Developing an Entrustable Professional Activity to Improve the Care of LGBTQ+ Youth.

Despite the multitude of health inequities often experienced by lesbian, gay, bisexual, transgender, and queer (LGBTQ)+ youth, few training programs consistently and comprehensively address these disparities through education and assessment of learners. Over the past decade, programs have begun to incrementally increase the number of hours dedicated to LGBTQ+ health training; however, the lack of standardization for curricula and assessment remains a significant barrier. As medical education shifts to a competency-based approach, focusing on patient outcomes and the competencies trainees must achieve to meet those outcomes, we must take this opportunity to develop curricula and assessment tools that emphasize inclusive, affirming, equitable, and culturally humble care for LGBTQ+ youth. Entrustable professional activities (EPA) are increasingly used to educate and assess trainees on their progression from full supervision to unsupervised practice. Given their multifaceted use to standardize curricula, assess learners, and highlight programmatic gaps in education, we believe an EPA is the ideal tool to systematically improve LGBTQ+ health training in graduate medical education. Our team of national experts in this field developed an LGBTQ+ health EPA. We describe our methods of development, the functions and curricular components of the EPA, and the many applications for widespread program use.

A Quality Improvement Approach to Early Patient Discharge.

Lack of bed availability is a common problem in our pediatric unit, as in many hospitals. To address this issue, we instituted a quality improvement (QI) initiative involving collaborative nurse-physician rounding. This intervention has been shown to expedite discharge, improve patient care, and increase bed availability in other settings. METHODS: By utilizing PDCA (Plan, Do, Check, Act) processes, we created two improvement initiatives, "Increasing Patient Discharge Before 12 pm" and "Midnight Rounds with Discharge Focus." Senior resident and faculty physicians rounded on discharge-ready patients before teaching rounds, and by 10 am, placed discharge orders to allow for a 12 pm discharge. A night team consisting of senior residents and nurses conducted "Midnight Rounds" and identified potential discharges for the morning team. The project aimed to increase patient discharges before 12 pm from a June-November 2018 baseline of 15%-20% by June 2019. RESULTS: Patient discharge percentage before 12 pm increased from 15% to 21% (P < 0.01) by June 2019, and as a result, bed availability increased by 16% (P < 0.01). CONCLUSIONS: QI methodology clarified the root causes of limited bed availability. Understanding the existing discharge process allowed for QI initiatives to develop a consistent and sustainable discharge process. Patient discharge percentages before 12 pm increased by 40%, and bed availability increased by 16% after QI implementations.

National Pediatric Experience With Virtual Interviews: Lessons Learned and Future Recommendations.

The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community's innovations, including the use of virtual cafés to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.