A clinical antiracism curriculum for third-year medical students to bring antiracist principles to the bedside.

As medical educators, we have a responsibility to ensure our trainees are exposed to curricula dedicated to Diversity, Equity, and Inclusion (DEI), as illustrated by the Association of American Medical Colleges' recently released DEI Competencies Across the Curriculum. We designed and implemented a curriculum, Social Justice Rounds (SJR), that incorporates teaching on these topics directly into inpatient clinical work. SJR are brief team-based discussions facilitated by Pediatric Hospital Medicine faculty that focus on racism in medicine and other forms of discrimination experienced by patients and the effect it has on their interaction with the healthcare system. Medical students rotating through the Pediatrics Clerkship completed optional pre- and postclerkship surveys, which revealed statistically significant increases in students' frequency and comfort with conversations regarding DEI topics, both with the medical team and with patients. We believe that SJR provides a framework by which educators across specialties and institutions can provide trainees with foundational DEI skills.

Common in Adults and Often Overlooked in Pediatrics: A Case Report of Primary Hyperparathyroidism in an Adolescent Patient.

Primary hyperparathyroidism (pHPT) is a rare clinical entity in pediatric patients relative to adults. Consequently, the diagnosis is often delayed in pediatric patients, and children and adolescents are more likely to present with symptoms of hypercalcemia and end-organ damage. Here, we present the case of an adolescent patient with chest pain who was found to have a lytic bone lesion secondary to pHPT.

Continuing Medical Education in the Time of Social Distancing: The Case for Expanding Podcast Usage for Continuing Education.

ABSTRACT: The COVID-19 pandemic is forcing society to re-evaluate how it educates learners of all levels, from medical students to faculty. Travel restrictions and limits on large public gatherings have necessitated the cancelling of numerous regional and national conferences as well as local grand rounds at many academic centers. Podcasting provides a potential solution for providing CME in a safe, socially distant way as an alternative to these more traditional CME sources for health care professionals. Using a popular CME podcast for pediatric hospitalists as an example, this article describes the many advantages that podcasting poses over more traditional CME methods, outlines some of the methodological and technological considerations that go into creating a high-quality podcast, and describes how podcasting can be leveraged during a global pandemic. Finally, we identify areas for further research regarding podcasting, including effective ways to virtually replace the more social and community building aspects of traditional conferences and grand rounds.

Recognizing and Seizing the Teachable Moment.

All medical educators have experienced "teachable moments" during their career, and most can likely share examples of these moments from both training and their role as educators. In addition, most if not all have faced a situation in which an educational opportunity fell short or was missed entirely. This View from the Association of Pediatric Program Directors is designed to help pediatric medical educators recognize these teachable moments and feel better prepared to seize them when they arise. First, the authors collate definitions of the "teachable moment" from a variety of sources into 1 coherent definition, using common themes of shared responsibility between educator and learner, spontaneity, consideration of the learning environment, and expanding teaching into other applications. Next the authors provide methods to help educators capitalize on teachable moments when they occur, including discussing goals and expectations, building a culture of error, anticipating common errors made by learners, withholding the answer, managing time effectively, and practicing mindfulness. Numerous examples are described to further understanding. By employing these tactics, both educators and learners can maximize their ability to utilize teachable moments in a variety of clinical settings.

Learning by Doing: Design and Evaluation of a Quality Improvement Curriculum for Pediatric Hospitalists.

Quality improvement (QI) is a core competency for Pediatric Hospital Medicine (PHM) and required for maintenance of certification, but many hospitalists lack QI training. This project set out to increase a PHM faculty's QI knowledge and comfort participating in QI projects, while concurrently applying the skills learned to a QI project in the hospital. METHODS: We designed a 4-session curriculum utilizing principles of adult learning. Faculty immediately applied learned concepts to a QI project to increase the percentage of patients who were seen by an attending and billed for on the same day as admission to the PHM service. Attitudinal data and scores on the validated Quality Improvement Knowledge Application Tool- Revised knowledge assessment were compared precurriculum and postcurriculum. A manifest content analysis was carried out for qualitative questions. RESULTS: Twenty faculty (83%) completed the preassessment; 15 (63%) completed the postassessment. Respondents showed statistically significant improvements in their perceived ability to participate in QI projects and their Quality Improvement Knowledge Application Tool- Revised scores. The group completed a QI project that increased revenue for the division. Faculty appreciated that the curriculum was applied to a real QI project and felt they would use the new skills in their daily practice. DISCUSSION: This curricular model based on adult learning theory, with immediate application to a real QI project, conclusively showed attitudinal, knowledge-based, and hospital system-level improvements, and was well received by faculty.

Attending Physician's Attitudes Toward Podcasting as a Source of Medical Education: An Exploratory Study.

INTRODUCTION: People are increasingly consuming information on-demand. Podcasting is a growing medium for education in an on-demand world. There is a paucity of data on podcasting as a means of continuing medical education (CME) for attending physicians. METHODS: The authors performed an exploratory survey of a convenience sample of listeners to a Pediatric Hospital Medicine podcast to learn about their attitudes regarding podcasting. A 17-question survey consisting of demographic data, attitudinal questions, and qualitative questions was administered electronically in February 2018. RESULTS: At the time of the survey, the 12 podcast episodes were downloaded 17,288 times, with 162 CME credits being issued. Of 129 respondents, 75.2% were attendings. The majority agreed the podcast was of "high educational value" and was of equal or better educational value as medical journals or national conferences. Qualitative content analysis revealed listeners valued the convenience of the podcast, and community-based hospitalists felt the podcast connected them to the broader hospitalist community. DISCUSSION: Our respondents found podcasting to be a beneficial and convenient learning method. The ability to apply for CME credit was not a major motivation for listening. Further research is needed to investigate more objective outcomes and assess attitudes of a random sampling of physicians as opposed to a self-selected sample.

A Qualitative Analysis of Resident Adverse Event Reporting: What's Holding Us Back.

This study utilized focus groups of residents, who report adverse events at differing rates depending on their hospital site, to better understand barriers to residents' reporting and identify modifiable aspects of an institution's culture that could encourage resident event reporting. Focus groups included residents who rotated at 3 hospitals and represented 4 training programs. Focus groups were audio recorded and analyzed using qualitative methods. A total of 64 residents participated in 8 focus groups. Reporting behavior varied by hospital culture. Residents worried about damage to their professional relationships and lacked insight into the benefits of multiple reports of the same event or how human factors engineering can prevent errors. Residents did not understand how reporting affects litigation. Residents at other academic institutions likely experience similar barriers. This study illustrates that resident reporting is modifiable by changing hospital culture, but hospitals have only a few opportunities to mishandle reporting before resident reporting attitudes solidify.

Encouraging Resident Adverse Event Reporting: A Qualitative Study of Suggestions from the Front Lines.

INTRODUCTION: Little is known about what motivates residents to report adverse events. The goals of the qualitative study were to: (1) better understand facilitators to residents' event reporting and (2) identify effective interventions that encourage residents to report. METHODS: The authors conducted focus groups of upper-level residents from 4 training programs (2 internal medicine, a pediatric, and a combined medicine-pediatric) who rotated at 3 institutions within a large healthcare system in 2016. Quantitative data on reporting experience were gathered. Focus groups were audio recorded and transcribed. Two coders reviewed transcripts using the editing approach and organized codes into themes. RESULTS: Sixty-four residents participated in 8 focus groups. Residents were universally exposed to reportable events and knew how to report. Residents' reporting behavior varied by site according to local culture, with residents filing more reports at the pediatric hospital compared to other sites, but all groups expressed similar general views about facilitators to reporting. Facilitators included familiarity with the investigation process, reporting via telephone, and routine safety educational sessions with safety administrators. Residents identified specific interventions that encouraged reporting at the pediatric hospital, including incorporating an attending physician review of events into sign-out and training on error disclosure. CONCLUSIONS: This study provides insight into what motivates resident event reporting and describes concrete interventions to increase reporting. Our findings are consistent with the Theoretical Domains Framework of behavioral change. These strategies could prove successful at other pediatric hospitals to build a culture that values reporting and prepares residents as patient safety champions.

An Inpatient Patient Safety Curriculum for Pediatric Residents.

Introduction: Patient safety is recognized as an important part of pediatric resident education. There is a lack of published safety curricula targeting pediatric residents. A local needs assessment showed that while residents felt safety was an important part of their current and future jobs, they did not feel prepared to apply safety principles to their future careers or participate in a root cause analysis (RCA). Methods: This curriculum was delivered to senior-level pediatric and multiple-board residents during five monthly, hour-long, multidisciplinary sessions. Sessions covered systems-based thinking, terminology, the second victim phenomenon, RCA, and medication errors, while providing feedback on recent event reports filed by residents. Resident knowledge, attitudes, and reporting behavior were evaluated prior to and following the curriculum. Results: Attendees showed statistically significant improved safety attitudes and preparedness to apply safety to their future endeavors; conversely, there were no significant changes in nonattendees. There were no significant changes in knowledge scores or event reporting. Answers to qualitative questions identified learning about the reporting process, RCAs, and follow-up on filed event reports as valuable parts of the curriculum. Residents desired more time to debrief about safety events. Discussion: The curriculum succeeded in engaging residents in patient safety and making them feel prepared for future practice. Residents showed a dissonance between their intentions to report and their actual reporting behaviors, the reasons for which require further exploration. Residents desired a forum to deal with the emotions involved in errors. This curriculum is easily transferable to other institutions with minor modifications.