Handheld Electronic Device Use by Pediatric Hospitalists on Family Centered Rounds.

Physicians increasingly use handheld electronic devices (HED) to assist in daily work activities. The objectives of our study were to describe the practice patterns of pediatric hospitalists in the use of HED during daily work activities and Family Centered Rounds (FCR). We also examined perceptions of pediatric hospitalists on benefits and barriers of these devices on trainee education and family/patient interactions. An anonymous cross-sectional survey was sent to the American Academy of Pediatrics' Section on Hospital Medicine Listserv between October-November 2012, to determine pediatric hospitalists usage and attitudes of HED on FCR. A total of 140 Listserv members responded. Seventy six percent reported using a HED in daily work activities. One-third claimed their institution has a policy on device use. Eighty one percent of respondents practice FCR at their institution. Only 34 % of those who practice FCR use a HED on FCR. Those who have used a HED on FCR responded "always" or "often" to the following questions: 48 % feel the use of these devices improves educational experiences for learners on FCR, and 49 % feel these devices improve patient/family educational opportunities on FCR. Over 75 % of pediatric hospitalists used a HED in their daily work activities. A majority is unaware or claims their institution has no policy on handheld device use. While most respondents practice FCR, only one-third used these devices on FCR despite the belief that these devices improve trainee and patient/family educational opportunities on FCR.

Prioritization and Resource Allocation in Academic Global Health Partnerships.

OBJECTIVE: US-based academic institutions involved in global health (GH) partnerships can have a positive impact on health care systems in low/middle-income countries but lack a consistent approach. Existing priority setting and resource allocation (PSRA) frameworks do not adequately capture the interpersonal and sociopolitical complexity of decision-making in GH work. The authors explored how US-based GH practitioners prioritize and allocate resources for different types of support in academic GH partnerships. METHOD: In 2020 to 2021, the authors invited 36 US-based GH practitioners from the 2015 Pediatric GH Leadership Conference to participate in individual 1-hour semi-structured interviews. Using an iterative and inductive grounded theory approach, the study team analyzed interview transcripts through the lens of Heyse's framework on decision-making in humanitarian aid. RESULTS: The authors interviewed 20 GH practitioners and reached thematic sufficiency. A descriptive conceptual framework, capturing 18 distinct themes in 4 major categories, emerged from the data. In this framework, categories included: 1) stakeholders: those who influence and are influenced by the partnership; 2) goals: vision, mission, aims, and scope of the partnership; 3) implementation strategy: approach to accomplishing goals, categorized as relationship-oriented, task-oriented, context-oriented, or nonprescriptive; and 4) approach to conflict: response when goals and strategies do not align among stakeholders. CONCLUSION: Themes revealed a dynamic process for PSRA. Using our study findings, and building on existing literature, our framework highlights the complex interpersonal relationships, resource limitations, and sociopolitical and economic constraints that affect PSRA in GH partnerships. Finally, themes point to the field's evolution toward a more decolonized approach to GH.

Pediatric Residency Point-of-Care Ultrasound Training Needs Assessment and Educational Intervention.

Background Prior studies showed that point-of-care ultrasound (POCUS) training is not commonly offered in pediatric residency. We assessed the need for a pediatric POCUS curriculum by evaluating pediatric trainees' attitudes toward the use of POCUS and identifying barriers to training. We also aimed to evaluate the impact of a POCUS educational intervention on self-efficacy and behavior. Methods We conducted a cross-sectional survey of pediatric residents in a single large freestanding children's hospital distributed via an institutional listserv and administered online. The survey included opinion-rating of statements regarding POCUS and barriers to training. We also offered a two-week POCUS course with online modules and hands-on scanning. Participating residents completed pre- and post-course knowledge assessments and follow-up surveys up to 12 months following the course to assess POCUS use and self-report confidence on POCUS indications, acquisition, interpretation, and clinical application. Results Forty-nine respondents were included in the survey representing all three pediatric levels with 16 specialty interest areas. Ninety-six percent of trainees reported that POCUS is an important skill in pediatrics. Ninety-two percent of trainees reported that residency programs should teach residents how to use POCUS. The most important perceived barriers to POCUS training were scheduling availability for POCUS rotations and lack of access to an ultrasound machine. Fourteen participants completed the pre- and post-course knowledge tests, with eight and six participants also completing the six- and 12-month follow-up surveys, respectively. Self-ratings of confidence were significantly improved post-intervention in indications (P = 0.007), image acquisition (P = 0.002), interpretation (P = 0.002), and clinical application (P = 0.004). This confidence improvement was sustained up to 6-12 months (P = 0.004-0.032). Participants also reported higher categorical POCUS use after course completion (P = 0.031). Conclusions Pediatric trainees perceive POCUS as an important skill, hold favorable opinions towards the use of POCUS, and support POCUS training within a pediatric residency. A POCUS course can improve resident POCUS knowledge, instill confidence, and motivate higher POCUS use. Further study is needed to evaluate POCUS applications in pediatric medicine to develop a standardized POCUS curriculum and establish a training guideline for pediatric residency.

Clinical myocarditis masquerading as acute coronary syndrome.

We report a series of children with clinical myocarditis presenting with chest pain and elevated cardiac troponin I mimicking coronary syndrome. Our series illustrates the complementary role the magnetic resonance imaging and computed tomographic angiography can play in the evaluation of these patients. Elevated cardiac troponin I levels were found to be related to the extent of myocardial involvement, but did not necessarily indicate poor prognosis in children with myocarditis.

Use of Computer Technology During Family-Centered Rounds: A Qualitative Study of Parent Perspectives.

OBJECTIVES: Physicians often use computer technologies to assist in work activities, including family-centered rounds (FCR), but little is known about the attitudes of families on the use of these technologies. We aimed to describe these perceptions on the presence and use of computer technologies during FCR. METHODS: We conducted observations of FCR from a parent's visual perspective to "see what they see." This was followed by in-depth interviews with the families of patients admitted to the hospitalist service at our institution to describe their experience with the use of computer technology by the medical team during FCR. RESULTS: From the analysis of 31 individual interview transcripts, our research team identified the following 4 themes: (1) technology serves a purpose during FCR; (2) to view data in real time; (3) do not lose the human connection; and (4) transparency is valued. Thirty-eight observations showed broad use of computer technologies by the medical team. Devices were used to provide data that would educate the family; however, the devices were often placed between the medical team and family, creating a physical barrier. CONCLUSIONS: Families recognized the benefit of computer technologies in the care of their child and would like greater sharing of information by the medical team. They insisted their child always be "placed first" and that the team be transparent with their use of technology. Computer technology may create possible obstructions and distractions to the medical team. As computer technologies become more commonplace in medicine, maintaining the essence of good patient-communication and family centered care is essential.

Haiti's rural Central Plateau: Baseline data from mobile health clinics.

INTRODUCTION: George Washington Students for Haiti conducts mobile clinics in the Central Plateau of Haiti. Baseline health data for specific rural areas of Haiti are needed. METHODS: Medical teams conducted mobile clinics in rural locations of Haiti's Central Plateau. Diagnoses, blood pressure, growth parameters, medications prescribed, and referrals were recorded. RESULTS: Analyses included 865 patients. The leading pediatric diagnoses were acute respiratory infection, dermatitis, and abdominal pain. Using height for age, 22.9% of children were categorized as malnourished. The primary adult diagnoses were gastroesophageal reflux disease (GERD) (23.3%), genitourinary disorders (15.9%), and cataracts (15.1%). Of all adults, 21.3% had hypertension Stage 1, and 15.4% had hypertension Stage 2. DISCUSSION: This study provides valuable baseline health data for those providing medical care in the Central Plateau of Haiti. Effective health care targets include intestinal parasitic infections and malnourishment for children; hypertension and GERD for adults.

A "Resident-as-Teacher" Curriculum Using a Flipped Classroom Approach: Can a Model Designed for Efficiency Also Be Effective?

PROBLEM: The Accreditation Council for Graduate Medical Education requires training that enhances resident teaching skills. Despite this requirement, many residency training programs struggle to implement effective resident-as-teacher (RAT) curricula, particularly within the context of the 80-hour resident workweek. APPROACH: In 2013, the authors developed and evaluated an intensive one-day RAT curriculum using a flipped classroom approach. Twenty-nine second-year residents participated in daylong RAT sessions. The curriculum included four 1-hour workshops focusing on adult learning principles, giving feedback, teaching a skill, and orienting a learner. Each workshop, preceded by independent reading, featured peer co-teaching, application, and feedback. The authors evaluated the curriculum using pre- and postworkshop objective structured teaching examinations (OSTEs) and attitudinal and self-efficacy teaching questionnaires. OUTCOMES: Residents demonstrated statistically significant improvements in performance between pre- and postworkshop OSTEs on each of three core skills: giving feedback (P = .005), orienting a learner (P < .001), and teaching a skill (P < .001). Residents expressed positive attitudes surrounding teaching on the retrospective pre-post attitudinal instrument (P < .001) and rated themselves as more effective teachers (P < .001) after the training. NEXT STEPS: The authors have demonstrated that the flipped classroom approach is an efficient and effective method for training residents to improve teaching skills, especially in an era of work hour restrictions. They have committed to the continuation of this curriculum and are planning to include assessment of its long-term effects on resident behavior change and educational outcomes.

A 3-Day-Old Girl Referred From Her Pediatrician for Oral Ulcerations.

A 3-day-old girl was referred from her pediatrician for oral ulcerations. The patient was otherwise well appearing and afebrile. Her prenatal and antenatal courses were unremarkable, except for a failed routine hearing screen. The patient's examination was notable for several yellowish ulcers on erythematous bases located on her anterior tonsillar pillars. The patient also had a right coloboma and a II/VI systolic ejection murmur. Laboratory analyses revealed a traumatic lumbar puncture with 182 000 red blood cells and 808 white blood cells, as well as a complete blood count that showed thrombocytopenia and leukocytosis. During the patient's hospitalization, she developed a new facial rash. Her physical examination findings, along with her diagnostic evaluation and hospital course, ultimately led to 2 surprising diagnoses elaborated on in this case discussion.