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Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis has been reported in several southern U.S. states and Hawai'i. We present the first locally acquired human cases of A. cantonensis meningoencephalitis in three children in Florida, occurring between June 2021 and January 2022. Clinicians should be attuned to this possible diagnosis in this region., (Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2024.)

Competing Interests: The authors declare no conflicts of interest.

Background and Objectives: Rapid growth in pediatric hospital medicine (PHM) fellowships has occurred, yielding many new program directors (PDs). Characteristics of PDs have potential implications on the field. To describe characteristics (demographic, educational) and scholarly interests of PHM fellowship PDs., Methods: We developed and distributed a 15-question, cross-sectional national survey to the PHM PDs listserv. Questions were pilot tested. The survey was open for 4 weeks with weekly reminders. Responses were summarized using descriptive statistics., Results: Fifty-six current fellowship leaders (40 PDs, 16 associate PDs [APDs]) responded, including at least 1 from 43 of 59 active PHM fellowship programs (73%). Most respondents identified as female (71%) and ≤50 years old (80%). Four (7%, n = 2 PD, 2 APD) leaders identified as underrepresented in medicine. About half (n = 31, 55.4%) completed a fellowship themselves (APDs > PDs; 87.5% vs 42.5%), and 53.5% (n = 30) had advanced nonmedical degrees (eg, Master of Science, Doctor of Philosophy; APDs > PDs; 62% vs 45%). Most leaders (59%, n = 33) chose multiple domains when asked to select a "primary domain of personal scholarship." Education was the most frequently selected (n = 37), followed by quality improvement (n = 29) and then clinical research (n = 19)., Conclusions: This survey confirms a high percentage of women as PHM fellowship leaders and highlights the need to increase diversity. Less than half of senior PDs completed a fellowship in any specialty. Leaders report interest in multiple domains of scholarship; few focus solely on clinical research., (Copyright © 2024 by the American Academy of Pediatrics.)

Objectives: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality., Methods: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored., Results: A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores., Conclusions: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores., (Copyright © 2023 by the American Academy of Pediatrics.)

Objectives: Virtual rounds enable remote participation in bedside clinical encounters. Their effects on education remain poorly characterized and limited by lack of foundational evidence establishing that this approach is welcomed among learners and educators. We assessed technical feasibility and acceptability of incorporating video conferencing into daily work rounds of pediatric residents and attending physicians., Methods: We conducted a cross-sectional survey-based study of attending observers and pediatric residents participating in rounds both at the bedside and via video teleconferencing from September to December 2020. Participant experiences were assessed and summarized using parametric Likert-type questions regarding technical issues, efficiency, educational experience, and engagement. Associations between technical aspects and individual perceptions of virtual rounds and self-reported engagement were also measured., Results: Of 75 encounters, 29% experienced technical issues, 45% of which were attributable to a low-quality tablet stand. Negative impacts of virtual rounding on efficiency were reported in 6% of responses. Virtual participants were engaged (70%) and reported educational value for 65% of encounters. Comfort with virtually asking questions (odds ratio 3.3; 95% confidence interval 2.0-5.7) and performing clinical tasks for other patients (odds ratio 0.42; 95% confidence interval 0.2-0.9) were associated with engagement (P <.05)., Conclusions: Virtual participation in rounds was technically feasible and maintained educational value and engagement for residents in the majority of encounters, without sacrificing efficiency. Even as restrictions from the coronavirus disease 2019 pandemic are lifted, this rounding model has many important applications, including increasing educational opportunities for remote learners and making multidisciplinary rounds more accessible., (Copyright © 2022 by the American Academy of Pediatrics.)

Objectives: To develop an institutional machine-learning (ML) tool that utilizes demographic, socioeconomic, and medical information to stratify risk for 7-day readmission after hospital discharge; assess the validity and reliability of the tool; and demonstrate its discriminatory capacity to predict readmissions., Patients and Methods: We performed a combined single-center, cross-sectional, and prospective study of pediatric hospitalists assessing the face and content validity of the developed readmission ML tool. The cross-sectional analyses used data from questionnaire Likert scale responses regarding face and content validity. Prospectively, we compared the discriminatory capacity of provider readmission risk versus the ML tool to predict 7-day readmissions assessed via area under the receiver operating characteristic curve analyses., Results: Overall, 80% (15 of 20) of hospitalists reported being somewhat to very confident with their ability to accurately predict readmission risk; 53% reported that an ML tool would influence clinical decision-making (face validity). The ML tool variable exhibiting the highest content validity was history of previous 7-day readmission. Prospective provider assessment of risk of 413 discharges showed minimal agreement with the ML tool (κ = 0.104 [95% confidence interval 0.028-0.179]). Both provider gestalt and ML calculations poorly predicted 7-day readmissions (area under the receiver operating characteristic curve: 0.67 vs 0.52; P = .11)., Conclusions: An ML tool for predicting 7-day hospital readmissions after discharge from the general pediatric ward had limited face and content validity among pediatric hospitalists. Both provider and ML-based determinations of readmission risk were of limited discriminatory value. Before incorporating similar tools into real-time discharge planning, model calibration efforts are needed., (Copyright © 2022 by the American Academy of Pediatrics.)

Background: Children with tracheostomy are frequently admitted to the hospital for tracheostomy-associated respiratory infections (TRAINs). However, there remains a paucity of evidence to direct the diagnosis, treatment, and prevention of TRAINs. An important first step to addressing this knowledge gap is to synthesize existing data regarding TRAINs to inform current practice and facilitate innovation., Data Sources: We searched PubMed, Embase, Cochrane Library, CINAHL, and Web of Science from inception to October 2020. Original research articles and published abstracts including children and young adults 0-21 years of age with tracheostomy were included. Included studies assessed the clinical definitions of and risk factors for TRAINs, microbiologic epidemiology and colonization of tracheostomies, and treatment and outcomes of TRAINs., Data Synthesis: Out of 5755 studies identified in the search, 78 full-text studies were included in the final review. A substantial number of studies focused on the detection of specific pathogens in respiratory cultures including Pseudomonas aeruginosa. Several different definitions of TRAIN including clinical, microbiologic, and laboratory testing results were utilized; however, no uniform set of criteria were identified. The few studies focused on treatment and prevention of TRAIN emphasized the role of empiric antimicrobial therapy and the use of inhaled antibiotics., Conclusions: Despite a growing number of research articles studying TRAINs, there is a paucity of prospective interventional trials to guide the diagnosis, treatment, and prevention of respiratory disease in this vulnerable population. Future research should include studies of interventions designed to improve short- and long-term respiratory-related outcomes of children with tracheostomy., (© 2022 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Competing Interests: CONFLICTS OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

Competing Interests: FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

Background: Social determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills., Methods: We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9-12 months after participation., Results: 85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38-47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02)., Discussion: Simulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting., (© 2021. The Author(s).)

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Objective: To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs)., Study Design: A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers., Results: Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline., Conclusions: Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: When grown in human serum, laboratory isolates of Pseudomonas aeruginosa exhibit tolerance to antibiotics at inhibitory concentrations. This phenomenon, known as serum-associated antibiotic tolerance (SAT), could lead to clinical treatment failure of pseudomonal infections. Our purpose in this study was to determine the prevalence and clinical impact of SAT in Pseudomonas isolates in hospitalized children., Methods: The SAT phenotype was assessed in patients aged <18 years admitted with respiratory or blood cultures positive for P. aeruginosa. The SAT phenotype was a priori defined as a ≥2-log increase in colony-forming units when grown in human serum compared with Luria-Bertani medium in the presence of minocycline or tobramycin., Results: SAT was detected in 29 (64%) patients. Fourteen patients each (34%) had cystic fibrosis (CF) and tracheostomies. Patient demographics and comorbidities did not differ by SAT status. Among CF patients, SAT was associated with longer duration of intravenous antibiotics (10 days vs 5 days; P < .01)., Conclusions: This study establishes that SAT exists in P. aeruginosa from human serum and may be a novel factor that contributes to differences in clinical outcomes. Future research should investigate the mechanisms that contribute to SAT in order to identify novel targets for adjunctive antimicrobial therapies., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The Johns Hopkins Pediatrics Clerkship developed the PRECEDE (preclerkship educational exercises) curriculum with the primary goal of offering students formative instruction in essential pediatric clinical skills to prepare them for their clerkship. PRECEDE sessions occur at the beginning of each basic clerkship for new clinical clerkship students. The otitis media module is one in a series of modules presented in the curriculum and consists of a lecture and four short skills-development stations, each with a faculty facilitator., Methods: This 2-hour module began with a 1-hour didactic overview of otitis media. Medical students were divided into three groups. One group learned about writing prescriptions via two otitis media clinical vignettes. Another group explored visualization and diagnosis of otitis media via video. The last student group was subdivided and learned proper techniques for positioning and restraining pediatric patients during otoscopic exams and the psychomotor skills for performing otoscopic examinations, including pneumatic otoscopy. Student groups rotated through all four activity stations. Students were guided through discussion to develop interpretation, diagnostic, and treatment skills for acute otitis media., Results: Between 2010 and 2012, 254 third- and fourth-year medical students participated in this module. When asked to evaluate overall quality, 86% of learners rated the module as excellent, and 14% rated it as good., Discussion: By establishing these important skills, students may be better equipped to develop appropriate otitis media assessments, diagnoses, and care plans for patients and to use otitis media as a platform for broad education in other essential pediatric skills., (© 2020 Cooper et al.)

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Aim: In 2011, Johns Hopkins Medicine integrated with All Children's Hospital in St. Petersburg Florida to create an academic campus nearly 1000 miles from Baltimore. In 2014, the newly named Johns Hopkins All Children's Hospital established a new pediatric residency program. At that time, the Association for Graduate Medical Education had not accredited a new pediatric program in the USA in over 10 years., Methods: A unique set of circumstances provided an opportunity for program developers to build the residency under newly identified core tenets to create a number of innovative features targeted to address the many calls for change in graduate medical education., Results: This paper focuses on three of those innovations and demonstrates how they address the many challenges introduced by the changing landscape of graduate medical education., Conclusion: Although a full evaluation of our program is only possible after many years, this article presents the core tenets which guided curricular development and discusses our experiences thus far. We provide lessons learned for programs considering similar innovations.

Background: Errors in the timely diagnosis and treatment of infants with hypoglycemic seizures can lead to significant patient harm. It is challenging to precisely measure medical errors that occur during high-stakes/low-frequency events. Simulation can be used to assess risk and identify errors., Objective: We hypothesized that general emergency departments (GEDs) would have higher rates of deviations from best practices (errors) compared to pediatric emergency departments (PEDs) when managing an infant with hypoglycemic seizures., Methods: This multicenter simulation-based prospective cohort study was conducted in GEDs and PEDs. In situ simulation was used to measure deviations from best practices during management of an infant with hypoglycemic seizures by inter-professional teams. Seven variables were measured: five nonpharmacologic (i.e., delays in airway assessment, checking dextrose, starting infusion, verbalizing disposition) and two pharmacologic (incorrect dextrose dose and incorrect dextrose concentration). The primary aim was to describe and compare the frequency and types of errors between GEDs and PEDs., Results: Fifty-eight teams from 30 hospitals (22 GEDs, 8 PEDs) were enrolled. Pharmacologic errors occurred more often in GEDs compared to PEDs (p = 0.043), while nonpharmacologic errors were uncommon in both groups. Errors more frequent in GEDs related to incorrect dextrose concentration (60% vs. 88%; p = 0.025), incorrect dose (20% vs. 56%; p = 0.033), and failure to start maintenance dextrose (33% vs. 65%; p = 0.040)., Conclusions: During the simulated care of an infant with hypoglycemic seizures, errors were more frequent in GEDs compared to PEDs. Decreasing annual pediatric patient volume was the best predictor of errors on regression analysis., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Patients often cannot recognise the names and faces of providers involved in their hospital care., Objective: The aim of this study was to determine whether photographs of a patient's providers (physicians and ancillary support staff) using the FACES (Faces of All Clinically Engaged Staff) instrument would increase recognition of the healthcare team, improve the perception of teamwork, and enhance patient satisfaction., Methods: Cluster randomised controlled trial with patients admitted to four adult internal medicine services of an urban, tertiary care hospital. Patients randomly admitted to two services received the FACES instrument, while the remainder served as control. Study measurements included the proportion of patients able to recognise their care providers by photograph, name and role, as well as patient rating of communication among healthcare team members and their satisfaction with the hospital experience as assessed by a survey., Results: A total of 197 of the 322 (61.2%) patients screened for participation proved eligible for the study. Key exclusion criteria included cognitive or visual impairment and non-fluency with English. Patients receiving the FACES instrument recognised more provider names, faces and roles than controls (all P<.001). The intervention group more strongly agreed with statements that healthcare providers communicated frequently and effectively with each other (68% vs 52%, P=.02), and worked well together (69% vs 53%, P=.02). When rating their satisfaction with the hospital experience, 50% of patients in the intervention group assigned the highest possible rating, compared with 36% of control (P=.06)., Limitations: Nursing staff, although integral to healthcare teams, were not included in the FACES instrument due to privacy concerns., Conclusions: The FACES instrument improved patients' recognition of providers' names and roles, as well as patients' perception of inter-provider teamwork. There was a non-significant trend towards improved satisfaction., (© 2016 John Wiley & Sons Ltd.)

Background: Each year in the United States, 72,000 pediatric patients develop septic shock, at a cost of $4.8 billion. Adherence to practice guidelines can significantly reduce mortality; however, few methods to compare performance across a spectrum of emergency departments (EDs) have been described., Objectives: We employed standardized, in situ simulations to measure and compare adherence to pediatric sepsis guidelines across a spectrum of EDs. We hypothesized that pediatric EDs (PEDs) would have greater adherence to the guidelines than general EDs (GEDs). We also explored factors associated with improved performance., Methods: This multi-center observational study examined in situ teams caring for a simulated infant in septic shock. The primary outcome was overall adherence to the pediatric sepsis guideline as measured by six subcomponent metrics. Characteristics of teams were compared using multivariable logistic regression to describe factors associated with improved performance., Results: We enrolled 47 interprofessional teams from 24 EDs. Overall, 21/47 teams adhered to all six sepsis metrics (45%). PEDs adhered to all six metrics more than GEDs (93% vs. 22%; difference 71%, 95% confidence interval [CI] 43-84). Adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. In a multivariable regression model, only greater composite team experience had greater adjusted odds of achieving an adherent sepsis score (adjusted odds ratio 1.38, 95% CI 1.01-1.88)., Conclusions: Using standardized in situ scenarios, we revealed high variability in adherence to the pediatric sepsis guideline across a spectrum of EDs. PEDs demonstrated greater adherence to the guideline than GEDs; however, in adjusted analysis, only composite team experience level of the providers was associated with improved guideline adherence., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: In an effort to assess medical students' abilities to identify a medication administration error in an outpatient setting, we designed and implemented a standardized patient simulation exercise which included a medication overdose., Methods: Fourth year medical students completed a standardized patient (SP) simulation of a parent bringing a toddler to an outpatient setting. In this case-control study, the majority of students had completed a patient safety curriculum about pediatric medication errors prior to their SP encounter. If asked about medications, the SP portraying a parent was trained to disclose that she was administering acetaminophen and to produce a package with dosing instructions on the label. The administered dose represented an overdose. Upon completion, students were asked to complete an encounter note., Results: Three hundred forty students completed this simulation. Two hundred ninety-one students previously completed a formal patient safety curriculum while 49 had not. A total of two hundred thirty-four students (69%) ascertained that the parent had been administering acetaminophen to their child. Thirty-seven students (11%) determined that the dosage exceeded recommended dosages. There was no significant difference in the error detection rates of students who completed the patient safety curriculum and those who had not., Conclusions: Despite a formal patient safety curriculum concerning medication errors, 89% of medical students did not identify an overdose of a commonly used over the counter medication during a standardized patient simulation. Further educational interventions are needed for students to detect medication errors. Additionally, 31% of students did not ask about the administration of over the counter medications suggesting that students may not view such medications as equally important to prescription medications. Simulation may serve as a useful tool to assess students' competency in identifying medication administration errors.

Objective: One of the greatest challenges for clerkship directors is assigning a final grade and determining the precise point at which a student either passes or fails a clinical clerkship. The process of incorporating both subjective and objective assessment data to provide a final summative grade can be challenging. We describe our experience conducting a standard-setting exercise to set defensible cut points in a 4-tiered grading system in our pediatric clerkship., Methods: Using the Hofstee standard-setting approach, 8 faculty members participated in an exercise to establish grade cut points. These faculty members were subsequently surveyed to assess their attitudes toward the standard-setting process as well as their reactions to these newly proposed standards. We applied the new cut points to a historic cohort of 116 Johns Hopkins University School of Medicine students from the academic year 2012-2013 to assess the potential impact on grade distributions., Results: The resultant grading schema would lead to a significant increase in the number of students receiving a failing grade and a decrease in the number of students receiving a grade of honors in a historical cohort. Faculty reported that the Hofstee method was easy to understand and fair. All faculty members thought that grade inflation presently exists within the pediatric clerkship., Conclusions: This study demonstrates that practical standards using the Hofstee method can be set for medical students in a pediatric clerkship in which multiple performance measures are used., (Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Simulation-based education is expensive and requires greater resources than traditional methods, yet there is limited evidence to justify such expenditures for medical student education., Methods: We describe the implementation and evaluation of a simulation-based curriculum delivered to medical students during a pediatric clerkship. This prospective mixed-methods study evaluated a 5-day long simulation-based clinical skills curriculum (PRE-Clerkship EDucational Exercises [PRECEDE]) at the Johns Hopkins University School of Medicine. Two hundred medical students participated in PRECEDE during a 2-year period and were compared with 236 students who had not. Outcomes were assessed across 3 levels of Kirkpatrick's framework for evaluation. The 4-level model consists of reaction, learning, behavior, and results criteria. Secondary outcomes measured changes in assessment scores across 16 student performance domains during clerkship, changes in performance on the National Board of Medical Examiners subject examination in pediatrics, and student assessments of the curriculum., Results: Improvements were noted across 3 levels of the Kirkpatrick's model. Student performance evaluations were significantly higher across all 16 evaluation components, with effect sizes ranging from small to medium (Cohen's d, 0.23-0.44). Students scored significantly higher on the National Board of Medical Examiners pediatric shelf examination (80 vs. 77, P<0.001). Ninety-seven percent of the medical students agreed that their skills increased and that the time lost to real clinical experiences was a worthwhile trade-off for this curriculum, Conclusions: The implementation of a simulation-based curriculum within a pediatrics clerkship resulted in higher knowledge scores and led to improvements in medical student clinical performance during the clerkship.

Background: Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers., Objective: We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic., Methods: Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study., Results: Of the 229 caregivers who completed the survey (91.2% response rate), 171 (74.6%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3%) stated that they would like to email doctors, although only 18 (10.7%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95% CI 0.14-0.82) as were those with annual incomes less than US $30,000 (adjusted OR 0.26, 95% CI 0.09-0.74)., Conclusions: Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email.

Objective: Follow-up of pediatric patients after an emergency department (ED) visit is important for monitoring changes in patient health and informing patients of test results conducted during the visit. The telephone has been the standard method of communication, but contact rates are poor. We conducted a survey to assess pediatric caregiver attitudes toward and access to alternate electronic communication modalities after a pediatric ED encounter., Subjects and Methods: Participants (n=102) were recruited from an urban community ED and completed a 35-item questionnaire in this cross-sectional study., Results: The majority of pediatric caregivers have Internet access in their home (72%), although less than half check e-mail daily (46%). A larger percentage owns a cell phone (90%) and checks text messages daily (87%). The majority agree that more doctors should communicate by e-mail (70%), and nearly half (45%) would like to receive test results by text message., Conclusions: Caregivers of children have access to the Internet and mobile phone technologies, and many would be interested in communicating with healthcare providers following an ED visit. Cell phone and text-messaging technologies appear to be more available than e-mail and may serve as an underutilized contact method. A combination of modalities directed by caregiver preferences may improve ED follow-up contact rates.

Background: The traditional role of the faculty inpatient attending providing clinical care and effectively teaching residents and medical students is threatened by increasing documentation requirements, pressures to increase clinical productivity, and insufficient funding available for medical education. In order to sustain and improve clinical education on a general pediatric inpatient service, we instituted a comprehensive program change. Our program consisted of creating detailed job descriptions, setting clear expectations, and providing salary support for faculty inpatient attending physicians serving in clinical and educational roles. This study was aimed at assessing the impact of this program change on the learners' perceptions of their faculty attending physicians and learners' experiences on the inpatient rotations., Methods: We analyzed resident and medical student electronic evaluations of both clinical and teaching faculty attending physician characteristics, as well as resident evaluations of an inpatient rotation experience. We compared the proportions of "superior" ratings versus all other ratings prior to the educational intervention (2005-2006, baseline) with the two subsequent years post intervention (2006-2007, year 1; 2007-2008, year 2). We also compared medical student scores on a comprehensive National Board of Medical Examiners clinical subject examination pre and post intervention., Results: When compared to the baseline year, pediatric residents were more likely to rate as superior the quality of didactic teaching (OR=1.7 [1.0-2.8] year 1; OR=2.0 [1.1-3.5] year 2) and attendings' appeal as a role model (OR=1.9 [1.1-3.3] year 2). Residents were also more likely to rate as superior the quality of feedback and evaluation they received from the attending (OR=2.1 [1.2-3.7] year 1; OR=3.9 [2.2-7.1] year 2). Similar improvements were also noted in medical student evaluations of faculty attendings. Most notably, medical students were significantly more likely to rate feedback on their data gathering and physical examination skills as superior (OR=4.2 [2.0-8.6] year 1; OR=6.4 [3.0-13.6] year 2)., Conclusions: A comprehensive program which includes clear role descriptions along with faculty expectations, as well as salary support for faculty in clinical and educational roles, can improve resident and medical student experiences on a general pediatric inpatient service. The authors provide sufficient detail to replicate this program to other settings.

Objective: Medical knowledge is one of six core competencies in medicine. Medical student assessments should be valid and reliable. We assessed the relationship between faculty and resident global assessment of pediatric medical student knowledge and performance on a standardized test in medical knowledge., Methods: Retrospective cross-sectional study of medical students on a pediatric clerkship in academic year 2008-2009 at one academic health center. Faculty and residents rated students' clinical knowledge on a 5-point Likert scale. The inter-rater reliability of clinical knowledge ratings was assessed by calculating the intra-class correlation coefficient (ICC) for residents' ratings, faculty ratings, and both rating types combined. Convergent validity between clinical knowledge ratings and scores on the National Board of Medical Examiners (NBME) clinical subject examination in pediatrics was assessed with Pearson product moment correlation correction and the coefficient of the determination., Results: There was moderate agreement for global clinical knowledge ratings by faculty and moderate agreement for ratings by residents. The agreement was also moderate when faculty and resident ratings were combined. Global ratings of clinical knowledge had high convergent validity with pediatric examination scores when students were rated by both residents and faculty., Conclusions: Our findings provide evidence for convergent validity of global assessment of medical students' clinical knowledge with NBME subject examination scores in pediatrics., (Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether medical students and faculty perceive differences in the effectiveness of interactions with real patients versus simulated patients (SPs) in communication skills training., Method: In 2008, the authors recruited volunteer outpatients (VOs) from the Johns Hopkins University School of Medicine internal medicine practice to participate in communication skills training for all first-year medical students. VOs and SPs were assigned to clinic rooms in the simulation center. Each group of five students and its preceptor rotated through randomly assigned rooms on two of four session days; on both days, each student interviewed one patient for 15 minutes, focusing on past medical and family history or social history. Patients used their own histories, not scripts; students were not blinded to patient type. Students and faculty then rated aspects of the interview experience. Generalized linear latent and mixed-models analysis was used to compare ratings of communication skills training with VOs versus SPs., Results: All 121 first-year students participated in 242 interviews, resulting in 237 usable questionnaires (98%). They rated their experiences with VOs significantly higher than those with SPs on comfort, friendliness, amount of learning, opportunity to build relationships, and overall meeting of communication skills training needs. The 24 faculty preceptors' ratings of the 242 interactions did not differ significantly between VOs and SPs., Conclusions: Use of VOs was well received by students and faculty for teaching communication skills. Expanding and further studying VOs' participation will allow greater understanding of their potential role in communication skills training of preclinical medical students.

Background: The purpose of this study was to evaluate the impact of a patient-safety curriculum administered during a paediatric clerkship on medical students' attitudes towards patient safety., Methods: Medical students viewed an online video introducing them to systems-based analyses of medical errors. Faculty presented an example of a medication administration error and demonstrated use of the Learning From Defects tool to investigate the defect. Student groups identified and then analysed medication errors during their clinical rotation using the Learning From Defects framework to organise and present their findings. Outcomes included patient safety attitudinal changes, as measured by questions derived from the Safety Attitudes Questionnaire., Results: 108 students completed the curriculum between July 2008 and July 2009. All student groups (25 total) identified, analysed and presented patient safety concerns. Curriculum effectiveness was demonstrated by significant changes on questionnaire items related to patient safety attitudes. The majority of students felt that the curriculum was relevant to their clinical rotation and should remain part of the clerkship., Conclusions: An active learning curriculum integrated into a clinical clerkship can change learners' attitudes towards patient safety. Students found the curriculum relevant and recommended its continuation.

Objective: The aim of this study was to determine if an information sheet containing photographs and explanations of the training level of medical providers could enhance a parent's ability to identify their child's providers and whether this would impact parental attitudes toward trainee involvement and patient satisfaction., Methods: This was a prospective, mixed methods study of parent-child dyads admitted to an academic general pediatric inpatient service. The intervention group received a photo information sheet (Photographs of Academic Clinicians and Their Educational Status [PHACES] tool) consisting of passport-sized photos of the medical team along with information regarding their training. Parents were asked to name their child's providers, were surveyed about their attitudes toward trainees, participated in a brief, semistructured interview and completed the patient satisfaction questionnaire (ABIM-PSQ)., Results: Comparing intervention with control parents, 40 of 49 (82%) versus 19 of 51 (37%) were able to name at least one provider (adjusted odds ratio 8.0; P < .01). Parents who received the intervention were more likely to correctly match the face with the name of the medical student (67% vs 14%; P < .01) and attending (80% vs 24%; P < .01). Parents who received the intervention were more likely to report acceptance of the involvement of medical students and house staff as well as an improved understanding of their roles. Parents who received the intervention scored higher on the ABIM-PSQ (mean 48.3 vs 45.4; P = .008)., Conclusions: An information sheet containing the photographs of health care providers along with an explanation of their training improves recognition of the health care team members, improves acceptance of trainee involvement, and improves satisfaction with care delivered by physicians in training., (Copyright 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objectives: Obesity is the most common chronic disease of childhood. Although it is accepted that diet and exercise practices are important, there is little data to discern the contributions of specific activities toward a healthy body weight. We sought to identify associations between bicycling and overweight status and to compare this with other physical activities and dietary practices thought to be protective against overweight status., Methods: We constructed a survey to gather dietary and activity practices in a cross-sectional, convenience sample of 100 children presenting to an urban hospital setting in Baltimore, Maryland. We chose to emphasize bicycling because it is a widely available activity that requires a sustained level of moderate energy expenditure, yet little is known about the relationship of this particular activity with childhood overweight status., Results: The mean age of our population was 11.8 years and 56% were overweight (body mass index>85 percentile). Most (96%) knew how to ride a bike and 80% reported owning a bike. Children who rode a bike just once a week or less were the most likely to be overweight (multivariate-adjusted odds ratio 6.6, 95% confidence interval, 2.1-21). This association was stronger than for all other dietary and activity practices. We found that approximately half of our participants do not eat breakfast, fruits, or vegetables regularly. More than half never ride a bike to school, walk to school, or participate in any organized sport., Conclusions: Riding a bicycle at least 2 or more days during the week is associated with a decreased likelihood of being overweight during childhood.

Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract illness (LRI) in infants and children worldwide and causes significant LRI in the elderly and in immunocompromised patients. The goal of RSV vaccination is to prevent serious RSV-associated LRI. There are several obstacles to the development of successful RSV vaccines, including the need to immunize very young infants, who may respond inadequately to vaccination; the existence of two antigenically distinct RSV groups, A and B; and the history of disease enhancement following administration of a formalin-inactivated vaccine. It is likely that more than one type of vaccine will be needed to prevent RSV LRI in the various populations at risk. Although vector delivery systems, synthetic peptide, and immune-stimulating complex vaccines have been evaluated in animal models, only the purified F protein (PFP) subunit vaccines and live attenuated vaccines have been evaluated in recent clinical trials. PFP-2 appears to be a promising vaccine for the elderly and for RSV-seropositive children with underlying pulmonary disease, whereas live cold-passaged (cp), temperature-sensitive (ts) RSV vaccines (denoted cpts vaccines) would most probably be useful in young infants. The availability of cDNA technology should allow further refinement of existing live attenuated cpts candidate vaccines to produce engineered vaccines that are satisfactorily attenuated, immunogenic, and phenotypically stable.