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.     

Design,Validity, and Reliability of a Pediatric Resident JumpSTART Disaster Triage Scoring Instrument

ObjectiveTo design an instrument for scoring residents learning pediatric disaster triage (PDT), and to test the validity and reliability of the instrument.MethodsWe designed a checklist-based scoring instrument including PDT knowledge and skills and performance, as well as a global assessment. Learners' performance in a 10-patient school bus crash simulation was video recorded and scored with the instrument. Learners triaged the patients with a color-coded algorithm (JumpSTART, Simple Triage and Rapid Treatment). Three evaluators observed the recordings and scored triage performance for each learner. Internal and construct validity of the instrument were established via comparison of resident performance by postgraduate year (PGY) and correlating instrument items with overall score. Validity was assessed with analysis of variance and the D statistic. We calculated evaluators' intraclass correlation coefficient (ICC) for each patient, skill, triage decision, and global assessment.ResultsThere were 37 learners and 111 observations. There was no difference in total scores by PGY (P = .77), establishing internal validity. Regarding construct validity, most instrument items had a D statistic of >0.5. The overall ICC among scores was 0.83 (95% confidence interval [CI] 0.74–0.89). Individual patient score reliability was high and was greatest among patients with head injury (ICC 0.86; 95% CI 0.79–0.91). Reliability was low for an ambulatory patient (ICC 0.29; 95% CI 0.07–0.48). Triage skills evaluation showed excellent reliability, including airway management (ICC 0.91; 95% CI 0.86–0.94) and triage speed (ICC 0.81; 95% CI 0.72–0.88). The global assessment had moderate reliability for skills (ICC 0.63; 95% CI 0.47–0.75) and knowledge (ICC 0.64; 95% CI 0.49–0.76).ConclusionsWe report the validity and reliability testing of a PDT-scoring instrument. Validity was confirmed with no performance differential by PGY. Reliability of the scoring instrument for most patient-level triage, knowledge, and specific skills was high.     

Associations Between Prenatal Food Insecurity and Prematurity,Pediatric Health Care Utilization,and Postnatal Social Needs

ObjectiveChildhood food insecurity endangers child development and health outcomes. Food insecurity will grow increasingly common in the economic wake of the coronavirus pandemic and prenatal care represents an early, clinical opportunity to identify families at risk. However, longitudinal relationships between clinically-identified prenatal food insecurity and prematurity, pediatric health care utilization, and postnatal social needs have not been described.MethodsWe examined longitudinal data from mother-child dyads who received prenatal and pediatric care and social needs screening at a large academically-affiliated safety net medical center between October 2018 and July 2019. Associations among household food insecurity and premature birth, pediatric inpatient and outpatient utilization, missed immunizations, and postnatal social needs were estimated using adjusted regression.ResultsAmong the 268 mothers, those who experienced prenatal household food insecurity had 3 times higher odds of having a child born prematurely (95% confidence interval [CI] 1.0–8.9, P = .05) and had children with higher inpatient hospitalizations (incidence rate ratio [IRR] 2.4, 95% CI 1.0–5.6, P = .04) and missed immunizations (IRR 3.4, 95% CI 1.1–10.3, P = .03) in the first 6 months of the child's life. These mothers also had higher odds of having any social needs in the pediatric setting (odds ratio 3.4; 95% CI 1.5–8.0, P = .004).ConclusionsPrenatal household food insecurity was linked to future adverse perinatal and pediatric outcomes in low-income mother-child dyads. Food insecurity identifies children at social and medical risk, providing an early clinical opportunity to intervene.     

Lack of Preparedness for Pediatric to Adult-Oriented Health Care Transition in Hospitalized Adolescents and Young Adults

Objective

We examined the self-reported preparedness of hospitalized adolescents and young adults (AYA) for transition from pediatric to adult-oriented health care with regard to: 1) previous health care transition (HCT) preparation, 2) Self-Determination Theory (SDT) constructs of health self-management autonomy and competence, and 3) their perception of medical knowledge, attitudes, and concerns.

Addressing the Social Needs of Spanish- and English-Speaking Families in Pediatric Primary Care

ObjectiveTo describe the social needs of families working with Health Leads (HL) at 18 pediatric practices in 9 US cities and how reported social needs and success addressing them varied according to parents’ preferred health care language.MethodsWe evaluated the social needs of English and Spanish speakers who received assistance from HL from September 2013 to August 2015. The study sample included 11,661 households in the 4 regions where HL provided support within pediatric primary care practices. We used multivariable regression stratified by region to assess the association between language and successful resource connections.ResultsReported social needs differed by language. Spanish speakers most frequently reported needs related to food (eg, food stamps, Special Supplemental Nutrition Program for Women, Infants, and Children, and food pantries). English speakers most frequently reported child-related needs (eg, childcare vouchers, Head Start, and school enrollment). The association between household language and the odds of a successful resource connection varied by region.ConclusionsOur findings highlight the importance of considering language barriers and community context when addressing unmet social needs as part of primary care.     

Pediatric Cardiology Boot Camp: Description and Evaluation of a Novel Intensive Training Program for Pediatric Cardiology Trainees

The transition from residency to subspecialty fellowship in a procedurally driven field such as pediatric cardiology is challenging for trainees. We describe and assess the educational value of a pediatric cardiology “boot camp” educational tool designed to help prepare trainees for cardiology fellowship. A two-day intensive training program was provided for pediatric cardiology fellows in July 2015 at a large fellowship training program. Hands-on experiences and simulations were provided in: anatomy, auscultation, echocardiography, catheterization, cardiovascular intensive care (CVICU), electrophysiology (EP), heart failure, and cardiac surgery. Knowledge-based exams as well as surveys were completed by each participant pre-training and post-training. Pre- and post-exam results were compared via paired t tests, and survey results were compared via Wilcoxon rank sum. A total of eight participants were included. After boot camp, there was a significant improvement between pre- and post-exam scores (PRE 54 ± 9 % vs. POST 85 ± 8 %; p ≤ 0.001). On pre-training survey, the most common concerns about starting fellowship included: CVICU emergencies, technical aspects of the catheterization/EP labs, using temporary and permanent pacemakers/implantable cardiac defibrillators (ICDs), and ECG interpretation. Comparing pre- and post-surveys, there was a statistically significant improvement in the participants comfort level in 33 of 36 (92 %) areas of assessment. All participants (8/8, 100 %) strongly agreed that the boot camp was a valuable learning experience and helped to alleviate anxieties about the start of fellowship. A pediatric cardiology boot camp experience at the start of cardiology fellowship can provide a strong foundation and serve as an educational springboard for pediatric cardiology fellows.     

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.     

Effectiveness of Communication Skills Training on Perceptions and Practice of Pediatric Residents

Objective  

To assess the effectiveness of a structured communication skills training workshop on the perceptions and practice of pediatric residents.