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3. A Faculty Development Workshop for High-Value Care Education Across Clinical Settings

Author

Herrmann, Lisa E, Tchou, Michael, Beck, Jimmy, Dewan, Maya, Avery, Carolyn, Schickedanz, Adam, Quinonez, Ricardo, and Walker, Lauren

Subjects
Pediatric, Clinical Research, Health Services, Behavioral and Social Science, Quality Education, Curriculum, Education, Education, Medical, Faculty, Medical, Humans, Pediatrics, Quality of Health Care, Staff Development, Editor's Choice, Faculty Development, High-Value Care
Abstract

IntroductionDespite rising health care costs, trainees frequently do not receive formal high-value care (HVC) training. As medical education often occurs through informal learning, it is imperative that medical educators be prepared to teach HVC concepts across clinical settings.MethodsThis workshop was created to provide frameworks for teaching HVC across four pediatric educational settings: (1) case-based conferences, (2) inpatient rounding, (3) ambulatory visits, and (4) conversations with patients and families. Frameworks were developed based on literature review, content experts' knowledge, and internal assessment and feedback. The workshop was divided into two sections: a didactic overview of HVC education and interactive small-group sessions to practice application of the Toolkit for Teaching High-Value Care. At the end of the workshop, participants completed the Prescription for High-Value Care to create a personal action plan.ResultsThis workshop has been presented at both national and local pediatric conferences. From over 89 evaluations (83% response rate), participants felt the workshop met objectives, served as a valuable use of their time, and provided useful resources. Evaluations elicited specific actions that participants gleaned from workshop content along with proposed behavior changes, such as creating HVC case-based conferences at their home institution and initiating more value-based discussions.DiscussionThis workshop has been successfully presented in both national and local settings and has been well received by participants. The workshop is targeted for clinical educators and aims to address the gap in faculty development for HVC education.

Published
2018

6. Pediatric Hospital Medicine Fellows’ Perspectives on Autonomy Through Time

Author

Jurgens, Valerie, Librizzi, Jamie, Shah, Neha, Bhansali, Priti, Balmer, Dorene F., and Beck, Jimmy

Abstract

Promoting autonomy is at the core of fellowship education. Pediatric hospital medicine (PHM) fellowship programs are relatively new, and many supervising physicians are not trained on how to promote fellow autonomy. Moreover, no studies have explored fellows’ perception of autonomy throughout training. To fill this gap, we explored PHM fellows’ perceptions of autonomy throughout training.PHM fellows starting fellowship in July 2021 were recruited to participate in a longitudinal qualitative study. Using self-determination theory as a sensitizing framework, the authors conducted semistructured interviews with 14 fellows throughout fellowship. Incoming data were iteratively analyzed, and codes were created from patterns in the data. Coded data were clustered into themes.Four themes developed: (1) at the beginning of fellowship, fellows valued direct observation and close supervision from their attending. (2) Initially, fellows felt pressured to make the identical clinical decision as their attending, but over the course of training, they realized their autonomous decisions could coexist with different decisions from their attending physicians. (3) At first, fellows desired attending presence to support and guide their decision making. Over time, fellows desired a coach who could provide valuable formative feedback. (4) Because of the hierarchical nature of medicine, conversations between fellows and attending physicians about autonomy were challenging to initiate.Fellows’ perceptions of autonomy change throughout fellowship, which should be taken into consideration as provisions of autonomy evolve through training. Our findings can inform PHM fellowship curricula and professional development around the promotion of autonomy in fellowship.

Published
2024
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13. The Norms and Corporatization of Medicine Influence Physician Moral Distress in the United States.

Author

Beck, Jimmy, Falco, Carla N, O'Hara, Kimberly L., Bassett, Hannah K, Randall, Cameron L., Cruz, Stephanie, Hanson, Janice L., Dean, Wendy, and Senturia, Kirsten

Subjects
*WELL-being, *HOSPITAL medical staff, *ETHICS, *HOSPITALISTS, *CHILDREN'S hospitals, *JOB stress, *RESEARCH methodology, *PRIVATE sector, *INTERVIEWING, *RISK assessment, *QUALITATIVE research, *CORPORATIONS, *PSYCHOSOCIAL factors, *RESEARCH funding, *THEMATIC analysis, *INDUSTRIAL hygiene, *PSYCHOLOGICAL distress, *PSYCHOLOGY of physicians
Abstract

PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents. ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized. FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed. InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine. [ABSTRACT FROM AUTHOR]

Published
2023
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20. Management and Outcomes in Children with Third-Generation Cephalosporin-Resistant Urinary Tract Infections

Author

Wang, Marie E, primary, Greenhow, Tara L, additional, Lee, Vivian, additional, Beck, Jimmy, additional, Bendel-Stenzel, Michael, additional, Hames, Nicole, additional, McDaniel, Corrie E, additional, King, Erin E, additional, Sherry, Whitney, additional, Parmar, Deepika, additional, Patrizi, Sara T, additional, Srinivas, Nivedita, additional, and Schroeder, Alan R, additional

Published
2021
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23. Financial Difficulties in Families of Hospitalized Children

Author

Bassett, Hannah K, primary, Coller, Ryan J, additional, Beck, Jimmy, additional, Hummel, Kevin, additional, Tiedt, Kristin A, additional, Flaherty, Brian, additional, Tchou, Michael J, additional, Kapphahn, Kristopher, additional, Walker, Lauren, additional, and Schroeder, Alan R, additional

Published
2020
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25. Clinical Response to Discordant Therapy in Third-Generation Cephalosporin-Resistant UTIs

Author

Wang, Marie E., primary, Lee, Vivian, additional, Greenhow, Tara L., additional, Beck, Jimmy, additional, Bendel-Stenzel, Michael, additional, Hames, Nicole, additional, McDaniel, Corrie E., additional, King, Erin E., additional, Sherry, Whitney, additional, Parmar, Deepika, additional, Patrizi, Sara T., additional, Srinivas, Nivedita, additional, and Schroeder, Alan R., additional

Published
2020
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27. Current Practices and Perspectives on Peer Observation and Feedback: A National Survey

Author

McDaniel, Corrie E., primary, Singh, Amit T., additional, Beck, Jimmy B., additional, Birnie, Krista, additional, Fromme, H. Barrett, additional, Ginwalla, Cherie F., additional, Griego, Elena, additional, King, Marta, additional, Maniscalco, Jennifer, additional, Nazif, Joanne, additional, Patra, Kamakshya P., additional, Seelbach, Elizabeth, additional, Walker, Jacqueline M., additional, and Bhansali, Priti, additional

Published
2019
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30. 1519. Management and Outcomes of Children with Extended-Spectrum Cephalosporin-Resistant Urinary Tract Infections (ESC-R UTIs)

Author

Wang, Marie, primary, Greenhow, Tara, additional, Lee, Vivian, additional, Beck, Jimmy, additional, Bendel-Stenzel, Michael, additional, Hames, Nicole, additional, McDaniel, Corrie, additional, King, Erin, additional, Sherry, Whitney, additional, Parmar, Deepika, additional, Patrizi, Sara, additional, Srinivas, Nivedita, additional, and Schroeder, Alan, additional

Published
2018
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31. 1522. Initial Clinical Response of Children with Extended-Spectrum Cephalosporin-Resistant Urinary Tract Infections (ESC-R UTI’s) Started on Discordant Antibiotics

Author

Wang, Marie, primary, Lee, Vivian, additional, Greenhow, Tara, additional, Beck, Jimmy, additional, Bendel-Stenzel, Michael, additional, Hames, Nicole, additional, McDaniel, Corrie, additional, King, Erin, additional, Sherry, Whitney, additional, Parmar, Deepika, additional, Patrizi, Sara, additional, Srinivas, Nivedita, additional, and Schroeder, Alan, additional

Published
2018
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33. Teaching High-Value Care: Case Vignettes for Pediatric Practice

Author

Walker, Lauren LaRue, primary, Hopkins, Akshata, additional, Rooholamini, Sahar Nayereh, additional, McDaniel, Corrie, additional, Jones, Yemisi, additional, Herrmann, Lisa E., additional, Lee, Vivian, additional, Bynum, Francine, additional, Tchou, Michael, additional, and Beck, Jimmy, additional

Published
2018
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48. The Chief Residency in U.S. and Canadian Graduate Medical Education: A Scoping Review.

Author

McDaniel, Lauren M., Molloy, Matthew J., Blanck, Jaime, Beck, Jimmy B., and Shilkofski, Nicole A.

Abstract

AbstractPhenomenonApproachFindingsInsightsDespite the nearly universal presence of chief residents within U.S. and Canadian residency programs and their critical importance in graduate medical education, to our knowledge, a comprehensive synthesis of publications about chief residency does not exist. An understanding of the current state of the literature can be helpful to program leadership to make evidence-based improvements to the chief residency and for medical education researchers to recognize and fill gaps in the literature.We performed a scoping review of the literature about chief residency. We searched OVID Medline, PsycINFO, ERIC, and Web of Science databases through January 2023 for publications about chief residency. We included publications addressing chief residency in ACGME specialties in the U.S. and Canada and only those using the term “chief resident” to refer to additional responsibilities beyond the typical residency training. We excluded publications using chief residents as a convenience sample. We performed a topic analysis to identify common topics among studies.We identified 2,064 publications. We performed title and abstract screening on 1,306 and full text review on 208, resulting in 146 included studies. Roughly half of the publications represented the specialties of Internal Medicine (n = 37, 25.3%) and Psychiatry (n = 30, 20.5%). Topic analysis revealed six major topics: (1) selection of chief residents (2) qualities of chief residents (3) training of chief residents (4) roles of chief residents (5) benefits/challenges of chief residency (6) outcomes after chief residency.After reviewing our topic analysis, we identified three key areas warranting increased attention with opportunity for future study: (1) addressing equity and bias in chief resident selection (2) establishment of structured expectations, mentorship, and training of chief residents and (3) increased attention to chief resident experience and career development, including potential downsides of the role. [ABSTRACT FROM AUTHOR]

Published
2023
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