Implementing Entrustable Professional Activities in Pediatric Fellowships: Facilitating the Process.

BACKGROUND AND OBJECTIVES: Entrustable professional activities (EPAs) will be used for initial certification by the American Board of Pediatrics by 2028. Less than half of pediatric fellowships currently use EPAs for assessment, yet all will need to adopt them. Our objectives were to identify facilitators and barriers to the implementation of EPAs to assess pediatric fellows and to determine fellowship program directors' (FPD) perceptions of EPAs and Milestones. METHODS: We conducted a survey of FPDs from 15 pediatric subspecialties. EPA users were asked about their implementation of EPAs, barriers encountered, and perceptions of EPAs. Nonusers were queried about deterrents to using EPAs. Both groups were asked about potential facilitators of implementation and their perceptions of Milestones. RESULTS: The response rate was 65% (575/883). Of these, 344 (59.8%) were EPA users and 231 (40.2%) were nonusers. Both groups indicated work burden as a barrier to implementation. Nonusers reported more barriers than users (mean [SD]: 7 [3.8] vs 5.8 [3.4], P < .001). Both groups identified training materials and premade assessment forms as facilitators to implementation. Users felt that EPAs were easier to understand than Milestones (89%) and better reflected what it meant to be a practicing subspecialty physician (90%). In contrast, nonusers felt that Milestones were easy to understand (57%) and reflected what it meant to be a practicing subspecialist (58%). CONCLUSIONS: Implementing EPA-based assessment will require a substantial investment by FPDs, facilitated by guidance and easily accessible resources provided by multiple organizations. Perceived barriers to be addressed include FPD time constraints, a need for additional assessment tools, and outcomes data.

Overview of short bowel syndrome and intestinal transplantation / Actualización sobre síndrome de intestino corto y transplante intestinal

Short bowel syndrome is at once a surgical, medical, and a disorder, with potential for life-threatening complications as well as eventual independence from artificial nutrition. Navigating through the diagnostic and therapeutic decisions is ideally accomplished by a multidisciplinary team comprised of nutrition, pharmacy, social work, medicine, and surgery. Early identification of patients at risk for long-term PN-dependency is the first step towards avoiding severe complications. Close monitoring of nutritional status, steady and early introduction of enteral nutrition, and aggressive prevention, diagnosis and treatment of infections such as line sepsis, and bacterial overgrowth can significantly improve prognosis. Intestinal transplantation is an emerging treatment that may be considered when intestinal failure is irreversible and children are suffering from serious complications related to TPN administration.

El síndrome de intestino corto es una entidad médico-quirúrgico, con potencial riesgo para poner en peligro la vida de los niños, y que en su manejo incluye nutrición artificial. El estudio diagnóstico y terapéutico se logra idealmente con un equipo multidisciplinario compuesto de nutricionista, químico, trabajadora social, médico y cirujano. Uno de los primeros pasos, es la identificación anticipada de pacientes a riesgo de presentar complicaciones severas por el uso prolongado de nutrición parenteral. Su pronóstico se mejora con la estrecha supervisión del estado nutricional, por la introducción temprana de la nutrición enteral y la prevención a tiempo en el diagnóstico y tratamiento de infecciones bien de la línea arterial, o por sobrecrecimiento bacteriano. El transplante intestinal emerge como parte del tratamiento que puede ser considerado cuando la falla intestinal es irreversible y en los niños que presentan complicaciones serias relacionadas con la administración de nutrición parenteral.