Current Practices in Pediatric Emergency Medicine Fellowship Trauma Training.

OBJECTIVE: The management of injured children is a required element of pediatric emergency medicine (PEM) fellowship training. Given the relatively infrequent exposure of trainees to major trauma, it is important to understand how programs train fellows and assess their competency in pediatric trauma. METHODS: An online survey was sent to 84 PEM fellowship program directors (PDs). Program directors were asked to describe their program's characteristics, the degree of fellow independence, educational techniques used to train fellows in trauma, and their expectation of fellows' competency in 14 core trauma-related skills upon graduation. Program directors were classified as having high expectations if they anticipated that graduating fellows could perform 12 trauma skills or more independently. RESULTS: Fifty-nine programs (70%) responded. Although most programs (55, 93%) identified as pediatric trauma centers, fellows at the majority of programs (41, 69%) spent some or all of their trauma experience at an outside hospital. Only a minority of programs (17, 29%) allowed fellows to lead pediatric trauma resuscitations as independent attendings without precepting. Programs used over a dozen different educational methods to varying degrees. Less than half of programs (28, 47%) used a formal trauma curriculum. Whereas 33 PDs (56%) had high expectations, only 9 (15%) expected fellows to be able to perform all 14 skills. CONCLUSIONS: There is considerable variability in how PEM fellows are trained to care for injured children. Most PDs do not realistically expect fellows to be able to perform all recommended trauma skills after graduation. Our findings highlight the need for further research and efforts to standardize the training of PEM fellows in pediatric trauma.

Implementation of a Chief Resident Selection Process Designed to Mitigate Bias: Lessons Learned.

BACKGROUND: Chief residency selection processes are often opaque and beset by bias, which can result in disparities in who is selected for this important role. As a chief residency can lead to future academic and/or leadership positions, efforts to increase diversity in academic medicine and physician leadership may be aided by an inclusive chief resident (CR) selection process designed to mitigate bias.  Objective: To implement and evaluate the acceptability of a CR selection process that is inclusive and designed to mitigate bias.  Methods: In the 2021-2022 academic year, we designed and implemented a CR selection process aligned with published strategies known to mitigate bias in academic recruitment. The four-step opt-out CR selection process included a nomination survey, structured interviews, a clinical review, and a holistic review of each candidate. Each step was clearly delineated, assigned a specific number of points, and scored on a designated rubric. The candidates with the highest and second-highest number of points were awarded the two CR positions. Our selection process excluded examination scores and precluded consideration of "fit" between the selected CRs, as these are known sources of potential bias. In January 2023, we surveyed our department to obtain post-implementation feedback and to assess satisfaction with the process, before repeating the process for 2022-2023. RESULTS: Survey response rates were 47% (14/30) for residents and 29% (18/63) for departmental faculty. The majority of responding residents (64%) and faculty (100%) were satisfied with the CR selection process, finding it fair and inclusive. Nearly 80% of residents and 100% of faculty wished to repeat the process in 2022-2023.  Conclusions: An inclusive CR selection process utilizing strategies to mitigate bias was feasible, and acceptable to residents and faculty. We recommend that residency training programs make efforts to implement CR selection practices that are inclusive and aim to mitigate bias.

Fever determination in young infants: prevalence and accuracy of parental palpation.

OBJECTIVES: Pediatricians routinely advise parents to seek immediate medical attention if their young infant develops a fever. Many parents rely on palpation to assess their child's temperature. Our objective was to determine the prevalence and accuracy of parental palpation for fever in young infants. METHODS: We enrolled a convenience sample of infants younger than 3 months presenting to a pediatric emergency department with any complaint. Parents answered questions regarding their usual fever determination practices and palpated their infants to assess for fever. Parental predictions were then compared with the standard rectal temperature obtained at triage. RESULTS: Ninety-six infants were enrolled. Fifty-seven percent of parents reported palpation as a usual method of fever assessment, with 87% palpating for fever at least occasionally. Of the 78% of parents who owned a thermometer, nearly half used palpation regularly. As compared with the "gold standard" of rectal thermometry, parental palpation for fever had a sensitivity of 81%, specificity of 82%, positive predictive value of 59% and negative predictive value of 93%. After eliminating from analysis those infants whose parents had used a thermometer at home, we found a sensitivity of 67%, specificity of 84%, positive predictive value of 33%, and negative predictive value of 95%. CONCLUSIONS: Many parents rely on palpation as a usual method of fever determination in young infants, including nearly half of those who own a thermometer. Parental palpation overestimates the presence of fever, but is likely to be accurate when parents report that their baby is not febrile. As a sole method of determining fever, parental palpation is unreliable.

Using a computerized sign-out system to improve physician-nurse communication.

BACKGROUND: Communication problems among health care workers are a common, preventable source of hospital-related morbidity and mortality. Internal medicine residents at Jacobi Medical Center (Bronx, NY) began using an electronic sign-out program that had been incorporated into the computerized medical record. This new system had been developed to improve the quality of information transfer between cross-covering residents. Eighteen months later, a pilot study was initiated to explore the potential benefits of offering inpatient nurses access to this sign-out data. METHODS: Nursing staff members were provided electronic access to the residents' sign-out information. Nurses received printouts of the computerized sign-outs at the start of each shift and were asked to use the sign-out program as a basis for their care plans and nursing change-of-shift "report." RESULTS: The 19 (of 20) nurses who completed the survey agreed that using the resident sign-out program positively affected their ability to care for their patients. In addition, the intervention improved nurses' understanding of the patients' reason for admission, helped to improve communication between physicians and nurses, and raised nursing morale. DISCUSSION: Incorporation of a housestaff electronic sign-out system into nursing daily workflow demonstrated multiple benefits and facilitated the transfer of valuable patient information from housestaff to nurses.

Providing rapid feedback to residents on their teaching skills: an educational strategy for contemporary trainees.

OBJECTIVE: The objective of this study was to assess the attitudes of contemporary residents toward receiving rapid feedback on their teaching skills from their medical student learners. METHODS: Participants consisted of 20 residents in their second post-graduate training year. These residents facilitated 44 teaching sessions with medical students within our Resident-as-Teacher program. Structured, written feedback from students was returned to the resident within 3 days following each session. Residents completed a short survey about the utility of the feedback, whether they would make a change to future teaching sessions based on the feedback, and what specifically they might change. The survey utilized a 4-point scale ("Not helpful/likely=1" to "Very helpful/likely=4"), and allowed for one free-text response. Free-text responses were hand-coded and underwent qualitative analysis to identify themes. RESULTS: There were 182 student feedback encounters resulting from 44 teaching sessions. The survey response rate was 73% (32/44). Ninety-four percent of residents rated the rapid feedback as "very helpful," and 91% would "very likely" make a change to subsequent sessions based on student feedback. Residents' proposed changes included modifications to session content and/or their personal teaching style. CONCLUSIONS: Residents found that rapid feedback received from medical student learners was highly valuable to them in their roles as teachers. A rapid feedback strategy may facilitate an optimal educational environment for contemporary trainees.

Hazing of suburban middle school and high school athletes.

Little is known about the prevalence of hazing behaviors among adolescent athletes. Our survey of 1105 6th-12th grade athletes found that 17.4% had been subjected to practices that qualify as hazing. Many of these teenagers do not comprehend the abusive and potentially dangerous nature of hazing.

A look at the pediatrician as parent: experiences with the introduction of varicella vaccine.

Many physicians voiced reservations about routine use of the varicella vaccine for healthy children after its licensing in 1995. Anecdotal evidence suggested that some pediatricians who were parents themselves were electing not to vaccinate their own children against chickenpox. Little has been written about pediatrician-parents' behaviors in caring for their own children, and how these practices may differ from the behavior that these same pediatricians apply in practice. Pediatricians' tacit attitudes toward medical interventions might be better understood from their behaviors as parents than from their clinical practices, which may be influenced by a sense of responsibility to follow guidelines of professional organizations. Varicella vaccination practices were examined to determine whether pediatricians' behaviors in parenting their own children differed from their recommendations for their patients. A mail survey was sent to 1,762 New York State pediatricians selected randomly from the membership directory of the American Academy of Pediatrics. The response rate was 43% (764/1,762); 63% of responding pediatricians were parents. Eighty-five percent of pediatricians recommended varicella vaccine routinely in practice. Of the pediatricians' own eligible children, 88% (256/291) had been vaccinated against chickenpox. We found a high overall rate of compliance with recommendations for routine use of varicella vaccine. Pediatricians who were parents were just as likely as nonparent pediatricians to recommend the vaccine routinely for their patients. Importantly, pediatrician-parents demonstrated no "double standard"; at the time of the study, 88% of pediatricians' own eligible children had been vaccinated against varicella.

Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction.

BACKGROUND: While there are numerous benefits of smartphone use for physicians, little is known about the negative effects of using these devices in the context of patient care. OBJECTIVE: To assess resident and faculty smartphone use during inpatient attending rounds and its potential as a source of distraction during transfer of clinical information. DESIGN: Cross-sectional survey. SETTING: University-affiliated public teaching hospital. PARTICIPANTS: All housestaff and inpatient faculty in the departments of Medicine and Pediatrics. METHODS: Participants were asked about smartphone ownership, usage patterns during attending rounds, and whether team members had ever missed important data during rounds due to distraction from smartphones. Attendings were asked whether policies should be established for smartphone use during rounds. RESULTS: The overall response rate was 73%. Device ownership was prevalent (89% residents, 98% faculty), as was use of smartphones during inpatient rounds (57% residents, 28% attendings). According to self-reports, smartphones were used during rounds for patient care (85% residents, 48% faculty), reading/responding to personal texts/e-mails (37% residents, 12% faculty), and other non-patient care uses (15% residents, 0% faculty). Nineteen percent of residents and 12% of attendings believed they had missed important information because of distraction from smartphones. Residents and faculty agreed that smartphones "can be a serious distraction during attending rounds," and nearly 80% of faculty believed that smartphone policies should be established. CONCLUSIONS: Smartphone use during attending rounds is prevalent and can distract users during important information transfer. Attendings strongly favored the institution of formal policies governing appropriate smartphone use during inpatient rounds.