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Background/objectives: Children with chronic medical conditions (CCMC) have high rates of mental health (MH) conditions. This study examines associations between MH educational resources during fellowship and 3 dependent variables: fellows' interest, perceived responsibility, and self-reported competence in assessing MH concerns of CCMC., Methods: Subspecialty fellows taking the American Board of Pediatrics in-training examinations in February 2020 were invited to participate in a survey inquiring about MH educational resources. Logistic regression examined associations between MH educational resources and the 3 dependent variables, adjusting for demographics and program-level characteristics., Results: Of the 97.7% (4216) fellows who responded, 3870 were included in analyses. About 37.5% reported formal MH teaching sessions; 36.7% reported on-site MH professionals engaged in teaching; 41.6% reported co-assessing patients with MH specialists; and 28.3% reported performance evaluation of their MH skills. All 4 resources were significantly and positively associated with self-reported competence in adjusted analyses, with odds ratios (OR) ranging from 1.28 (95% confidence interval (95% CI): 1.03-1.58) for formal teaching sessions to 2.14 (95% CI: 1.73-2.65) for performance evaluation. Resources were positively associated with the dependent variables in a "dose-response" pattern. Respondents who reported having all 4 educational resources compared to zero resources had an OR of 2.20 (95% CI: 1.74-2.78) for high MH interest, 3.18 (95% CI: 2.45-4.12) for high perceived responsibility, and 4.38 (95% CI: 3.43-5.60) for high self-reported competence CONCLUSIONS: Access to mental health educational resources was associated with higher interest, perceived responsibility, and self-reported competence; investing in these resources may improve fellows' skills in addressing the emotional needs of CCMC., Competing Interests: Declaration of Competing Interest Although Drs Green and Leyenaar are paid consultants by the American Board of Pediatrics, this does not affect their objectivity. They were hired to perform rigorous research and the data collected and analyses performed objectively state the findings of these data., (Copyright © 2023 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: Determine extent of impact of coronavirus disease 2019 (COVID-19) pandemic on career choice and employment of pediatricians entering pediatric workforce., Methods: A national, cross-sectional electronic survey of pediatricians registering for the 2021 American Board of Pediatrics initial general certifying examination on the impact of the COVID-19 pandemic on 3 aspects of career (career choice, employment search, employment offers) was performed. Data were analyzed using descriptive statistics and multivariate logistic regression to determine factors associated with the pandemic's impact on career. Thematic analysis was used to generate themes for open-ended survey questions., Results: Over half (52.3%, 1767 of 3380) of pediatricians responded. Overall, 29.1% reported that the pandemic impacted their career (career choice [10.4%], employment search [15.6%], or employment offers [19.0%]); applicants to general pediatrics (GP) (52.9%) or pediatric hospitalist (PH) positions (49.3%) were most affected. Multivariate logistic regression modeling found those applying to GP (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 2.22-6.60), PH (OR: 9.02, 95% CI: 5.60-14.52), and International Medical Graduates (IMGs) (OR: 1.90; 95% CI: 1.39-2.59) most likely to experience any career impact., Conclusions: Almost one third of pediatricians registering for the initial general pediatrics certifying examination reported their careers were impacted by the COVID-19 pandemic, with 10% of respondents reporting the pandemic impacted their career choice. Half of new pediatricians seeking employment reported being impacted by the pandemic, particularly IMGs. As the pandemic evolves, career advising will continue to be critical to support trainees in their career choices and employment., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This national study identified the rotations in which pediatric residents received training in the assessment and treatment of behavioral/mental health (B/MH) problems, and examined associations between learning B/MH skills during multiple clinical rotations and resident-reported interest in B/MH issues., Methods: Cross-sectional survey of applicants for the initial American Board of Pediatrics certifying exam (62.4% response rate; 1555 eligible respondents). Respondents reported their overall interest in B/MH issues, and specified where they had received training in 7 B.M. assessment skills and 8 treatment skills. Logistic regression models were estimated to identify associations between learning B/MH assessment and treatment skills in multiple clinical rotations and resident-reported B/MH interest, adjusting for respondent characteristics., Results: Respondents reported continuity clinic as the predominant site of B/MH learning, followed by development-behavioral and adolescent rotations. Multisite learning varied across B/MH skills, ranging from 45.1 % (n = 678) for using rating scales to titrate medications to 82.1% (n = 1234) for eliciting parent concerns. 946 (63.2%) reported having overall interest in B/MH issues. Adjusting for respondent characteristics, learning the majority of B/MH skills in >1 rotation was associated with an increased odds of B/MH interest for both assessment and treatment domains (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] 1.16-1.83 for assessment skills and aOR = 1.36, 95% CI 1.09-1.69 for treatment skills)., Conclusions: The majority of residents report learning B/MH skills in continuity clinic, with substantial variation in the proportion learning these skills in more than one rotation. Teaching B/MH skills during multiple clinical rotations may enhance resident interest in B/MH care delivery for children., (Published by Elsevier Inc.)

Background/objective: Pediatric residents must demonstrate competence prior to graduation in Accreditation Council for Graduate Medical Education (ACGME) required procedures. Recent literature shows general pediatricians (GPeds) infrequently perform these procedures yet believe them important to learn. The purpose of this study was to determine why GPeds believe learning procedures was important, what barriers prevent them from developing and maintaining procedural skills, and what procedures they believe should be included in training., Methods: Fifty-one GPeds from the American Board of Pediatrics General Examination Committee and the central Ohio region participated in 30-minute semistructured recorded phone interviews that probed their use of procedures across training and current practice. Participants represented urban, suburban, and rural geographic regions and practiced in a variety of settings. We conducted a thematic analysis of transcribed interviews., Results: GPeds believed currently required ACGME procedures were crucial to learn for 5 reasons: 1) adaptation to change in practice type or location, 2) emergency preparedness, 3) counseling patients and families, 4) distance from a tertiary care center and specialists, and 5) professional identity as a pediatrician. Numerous barriers, particularly never learning the procedures, prevented GPeds from performing procedures in practice. Recommended procedures to be taught included high- (eg, circumcision), and low-risk (eg, cerumen removal, nasopharyngeal swabs, umbilical cauterization) skills., Conclusions: GPeds believed procedural training was important, however may never have learned certain procedures. These findings suggest that teaching methods should be adapted or customized procedural education should be implemented to ensure relevancy of skills learned for clinical practice., (Copyright © 2021 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: Explore pediatric residents' experiences and confidence with quality improvement (QI)., Methods: Pediatric residents were surveyed nationally in July 2017 about their demographic characteristics, experiences with QI projects over the previous year, and confidence with QI skills. Descriptive statistics and distributions of each individual demographic and QI variable, as well as training program size, were calculated for each variable. QI question responses were compared to demographic characteristics of the respondents, and chi-square statistics were calculated., Results: In total, 11,137 out of 11,304 (98.5%) residents completed the survey. Half of residents had participated in a QI project over the previous academic year, and 78% of third-year residents reported having done so. However, few of these residents self-reported moderate or high confidence in their ability to design a QI project (28.9%), use QI tools (23.1%), use QI methodologies (24.0%), or use data to track changes in their personal practice over time (28.9%). Residents in small or medium programs were statistically more likely to rate their confidence in certain QI abilities higher than those in large programs., Conclusions: Although recent pediatric residents appear to be participating in QI activities during training, their self-perception of their QI skills development remains low. Residents in small and medium programs provide more favorable reports., (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout., Methods: Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time., Results: In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22-0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22-0.36), or a job change (aOR, 0.48; 95% CI, 0.36-0.65)., Conclusions: Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians' jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout., (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: Children with medical complexity (CMC) account for disproportionate hospital utilization and adverse outcomes after discharge, and several gaps exist regarding the quality of hospital to home transitional care for this population. We conducted an expert elicitation process to identify important and feasible hospital to home transitional care interventions for CMC from the perspectives of parents and health care professionals., Methods: We conducted a 2-round electronic Delphi process to identify important and feasible transitional care interventions. Panelists included parents of CMC and multidisciplinary health care professionals. In the first round, panelists rated the importance and feasibility of 39 transitional care interventions on a 9-point Likert scale; agreement between panelists was defined according to RAND/UCLA Appropriateness Methods. The second round of data collection evaluated 16 interventions that panelists did not agree on in the first round and 8 new or revised interventions, accompanied by quantitative and qualitative data summaries., Results: A total of 29 parents of CMC and 37 health care professionals participated in the Delphi process (response rate 75%). Both stakeholder panels endorsed most interventions as important; health care professionals were less likely to rate several interventions as feasible compared with the parent panel. Over 2 rounds of data collection, the 2 stakeholder panels endorsed 25 interventions as important as well as feasible. These interventions related to family engagement during the hospitalization, care coordination and social support assessment, predischarge education, and written materials., Conclusions: Parents and health care professionals considered several transitional care interventions important as well as feasible. This research might inform hospitals' transitional care programs and policies., (Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: From 2010 to 2014, pediatricians completed Part 4 Maintenance of Certification (MOC) through practice- or organization-developed quality improvement (QI) activities approved by the American Board of Pediatrics (ABP). Organization-developed activities were online modules, such as the ABP's Performance Improvement Modules (PIMs), through which pediatricians implemented QI strategies in practice and reported quality measures., Objectives: Aim 1 was to assess the proportion of pediatricians who completed practice- vs organization-developed QI activities for Part 4 MOC and to test the relationship between activities and pediatrician demographics. Aim 2 was to assess the relationship between PIM completion and improvement in care processes and outcomes as determined by PIM quality measures., Methods: For aim 1, using deidentified demographic data from the ABP, we summarized QI activity completion and performed bivariate testing by pediatrician demographics. For aim 2, using deidentified parent and pediatrician-reported quality measures from the Attention-Deficit/Hyperactivity Disorder (ADHD), Asthma, Hand Hygiene, and Influenza PIMs, we used 2-sample tests of proportions to calculate pre-post changes in quality measures., Results: For aim 1, of 50,433 pediatricians who completed Part 4 MOC from 2010 to 2014, 22% completed practice-developed and 78% organization-developed activities. More pediatricians completed organization-developed activities, regardless of age, gender, or subspecialty status. The majority (73%) of pediatricians who completed organization-developed activities completed ABP PIMs. For aim 2, PIM completion was associated with improvement on nearly all pediatrician- and parent-reported quality measures., Conclusions: At the outset of the Part 4 MOC system, pediatricians most commonly completed online, organization-developed activities. Pediatricians and parents reported improvements in care processes and outcomes associated with PIMs, suggesting PIMs can be an effective means of facilitating practice improvement., (Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care., Methods: Focus groups were conducted with youth with a history of mental health needs and previous service use who had aged out of foster care. Questions were informed by the Health Belief Model and addressed 4 domains: youth perceptions of the "threat of mental health problems," treatment benefits versus barriers to accessing mental health services, self-efficacy, and "cues to action." Data were analyzed using a modified grounded-theory approach., Results: Youth (N = 28) reported ongoing mental health problems affecting their functioning; however, they articulated variable levels of reliance on formal mental health treatment versus their own ability to resolve these problems without treatment. Past mental health service experiences influenced whether youth viewed treatment options as beneficial. Youth identified limited self-efficacy and insufficient psychosocial supports "cueing action" during their transition out of foster care. Barriers to accessing mental health services included difficulties obtaining health insurance, finding a mental health provider, scheduling appointments, and transportation., Conclusions: Youths' perceptions of their mental health needs, self-efficacy, psychosocial supports during transition, and access barriers influence mental health service use after aging out of foster care. Results suggest that strategies are needed to 1) help youth and clinicians negotiate shared understanding of mental health treatment needs and options, 2) incorporate mental health into transition planning, and 3) address insurance and other systemic barriers to accessing mental health services after aging out of foster care., (Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings; to develop a framework to conceptualize factors influencing career satisfaction., Methods: Semistructured interviews were conducted with community and tertiary care hospitalists, using purposeful sampling to attain maximum response diversity. We used closed- and open-ended questions to assess levels of career satisfaction and its determinants. Interviews were conducted by telephone, recorded, and transcribed verbatim. Emergent themes were identified and analyzed using an inductive approach to qualitative analysis., Results: A total of 30 interviews were conducted with community and tertiary care hospitalists, representing 20 hospital medicine programs and 7 Northeastern states. Qualitative analysis yielded 657 excerpts, which were coded and categorized into 4 domains and associated determinants of career satisfaction: 1) professional responsibilities; 2) hospital medicine program administration; 3) hospital and health care systems; and 4) career development. Although community and tertiary care hospitalists reported similar levels of career satisfaction, they expressed variation in perspectives across these 4 domains. Although the role of hospital medicine program administration was consistently emphasized by all hospitalists, community hospitalists prioritized resource availability, work schedule, and clinical responsibilities, while tertiary care hospitalists prioritized diversity in nonclinical responsibilities and career development., Conclusions: We illustrate how hospitalists in different organizational settings prioritize both consistent and unique determinants of career satisfaction. Given associations between physician satisfaction and health care quality, efforts to optimize modifiable factors within this framework, at both community and tertiary care hospitals, may have broad impacts., (Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)