Pediatric Faculty Engagement and Associated Areas of Worklife After a COVID19 Surge.

Purpose: Healthcare organizations strive to increase physician engagement and decrease attrition. However, little is known about which specific worklife areas may be targeted to improve physician engagement or retention, especially after stressful events such as a COVID19 surge. Our objective was to identify demographic characteristics and worklife areas most associated with increased physician engagement and decreased intent to leave in pediatric faculty. Patients and Methods: In September 2020, we conducted a cross-sectional survey of faculty at an academic, tertiary-care children's hospital. A convenience and voluntary sampling approach was used. The survey included demographics, Maslach Burnout Index-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS). The MBI-HSS was used to measure faculty engagement. The AWS measures satisfaction with six worklife areas (workload, control, reward, fairness, community, values). We used bivariate analyses to examine relationships between worklife areas and engagement and between worklife areas and intent to leave. We included multivariate logistic regression models to examine worklife areas most associated with increased work engagement and decreased intent to leave. Results: Our response rate was 41% (113/274 participants). In bivariate analysis, engaged faculty reported higher satisfaction in all worklife areas. In multivariate analyses, positive perceptions of workload (odds ratio (OR) 2.83; 95% confidence interval (CI), 1.2-6.9), control (OR, 3.24; 95% CI 1.4-7.3), and community (OR, 6.07; 95% CI 1.9-18.7) were associated with engagement. Positive perceptions of values (OR, 0.07; 95% CI 0.02-0.32) and community (OR, 0.19; 95% CI 0.05-0.78) were negatively associated with intent to leave. Conclusion: We found that positive perceptions of workload, control, and community were most associated with engagement. Alignment of values and increased sense of community were associated with decreased intent to leave. Our findings suggest specific worklife areas may be targeted to increase faculty engagement and retention.

Changes in Pediatric Faculty Burnout During the COVID-19 Pandemic.

OBJECTIVES: To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated workflow changes, such as deployment on pediatric faculty burnout in an early epicenter of the pandemic. We hypothesized burnout would increase during the COVID-19 surge. METHODS: We conducted serial cross-sectional surveys of pediatric faculty at an academic, tertiary-care children's hospital that experienced a COVID-19 surge in the Northeastern United States. Surveys were administered pre-surge (February 2020), during the surge (April 2020), and postsurge (September 2020). The primary outcome was burnout prevalence. We also measured areas of worklife scores. We compared responses between all 3 survey periods. Continuous variables were analyzed by using Student's t or Mann-Whitney tests, and categorical variables were analyzed by using χ2 or Fisher's exact test, as appropriate. RESULTS: Our response rate was 89 of 223 (40%) presurge, 100 of 267 (37%) during the surge, and 113 of 275 (41%) postsurge. There were no differences in demographics, including sex, race, and academic rank between survey periods. Frequency of burnout was similar in all 3 periods (20% to 26%). The mean scores of emotional exhaustion improved during the surge (2.25 to 1.9; P = .04). CONCLUSIONS: Contrary to our hypothesis, we found no changes in pediatric faculty burnout after a COVID-19 surge. Emotional exhaustion improved during the COVID-19 surge. However, these findings represent short-term responses to the COVID-19 surge. Longer-term monitoring of the impact of the COVID-19 surge on pediatric faculty burnout may be necessary for health care organizations to mitigate burnout.

Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care.

The child welfare system strives to provide children and adolescents in foster care with a safe, nurturing environment through kinship and nonkinship foster care placement with the goal of either reunification with birth parents or adoption. Pediatricians can support families who care for children and adolescents who are fostered and adopted while attending to children's medical needs and helping each child attain their developmental potential. Although this report primarily focuses on children in the US child welfare system, private and internationally adopted children often have similar needs.

Comprehensive Health Evaluation of the Newly Adopted Child.

Children who join families through the process of adoption, whether through a domestic or international route, often have multiple health care needs. Pediatricians and other health care personnel are in a unique position to guide families in achieving optimal health for the adopted children as families establish a medical home. Shortly after placement in an adoptive home, it is recommended that children have a timely comprehensive health evaluation to provide care for known medical needs and identify health issues that are unknown. It is important to begin this evaluation with a review of all available medical records and pertinent verbal history. A complete physical examination then follows. The evaluation should also include diagnostic testing based on findings from the history and physical examination as well as the risks presented by the child's previous living conditions. Age-appropriate screenings may include, but are not limited to, newborn screening panels and hearing, vision, dental, and formal behavioral and/or developmental screenings. The comprehensive assessment may occur at the time of the initial visit to the physician after adoptive placement or can take place over several visits. Adopted children can be referred to other medical specialists as deemed appropriate. The Council on Adoption, Foster Care, and Kinship Care is a resource within the American Academy of Pediatrics for physicians providing care for children who are being adopted.

Evaluation of a Speed Mentoring Program: Achievement of Short-Term Mentee Goals and Potential for Longer-Term Relationships.

OBJECTIVE: Speed mentoring provides brief mentoring and networking opportunities. We evaluated 1) a national speed mentoring program's ability to encourage in-person networking and advice-sharing, and 2) 2 potential outcomes: helping mentees achieve 3-month goals, and fostering mentoring relationships after the program. METHODS: An outcome approach logic model guided our program evaluation. Sixty mentees and 60 mentors participated. Each mentee met with 6 mentors for 10 minutes per pairing. At the program, mentees created goals. At 3 months, mentors sent mentees a reminder e-mail. At 4 months, participants received a Web-based survey. RESULTS: Forty-two (70%) mentees and 46 (77%) mentors completed the survey. Participants reported the program allowed them to share/receive advice, to network, to provide/gain different perspectives, and to learn from each other. Mentors as well as mentees identified shared interests, mentor-mentee chemistry, mentee initiative, and mentor approachability as key qualities contributing to ongoing relationships. Many mentor-mentee dyads had additional contact (approximately 60%) after the program and approximately one-third thought they were likely to continue the relationship. Goal-setting encouraged subsequent mentor-mentee contact and motivated mentees to work toward attaining their 3-month goals. The mentors aided mentees goal attainment by providing advice, offering support, and holding mentees accountable. CONCLUSIONS: A national speed mentoring program was an effective and efficient way to establish national connections, obtain different perspectives, and receive advice. Goal-setting helped mentees in achieving 3-month goals and fostering mentoring relationships outside of the program. These elements continue to be a part of this program and might be valuable for similar programs.

Learning disorders: How pediatricians can help.

Learning disabilities are common and can negatively affect the individual and, ultimately, society. Pediatricians should be able to identify the risk factors for learning disabilities, recognize the early warning signs, and apply the appropriate diagnostic tools. Pediatricians also can play a crucial role by encouraging schools to provide accommodations for the child, requesting multifactorial evaluations from the school district, and referring patients for detailed neuropsychological evaluation outside the school district when appropriate. Information from the pediatrician can help the school formulate an individualized education plan for the child. Additionally, the primary care pediatrician can support families with referrals to appropriate healthcare specialists.

The pediatrician's role in supporting adoptive families.

Each year, more children join families through adoption. Pediatricians have an important role in assisting adoptive families in the various challenges they may face with respect to adoption. The acceptance of the differences between families formed through birth and those formed through adoption is essential in promoting positive emotional growth within the family. It is important for pediatricians to be aware of the adoptive parents' need to be supported in their communication with their adopted children.

Growth of infants' length, weight, head and arm circumferences in relation to low levels of blood lead measured serially.

To determine whether levels of blood lead during gestation and infancy that are below the CDC action level of 10 microg/dl affect infant growth, we studied 211 disadvantaged mother-infant pairs from Albany, NY. Mothers' lead levels were low (second trimester chi = 2.8 microg/dl) as were infants' (chi = 3.3 microg/dl at 6 months; 6.4 microg/dl at 12 months). Multiple linear regression analyses showed that second trimester lead levels were related to reduced head circumference at 6 and 12 months. Infants of mothers with second trimester lead at or above the median (>or=3 microg/dl) exhibited negative associations between blood lead and head circumference at 6 and 12 months, and with weight-for-age, weight-for-length, and upper arm circumference at 6 months, but those below the median did not. Infants' 6-month lead level was related to head circumference at 12 months in the total sample, and in the subsample of infants whose blood lead was above the infants' 6-month blood lead median. Infants were also grouped by changes in their relative blood lead status, that is, above vs. below the median, from second trimester to 12 months of age. Infants whose lead levels changed from above to below the median were larger than infants whose lead levels went from below to above the median. The results suggest that lead may affect some dimensions of infant growth at levels below 10 microg/dl, but effects of lead levels less than 3 microg/dl are not evident in this sample.

Health care in the first year after international adoption.

After international adoption, routine screenings for infectious and nutritional diseases, lead exposure, and vision and hearing difficulties are early priorities for children's postadoptive health care. Specific health concerns raised before adoption should also be reviewed after children arrive home with their families. Once appropriate postadoptive screenings and immunizations have been initiated, the challenge for the primary care provider is to determine the intervals and content of future follow-up visits. Clinical decision making is influenced by a specific child's age, acute medical needs, and developmental assessments.