Improvement of cardiac auscultation skills in pediatric residents with training

Cardiac murmurs, most of which are harmless, are present in more than 50% of children. Good auscultation skills are required to prevent unnecessary referrals. The auscultation skills of a group of 21 pediatric residents were assessed. Based on their identification of key features such as S1, S2, timing, grade, location, quality of the murmur, and any extra sounds, residents were asked to make a clinical diagnosis. The overall diagnostic accuracy for all residents was 30% and improved with years of training. The average score for correctly identified key features was 46% with no significant improvement with year of training. Residents who had completed a cardiology rotation scored better than the others (41% vs 18% for correct diagnosis). Clinical auscultation skills of pediatric residents in our institution showed significant improvement with training, especially in the ability to recognize a harmless heart murmur.     

Teaching practice management skills to pediatric residents

To satisfy the core competencies required by the Pediatric Residency Review Committee, the author describes an educational program for the residents in a large pediatric training program. The course provides a year-long overview of multiple medical management topics. The sessions cover nonclinical subjects usually missed in other educational settings, with particular focus on areas of finance, compliance, personnel management, career advancement, and leadership. The series is currently in its third year, with a positive response from the participants, and demonstrated improvement in resident knowledge of the covered areas.     

A comparison of the radiographic interpretation skills of pediatric transport nurses and pediatric residents

OBJECTIVE: To compare the radiograph interpretation skills of pediatric/neonatal transport nurses to those of 3rd-year pediatric residents. DESIGN: A validation study of radiograph interpretation. METHODS: Twelve pediatric transport nurses and nine senior pediatric residents were asked to interpret 20 radiographs or sets of radiographs. These films had been previously selected and interpreted by a panel of pediatric radiologists. The subjects' interpretations were compared with those of the radiologists, and a score was assigned for each film or set of films. Five points were awarded for an interpretation in complete agreement with the radiologists' interpretation; 2.5 points were awarded for partial agreement. No points were awarded for complete disagreement. Subjects also answered questions about prior training and experience in radiograph interpretation. RESULTS: The 3rd-year residents' mean score was 66.34 (range 57.5-82.5), while the nurses had a mean score of 33.75 (range 17.5-47.5). This difference was significant (P < 0.001). The residents had a mean of 133.33 of formal radiology instruction, while the nurses had less than 10 hours of instruction. The nurses had received focused training in the identification of pneumothoraces. The nurses had higher mean scores than the residents on the two sets of films demonstrating pneumothoraces, but this difference was not significant. CONCLUSIONS: The 3rd-year residents had significantly higher mean scores on a test of radiograph interpretation. The major difference between the groups appears to be the amount of formal training afforded the residents. The nurses' performance on the films demonstrating pneumothoraces suggests that focused training may be an effective means by which to gain skills important to transport.     

Adolescent medicine: attitudes and skills of pediatric and medical residents

Adolescents receive care from different specialists whose training may affect the quality of care. To measure possible effects, all 80 level 1 and 3 pediatric and medical residents at one institution completed a questionnaire that asked if they planned to care for adolescents and determined their attitudes and skills for 30 relevant tasks. The mean age chosen for transfer of care from a pediatrician to an internist was 18.7 years by the pediatric residents and 16.6 years by the medical residents (P = .00001). Skill in obtaining histories; staging puberty; screening for scoliosis; performing pelvic examinations; diagnosing delayed puberty, psychiatric disorders, or learning disabilities; immunizing; and treating knee and hip pain more often were thought to be important by pediatric residents (88% to 100%) than by medical residents (40% to 75%) (P less than .02). More than 70% of PL-3 but fewer than 50% of ML-3 residents rated themselves skilled for these tasks (P less than .05). Fewer than 60% of each resident group rated themselves skilled in contraception. Both groups rated themselves underskilled in adolescent history-taking; counseling; evaluation of psychopathology; and treatment of dysmenorrhea and hypertension. In both groups, the decision to care for an adolescent was negatively influenced by the presence of a psychosocial disorder. In conclusion, both pediatric and medical residents plan to care for adolescents, and both recognize deficiencies in their training. Pediatric residents, however, are more confident of their skills in adolescent care than are medical residents.     

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.     

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.     

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.     

Technical skills required in general pediatric practice.

Several years ago the American Board of Pediatrics developed a list of 101 technical procedures, which was sent to directors of accredited pediatric programs (N = 231). There was a 70% response and 72 of 101 procedures were considered necessary for residents to develop competency by at least 80% of the program directors. The list of 72 procedures was then sent to 500 randomly selected general pediatricians from a pool size of 10,304. The response rate was 35%. Forty-nine of the 72 procedures were considered necessary by 80% of those responding and one third of the skills (24 of 72) could be classified as absolutely necessary because more than 95% of practitioners considered them to be. Only 7 procedural skills were considered unnecessary by more than 50% of practitioners. It is suggested that program directors consider the 24 skills as ones that should be taught and competence in performing them be verified and recorded.