A novel workplace-based assessment for competency-based decisions and learner feedback.

BACKGROUND: Increased recognition of the importance of competency-based education and assessment has led to the need for practical and reliable methods to assess relevant skills in the workplace. METHODS: A novel milestone-based workplace assessment system was implemented in 15 pediatrics residency programs. The system provided: (1) web-based multisource feedback (MSF) and structured clinical observation (SCO) instruments that could be completed on any computer or mobile device; and (2) monthly feedback reports that included competency-level scores and recommendations for improvement. RESULTS: For the final instruments, an average of five MSF and 3.7 SCO assessment instruments were completed for each of 292 interns; instruments required an average of 4-8 min to complete. Generalizability coefficients >0.80 were attainable with six MSF observations. Users indicated that the new system added value to their existing assessment program; the need to complete the local assessments in addition to the new assessments was identified as a burden of the overall process. CONCLUSIONS: Outcomes - including high participation rates and high reliability compared to what has traditionally been found with workplace-based assessment - provide evidence for the validity of scores resulting from this novel competency-based assessment system. The development of this assessment model is generalizable to other specialties.

Electron microscopic investigation and elemental analysis of titanium dioxide in sun lotion.

OBJECTIVE: The objective of this research was to determine the size, shape and aggregation of titanium dioxide (TiO2 ) particles which are used in sun lotion as UV-blocker. METHODS: Overall, six sunscreens from various suppliers and two reference substances were analysed by electron microscopy (EM) techniques in combination with energy dispersive X-ray spectroscopy (EDS). Because of a high fat content in sun lotion, it was impossible to visualize the TiO2 particles without previous EM sample preparation. Different defatting methods for TiO2 from sun screens were tested. A novel sample preparation method was developed which allowed the characterization of TiO2 particles with the help of EM and EDS. RESULTS: Aggregates of titanium dioxide with the size of primary particles varying between 15 and 40 nm were observed only in five products. In the sun lotion with the highest SPF, only few small aggregates were found. In the sun screen with the lowest SPF, the largest aggregates of TiO2 particles were detected with sizes up to 1.6 µm. In one of the sun lotions, neither TiO2 nor ZnO was found in spite of the labelling. Instead, approx. 500 nm large diamond-shaped particles were observed. These particles are composed of an organic material as only carbon was detected by EDS. CONCLUSION: A novel defatting method for sample preparation of titanium dioxide nanoparticles used in sun cosmetics was developed. This method was applied to six different sun lotions with SPF between 30 and 50+. TiO2 particles were found in only five sunscreens. The sizes of the primary particles were below 100 nm and, according to the EU Cosmetic Regulation, have to be listed on the package with the term 'nano'.

[Is there an Association between Prevention Campaign Knowledge and Sun Protection Behaviour of Parents for their Children? Results of a Parent Survey]. / Gibt es einen Zusammenhang zwischen der Kenntnis von Sonnenschutzkampagnen und dem Sonnenschutz von Kindern durch ihre Eltern? Ergebnisse einer Elternbefragung.

AIM: The aims of this study are to assess prevalence of awareness of sun protection campaigns among parents in Bavaria, Germany, to analyse the impact of sociodemographic factors on campaign knowledge and the association between parental campaign knowledge and sun protection behaviour in their children. METHODS: A cross-sectional survey was undertaken in 2010-2011 in Bavaria, Germany, with parents of 4,579 children aged 5-6 years (response rate 61%). RESULTS: Prevalence of knowledge of sun protection campaigns is 13% among parents in Germany and independent of sociodemographic factors. Ignorance of sun protection campaigns is associated with inadequate sun protection behaviour in children independent of sociodemographic and exposure characteristics. CONCLUSION: Awareness of sun protection campaigns is low among parents. Knowledge of adequate sun protection behaviour should be further increased at the population level in Germany independently of sociodemographic status.

[The impact of migration background on children's secondhand smoke exposure. A cross-sectional study within the health monitoring units (GME) in Bavaria, Germany]. / Die Bedeutung des Migrationshintergrundes für die Tabakrauchbelastung von Kindern. Eine Querschnittstudie im Rahmen der Gesundheits-Monitoring-Einheiten (GME) in Bayern.

AIM OF THE STUDY: Differences in children's secondhand smoke (SHS) exposure were examined by migration-specific characteristics, socioeconomic factors and living conditions, as well as with regard to the parents SHS knowledge and SHS attitudes. STUDY POPULATION AND METHODS: Data from 5,336 pre-school children (29% migrants) were collected in a cross-sectional study in 2008/2009 in Germany through parental questionnaire (response rate: 61%). Using multiple logistic regression, the association of migration background and children's SHS exposure was analysed. RESULTS: Children with a migration background are at an increased risk of SHS exposure in their homes. Multivariate analyses show that adjusting for socioeconomic factors and parental knowledge of how to protect their children from SHS reduces the estimates of migration background significantly. Compared to children without migration background, the chance of SHS exposure for children with migration background is still increased (OR [95% CI]: 1.57 [1.23-2.01]). Children of Turkish-speaking families, compared to children from German-speaking families, are most often burdened by SHS (3.05 [2.18-4.26]). CONCLUSION: Migrant-sensitive tobacco prevention in selected risk groups is necessary to provide support for creating smoke-free homes for children.

Need for Time and Training: Pediatric Program Directors' Perceptions About Mentorship of Residents.

OBJECTIVE: We aimed to describe pediatric program directors' perceptions of existing mentorship programs in pediatric residencies, to assess whether characteristics used for mentor-mentee assignments impact mentoring outcomes, and to identify barriers to success in mentorship programs. METHODS: With the support of the Association of Pediatric Program Directors (APPD) Research Task Force, we conducted a cross-sectional survey study of all associate pediatric program directors in the United States in March 2022. RESULTS: Nearly half (82 of 197, 41.6%) of programs responded. Most (87.8%) report having a formal mentoring program. Half of programs (51.4%) do not provide training to residents on how to be a mentee, and only slightly more than half (62.5%) provide training to faculty mentors. Most programs (80.6%) do not provide protected time for faculty mentors. There were no meaningful associations with characteristics used for mentorship matches and perceived successful mentorship. Top barriers from the program leadership perspective included faculty and residents lacking time, residents lacking skills to be proactive mentees, and inadequate funding. CONCLUSIONS: While a majority of programs have formal mentorship programs, many do not provide training to mentors or mentees. Barriers to mentorship include a lack of funding and time. National organizations, such as APPD and the Accreditation Council for Graduate Medical Education, have an opportunity to provide guidance and support for protected time, funding, and training for mentors and mentees.

A Survey Study of Motivators for Pediatric Hospitalists to Work in the Community.

BACKGROUND AND OBJECTIVE: The loss of pediatric beds in the community has contributed to decreased access to pediatric inpatient and emergency services. Community pediatric hospitalist programs could reduce the overhead of inpatient care, promoting the financial feasibility of caring for hospitalized children closer to home. This study aims to determine which career motivators are the most important for pediatric hospitalists to begin working in, remain in, and leave the community setting. METHODS: A survey was sent to a convenience sample of 269 community hospitalists from 31 different sites. Sites were invited if the program director was known to the authors. Responses were evaluated and χ-square or Fisher's exact test were used to compare the differences. RESULTS: One hundred twenty six community pediatric hospitalists completed the survey (response rate 49.1%). The 3 most important motivators for pediatric hospitalists to begin working in the community were work-life integration (80%), geographic location (75%), and flexible hours (71%). Pediatric hospitalists who planned to leave the community setting were more likely to cite mentoring and teaching opportunities (76% vs 32%, P = .0002), opportunities for research and quality improvement (29% vs 10%, P = .021), and paid time for nonclinical interests (52% vs 26%, P = .02) as very important. CONCLUSIONS: This study demonstrates key motivators for pediatric hospitalists to work in the community and elucidates motivators for transitioning to larger pediatric centers. This knowledge may be used to guide community pediatric hospital medicine recruitment and program development that could lead to improved retention.

Gender and work-life balance: Results of a national survey of pediatric hospitalists.

In medicine, difficulty integrating work and home can lead to decreased job satisfaction, diminished well-being, and increased turnover. Understanding the experience of pediatric hospitalists can provide insights into building a stable, long-term workforce. We aim to examine gender differences in work-life balance and parental leave for physicians practicing Pediatric Hospital Medicine. METHODS: This was a cross-sectional survey study of 1096 pediatric hospitalists. Responses were collected via an online survey platform and summarized using descriptive statistics, including frequency distributions and measures of central tendency. A multivariable logistic regression was used to examine associated variables and work-life balance satisfaction. We analyzed free responses on parental leave to provide nuance to quantitative survey data. RESULTS: Five hundred and sixty-five respondents (52% response rate) completed the survey with 71% women. 343 (62%) prioritize work-life balance in career decision-making. Women report taking on more household responsibilities than their partners (41.4% vs. 8.4%; p < .001) including a larger percentage of caregiving and domestic tasks. Female gender and performing <50% caregiving were associated with decreased work-life balance satisfaction; performing <50% domestic tasks increased satisfaction. Median parental leaves were 4 weeks, with men taking significantly shorter leaves (3.5 vs. 6 weeks; p < .001) and more "paid back" time off. CONCLUSION: Work-life balance is an important factor in career decisions for men and women. Women perceive carrying a larger load at home. Qualitative results suggest that parental leave may be inadequate in length and salary support for men and women. This study adds insights into work-life integration in PHM.

Gender Communication Differences on a Pediatric Provider Listserv.

BACKGROUND AND OBJECTIVES: Gender-based communication differences are described in educational online communities, but have not been rigorously evaluated in medical online communities. Understanding gender differences in communication may provide insight into gender disparities in the medical profession. Our objective was to describe gender differences in post frequency, content, and language styles on the American Academy of Pediatrics Section on Hospital Medicine (SOHM) listserv. METHODS: Posts were obtained from publicly available SOHM listserv archives. The first month of every quarter of 2019 and 2020 were reviewed. Two reviewers assigned a post topic (clinical, research, etc) and format (question vs statement) to all deidentified original posts (K = 1.0 topic, 0.89 format). Six trained reviewers assigned language styles (intraclass coefficient = 0.73, indicating good agreement). RESULTS: We analyzed 1592 posts: 287 original posts and 1305 responses. Frequency: Women authored 50% of posts. The 9 most frequent posters (7 men, 2 women) accounted for 19.5% of posts. Content: Men's posts had more words than women's (132.51 vs 112.3, P ≤ .01). Men were more likely to post about health policy and research (P < .001). Men were more likely to post statements compared with women (39% vs 21%, P < .001). Style: Men's posts were more likely to be coded adversarial (12.3% vs 5.5%, P < .001) authoritative (12.2% vs 6.5%, P < .001) or self-amplifying (6.5% vs 3.6%, P < .001). CONCLUSIONS: Women contribute disproportionately fewer posts to the American Academy of Pediatrics SOHM listserv compared with their percentage in the subspecialty. We noted significant gender differences in language style and content, which may impact career development and online community inclusion.

Association Between Gender and Salary Among Pediatric Hospital Medicine Physicians.

OBJECTIVES: Gender-based disparities in salary exist in multiple fields of medicine. However, there is limited data examining gender inequities in salary in pediatric hospital medicine (PHM). Our primary objective was to assess whether gender-based salary differences exist in PHM. The secondary objective was to assess if, among women, the differences in salary varied on the basis of leadership positions or self-identified race and ethnicity. METHODS: We conducted a survey-based, cross-sectional study of pediatric hospitalists in December 2021. Our primary outcomes were base and total salary, adjusted for the reported number of average weekly work hours. We performed subanalyses by presence of a leadership position, as well as race. We used a weighted t test using inverse probability weighting to compare the outcomes between genders. RESULTS: A total of 559 eligible people responded to our survey (51.0%). After propensity score weighting, women's mean base salary was 87.7% of men's base (95% confidence interval [CI] 79.8%-96.4%, P < .01), and women's total salary was 85.6% of men's total (95% CI 73.2%-100.0%, P = .05) salary. On subgroup analysis of respondents with a leadership position, women's total salary was 80.6% of men's total salary (95% CI 68.7%-94.4%, P < .01). Although women who identified as white had base salaries that were 86.6% of white men's base salary (95% CI 78.5%-95.5%, P < .01), there was no gender-based difference noted between respondents that identified as nonwhite (88.4% [69.9%-111.7%] for base salary, 80.3% [57.2% to 112.7%]). CONCLUSIONS: Gender-based discrepancies in salary exists in PHM, which were increased among those with leadership roles. Continued work and advocacy are required to achieve salary equity within PHM.

Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship.

PURPOSE: Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions. METHOD: This multimethod study was performed at 6 U.S.-based institutions from March through October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses. RESULTS: Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]). CONCLUSIONS: This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.

[The occurrence of plasticisers (phthalates) in communal facilities under special consideration of results from LUPE 3]. / Vorkommen von Weichmachern (Phthalaten) in Gemeinschaftseinrichtungen unter besonderer Bedeutung der Ergebnisse von LUPE 3.

Children are a very susceptible subgroup of the general population and therefore health authorities have a special interest to prevent them from health hazards. In a study of 3 German Bundesländer the indoor air and dust samples of altogether 63 German daycare centres were analysed for the presence of phthalate diesters in 2011/12 (LUPE 3 study). Inhalable dust and gas phases were collected with a glass fibre filter and polyurethane foam over approximately 6 h while children were attending these facilities. Settled dust was collected by vacuuming the floor of the room using an ALK dust sampler. Indoor air and dust were analysed using a GC/MS system. Median values in the dust samples were 888 mg/kg for di-2-ethylhexyl phthalate (DEHP), 302 mg/kg for diisononyl phthalate (DiNP), 34 mg/kg for diisodecyl phthalate (DiDP), 21 mg/kg for di-n-butyl phthalate (DnBP), and 20 mg/kg for diisobutyl phthalate (DiBP). For DEHP and DiNP maximum values of 10,086 mg/kg and 7,091 mg/kg were observed, respectively. DEHP and DiNP were responsible for 70% and 24% of the total phthalate concentration in the dust. In indoor air phthalates are found mainly in the particulate phase of the filters. Only the more volatile phthalates dimethyl phthalate and diethyl phthalate were found also in the gas phase. The median values in the indoor air were 470 ng/m³ for DiBP, 230 ng/m³ for DnBP, 190 ng/m³ for DEHP, and 100 ng/m³ for DiNP. DnBP and DiBP were together responsible for 55% of the total phthalate concentration in the indoor air. Overall, our study showed that the concentrations of phthalates in indoor air of daycare centers are slightly higher and in dust samples lower compared with schools.

Impact of COVID-19 on the Sense of Job Security Among Community Pediatric Hospitalists.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic offers a prime opportunity to examine the ability of community pediatric hospital medicine programs to respond to external stressors. This study aims to characterize the impact of the COVID-19 pandemic on compensation and furlough among community pediatric hospitalists, as well as self-reported sense of job security. METHODS: This study was part of a larger quantitative project investigating community pediatric hospitalists' career motivators. The survey was drafted through an iterative process by the authors. It was disseminated via e-mail to a convenience sample of community pediatric hospitalists obtained through direct contact with community pediatric hospital medicine programs. Data were collected on changes in compensation and furlough because of COVID-19, as well as worry about job security measured as self-reported worry about one's job being permanently terminated on a 5-point Likert scale. RESULTS: Data were collected from 31 hospitals across the United States with 126 completed surveys. Because of COVID-19, many community pediatric hospitalists experienced reduced base pay and benefits and a minority experienced furlough. Nearly two-thirds (64%) reported some worry about job security. Initial base pay reduction, working in suburban areas compared with rural areas, and affiliation with a university-based center or free-standing children's hospital were significantly associated with greater worry about job security. CONCLUSIONS: The initial response to the COVID-19 pandemic resulted in changes in compensation and furlough for some community pediatric hospitalists and many expressed concerns about job security. Future studies should identify protective factors for community pediatric hospitalists' job security.

A Multisite Survey of Pediatric Hospitalists' Practices in Soliciting Feedback From Trainees.

OBJECTIVE: There is evidence that pediatric attending physicians value receiving feedback from trainees. With this study, we sought to determine the extent to which pediatric hospitalists value, solicit, and receive feedback from residents and medical students on specific areas of the attending's performance and identify perceived barriers to trainees' providing feedback. METHODS: A web-based survey was sent to pediatric hospitalists at 9 institutions in 2022. Survey questions were developed from existing literature, trainee input, faculty expertise, and a framework on the qualities of exemplary pediatric educators. Respondents answered yes-no and multiitem Likert scale questions and selected answers from predetermined lists related to feedback solicitation from trainees. χ-Square and Wilcoxon rank test statistics were used to analyze questions. RESULTS: Responses were gathered from 91 of 189 surveyed individuals (response rate: 48.1%). Respondents almost unanimously "agreed" or "strongly agreed" that feedback from medical students (88, 96.7%) and residents (89, 97.8%) can be valuable, but feedback was considered more valuable from residents (P <.05). Attending physicians asked for and received feedback more from residents than from medical students (P <.05). Attending physicians most commonly asked for feedback on "teaching skills." The largest perceived barriers to receiving feedback from trainees were trainee lacking comfort with giving feedback, trainee lacking awareness that providing feedback is within their role, and fear of retaliation. CONCLUSIONS: Although pediatric hospitalist respondents nearly unanimously valued feedback from trainees, attending physicians were inconsistent in their feedback solicitation practices. Attending physicians were more likely to ask for and receive feedback from residents than from medical students.

Learner Handoffs Within Clinical Rotations: From the Resident Perspective.

PURPOSE: Competency-based medical education relies on repeated longitudinal assessments of learners. Frequent attending physician transitions within clinical rotations present a significant barrier to the educational continuity required in competency-based medical education. Learner handoffs (LHs), or the transfer of information regarding learners on a team among faculty supervisors, is a potential solution. Although literature is available on educational leader and clinical faculty perspectives on LHs, perspectives of the learners have been less well described. METHOD: This qualitative study used thematic analysis of pediatric resident focus groups from 3 programs of varying size and geographic location from July to December 2021. Two authors independently read the first 3 transcripts to generate a codebook and then coded the remaining transcripts independently to ensure thematic saturation. Emerging themes were discussed and revised until a consensus was achieved. RESULTS: Forty-four pediatric residents from 3 programs participated in 8 focus groups. Themes were identified regarding LHs' positive impact on the (1) learner, (2) clinical practice, and (3) learning environment. Participants described numerous positive benefits to their own development, team functioning, trust, and patient safety. This experience was counterbalanced by risk of bias in the current LH context. Suggestions for the implementation of a structured LH framework were provided, with a focus on the content ( what information), process ( who is involved), and format ( how is it delivered) of LHs. Participants believed that the creation of a structured LH tool may mitigate perceived challenges, including bias and lack of transparency. CONCLUSIONS: Residents recognize potential benefits to learners themselves, their clinical practice, and their learning environment through LHs but express concerns regarding further propagating bias. The development of a structured and learner-centered LH tool could accelerate learner professional development while mitigating perceived challenges. Future research should define essential components of an LH model with input from all key stakeholders.

Effect of classroom air quality on students' concentration: results of a cluster-randomized cross-over experimental study.

UNLABELLED: To assess the effect of indoor air quality as indicated by the median carbon dioxide (CO2) level in the classroom on the concentration performance (CP) of students, a cross-over cluster-randomized experimental study was conducted in 20 classrooms with mechanical ventilation systems. Test conditions 'worse' (median CO2 level on average 2115 ppm) and 'better' (median CO2 level on average 1045 ppm) were established by the regulation of the mechanical ventilation system on two days in one week each in every classroom. Concentration performance was quantified in students of grade three and four by the use of the d2-test and its primary parameter 'CP' and secondary parameters 'total number of characters processed' (TN) and 'total number of errors' (TE). 2366 d2-tests from 417 students could be used in analysis. In hierarchical linear regression accounting for repeated measurements, no significant effect of the experimental condition on CP or TN could be observed. However, TE was increased significantly by 1.65 (95% confidence interval 0.42-2.87) in 'worse' compared to 'better' condition. Thus, low air quality in classrooms as indicated by increased CO2 levels does not reduce overall short-term CP in students, but appears to increase the error rate. PRACTICAL IMPLICATIONS: This study could not confirm that low air quality in classrooms as indicated by increased CO2 levels reduces short-term concentration performance (CP) in students; however, it appears to affect processing accuracy negatively. To ensure a high level of accuracy, good air quality characterized, for example, by low CO2 concentration should be maintained in classrooms.

Toxicity and elemental composition of particulate matter from outdoor and indoor air of elementary schools in Munich, Germany.

UNLABELLED: Outdoor particulate matter (PM(10)) is associated with detrimental health effects. However, individual PM(10) exposure occurs mostly indoors. We therefore compared the toxic effects of classroom, outdoor, and residential PM(10). Indoor and outdoor PM(10) was collected from six schools in Munich during teaching hours and in six homes. Particles were analyzed by scanning electron microscopy and X-ray spectroscopy (EDX). Toxicity was evaluated in human primary keratinocytes, lung epithelial cells and after metabolic activation by several human cytochromes P450. We found that PM(10) concentrations during teaching hours were 5.6-times higher than outdoors (117 ± 48 µg/m(3) vs. 21 ± 15 µg/m(3), P < 0.001). Compared to outdoors, indoor PM contained more silicate (36% of particle number), organic (29%, probably originating from human skin), and Ca-carbonate particles (12%, probably originating from paper). Outdoor PM contained more Ca-sulfate particles (38%). Indoor PM at 6 µg/cm(2) (10 µg/ml) caused toxicity in keratinocytes and in cells expressing CYP2B6 and CYP3A4. Toxicity by CYP2B6 was abolished with the reactive oxygen species scavenger N-acetylcysteine. We concluded that outdoor PM(10) and indoor PM(10) from homes were devoid of toxicity. Indoor PM(10) was elevated, chemically different and toxicologically more active than outdoor PM(10). Whether the effects translate into a significant health risk needs to be determined. Until then, we suggest better ventilation as a sensible option. PRACTICAL IMPLICATIONS: Indoor air PM(10) on an equal weight base is toxicologically more active than outdoor PM(10). In addition, indoor PM(10) concentrations are about six times higher than outdoor air. Thus, ventilation of classrooms with outdoor air will improve air quality and is likely to provide a health benefit. It is also easier than cleaning PM(10) from indoor air, which has proven to be tedious.

[Breast-feeding training programme as intervention approach at the hospital level: results of evaluation of the first phase of the STELLA study]. / Personalschulung als Interventionsansatz auf Klinikebene zur Stillförderung: Evaluationsergebnisse der ersten Phase der STELLA-Studie.

BACKGROUND: The health-promoting short- and long-term effects of breast-feeding are supported by a vast scientific literature. The Bavarian prospective cohort study 2005/2006 showed regional variations of breast-feeding rates. Furthermore, improvement in counselling mothers, particularly with regard to prevention and handling of breast-feeding problems, has a great potential for health promotion. The objective of this study is to promote breast-feeding in maternity clinics by improving the surrounding conditions. STUDY DESIGN: A clinic-based and community-related intervention trial was carried out in Lower Bavaria as a model region with below average breast-feeding rates. (1) INTERVENTION: an advanced training of maternity ward professionals of 10 hospitals and after-care midwives was performed from May until December 2008. The training programme was based on the WHO/UNICEF criteria of the "Ten Steps to Successful Breastfeeding" to deepen the breast-feeding knowledge and to improve the breast-feeding management. (2) EVALUATION: A singular assessment of the advanced training programme was undertaken concerning an increase of knowledge and the practicability in clinical everyday life by participants; improvements of the maternity wards were assessed via structural interviews with maternity ward staff before and after intervention. RESULTS: Approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training course. The survey after the training programme (response rate 83%) indicated that more than 80% of the participants stated to have learned something new and to be able to use the knowledge acquired for their own practice. Results of the clinic interviews showed a transfer of training contents into clinical work routines. Improvements at interview date were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each). CONCLUSION: Training of maternity ward professionals accounts for baby-friendly conditions in maternity clinics. Most willingness for improvements was shown by maternity ward staff particularly for bonding between mother and child as well as for additional feeding. Considerable differences between the hospitals were observed for the promotion of infant formulas before and after the intervention.

When educators are locked down: transitioning an international faculty development program from in-person to online during the COVID-19 pandemic in China.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic forced international faculty development programs in medical education to forgo in-person activities and transition to online learning. We sought to examine changes in international medical educators' evaluations of our faculty development program as it transitioned due to the pandemic. Methods: We compared survey responses from participants in our International Medical Educators Program between 2019 (in-person) and 2020 (online). The 43-item survey addressed aspects such as program evaluation and self-assessment of curriculum development and teaching skills. We analyzed data using t-tests to compare means and chi-square test for categorical variables, and performed thematic analysis of open-ended responses. Results: We found that trainees in both cohorts rated the program highly with regard to overall program quality and self-assessed learning outcomes, but the 2019 group reported stronger relationships with peers and instructors. Some scores for self-assessed outcomes were lower for the 2020 class, but no statistically significant differences were found in pre- and post- training scores between the two cohorts. Four themes emerged from the feedback: positive program utility, IMEP as an example of good curriculum design, timing issues, and online learning environment challenges. Conclusions: Despite pandemic challenges, the transition to online faculty development was favorably evaluated, with high confidence in the applicability of learned skills. Future efforts should focus on fostering community and optimizing interaction times to enhance learning experiences. The study contributes insights for global medical education communities in pandemic circumstances.