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Background During their residency program, pediatric residents frequently face ethical challenges. The aim of the study is to evaluate the pediatric residents’ knowledge and confidence to handle common ethical dilemmas during their training. Methods This is a survey-based cross-sectional study on all pediatric residents in the largest pediatric training center in Saudi Arabia. The survey had six sections: a) Demographics and self-assessment of religiosity, b) Sources of ethics education, c) Degree of confidence in dealing with ethical challenges in clinical practice, d) Rating of the quality of ethics education during residency, e) Agreement or disagreement regarding ten ethical scenarios, and f) Confidence level in handling 21 different ethical situations. The response to the survey questions was based on a Likert scale; the survey was electronically distributed to all pediatrics residents. Mean knowledge scores and 95% confidence intervals (CI) were calculated for each independent variable to test for associations. Comparisons were made using an independent t-test or an ANOVA test when there were more than two groups. Result Eighty residents responded to the study (85.1% response rate). Over 60% reported that the best source of ethical education for them was through discussions with a senior physician and it was through formal lecturers in 13.8%. One-fifth felt confident in dealing with ethical challenges. Only 2.5% rated the ethics education as “very good/excellent” and 12.5% rated the “support from residency program for ethics education” as being “very good/excellent.” Agreement of more than 80% was only noted for 4 of 10 of the ethical scenarios. Overall, only 16.4% felt “confident/extremely confident” in handling different ethical situations while 38.5% felt “not confident/a little confident” with more confidence among male residents (35.3% versus 18.7% p = 0.01). Marital status, year of residency, religiosity, and source of ethics knowledge had no impact on the level of confidence. Conclusion Overall, the ethics education was considered inadequate. Only one fifth had the confidence in dealing with ethical situations. Gender but not marital status, year of residency, religiosity, or source of ethics knowledge had an impact on the level of confidence in handling ethical situations.

Background: An adequate understanding of the relationship between breast-feeding practices and infant food allergy is essential for clinicians. Although there is evidence of an education gap in general breast-feeding concepts, little is known about the pediatric trainee knowledge and practice with regard to breast-feeding, maternal diet, and potential allergy outcomes. Objective: To assess pediatric residents’ knowledge, describe practices, and evaluate a module designed to provide evidence-based education about breast-feeding, food allergy, and food avoidance to inform future resources on the topic of breast-feeding and allergic outcomes. Methods: Pediatric residents completed a survey to assess the knowledge and comfort with regard to maternal dietary restriction, breast-feeding, and infant food allergy. Residents then viewed an online educational module about evidence-based breast-feeding and infant food allergy guidelines, and, after 1 month, completed the online questionnaire again. Results: Among respondents (N = 68), only 8% and 5%, felt knowledgeable and comfortable with current maternal diet during breast-feeding and infant food allergy recommendations, respectively. Eighty-seven percent had not received formal training on the topic, and a large percentage relied on mentor teaching (49%) or anecdotal evidence (19%) as opposed to available guidelines (32%) for guidance. Most respondents (61‐93%) correctly answered questions with regard to guidelines on primary and secondary food allergy prevention in relation to maternal diet. The upper-level residents answered more questions correctly about allergic proctocolitis compared with the interns (p Conclusion: Pediatric residents reported low comfort and perceived that they had little knowledge about maternal diet and infant food allergy, yet their actual performance suggested the opposite. Those who completed the educational module did not demonstrate knowledge improvement, which highlighted the need for the development of robust educational resources.

Objectives Prior work across medical and surgical specialties shows that parenthood during residency training is associated with challenges including limited parental leave, lack of accommodations for breastfeeding, and concerns about career impact. Less is known about the experience of parenthood during pediatric residency training. The objective of this study was to identify themes related to the experience of parenthood during pediatric residency. Methods In this qualitative study using thematic analysis, we performed semistructured interviews with participants who were currently in pediatric residency or had graduated in the previous 3 years and were parents during residency. Participants were recruited by e-mail. Data were collected and analyzed iteratively until thematic saturation was achieved. Two independent reviewers coded each transcript. Codes were grouped into categories and then into dominant themes. Results Thirty-one residents were interviewed from 13 pediatric residency programs. Four major themes regarding the experience of parenthood during pediatric residency were defined by the data: 1) the struggles of parenthood and residency exacerbate each other; 2) institutional modifiers strongly influence the experiences of resident parents; 3) resident parents develop skills and perspectives that enhance their pediatric training; and 4) although levels of support for pediatric resident parents vary, the culture of pediatrics positively influences the experience of parenthood in residency. Conclusions There are numerous challenges navigating parenthood and residency, but institutional policies and culture can modify the experience. Importantly, the educational value of parenthood to pediatric training was immense. Our findings may be used to design interventions to support parenting during residency.

Introduction: The National Malaria Guideline is a veritable tool for appropriate case management of malaria. Whether the pediatric residents who are the primary caregivers of children know and make use of this guideline in their routine practice is not yet assessed. Aim: The aim of the study is to assess the awareness of the Nigerian pediatric residents of the national guidelines for malaria case management (including antimalarial prescription for uncomplicated and severe malaria). Settings and Design: The descriptive study carried out during the 2017 National Postgraduate Medical College of Nigeria, Faculty of Paediatrics Update Course in Benin City. Subjects and Methods: Data were obtained using a self-administered questionnaire which was given to all pediatric residents who participated at the update course and who had given written informed consent. Statistical Analysis Used: The statistical analysis was done using the Statistical Package for the Social Sciences version 16.0 (Inc., Chicago, Illinois, USA). Results: Of the 108 participants whose questionnaires were analyzed, 75.0% were Part 1 candidates and 25.0% Part 2 candidates; mean age 34.0 ± 4.5 years (range 26–51 years) and 42 (39.0%) males while 66 (61.0%) were female. Ninety-four (87.0%) were aware of the current national guidelines for management of malaria and 45 (41.7%) had read the guidelines. Correctness of prescription was obtained from 39 (36.0%) respondents in uncomplicated malaria cases and 44 (40.7%) in severe malaria cases. This finding did not significantly associate with the years of practice, level of practice, practicing institutions, awareness, and reading of the national guideline. Conclusions: Most pediatric residents have not read nor use the national guidelines for management of malaria which reflected in poor prescription pattern of antimalarial drugs in routine practice.

Background: Despite advances in medical care, pediatric deaths are still an unfortunate reality. Most of these deaths occur within a hospital setting. End-of-life care is an important part of medical care for children with serious illnesses. Despite the importance, pediatric providers report a lack of comfort surrounding end-of-life care. Objective: To assess categorical pediatric residents’ perceptions and participation in providing end-of-life care to dying children and their families. Study Design: This is a survey-based, descriptive, mixed-methods study. Survey was sent to categorical pediatric residents at Indiana University School of Medicine in June 2018 to obtain both quantitative and qualitative information on resident perception and participation in end-of-life care. Surveys were sent to 100 residents with a response rate of 68%. Setting/Participants: Pediatric residents at Indiana University School of Medicine. Results: The comfort and participation in end-of-life care are limited in all levels of pediatric training. Residents do not feel comfortable with 19 of 22 questions related to end-of-life care. Only 32% of residents felt their education prepared them to participate in end-of-life care. Almost one-fifth (19.5%) of residents report participating in zero aspect of end-of-life care. Themes discussed by residents include education, experience, communication, social norms, emotions, self-care, comfort, and family. Conclusion: More formalized education and training is needed to increase resident comfort with and participation in end-of-life care. Such future interventions should focus on communication surrounding difficult conversations and providing guidance for families.

Background and Objectives The 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.” Methods Authors 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. Results Response 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. Conclusions Resident 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.

OBJECTIVE: Pediatric residents are expected to be competent in end-of-life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures. METHODS: Retrospective chart review of all deceased patients at one children’s hospital over 3 years collected patient demographics, time, and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within 48 hours of death. Descriptive statistics are presented. RESULTS: Of 579 patients who died during the study period, 46% had resident involvement. Most deaths occurred in the NICU (30% of all deaths); however, resident exposure to EOL care most commonly occurred in the PICU (52% of resident exposures) and were after withdrawals of life-sustaining therapy (41%), followed by nonescalation (31%) and failed resuscitation (15%). During their postgraduate year (PGY)-1

Objective: To assess the level of neonatal intensive care unit (NICU) disaster preparedness among pediatric residents. Methods: A mixed-methods study including qualitative interviews and quantitative surveys was used. Interviews guided survey development. Surveys were distributed to residents who rotated through Children’s National NICU. Questions assessed residents’ background in disaster preparedness, disaster protocol knowledge, NICU preparedness, roles during surge and evacuation, and views on training and education. Results: Survey response was 62.5% (n = 80) with 51.3% of invited residents completing it. Pediatric residents (PGY-2 and PGY-3) (n = 41) had low levels of individual disaster preparedness, particularly evacuations (86%). None were aware of specific NICU disaster protocols. Patient acuity, role ambiguity, knowledge, and training deficits were major contributors to unpreparedness. Residents viewed their role as system facilitators (eg, performing duties assigned, recruiting other residents, and clerical work like documentation). Resident training requests included disaster preparedness training every NICU rotation (48%) using multidisciplinary simulations (66%), role definition (56%), and written protocols (50%). Despite their unpreparedness, residents (84%) were willing to respond. Conclusion: Pediatric residents lacked knowledge of NICU disaster response but were willing to respond to disasters. Training should include multi-disciplinary simulations that can be refined iteratively to clarify roles, and residents should be involved in planning and execution.

INTRODUCTION Pubertal Tanner staging is a standard part of the pediatric physical examination and provides valuable insight into a child's growth and development. In practice, pediatric care practitioners have varying levels of confidence and expertise with Tanner staging. Currently, breast Tanner staging is taught via illustrated images or limited hands-on practice on real patients during pediatric residency training. METHODS We used synthetic materials to develop a lifelike, 3-dimensional, hands-on educational tool aimed at teaching medical students and pediatric resident physicians how to identify and distinguish among the 5 breast Tanner stages. This tool was evaluated by a group of experienced pediatric endocrinologists. RESULTS Thirty pediatric endocrinologists with an average of 16.7 years of clinical experience evaluated the model, and all participants believed the model was a valuable teaching tool for medical students and pediatric resident physicians. Tanner stages 1, 2, 3, 4, and 5 were correctly identified by 100%, 93%, 90%, 100%, and 73% of participants, respectively. CONCLUSIONS We show that the use of a synthetic, 3-dimensional, lifelike breast model to teach breast Tanner staging may be valuable within the context of pediatric medical education. Further refinement of the model as well as curriculum development and evaluation is necessary before broadly disseminating this model as an educational tool.

Amaç: Çalışmada, kadın pediatri asistanlarında uzun süreli 32 saatlik aralıksız vardiyaların leptin, melatonin, seks hormonları, IL-1β, TNF-α, IL-6, hematolojik parametreler, uyku kalitesi ve dikkat performansı üzerine etkilerininin değerlendirilmesi amaçlamıştır. FPR).Materyal ve Metot: 32 saat sürekli vardiyada (08:00-08:00 sonrası 08:00-17:00, n=10) çalışan FPR, gündüz saatlerinde (08:00-16: 00 saat, n=10) çalışan kadın sağlık profesyonelleri ile karşılaştırılmıştır.Bulgular: Çalışmada; eozinofil oranı (p=0.015), hemoglobin (p=0.010), hematokrit (p=0.012), progesteron (p=0.008), TNF α, (p=0.000), IL-1beta ve (p= 0.003) IL-6 düzeyleri (p= 0.000) FPR’de anlamlı olarak yüksek bulundu. Ayrıca FPR’nin sabahları uyanmakta güçlük çektiği (p=0,000), kötü rüyalar gördüğü (p=0,040) ve uyku kalitesinin kötü olduğu (p=0,010) bulundu. FPR daha iyi dikkat performansı gösterdi (p=0.000). Sonuç: FPR’de dikkat performansı daha yüksek olmasına rağmen, veriler uzun süreli sürekli 32 saatlik vardiya sisteminin inflamatuar yanıtı aktive ettiğini, over steroid üretimini bozduğunu ve uyku kalitesini azalttığını göstermektedir. Hep birlikte, bunlar iltihaplı hastalıklar veya üreme sorunları ile sonuçlanabilir., Aim: The study aimed at assessing effects of long-term 32-hours continuous shifts on leptin, melatonin, sex hormones, IL-1β, TNF-α, IL-6, hematological parameters, sleep quality and attention performance in female pediatric residents (FPR). Materials and Methods: FPR working under 32 hours continuous shifts (08:00-08:00h after 08:00-17:00h, n=10) were compared to female health professionals working in day-time hours (08:00-16:00h, n=10). Vital parameters, glucose, leptin, melatonin, estrogen, progesterone, IL-1β, TNF-α, and IL-6 concentrations, complete blood count (CBC) and erythrocyte sedimentation rate (ESR) were measured. The participants were also requested to fill in sleep quality questionnaires and visual attention test. Results: In the study; eosinophil ratio (p=0.015), hemoglobin (p=0.010), hematocrit (p=0.012), progesterone (p=0.008), TNF-α, (p=0.000), IL-1beta and (p= 0.003) IL-6 levels (p= 0.000) were found significantly higher in FPR. In addition, it was found that FPR had difficulty in waking up in the mornings (p = 0.000), had bad dreams (p = 0.040), and had poor sleep quality (p = 0.010). FPR had better attention performance (p=0.000). Conclusion: Although attention performance was higher in FPR, data suggest that long-term continuous 32-hour shift system activates inflammatory response, disturbs ovarian steroid production and reduces sleep quality. Alltogether, these may culminate in inflammatory diseases or reproductive problems.

BackgroundPrevious studies have suggested that resident physicians are the most meaningful teachers during the clinical clerkships of third-year medical students (MS3s). Unfortunately, residents often feel unprepared for this crucial role. The pediatrics clerkship at our institution identified a paucity in the frequency of resident-led teaching with MS3s. Lack of confidence, suboptimal teaching space, and insufficient time were cited as the most significant barriers. To enhance resident-led teaching of MS3s, we created teaching scripts of general pediatrics topics accessible via a smartphone application (app).MethodsPrior to the implementation of the app, MS3s and pediatric residents were surveyed on clerkship teaching practices. From May 2017 through July 2018, pediatric residents working with MS3s were introduced to the app, with both groups queried on resident teaching habits afterward. We compared pre-intervention and post-intervention data of time spent teaching, teaching frequency, and a ranking of pediatric resident teaching performance compared to residents of other MS3 core clerkships.Results44 out of 90 residents (49%) responded to a pre-intervention survey on baseline teaching habits. 49 out of 61 residents (80%) completed our post-intervention survey. Pre-intervention, 75% (33/44) of residents reported spending less than 5 min per teaching session on average. Post-intervention, 67% (33/49) reported spending more than 5 min (p p = 0.12) post-intervention. Post-intervention data demonstrated a statistically significant correlation between app use and increased frequency of teaching (p p ConclusionsResidency programs looking to reform resident-led teaching, particularly of residents early in their training, should consider our novel approach. In addition to addressing barriers to teaching and creating a platform for near-peer teaching, it is adaptable to any specialty or learner level. Future direction includes developing objective measures for teaching performance and content proficiency to better assess our intervention as an educational curriculum, as well as further investigation of the intervention as a controlled trial.

Introduction: Social determinants of health (SDOH) account for 80% of modifiable factors in a population’s health. Addressing SDOH in a healthcare setting can improve care, patient experience, health outcomes, and decrease cost. Therefore, screening for SODH in the pediatric setting has become an essential and evidence-based component of pediatric preventative care. Multiple barriers exist for its implementation, particularly for trainees. Methods: Using resident-driven quality improvement (QI) methodology, we aimed to increase SDOH screening to >90% for 9 individual questions at newborn and 1-year well visits and completely screen for all 9 questions at more than 40% of visits. Parents were provided with a paper screening form upon arrival to be completed before visits. We performed tests of change to improve distribution, documentation, and quality of interventions. Results: The primary outcome of complete screening for all 9 questions increased from 24% to 43% at newborn visits and 28% to 83% at 1-year visits. Screenings that identified at least 1 need increased from 8% to 19%, with provider response to an identified need increasing from 20% to 40%. These metrics were the secondary outcome measures. Conclusions: The use of parent completed paper screening forms improved SDOH screening, documentation, and interventions by residents and faculty.

Introduction: The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services, including primary care provider training. Unfortunately, many pediatricians feel uncertain assessing diagnostic risk and facilitating follow-up care for children with autism. Methods: We surveyed current residents regarding their confidence around engaging in specific practice behaviors and providing care for patients presenting with concerns for autism compared to other common concerns seen in primary care. Results: Residents were significantly more confident in their skills with respect to caring for patients with other common concerns than for patients with autism including statistically significant differences in their perceived ability to diagnose, communicate with families about, treat/manage, and facilitate follow-up care. Additionally, nearly all residents with career plans for primary care indicated that autism concerns should fall within their scope of practice and that further training and education about autism is important to their careers. Discussion: These findings underscore that although many current residents feel that being able to recognize and diagnose autism is important, they feel unprepared to do so within current training models and will likely carry this uncertainty forward into future practice. This study reflects clear targets for advancing incorporation of enhanced and active autism-specific training into pediatric residency programs.

Objective Describe current practices in systematic screening for social determinants of health (SDH) in pediatric resident clinics enrolled in the Continuity Research Network (CORNET). Methods CORNET clinic directors were surveyed on demographics, barriers to screening, and screening practices for 15 SDH, including the screen source, timing of screening, process of administering the screen, and personnel involved in screening. Incidence rate ratios were tabulated to investigate relationships among screening practices and clinic staff composition. Results Clinic response rate was 41% (65/158). Clinics reported screening for between 0 and 15 SDH (median, 7). Maternal depression (86%), child educational problems (84%), and food insecurity (71%) were the items most commonly screened. Immigration status (17%), parental health literacy (19%), and parental incarceration (21%) were least commonly screened. Within 3 years, clinics plan to screen for 25% of SDH not currently being screened. Barriers to screening included lack of time (63%), resources (50%), and training (46%). Conclusions Screening for SDH in our study population of CORNET clinics is common but has not been universally implemented. Screening practices are variable and reflect the complex nature of screening, including the heterogeneity of the patient populations, the clinic staff composition, and the SDH encountered.

Hydroxyurea is a well-established disease-modifying medication for sickle cell disease (SCD). At some institutions, hydroxyurea can only be ordered by "chemotherapy-certified" providers which may not include pediatric resident physicians.We conducted a survey of 39 American pediatric hospitals regarding their policy on resident hydroxyurea ordering for SCD. Our institution changed its policy in June 2016 to allow residents to order hydroxyurea for hospitalized patients with SCD who were already on hydroxyurea at home. We conducted a retrospective review of the medical records of a random sample of patients with SCD on hydroxyurea admitted the year before and the year after this policy change.In our national survey, 51% of surveyed hospitals allowed residents to order hydroxyurea, 19% required a second signature, and 30% did not allow residents to order hydroxyurea. In our institutional study, patients after the policy change were significantly more likely to have received their home hydroxyurea by hospital day 1: before 62/90 (69%) versus after 105/119 (88%), P=0.0005. The proportion of patients who inappropriately received hydroxyurea was very low in both groups: before 1/91 (1%) versus after 3/126 (2%), P=0.64, with no serious adverse clinical events due to inappropriate hydroxyurea administration.Considerable national variation in practice currently exists in regards to resident hydroxyurea ordering hospital policies. A policy allowing residents to order hydroxyurea significantly increased the likelihood of a patient receiving hydroxyurea while hospitalized with no significant increase in inappropriate hydroxyurea administration. Resident hydroxyurea ordering seems safe and beneficial.

Introduction: Feedback is a conscious, unbiased, and objective evaluation of performance in order to improve clinical skills, not to assess students' personal talents and values. This study aims to compare the views of pediatric residents and general medical students at Mashhad University of Medical Sciences regarding method of providing feedback in clinical education.Method: This cross-sectional study was conducted in the pediatric ward of hospitals affiliated to Mashhad University of Medical Sciences in 2018. The census method was used to select 35 pediatric residents and simple random sampling method was used to select 35 general medical students who had completed internship and apprenticeship. Data collection was carried out using a standard 21-item feedback questionnaire. Pediatric residents and general medical students were asked to identify the importance of feedback received during their clinical education using a 4-point Likert scale.Results: The majority of residents believe that feedback was only sometimes expected (27.1%), clearly and explicitly outlined (17.1%), fair (21.4%), and useful in correcting their attitude (18.6%), performance (17.1%), and behavior (27.1%). Majority of general medical students believed that clear, explicit (24.3%) feedback was related with their future career (14.3%) and most of them received positive feedbacks (20). Apart from propositions items 20, 18, and 17, most medical students and residents have selected the Often and Sometimes options, respectively to respond to items.Conclusion: Pediatric residents were less satisfied with the feedback received during the clinical education as compared to the general medical students.

This study characterizes the current firearm-related anticipatory guidance practices of pediatricians-in-training and the factors affecting those practices. In this study of Pediatric residents in the Mid-Atlantic region, surveys were distributed to 189 trainees at three hospitals. Eighty-one responses were collected between June 2017 and March 2018. The survey gathered information about the residents’ values related to firearms, firearm-specific counseling practices, barriers to providing counseling, and educational needs related to firearms. The residents surveyed overwhelmingly agreed (96%) that physicians have a responsibility to counsel patients on the risks posed by firearms. However, most (63%) never provide firearm-related counseling or do so in only 1–5% of well-child visits. Their unfamiliarity with safe storage devices contributes to a lack of comfort providing counseling. For pediatricians to provide potentially lifesaving counseling on firearm safety, they must be well-versed in the subject and feel comfortable and confident in doing so. Educational interventions addressing physician self-efficacy are necessary to accomplish this. There is an urgent need to develop a comprehensive firearm safety education program for physicians and trainees to improve firearm counseling.

OBJECTIVES: The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled with irrelevant information. When our institution changed electronic health records, a cumbersome electronic discharge workflow produced low-value HDI and contributed to a spike in discharge delays. Our aim was to decrease these delays while improving family and provider satisfaction with HDI. METHODS: We used quality improvement methodology to redesign the electronic discharge navigator and HDI to address the following issues: (1) difficulty preparing discharge instructions before time of discharge, (2) suboptimal formatting of HDI, (3) lack of standard templates and language within HDI, and (4) difficulties translating HDI into non-English languages. Discharge delays due to HDI were tracked before and after the launch of our new discharge workflow. Parents and providers evaluated HDI and the electronic discharge workflow, respectively, before and after our intervention. Providers audited HDI for content. RESULTS: Discharge delays due to HDI errors decreased from a mean of 3.4 to 0.5 per month after our intervention. Parents’ ratings of how understandable our HDIs were improved from 2.35 to 2.74 postintervention (P = .05). Pediatric resident agreement that the electronic discharge process was easy to use increased from 9% to 67% after the intervention (P < .001). CONCLUSIONS: Through multidisciplinary collaboration we facilitated advance preparation of more standardized HDI and decreased related discharge delays from the acute care units at a large tertiary care hospital.

Background Measuring burnout symptoms is important, but the Maslach Burnout Inventory (MBI) has 22 items. This project compared 3 single-item measures with the MBI and other factors related to burnout. Methods Data were analyzed from the 2016 and 2017 Pediatric Resident Burnout-Resilience Study Consortium surveys, which included standard measures of perceived stress, mindfulness, resilience, and self-compassion; the MBI; and the 1- and 2-item screening questions. Results In 2016 and 2017, data were collected from 1785/2723 (65%) and 2148/3273 (66%) eligible pediatric residents, respectively. Burnout rates on the MBI were 56% in 2016 and 54% in 2017. The Physician Work Life Study item generated estimates of burnout prevalence of 43% to 49% and, compared with the MBI for 2016 and 2017, had sensitivities of 69% to 72%, specificities of 79% to 82%, positive likelihood ratios of 3.4 to 3.8, and negative likelihood ratios of 0.35 to 0.38. The combination of an emotional exhaustion item and a depersonalization item generated burnout estimates of 53% in both years and, compared with the full MBI, had sensitivities of 85% to 87%, specificities of 84% to 85%, positive likelihood ratios of 5.7 to 6.4, and negative likelihood ratios of 0.18 for both years. Both items were significantly correlated with their parent subscales. The single items were significantly correlated with stress, mindfulness, resilience, and self-compassion. Conclusions The 1- and 2-item screens generated prevalence estimates similar to the MBI and were correlated with variables associated with burnout. The 1- and 2-item screens may be useful for pediatric residency training programs tracking burnout symptoms and response to interventions.

Purpose Practicing and resident pediatricians report inadequate skill in caring for adolescents, despite adolescents comprising roughly one-quarter of most general and subspecialty practices. This study examined the effectiveness of participation in an adolescent medicine rotation at improving pediatric residents’ self-perceived skills and confidence across nine key adolescent health domains. We also evaluated the impact of didactic instruction during the rotation. Methods Resident and recent-graduate participants (n = 34) completed milestone-based self-assessment of their skill and confidence caring for adolescent patients in nine key adolescent health-related domains. This study employed a post-test then retrospective pretest, an educational study design used to minimize response-shift bias whereby participants rate their skill and confidence at the end of the intervention (post-test), and then reflect back to retrospectively rate their preintervention skill (retrospective pretest). Additionally, differences in gains between those who did and did not participate in didactic instruction were evaluated. Didactic instruction was delivered during the adolescent medicine rotation utilizing a flipped-classroom model; participants received standardized preparatory materials and participated in active-learning workshops. Results Participants demonstrated a significant (p ≤ .0001) increase in self-perceived skill levels for all assessed domains after the rotation as compared to before the rotation, whether or not they received didactic instruction. Participation in didactic instruction did not yield significant (p ≤ .05) additional benefit for any of the assessed domains. Conclusions Participation in an adolescent medicine rotation is of value to pediatric resident trainees and leads to increased self-assessed skill and confidence in caring for youth.

Objective To determine the impact of a curriculum that included parent feedback, via the Communication Assessment Tool (CAT), on resident communication skills. Methods In a prospective, controlled study, categorical pediatric residents in continuity clinic were divided into control and intervention groups based on clinic day. Parent feedback was obtained for all residents at the beginning and end of the year using the CAT, a validated survey to assess physician communication. Intervention residents participated in learning conferences that reviewed communication best practices and received parental feedback via individual and group CAT scores. Scores were dichotomized as 5 (excellent) versus 1 to 4 (less than excellent) and reported as percentage of items rated excellent. Curriculum impact was assessed by comparing score changes between groups. Residents’ scores in both arms were combined to assess changes from the beginning of the year to the end. Statistical testing was performed using generalized linear mixed-effects models. Results All residents (N = 68) participated. Intervention (n = 38) and control (n = 30) residents received at least 10 CATs at the beginning and end of the year. The percentage of parents rating all items as excellent increased by similar percentages in intervention and control groups (60.9%–73.8% vs 61.1%–69.8; P = .38). When scores of residents in both arms were combined, improvement was found from the beginning to the end of the year for all CAT items (P Conclusions A curriculum including parent feedback from CATs did not significantly impact communication skills. However, communication skills improved over the year in intervention and control groups, suggesting that communication training occurs in multiple settings.

BACKGROUND AND OBJECTIVES:Safety event reporting systems facilitate identification of system-level targets to improve patient safety. Resident physicians report few safety events despite their role as frontline providers and the frequent occurrence of events. The objective of this study is to increase the number of pediatric resident safety event submissions from METHODS:We conducted an iterative quality improvement process with 39 pediatric residents at a children’s hospital. Interventions focused on 4 key drivers: user-friendly event submission process, resident buy-in, nonpunitive safety culture, and data transparency. The primary outcome measure of number of pediatric resident event submissions was analyzed by using statistical process control. Balancing measures included time from submission to feedback, duplicate submissions, and nonevent submissions. As a control, the primary outcome measure was monitored for nonpediatric residents during the same period.RESULTS:The mean number of pediatric resident event submissions increased from 0.9 to 5.7 submissions per 14 days. Impactful interventions included a designated space in the resident workroom to list safety events to submit, monthly project updates, and an interresident competition. There were no duplicate submissions or nonevent submissions in the postintervention period. Time to feedback in the postintervention period had both upward and downward shifts, with >8 consecutive points above and below the baseline period’s centerline. The control group showed no sustained change in event submissions.CONCLUSIONS:Our improvement process was associated with significant increase in pediatric resident safety event submissions without an increase in the number of submissions categorized as duplicates or nonevents.

Background/Purpose Advocacy is increasingly recognized as a core element of the physician’s responsibilities. Health advocacy training is an essential part of postgraduate medical education for pediatricians and a required curricular element of the Accreditation Council for Graduate Medical Education (ACGME). However, efforts to advance advocacy curriculum thus far have been inconsistent. Most pediatric trainee advocacy education is limited to a two-week to four-week advocacy rotation without a longitudinal component. We sought to understand whether additional training would be beneficial to equip residents with skills needed to effectively engage in …

Objective: Pediatricians often function as front-line providers for pediatric behavioral health concerns given the shortage of child and adolescent psychiatrists and barriers to accessing other behavioral health specialists. This study identified pediatric residents’ attitudes, knowledge, comfort and practices regarding managing psychotropic medication regimens for children and adolescents with behavioral …

Background: Children with medical complexity and technology dependence (CMC-TD) have significant health care and care coordination needs, with increased risk for medical errors. Standardizing pediatric resident documentation for these patients may help to improve patient safety. Objective: To increase the percentage of patients with care coordination notes containing specific documentation on technology from a baseline of 8% to a target goal of 55% among CMC-TD in a pediatric resident continuity clinic. Methods: …