounding this process, we can help students and residency programs better allocate their precious resources.     

Proposal for an administrative curriculum in pediatric emergency medicine fellowship training.

Administrative tasks make up a significant component of the practice of pediatric emergency medicine (PEM) physicians. Our survey of 10 academic pediatric emergency departments revealed that PEM physicians who are primarily clinical spent an average of 15% of their time on administrative tasks, and PEM physicians whose positions are administrative as well as clinical spent 30 to 60% of their time on administrative tasks. Of the 101 programs responding to our survey of 220 pediatric residency programs, 80% did not address hospital administrative issues, and many that did address these issues allowed these topics only one hour of presentation time per year. It is clear that there is a discrepancy between the demands placed upon PEM physicians to perform administrative tasks and the sparse or nonexistent opportunities for learning about administrative issues during residency training. It is incumbent upon pediatric emergency fellowship programs to provide an inclusive and well-structured administrative curriculum for their trainees. This article suggests a framework for such a curriculum.     

Community pediatrics: a consistent focus in residency training from 2002 to 2005.

OBJECTIVE: To assess changes in community pediatrics training from 2002 to 2005. METHODS: Pediatric residency program directors were surveyed in 2002 and 2005 to assess resident training experiences in community pediatrics. Program directors reported on the following: provision of training in community settings; inclusion of didactic and practical teaching on community health topics; resident involvement in legislative, advocacy, and community-based research activities; and emphasis placed on specific resources and training during resident recruitment. Cross-sectional and matched-pair analyses were conducted. RESULTS: A total of 168 program directors participated in 2002 (81% response rate), and 161 participated in 2005 (79% response rate). In both years, more than 50% of programs required resident involvement with schools, child care centers, and child protection teams. Compared with 2002, in 2005, more programs included didactic training on legislative advocacy (69% vs 53%, P < .01) and offered a practical experience in this area (53% vs 40%, P < .05). In 2005, program directors reported greater resident involvement in providing legislative testimony (P < .05), and greater emphasis was placed on child advocacy training during resident recruitment (P < .01). CONCLUSIONS: In the last several years, there has been a consistent focus on legislative activities and child advocacy in pediatric residency programs. These findings suggest a strong perceived value of these activities and should inform efforts to rethink the content of general pediatric residency training in the future.     

Teaching residents about development and behavior: meeting the new challenge.

OBJECTIVE: To determine the teaching methods, materials currently used, and unmet needs for teaching developmental-behavioral pediatrics (DBP) at pediatric training programs in the United States. DESIGN: Cross-sectional survey of US pediatric residency training programs. The survey questionnaire consisted of 3 instruments: a program director survey, a developmental-behavioral pediatrics survey, and an adolescent medicine survey. PARTICIPANTS: Survey packets were mailed in January 1997 to 211 programs identified by mailing labels from the Association of Pediatric Program Directors. RESULTS: Data from 148 programs (70%) completing both the DBP survey and program director survey were analyzed. Ninety-five percent of programs reported a block rotation, and 95% of those stated that the rotation was mandatory. Eighty-seven percent had a formal curriculum. Most programs reported using articles, lecture outlines, and precepting for teaching DBP. Few programs used standardized case-based or computerized materials. Most programs, however, indicated a desire for these materials. Few programs felt that 4 topics were covered adequately: adoption (12%), violence (24%), substance use (28%), and conduct problems (41%). Programs that perceived that they covered these topics adequately were more likely to use written cases as part of their curriculum (Mann-Whitney test, 1373.5; P=.04). Barriers to teaching included lack of adequate faculty, time, money, and curricular resources. CONCLUSIONS: Pediatric residency programs have made significant gains in mandatory DBP training. However, many programs report a lack of adequate faculty, teaching materials, and methods. Responding programs indicated an interest in case-based materials. This approach may represent an alternative and underutilized resource for teaching DBP.