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Objective Academic General Pediatrics (AGP) is a pediatric subspecialty with substantial faculty contributions in clinical care, research, education, and advocacy. However, AGP fellowship recruitment challenges exist. We aimed to describe AGP hiring practices from 2014 to 2019 and the role of fellowship training in hiring decisions. Methods We conducted a cross-sectional survey study of AGP Division Directors (DDs) and Fellowship Program Directors (PDs) from US-based academic institutions. Survey questions were developed iteratively and pilot-tested for content validity. Participants were identified from the Association of American Medical Colleges' directory of pediatric departments, Academic Pediatric Association's AGP Accreditation Committee's list of fellowship programs, and institutional websites. Descriptive analysis was used for close ended survey questions. Narrative responses were reviewed for trends. Results Forty-nine DDs (57%) and 22 PDs (73%) responded. All DDs reported at least one available faculty position and 73% reported filling a position with protected time. PDs reported 89 graduating fellows, 88% of whom secured an academic position with protected time. Seventy-percent of DDs and 100% of PDs reported that AGP fellows could secure an academic position with protected time, while only 22% and 1%, respectively, reported a graduating pediatric resident could secure a similar position. DDs indicated AGP fellowship trained candidates are preferable for enhancing research and education programs. Conclusion AGP remains an active subspecialty and the majority of graduating fellows secured faculty positions with protected time. Further studies are needed to understand ways to improve visibility of AGP fellowships.

Pediatric educators desire to and should strive to incorporate current educational methods and ideas into their professional practices. The overwhelming volume of medical education literature makes this difficult. This article provides an overview of 18 key articles from the 2018 literature that the authors considered impactful for the field of pediatric medical education. The author group has extensive combined leadership experience and expertise across the continuum of pediatric medical education and used an iterative, staged process to review 2270 abstracts from 13 medical education-related journals. This process aimed to identify a subset of articles that were most relevant to educational practice and scholarship and most applicable to pediatric medical education. Author pairs independently reviewed and scored abstracts and reached consensus to identify the abstracts that best met these criteria. Selected abstracts were discussed using different author pairs to determine the final articles included in this review. The 18 articles selected are summarized. The results showed a cluster of studies related to assessment, learner education and teaching, communication, and culture and climate. This review offers a summary for educators interested in remaining knowledgeable and current regarding the most relevant and valuable information in the field of medical education.

As collaborative work in medical education has increasingly moved online, team mentors have had to adapt their practices into the virtual environment. Fostering connection, communication and productivity on virtual teams requires specific skills and deliberate practice that differ from in-person teamwork. Drawing from best practices in business, education and medicine and also from our own experience as a virtual team, we present a guide for mentors to create and sustain successful virtual teams. Grounded in Tuckman's Five Stage Model of Team Development, we offer specific strategies for virtual team mentors to promote team cohesion, mitigate conflict, maintain productivity and leverage the benefits of the virtual environment.

Objective Professional development programs (PDPs) within academic professional organizations rely on faculty volunteers, but little is known about the volunteering process and experience. Our aim was to gain insights into the initial decision to volunteer, the experience of volunteering and the decision to re-volunteer or not (i.e. remain or leave as a volunteer). The study setting was a PDP of the Academic Pediatric Association, the Educational Scholars Program (ESP). Methods In 2014, 13 ESP faculty members participated in semi-structured phone interviews. The authors performed a general inductive analysis of the data, inductively created codes, and analyzed coded data for emergent themes that led to the creation of a model for recruiting and sustaining volunteers. Results Four themes related to the initial volunteer decision and the decision to re-volunteer or not (self-interest and altruism, reputation of the program, relevant skill set, doability), and four themes related to the experience of volunteering (emotional impact, career advancement and professional recognition, professional growth, and doability) emerged. The relationship among the themes led to the creation of a model of volunteering, involving a metaphorical volunteerism “tank” that is full when faculty initially volunteer and subsequently fills or empties as a result of dynamic interplay between the themes for each individual. Conclusions Leaders of PDPs may find our model of volunteering beneficial for enhancing the emotional and tangible benefits and minimizing the logistical issues of volunteering. This information should contribute to success in recruiting and retaining the volunteers who are essential for developing and sustaining PDPs.

Residents undergo professional identity formation during training, and the integration of a teacher identity into that of a clinician is part of this process. We aimed to measure the teacher identity of incoming interns of various specialties. In this cross-sectional, survey-based study, we modified a validated teacher identity scale and distributed it to residents attending orientation at a large, academic institution. A total of 297 residents took the survey, including 272 interns; 80% (218/272) of interns completed the survey and permitted use of their data. The mean score for global teacher identity was 4.16 (SD 0.67) on a 1 to 5 Likert scale. There were significant differences between interns’ current self-assessed teaching abilities and their desired future performance as teachers (P < 0.001 for all domains). Male interns had higher global teacher identity scores (4.27) than female interns (4.05; P = 0.02). There were no differences in global teacher identity between interns in medical, surgical, and supportive specialties. Interns who had participated in a student-as-teacher program in medical school had higher global teacher identity (P < 0.001) than those who had not. In conclusion, teacher identity is high in incoming interns, with higher scores in men and in those who completed student-as-teacher programs in medical school.

Pediatric educators desire to and should strive to incorporate current educational methods and ideas into their professional practices. The overwhelming volume of medical education literature makes this difficult. This article provides an overview of 18 key articles from the 2018 literature that the authors considered impactful for the field of pediatric medical education. The author group has extensive combined leadership experience and expertise across the continuum of pediatric medical education and used an iterative, staged process to review 2270 abstracts from 13 medical education-related journals. This process aimed to identify a subset of articles that were most relevant to educational practice and scholarship and most applicable to pediatric medical education. Author pairs independently reviewed and scored abstracts and reached consensus to identify the abstracts that best met these criteria. Selected abstracts were discussed using different author pairs to determine the final articles included in this review. The 18 articles selected are summarized. The results showed a cluster of studies related to assessment, learner education and teaching, communication, and culture and climate. This review offers a summary for educators interested in remaining knowledgeable and current regarding the most relevant and valuable information in the field of medical education.

Objective To determine if use of a health literacy low-inference, self-assessment measure (LISAM), promoted behavior change as measured by increased use of health literacy communication skills (HLCS). Methods The LISAM is a tool used by educators to self-assess their performances after giving a lecture. The tool is low inference because it self-assesses behaviors that are specific, with little room for subjectivity. Forty-four third-year medical students self-assessed HLCS using a LISAM modified to include health literacy communication skills (LISAM-HLCS). Self-assessment followed participation in an audio recorded, standardized patient encounter and again after listening to the recording. Students also created 3 written goals for improvement. This session was repeated 1 week later. Results At Session 2, 71.4% of students met at least 2 of their 3 self-created objectives. The 3 most commonly created objectives were using teach-back, asking more open ended questions, and obtaining patient input into the management plan. Use of the LISAM increased HLCS use at Session 2 versus Session 1 as assessed by both students and study investigators (P Conclusions Without faculty present, students met and adjusted objectives, catalyzing changes in HLCS. The LISAM-HLCS has the potential to empower students to improve communication skills and to reduce dependence on faculty observations.

The ongoing adoption of competency-based medical education (CBME) across health professions training draws focus to learner-centred educational design and the importance of fostering a growth mindset in learners, teachers, and educational programs. An emerging body of literature addresses the instructional practices and features of learning environments that foster the skills and strategies necessary for trainees to be partners in their own learning and progression to competence and to develop skills for lifelong learning. Aligned with this emerging area is an interest in Dweck's self theory and the concept of the growth mindset. The growth mindset is an implicit belief held by an individual that intelligence and abilities are changeable, rather than fixed and immutable. In this paper, we present an overview of the growth mindset and how it aligns with the goals of CBME. We describe the challenges associated with shifting away from the fixed mindset of most traditional medical education assumptions and practices and discuss potential solutions and strategies at the individual, relational, and systems levels. Finally, we present future directions for research to better understand the growth mindset in the context of CBME.

Burnout remains a widespread issue in graduate medical education, with current trends to mitigate burnout shifting toward institutional systematic interventions as opposed to personal individual interventions. In this article, we propose utilizing Knowle's adult learning theory in conjunction with Maslach's organizational context for burnout to implement systemic changes within the postgraduate training environment that we posit would both optimize the learning experience and reduce the incidence of burnout.

Education, like clinical medicine, should be based on the most current evidence in the field. Despite the overwhelming breadth of literature in medical education, pediatric educators desire and need to incorporate best practices into their educational approaches. This article provides an overview of 18 articles from the literature in 2017 that the authors consider to be key articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership experience and expertise across the continuum of pediatric medical education, used an iterative, staged process to review more than 1682 abstracts published in 2017. This process aimed to identify a subset of articles that were most relevant to educational practice and most applicable to pediatric medical education. In the process, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the abstracts that best met these criteria. Selected abstracts were discussed using different pairs to select the final articles included in this review. This paper presents summaries of the 18 articles that were selected. The results revealed a cluster of studies related to feedback, coaching, and observation; trainee progression, educator development, trainee entrustment, culture, and climate; and the medical student experience. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field of medical education.

Generational differences result in conscious and unconscious biases that affect day-to-day interactions among professionals in the field of pediatrics. From the millennial trainee to the baby boomer seasoned clinician educator, including the three authors of this article, who span three generations, all are guilty to some extent. Pediatricians are not alone. In fact, some of them may even be in “exalted” company: > “They [Young People] have exalted notions because they have not been humbled by life or learned its necessary limitations; moreover, their hopeful disposition makes them think themselves equal to great things, and that means having exalted notions. They would always rather do noble deeds than useful ones. Their lives are regulated more by moral feeling than by reasoning. All their mistakes are in the direction of doing things excessively and vehemently.” > > Aristotle1 Every day, multidisciplinary teams of pediatric health care professionals converge in a clinical setting, hoping to create a psychologically healthy workplace where all generations feel included and valued in patient care discussions. Nonetheless, although health care team members in the field of pediatrics intentionally work to remedy the generational differences that arise between parents and their children, generational comparisons persist. We all are products of our own generational upbringings and the events that shaped our own lives, which, in turn, lead to perceptions about other generations that may or may not be true. We then may treat others … Address correspondence to Christian D. Pulcini, MD, MPH, MEd, Department of Surgery and Pediatrics, The Robert Larner College of Medicine, The University of Vermont and The University of Vermont Children’s Hospital, 111 Colchester Avenue, Burlington, Vermont 05401. E-mail: christian.pulcini{at}uvm.edu

Faculty development (FD) continues to be a great need and challenge for faculty engaged in graduate medical education (GME) and such educator development should ultimately benefit learners in GME programs. As a Task Force within the Association of Pediatric Program Directors (APPD) FD Learning Community, our Educator subcommittee utilized multiple needs assessments to develop a novel educator development program called the APPD FD for Educators Nuts and Bolts (Nuts & Bolts) consisting of 1 to 2 page FD teaching aids. This paper outlines the development of these teaching aids and can be used as a reference for developing future Nuts & Bolts teaching aids. The development was based on 1) a defining framework (Glassick's criteria), 2) a clear model for evaluation of the program (Logic model), and 3) development of an assessment tool to demonstrate effectiveness of the teaching aids in FD at the local level. These 3 components help establish the scholarly nature of the FD Nuts & Bolts program. Multiple lessons learned from development of this program are presented to inform others engaged in educator program development. Detailed proposals for use of FD Nuts & Bolts for faculty improvement and plans for generating additional teaching aids are presented.

Objectives This study aims to gain an understanding of the perceptions of host clinical preceptors in Malawi and Lesotho of the professionalism exhibited by short-term learners from the United States and Canada during short-term global health electives. Methods Focus group discussions were conducted with 11 host clinical preceptors at two outpatient pediatric HIV clinics in sub-Saharan Africa (Malawi and Lesotho). These clinics host approximately 50 short-term global health learners from the United States and Canada each year. Focus group moderators used open-ended discussion guides to explore host clinical preceptors’ perceptions of the professionalism of short-term global health learners. Thematic analysis with an inductive approach was used to identify salient themes from these focus group discussions. Results Eleven of the 18 possible respondents participated in two focus group discussions. Adaptability, eagerness to learn, active listening, gratitude, initiative, and punctuality was cited as professional behaviors among short-term global health learners. Cited unprofessional behaviors included disregard of local clinicians’ expertise and unresponsiveness to feedback. Host clinical preceptors described difficulty providing feedback to short-term global health learners and discrepancies between what may be considered professional in their home setting versus in the study settings. Respondents requested pre-departure orientation for learners and their own orientation before hosting learners. Conclusions Both host clinical preceptors and short-term global health learners should be aware that behaviors that may be considered best practice in one clinical setting may be perceived as unprofessional in another. Future studies to develop a common definition of professionalism during short-term global health electives are merited.

OBJECTIVE Shift work on a pediatric emergency medicine (PEM) rotation makes didactic scheduling difficult, thereby limiting teaching opportunities. These constraints make this rotation an ideal setting to supplement resident education with an online curriculum. We aimed to determine if implementation of an online curriculum during a resident PEM rotation improves posttest performance and increases satisfaction with resident educational experience. METHODS This was a prospective before/after study of pediatric and emergency medicine residents on a 1-month rotation in a tertiary care pediatric emergency department. A curriculum was developed consisting of 17 online modules. In the first 5 months of the study, 42 control residents received traditional bedside teaching. In the last 12 months, 80 intervention residents completed at least 8 modules during their rotation. Both groups completed a pretest at rotation start and a posttest and end-of-rotation survey at rotation end. RESULTS Control group pretest and posttest scores were not significantly different. In the intervention group, posttest scores were significantly increased compared with pretest scores (68 vs 59, P < 0.01). A low percentage of residents completed the study. Only 42% of the 189 residents enrolled in the intervention group completed the posttest and 28% completed the survey. CONCLUSIONS Implementing an online PEM curriculum significantly improved knowledge. As residency programs face new duty hour requirements, online curricula may provide an effective way to supplement teaching. However, to capitalize on this self-directed curriculum, the low participation rates in this study suggest we must first determine and establish ways to overcome barriers to online learning.

Background Physicians are expected to be leaders of multi-disciplinary teams without formal training. A recent Research and Development report found a direct relationship between teamwork behaviors and patient outcomes. Introducing leadership training early in residency can help to refine trainees’ strengths and build teams to support patient care. Objective: To examine the perceived benefit of leadership training for pediatric interns on teamwork and communication via formalized leadership and team building training. Methods Using Kolb's Theory of Experiential Learning, a 90-minute workshop, developed by a pediatric trainee, covered topics useful for teambuilding and understanding the intern role in patient care. A Myers Briggs Type Indicator test was administered to determine individual leadership styles. Cases, reviewed and edited by experienced educators, were discussed in faculty-led, small predetermined groups. Assessment was conducted via an anonymous survey to evaluate the perceived benefit of the training. Results 54/63 (85%) interns participated and completed the survey. The results showed the following: 89% identified their unique leadership style; 78% understood how leadership styles affects conflict resolution; 89% appreciated the importance of different leadership styles in a team based setting; 91% acknowledged the applicability to daily practice; 59% gained new skills to enhance communication in teams; 80% increased knowledge for decision-making in clinical practice. Conclusion Teamwork and leadership are an integral part of a safe, effective, and efficient health care system. The overall perceived benefit of introducing leadership training to pediatric interns shows significant promise for shaping tomorrow's leaders of patient care and health systems. Our workshop demonstrates identifying and understanding leadership/personality styles is important early in residency. Future studies should be conducted to further build on their strengths and call for help from team members with different styles/strengths in difficult situations.

Background Assessment using entrustable professional activities (EPAs) is currently under study as a joint effort of the American Board of Pediatrics and program director community. However, limited evidence exists for the feasibility of EPA-based assessment in pediatrics. Aim Among pediatric residency programs that implemented EPA-based assessment over 3 academic years (2015-16, 2016-17, 2017-18), determine how often programs were “unable to assess” a resident on a given EPA. Methods 23 programs reported clinical competency committee (CCC) determined EPA supervision level assignments for all residents in their program for a subset of 5-6 of the 17 general pediatrics EPAs biannually (Fall and Spring), except interns who were only assessed at the end of the academic year (Spring). They indicated “unable to assess” whenever applicable. Results Across the 5 data collection cycles, there were 29,643 opportunities to assign an EPA supervision level to 1987 residents from all three post-graduate years. Of these, 4140 assignments (14%) were deemed “unable to assess.” Across all EPAs, this determination was made less often in mid-year reports than year-end reports (p=.005). Post-graduate year 3 (PGY3) residents and PGY2 residents had significantly lower frequencies of “unable to assess” assignments when compared with PGY1 residents (Figure). EPAs with the lowest rates of “unable to assess” included: EPA 4 (patients with acute, common dx) at 0.4%, EPAs 10 (initial resuscitation/stabilization) and 16 (handovers) at 0.9%, EPA 11 (manage information) at 4%, and EPA 13 (practice management) at 5%. EPAs with the highest rates of “unable to assess” included EPA 8 (transition to adult care) at 43%, EPA 17 (procedures) at 27%, EPA 14 (quality improvement) at 20%, and EPAs 12 (make referrals) and 9 (behavioral and mental health) at 14%. Conclusions “Unable to assess” assignments are related to the given EPA, training year, and timing of assessment within the academic year. CCCs may be less likely to assign EPA supervision levels at timepoints viewed as higher stakes, such as transition from one training year to the next. Future work should explore this further and consider the etiology behind high levels of inability to assess some EPAs in particular.

Background Despite interventions, burnout continues to increase among trainees. In a recent study of pediatric residents, the burnout rate was found to be > 50%. Though burnout is a major issue, there is limited data on effective interventions which begs the question, what are we missing? An organizational context for burnout titled Areas of Worklife, identified 6 areas that can affect burnout in the workplace: control, values, reward, fairness, workload, and community. Understanding how residents perceive these areas and their effect on burnout is invaluable as it provides a unique insight into the problem that could inform future interventions. Objectives: This study aimed to gain a deeper understanding of resident perspectives related to the six Areas of Worklife and their significance in the context of residency. Methods Using qualitative methodology, we conducted semi-structured interviews with a convenience sample of 15 residents and focused on resident's perspective of the Worklife areas. Interviews were recorded and transcribed verbatim. Analysis was conducted concurrent with data collection using a constant comparison method; we used ATLAS.ti to manage the data for coding and the principal investigator and 2 co-investigators created themes. Results Themes identified based on Worklife areas are listed in Table 1. Overall, patient care was a lens through which residents understood the areas of control, reward, values, and workload. The themes identified in these leading areas focused on the resident's ability to interact with and learn from patients. Conclusions Resident definitions of the Worklife areas highlight the importance of patient involvement in the residency training experience, which is consistent with the literature that shows patient care is a means for residents to find meaning in their work. Understanding residents perspectives on Worklife areas is essential when developing potential interventions for burnout in residency.

Background: Short-term global health electives (STGHEs) have become increasingly common, with evidence showing educational and clinical benefits for short-term learners (STLs). Despite increased recognition that STGHEs should be mutually beneficial for host sites and STLs, evidence demonstrating the impact on international host preceptors is lacking. Objectives: To understand international host preceptors’ perceptions regarding benefits and burdens of hosting STLs. Methods: Focus group discussions with a convenience sample of 10 of 18 eligible preceptors were conducted at pediatric STGHE sites in Malawi and Lesotho. Qualitative content analysis was performed to identify themes using a deductive-inductive approach. Findings: Common themes regarding benefits to preceptors included increased knowledge and resources for learning from STLs, broadened differential diagnoses, and the satisfaction of teaching. Regarding burdens, preceptors perceived that supervising STLs decreases efficiency. Preceptors identified the burden of having to intervene in instances that could lead to patient harm. Some preceptors perceived that STLs under-valued preceptors’ clinical decision-making in resource-limited contexts. Conclusions: Our findings emphasize the need for institutions to identify mutuality of benefits between STLs and host sites when developing STGHEs. Host preceptors identified robust pre-departure training for STLs, lengthened duration of STGHEs, and formal preceptor orientation as ways to enhance mutuality of benefits.

Introduction The American Board of Pediatrics and pediatrics community developed entrustable professional activities (EPAs) defining the foundation of general pediatrics care. We sought to determine the developmental progression of pediatric residents across 3 years of training for the 17 General Pediatrics (GP) EPAs. Methods Over 3 academic years (2015-18), 22 geographically representative residency programs in the APPD LEARN used scales with 5 or 8 anchors, describing levels of supervision from direct to indirect to entrustment, to assess EPAs biannually. Interns were assessed only at the end of Year 1. We fit growth curves to ordinal supervision levels for all 17 EPAs together using a linear mixed model and developed “Denver Developmental” charts to display the proportion of learners who have reached each given level of supervision on each EPA based on the growth curves. Results Figure 1 illustrates examples of the developmental progression for 5 of the 17 EPAs. The graphic demonstrates where 25% (beginning of white box), 75% (where white and blue boxes meet), and 90% (end of blue box) of residents achieve each supervision level for the EPA with the highest ratings (handovers) and 4 EPAs with the lowest ratings (quality improvement, resuscitate/stabilize, behavioral/mental health, and transition to adult care) across 3 years of training. Some levels were achieved by all residents by the end of the intern year (e.g., levels 1-3 for EPA 16, handovers). Most EPAs had one or more advanced levels where the 25%, 75%, or 90% data extended beyond the end of training. In those instances, the percent of residents achieving these levels is indicated on the right-hand side of Figure 1 (e.g., 12% of residents achieved level 8 for EPA 8, transition to adult care, by the end of training). Conclusion The GP EPA “Denver Developmental” progressions may help in early screening for underperforming residents. This is critical information for the learner and the program. For the former, providing feedback provides an opportunity for improvement and for the latter, if a number of learners are not progressing as expected this may indicate curricular gaps.

The Federation of Pediatric Organizations engaged members of the pediatric community in an 18-month process to envision the future of the workforce in pediatrics, culminating in a Visioning Summit on the Future of the Workforce in Pediatrics. This article documents the planning process and methods used. Four working groups were based on the 4 domains that are likely to affect the future workforce: Child Health Research and Training, Diversity and Inclusion, Gender and Generations, and Pediatric Training Along the Continuum. These groups identified the issues and trends and prioritized their recommendations. Before the summit, 5 key megatrends cutting across all domains were identified: 1. Aligning Education to the Emerging Health Needs of Children and Families 2. Promoting Future Support for Research Training and for Child Health Research 3. Striving Toward Mastery Within the Profession 4. Aligning and Optimizing Pediatric Practice in a Changing Health Care Delivery System 5. Taking Advantage of the Changing Demographics and Expertise of the Pediatric Workforce At the Visioning Summit, we assembled members of each of the working groups, the Federation of Pediatric Organizations Board of Directors, and several invited guests to discuss the 5 megatrends and develop the vision, solutions, and actions for each megatrend. Based on this discussion, we offer 10 recommendations for the field of pediatrics and its leading organizations to consider taking action.

On a daily basis, patients put their trust in the healthcare system for safe and high-quality healthcare. However, what evidence do we have as an educational community that our supervising faculty members are competent to fulfill this responsibility? Few, if any, requirements exist for faculty members to have continuous professional development in the field of medical education. Many faculty “love to teach”, however, this love of teaching does not make them competent to teach or assess the competence of trainees whom they supervise. Faculty members who have a significant role as a teacher in the clinical setting should be assessed with regards to their baseline competence in applicable teaching EPAs. When competence is reached, an entrustment decision can be made. Once proficient or expert, a statement of awarded responsibility (STAR) may be granted. The time has come to reach beyond the “standards” of the old adage “see one, do one, teach one” in medical education. In this personal view, the authors outline an argument for and list the potential benefits for teachers, learners, and patients when we assess clinical teachers using EPAs within a competency-based medical education framework.

Education, like clinical medicine, should be based on the most current evidence in the field. Unfortunately, medical educators can be overwhelmed by the sheer volume and range of resources for this literature. This article provides an overview of 15 articles from 2016 that the authors consider the top articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership and expertise across the continuum of pediatric medical education, used an iterative 3-stage process to review more than 6339 abstracts published in 2016. This process was designed to identify a small subset of articles that were most relevant to educational practices and most applicable to pediatric medical education. In the first 2 stages, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the articles that best met these criteria. In the final stage, all articles were discussed using a group consensus model to select the final articles included in this review. This article presents summaries of the 15 articles that were selected. The results revealed a cluster of studies related to observed standardized clinical encounters, self-assessment, professionalism, clinical teaching, competencies/milestones, and graduate medical education management strategies. We provide suggestions on how medical educators can apply the findings to their own practice and educational settings. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field.

This article was migrated. The article was marked as recommended. Medical educators have an unprecedented opportunity to advance the field through dissemination of their work in academic publications. Also, their advancement may depend heavily on the number of publications. However, writing is, for many medical educators, a daunting task. Fortunately, authors have provided valuable articles and tips on the "how-to" of writing, and faculty development workshops have provided venues during which one can write a basic paper. These all are valuable, but they do not cover some of the unforeseen potential problems associated with publishing. Hence, we offer common pitfalls that the unsuspecting author will want to avoid, grouped into four categories--ethics of publishing, aims of discourse, setting boundaries, and accountability--in a reflective framework that most educators will recognize. These highlights should better equip novice medical educators, provide insights for experienced medical education mentors, and enhance the likelihood that the scholarly work will be published.

Purpose To investigate evidence for validity of faculty members' pediatric milestone (PM) ratings of interns (first-year residents) and subinterns (fourth-year medical students) on nine subcompetencies related to readiness to serve as a pediatric intern in the inpatient setting. Method The Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN) and the National Board of Medical Examiners collaborated to investigate the utility of assessments of the PMs for trainees' performance. Data from 32 subinterns and 179 interns at 17 programs were collected from July 2012 through April 2013. Observers used several tools to assess learners. At each site, a faculty member used these data to make judgments about the learner's current developmental milestone in each subcompetency. Linear mixed models were fitted to milestone judgments to examine their relationship with learner's rank and subcompetency. Results On a 5-point developmental scale, mean milestone levels for interns ranged from 3.20 (for the subcompetency Work effectively as a member of a team) to 3.72 (Humanism) and for subinterns from 2.89 (Organize and prioritize care) to 3.61 (Professionalization). Mean milestone ratings were significantly higher for the Professionalism competency (3.59-3.72) for all trainees compared with Patient Care (2.89-3.24) and Personal and Professional Development (3.33-3.51). Mean intern ratings were significantly higher than mean subintern ratings for all nine subcompetencies except Professionalization, Humanism, and Trustworthiness. Conclusions The PMs had a coherent internal structure and could distinguish between differing levels of trainees, which supports their validation for documenting developmental progression of pediatric trainees.

Importance Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence. Objective To measure the development of pediatric trainees’ clinical skills over time using EPA-based assessment data. Design, Setting, and Participants Prospective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018. Interventions Longitudinal, prospective assessment using EPAs. Main Outcomes and Measures Trajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA. Results Across the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25 503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to “unsupervised practice” varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician). Conclusions and Relevance This study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence.

Objective To identify existing challenges and potential strategies for providing complex care training to future pediatricians from a national group of educators. Methods Data were collected from pediatric educators involved in complex care at the Pediatric Educational Excellence Across the Continuum national meeting. Participants completed an anonymous 15-item survey adapted from the Association of American Medical Colleges (AAMC) Best Practices for Better Care initiative and participated in a focus group to understand the challenges and potential solutions to pediatric complex care education. Data were analyzed using grounded theory. Results Of the 15 participants, 9 (60%) were in educational leadership positions. All participants provided care to children with medical complexity (CMC), although 80% (n = 12) reported no formal training. Thematic analysis revealed learners' challenges in 2 domains: 1) a lack of ownership for the patient because of decreased continuity, decision-making authority, and autonomy, as a result of the multitude of care providers and parents' distrust; and 2) a sense of being overwhelmed as a result of lack of preparedness and disruptions in work flow. Participants suggested 3 mitigating strategies: being candid about the difficulties of complex care, discussing the social mandate to care for CMC, and cultivating humility among learners. Conclusions Residency education must prepare pediatricians to care for all children, regardless of disease. Training in complex care involves redefining the physician's role so that they are better equipped to participate in collaboration, empathy and advocacy with CMC. This study is the first to identify specific challenges and offer potential solutions to help establish training guidelines.

The goal of this chapter is to provide an overview of the state of health literacy education in the health care professions and to provide resources that will be useful to individuals who are interested in personal development or would like to facilitate improvement in the systems in which care is delivered on a daily basis. Core competencies for effective communication between patient and provider are discussed first, followed by a review of strategies that have been used to change health care provider’s behaviors and the outcomes of these efforts. A brief discussion of the science of learning is included to demonstrate how educational gaps can be filled using evidence-based strategies.

Introduction Mentorship is a vital component of academic and professional development. Mentees report positive impacts from mentorship programs, yet institutions and societies may struggle to meet their mentees’ needs due to factors such as mentor fatigue and lack of mentor training. To address this in our own professional society, the Association of Pediatric Program Directors, we developed a mentor toolkit in order to utilize a variety of mentoring models, provide faculty development for midlevel mentors, and offer guidance to mentees. Methods Most of these tools were designed to be administered in an interactive format such as a workshop or seminar with think-pair-share opportunities. The toolkit begins by providing a definition of mentoring and reinforcing the benefits and the characteristics of effective mentoring relationships. Next, we discuss the important role that mentees have in creating and maintaining effective mentoring relationships (i.e., mentee-driven mentoring). We then introduce a mentoring mosaic activity designed to help mentees examine their professional network and think about how they might expand it to fulfill the spectrum of their mentoring needs. Next, we present guidelines for the implementation of four mentoring models that can be used within one's institution: traditional dyadic mentoring, peer group mentoring, meet the professor mentoring, and speed mentoring. We then provide tools that can be used to help facilitate effective mentoring development. Results This toolkit has successfully served as a self-guided resource at national meetings for many years, garnering positive feedback from mentors and mentees alike. Discussion The principles and methods are easily generalizable and may be used to guide mentorship programs within institutional and professional societies, as well as to assist mentors and mentees in optimizing their individual mentoring relationships.

Although our country faces a looming shortage of doctors, constraints of space, funding, and patient volume in many existing residency programs limit training opportunities for medical graduates. New residency programs need to be created for the expansion of graduate medical education training positions. Partnerships between existing academic institutions and community hospitals with a need for physicians can be a very successful means toward this end. Baylor College of Medicine and The Children’s Hospital of San Antonio were affiliated in 2012, and subsequently, we developed and received accreditation for a new categorical pediatric residency program at that site in 2014. We share below a step-by-step guide through the process that includes building of the infrastructure, educational development, accreditation, marketing, and recruitment. It is our hope that the description of this process will help others to spur growth in graduate medical training positions.Keywords: graduate medical education; funding; physician shortage(Published: 8 August 2016)Citation: Med Educ Online 2016, 21: 32271 - http://dx.doi.org/10.3402/meo.v21.32271

To evaluate the impact of a tuberculosis (TB) educational intervention (EI) on change in adolescent student knowledge and participation in a TB prevention program.From 2/2013-5/2015, students from 2 high schools in Houston, TX participated. The 25-min EI discussed TB bacteriology, epidemiology, symptoms, and indications for TB testing/treatment. Students completed pre- and post-quizzes. Immediately after the EI, students were invited to participate in voluntary TB risk-factor screening, testing and treatment. At 6 months, focus groups were conducted.895 students attended the EI. 827 students (92%) completed the EI quizzes. Knowledge improved by 12% (pre: 70%; post: 82%, p0.001); 78% shared their TB knowledge. Following the EI, 671/827 (81%) enrolled in a TB prevention program. Focus groups indicated that the EI stimulated student learning about TB and increased their willingness to participate.A brief, one-time, TB EI is an effective method to encourage adolescents to learn about TB and motivate their uptake of TB risk-factor screening, testing and treatment. Similar EIs should accompany TB prevention programs targeting adolescents.The study's procedures could be considered for incorporation into school-based TB prevention programs to improve the identification, testing and treatment of adolescents at risk for TB.

From the Department of Pediatrics, Cincinnati Children’s Hospital Medical Center/ University of Cincinnati College of Medicine, Cincinnati, OH; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX; Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY; and Department of Pediatrics, University of Rochester Medical Center, A cademic institutions have strong incentives to develop faculty who are productive researchers, master clinicians, and educators. Forward-thinking institutions are encouraging their educators to become not only stellar teachers, but also productive scholars through peerreviewed dissemination of rigorously developed and evaluated curricular innovations, evaluation tools, and teaching methodologies. This emphasis on evaluation is imperative to ensure that educational programs effectively and efficiently meet the needs of the learners and the healthcare system. Even though many educator development programs train faculty to be good teachers, relatively few emphasize educational scholarship and research. Moreover, few of these are national programs offering participants the benefits of national mentoring and networking. The Educational Scholars Program (ESP) is a competitive national faculty development program created by the Academic Pediatric Association in 2006. The ESP is designed to cultivate skills in developing and evaluating curricula, conducting methodologically sound educational research, and effectively disseminating scholarly work. Mentorship and networking are key components of the ESP; each scholar is paired with a local project mentor and a national advisor with proven educational scholarship skills. Cohorts of scholars complete a 3-year longitudinal curriculum, including day-long sessions at 3 Pediatric Academic Society meetings and 6 online learning modules, each focused on specific educational scholarship skills. The cohorts form learning communities and serve as peer mentors. Scholars create an educator portfolio documenting their teaching activities and scholarly accomplishments. They also complete an educational project that they disseminate via peerreviewed publication or national presentation. The goal of this study was to describe the professional impact and value of the ESP on graduates and their institutions.

Background : The Accreditation Council for Graduate Medical Education requires residency programs to provide curricula for residents to engage in scholarly activities but does not specify particular guidelines for instruction. We propose a Resident Scholarship Program that is framed by the self-determination theory (SDT) and emphasize the process of scholarly activity versus a scholarly product. Methods : The authors report on their longitudinal Resident Scholarship Program, which aimed to support psychological needs central to SDT: autonomy, competence, and relatedness. By addressing those needs in program aims and program components, the program may foster residents’ intrinsic motivation to learn and to engage in scholarly activity. To this end, residents’ engagement in scholarly processes, and changes in perceived autonomy, competence, and relatedness were assessed. Results : Residents engaged in a range of scholarly projects and expressed positive regard for the program. Compared to before residency, residents felt more confident in the process of scholarly activity, as determined by changes in increased perceived autonomy, competence, and relatedness. Scholarly products were accomplished in return for a focus on scholarly process. Conclusions : Based on our experience, and in line with the SDT, supporting residents’ autonomy, competence, and relatedness through a process-oriented scholarship program may foster the curiosity, inquisitiveness, and internal motivation to learn that drives scholarly activity and ultimately the production of scholarly products. Keywords: scholarly activity; residency training; research; self-directed learning; self-determination theory (Published: 14 June 2016) Citation: Med Educ Online 2016, 21: 31021 - http://dx.doi.org/10.3402/meo.v21.31021