Pediatric residency training: ten years after the Task Force report.

A sample of 3000 pediatricians who had completed their residency training in 1978 or later were surveyed regarding the perception of the adequacy of their residency training in specific aspects of pediatric practice and in a number of subspecialty areas. The survey was almost identical with the one that formed the basis for the American Academy of Pediatrics Task Force on Pediatric Education report in 1978. The results revealed relatively little change in the high rates of perceived "insufficient training" in all the areas of pediatrics described as "underemphasized" in the Task Force report. However, those residents who received their training during the second half of the 10 years since the Task Force survey reported significant improvement in the previously underemphasized areas of developmental and behavioral pediatrics and adolescent medicine. Results also revealed a significant increase in the number of pediatricians who identify either a subspecialty interest or subspecialty practice in developmental or behavioral pediatrics. The increase in pediatric subspecialists and the improved training experience since 1984 indicate that the Task Force report may have had a positive impact on residency training in developmental and behavioral pediatrics.     

A nationwide survey of behavioral pediatric residency training

This survey assessed the prevalence of behavioral pediatric residency training in the U.S., the professional background of faculty, training methods utilized, curriculum content, and barriers to expansion of behavioral training. Questionnaires were returned by 60% of 246 accredited pediatric residency programs; of these, 49% had a "formal" behavioral training program, 38% offered some training, and 13% offered none. Formal programs identified 419 faculty members involved in teaching behavioral pediatrics to residents: physicians (48%), psychologists (21%), social workers (19%), nurses (8%), other (4%). Mandatory training was more frequent than elective training; continuous training was more likely than block rotations to be mandatory. "Inadequate funding" and "lack of appropriately trained faculty" were most frequently cited as barriers to expansion of the teaching of behavioral pediatrics.     

Resident training in pediatric critical care transport medicine: a survey of pediatric residency programs

OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) Program Requirement for Pediatrics includes specific objectives that pediatric residents participate in both the pre-hospital care of acutely ill or injured patients and the stabilization and transport of patients to critical care areas. Previously, residents were often included as the physician component for many pediatric critical care transport teams. Subsequent regionalization of transport services and development of nurse-only transport teams prompted us to determine the current level of resident participation in pediatric critical care transport as well as how individual residency programs were meeting the educational objectives. METHODS: A questionnaire was mailed to each pediatric residency program listed in the 1996-1997 GME Directory. Information was obtained regarding the size of the hospital and the residency program, the presence of a pediatric critical care transport team, the number of annual transports, and transport team leader. In addition, the use of pediatric residents for transports was ascertained, as well as their specific role, training requirements, and method of evaluation. RESULTS: Data were received from 138 programs for a return rate of 65%. Eighty percent of programs offered a pediatric critical care transport service. Nurse-led teams were used for 51% of NICU and 44% of PICU transports. Of the 82 NICU and 84 PICU teams that used residents, the majority used them as team leaders (60% and 70%; respectively) with only the minority requiring that they be at the PL-3 year or greater. The training and/or certification required for resident participation in transports varied among programs, with 85% requiring completion of a NICU or PICU rotation, and 94% requiring NRP or PALS certification. Programs that did not allow resident participation provided exposure to Transport Medicine by various mechanisms, including lectures and emergency department (ED) rotations. CONCLUSION: Pediatric resident participation in critical care transport varies widely among pediatric critical care transport teams. The degree to which residents participate in the transport team would appear to have diminished in comparison to previous studies. Transport teams often use other resources, such as nurses, fellows, or attendings, to lead their transport teams. Pediatric resident exposure to and participation in Transport Medicine varies among programs, as do the methods used to prepare residents for their experience.     

Pediatric resident training in telephone management: a survey of training programs in the United States

Although practicing pediatricians spend a major portion of each day in the management of acute illness via telephone, information concerning instructional programs in telephone management is scanty. A 34-item questionnaire was mailed to the 242 program directors of US training programs to obtain information on how telephone calls are handled in pediatric training programs and how pediatric house officers are trained in telephone management. Fifty-five percent of programs have a formalized system for handling telephone calls. One half of programs have a policy on who can answer telephone calls; 11% stated that only physicians are permitted to handle calls. Residents handle an average of 19 calls per day (39% of the total calls received). Only 51% of programs document any telephone calls and only 19% document all calls. Despite the volume of calls handled by pediatric residents, only 45% of training programs offer specific training in telephone management. The most common instructional method is lecturing. Less than one third of programs have a review system or periodically audit telephone calls. Programs that offer resident training in telephone management are significantly more likely to have a system for handling calls, to document calls, and to have a review system.     

Pediatric radiologist-driven didactics for a pediatric residency program: a quality initiative

Background

Pediatric residents exhibit knowledge gaps in appropriateness of imaging utilization.

Objective

This study evaluates the value of radiologist-driven imaging education in a pediatric residency program. The primary goals of this educational program were to provide pediatric residents with resources such as the American College of Radiology Appropriateness Criteria, support optimal resource utilization and patient care, increase resident understanding of radiation risk, and determine the value of integrating radiologists into pediatric education.

Materials and methods

A needs assessment was performed in which the chief residents of a large pediatric program were surveyed. The consensus of chief residents was that a four-part lecture series delivered by a pediatric radiology fellow would be beneficial to the pediatric residents. Topics included general radiation risk as well as basic imaging topics in the chest, abdomen, neurological system, extremities and vasculature. Each lecture integrated appropriate ordering, ALARA (As Low As Reasonably Achievable)/Image Gently, and basic image interpretation. Residents were asked, using a Likert scale, to rate their understanding of radiation risk, the ACR Appropriateness Criteria, and other topics of interest before and after each lecture. Pediatric residents were given a 10-item quiz before and after the lecture series to assess their knowledge regarding the best test to order in clinical scenarios.

Results

The average pre-lecture score for knowledge of radiation risk was 3.27 (95% confidence interval [CI]: 3.02–3.51) out of 5, which improved to 4.27 (95% CI: 4.09–4.57) post-lecture. There was an increase in understanding of ACR appropriateness, with pre-lecture rating of knowledge increasing from 1.91 (95% CI 1.54–2.29) out of 5 to 3.61 (95% CI 3.33–3.90) post-lecture. The residents averaged 82.7% (95% CI 77.3%–88.1%) on the appropriateness pre-test and 93.8% (95% CI 90.3%–97.2%) on the post-test. Residents provided positive feedback upon conclusion of the program and reported a beneficial effect on their education.

Conclusion

A radiologist-driven lecture series in a pediatric residency can improve resident understanding of appropriate ordering practices and radiation risk. Radiologist participation in pediatric residency training is well-received.

     

Pain relief for neonatal circumcision: a follow-up of residency training practices.

OBJECTIVE: To assess current training practices regarding the provision of effective analgesia for routine newborn circumcision. METHODS: All family practice (FP), obstetric and gynecologic (OB/GYN), and pediatric (PED) residency program directors in the United States received a mailed survey in 2003 (N = 940). RESULTS: Survey responses were received from 86% (811/940) of the programs (FP 88%, OB/GYN 82%, and PED 87%). Eighty-two percent (669/811) of all programs surveyed taught circumcision (FP 95%, OB/GYN 89%, and PED 49%). Of programs that taught circumcision, 97% (648/669) taught the administration of an anesthetic, either locally or topically. This proportion is significantly higher than that reported in 1998 (71%, 374/527; P < .001). However, of these same programs that taught circumcision, the anesthetic techniques were used frequently or always in only 84%. CONCLUSIONS: The percentage of training programs that teach effective analgesia for neonatal circumcision increased dramatically since the time of the previous data collection. Despite this improvement in teaching practices, some training programs may not consistently use effective analgesia for neonatal circumcision.     

Pediatric emergency medicine fellowships: a survey

A survey of 24 existing pediatric emergency medicine fellowship programs as of December 1987 was conducted in order to characterize the following attributes of training in pediatric emergency medicine: amount of clinical time, required and elective rotations, didactic and research experience, patient volume, and staffing. Time spent in the emergency department varies between three and 10 months annually, with a mean of 34.5 hours per week. Twenty-two (92%) of the programs have required rotations. All responding programs require research and some degree of didactic education. Patient volume varies between 20,000 and 70,000, with a median of 41,000. The data offered should act as a reference for the further development of new and existing programs.     

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.     

A statewide survey of domestic violence screening behaviors among pediatricians and family physicians

OBJECTIVE: To assess rates of previous domestic violence (DV) training, current screening practices, and barriers to screening among Connecticut pediatric primary care physicians. DESIGN: Self-administered mail survey. SETTING: State of Connecticut. PARTICIPANTS: Pediatricians and pediatric care-providing family practice physicians (N = 903). RESULTS: The response rate was 49% (n = 438). The demographic characteristics of the response sample were as follows: 70% male, 76% older than 40 years, 84% white, 87% in private practice, and 64% in suburban practice. Only 12% of the physicians reported routinely screening for DV at all well-child care visits, 61% reported screening only selective patients, and 30% said they did not screen for DV at all. Sixteen percent of the physicians reported having an office protocol for dealing with victims of DV. Respondents practicing in an urban setting were significantly more likely to screen routinely for DV than those practicing in a suburban setting (odds ratio, 1.77; 95% confidence interval, 1.12-2.79). Prior DV training was the strongest predictor of routine screening (odds ratio, 5.17; 95% confidence interval, 3.13-8.56). In fact, respondents with previous training made up 64% of those who routinely screened for DV. CONCLUSIONS: Only a minority of Connecticut pediatric care physicians routinely screen mothers for DV. Primary care physicians with education and training about DV are screening at higher rates than physicians with no education and training. Pediatric physicians need training, protocols, and best-practice models on how to identify and intervene with families experiencing DV.