A Qualitative Study of Resident Advocacy Work.

BACKGROUND: Advocacy is a critical component of pediatric training and practice. Pediatric resident advocacy experiences include skill development and real-world projects, but little is known about how pediatric residents participate in advocacy. Without this knowledge, educators run the risk of underpreparing residents for the full scope of advocacy work. This study sought to investigate how residents participate in advocacy by characterizing their projects using an evidence-informed conceptual framework and describing the unique lessons were learned by the residents. METHODS: The authors used principles of thematic analysis to interrogate existing documents derived from pediatric residents from 2013 to 2021 at 1 institution. They purposefully sampled and deidentified project proposals and written reflections. Using a constant comparative method, they created codes. Codes, connections between codes, and findings were refined by discussion. RESULTS: Residents demonstrated 4 different types of advocacy: some residents participated in directed agency or activism and others focused on shared agency or activism. Residents reflected on different learning experiences; residents who participated in shared forms of advocacy learned skills such as "Partnering," "Evaluating," and "Planning." Residents who were involved in directed forms of advocacy shared lessons on "Leading," "Presenting," and "Intervening." Advocacy work also changed over time: in later projects (2016-2021) residents took ownership of the role of "advocate"; social and political climate was salient in reflections. CONCLUSIONS: Pediatric residents advocate through shared activism and agency and directed activism and agency. Educators should recognize, support, and supplement the experiences of residents as they participate in different types of advocacy.

A Pediatric Resident Advocacy in Complex Care Curriculum.

Introduction: Children and youth with special health care needs (CYSHCN) are a special, vulnerable population. Children with medical complexity (CMC) represent a smaller, medically fragile sliver (6%) of the US child population. Several professional pediatric entities direct (or require) pediatric educators to instruct residents in advocacy for all children, explicitly including CYSHCN/CMC populations. While many existing curricula address pediatric advocacy education, a gap remains in curricula specifically designed to aid learners in advocacy of CYSHCN/CMC. Methods: Using Kolb's experiential learning cycle as a framework, we designed and delivered a comprehensive outpatient complex care curriculum, including several didactic video lectures (total: 60:04 minutes, median: 6:25 minutes) and experiential site visits devoted to advocacy topics for CMC, as one portion of a 4-week elective complex care rotation. Residents completed pre- and posttests of knowledge and pre- and postsurveys to self-assess attitudes, comfort, and behavior; viewed didactic video lectures; and engaged in experiential site visits. Reflective statements captured attitudes regarding advocacy for CMC. Results: Between July 2016 and June 2020, 47 trainees completed the rotation; data were available for 30 trainees. Residents demonstrated a statistically significant improvement in knowledge (p < .001), as well as improved attitudes, diversity sensitivity, and comfort in advocating for CMC postrotation. Qualitative comments showed overwhelmingly positive learner reaction. Discussion: This curriculum, which can be offered as a stand-alone resource or a supplement to a comprehensive complex care curriculum, incorporates didactic and experiential teaching methods and addresses a significant competency in advocacy education.

Current status of African pediatric oncology education efforts aligned with the Global Initiative for Childhood Cancer.

Education of the pediatric oncology workforce is an important pillar of the World Health Organization CureAll technical package. This is not only limited to healthcare workers, but all stakeholders in the childhood cancer management process. It includes governmental structures, academic institutions, parents and communities. This review evaluated the current educational and advocacy training resources available to the childhood cancer community, the contribution of SIOP Africa in the continental educational needs and evaluated future needs to improve the management of pediatric malignancies in reaching the Global Initiative for Childhood Cancer goals. Childhood cancer, unlike adult cancers, has not been prioritized in African cancer control plans nor the teaching and advocacy surrounding pediatric oncology. The availability of formal training programs for pediatric oncologists, pediatric surgeons and radiotherapy specialists are limited to particular countries. In pharmacy and nutritional services, the exposure to pediatric oncology is limited while training in advocacy doesn't exist. Many nonacademic stakeholders are creating the opportunities in Africa to gain experience and train in these various fields, but formal training programs should still be advocated for. LEARNING POINTSThe African continent has various resources to increase the capacity of childhood cancer care stakeholders to increase their knowledge.African pediatric oncology teams rely on a multitude of international sources for training while developing their own.There is a greater need for formal, standardized cancer training especially for pediatric surgeons, radio-oncologists and nurses.Greater inclusion of pathologists, pediatric oncology pharmacists and dieticians into multidisciplinary care and childhood cancer training should be facilitated and resourced.Successful advocacy programs and tool kits exist in parts of Africa, but the training in advocacy is still underdeveloped.

Child Advocacy in Action: If Not You, Who? If Not now, When?

The notion that the physician has a responsibility to both the patient in their care and the community in which they reside has been a source of inspiration and tension within the profession for centuries. The profession of Pediatrics has uniquely incorporated advocacy into its training programs and will likely continue to incorporate advocacy into its professional standards for the foreseeable future. In this article, we review the history of advocacy within the profession, outline the skills needs for successful child health advocacy and offer examples of how advocacy combined with pediatric practice has improved the lives of children.

Community Advocacy in Pediatric Practice: Perspectives from the Field.

Pediatrics is a specialty that is grounded in advocacy, possibly more than any other field of medicine. Infants, children, and adolescents depend on others to cover their basic needs including food, shelter, and education and rely on proxy voices to speak out on their behalf. In this article, we describe the importance of community advocacy in pediatrics, best practices for training pediatricians in community advocacy, and case studies to highlight trainee experiences and demonstrate how community advocacy and community-based participatory research can be incorporated in the career of a pediatrician.

Operating Principles and Competencies for Engagement in Global/Local Settings.

This article reviews operating principles to guide engagement with local and global partners aimed at improving child health status. In the realms of research, education, clinical care, and administration, these principles are part of an organizing framework to be paired with faculty competencies that address the values/ethics of engagement, specific roles/responsibilities of partners, effective communication strategies among partners, the value of teamwork, and a full understanding of special considerations. Readers are referred to examples of prior advocacy work and implementation research models.

Derecho de niños, niñas y adolescentes en la práctica clínica: Estrategias de capacitación durante la formación de pediatras / Rights of children and adolescents in clinical practice: Training strategies for pediatricians

Introducción: Los derechos de los niños, niñas y adolescentes (NNA) constituyen aspectos fundamentales durante el ejercicio profesional para todos aquellos que trabajan en salud infantil Objetivo: Comunicar la experiencia educativa: contenidos y estrategia pedagógica para abordarlos de una manera accesible y atractiva, a fin de facilitar el cumplimiento y asegurar la incorporación de conocimientos y valores considerados fundamentales en la formación de un pediatra. Métodos: Se realizó un curso virtual sobre derechos de NNA en la práctica clínica para residentes donde se esperaba: revisar las prácticas profesionales en salud desde la perspectiva de derechos de NNA, incorporar diversos lenguajes y estrategias a las situaciones de comunicación entre niños y profesionales de la salud para garantizar tales derechos. Se realizaron en torno a tres consideraciones pedagógicas: 1) Estructura de portal educativo, 2) lectura hipermedial e interactiva y 3) Retroalimentaciones constructivas. Resultados: Participaron 71 residentes, el 85% de los participantes fueron de 4to año, y el 100% de los mismos lo finalizaron. Conclusiones: La práctica asistencial supervisada ocupa gran parte del tiempo activo del residente. La oferta educativa a distancia a través de plataformas virtuales ofrece una alternativa valiosa siempre que se asegure el acceso y cumplimiento de las actividades; dichas premisas dependen en gran parte del diseño pedagógico y atractivo presentado (AU)

Introduction: The Rights of Children and Adolescents comprise aspects that are fundamental for professionals working in the field of healthcare in children. Objective: To describe the educational experience, contents, and strategy for an accessible and attractive approach to facilitate compliance and assure the incorporation of knowledge and values considered to be essential for the training in pediatrics. Methods: an online course on the Rights of Children and Adolescents in clinical practice for residents with the aim to revise practices of health care professionals for the point of view of Rights of Children and Adolescents, to incorporate different manners of speech and strategies in communication settings involving children and health care professionals to guarantee these rights. Interventions took place in three educational settings: 1) Structure of an educational website, 2) Multimedia and interactive reading, and 3) Constructive feedback. Results: 71 residents participated, 85% of whom were fourth year residents, and 100% completed the study. Conclusions: Supervised patient care makes up a large part of the work time of a resident. Online education through platforms provides a valuable alternative whenever access and compliance to the activities are assured. Compliance largely depends on the design and attractiveness of the material presented (AU)

Modern-day Slavery in our Health Care System: An Advocacy Journey.

The following is the winning submission from the third annual Section on Pediatric Trainees essay competition. This year's competition was informed by the 2018-2019 Section on Pediatric Trainees Advocacy Campaign: Advocacy Adventure, which empowered trainees to find their areas of passion, acquire and polish new skills, and organize advocacy efforts collaboratively. We asked writers to share experiences as physician advocates and were impressed with the broad variety of important topics submitted by trainees from around the country. This essay by Drs Panda and Garg highlights a critical issue facing children, human trafficking, and shares their innovative and sustainable survivor-informed training for pediatric trainees. Along with the runner-up submission by Dr Ju, which also appears in this issue, this piece is a wonderfully inspiring reminder that we are all well positioned to advocate for children in our roles as trainees and pediatricians.

Training Parents of Youth with Autism Spectrum Disorder to Advocate for Adult Disability Services: Results from a Pilot Randomized Controlled Trial.

This study presents findings from a pilot randomized controlled trial, testing a 12-week intervention to train parents of youth with autism spectrum disorder (ASD) to advocate for adult disability services-the Volunteer Advocacy Program-Transition (VAP-T). Participants included 41 parents of youth with ASD within 2 years of high school exit, randomly assigned to a treatment (N = 20) or wait-list control (N = 21) group. Outcomes, collected before and after the intervention, included parental knowledge about adult services, advocacy skills-comfort, and empowerment. The VAP-T had acceptable feasibility, treatment fidelity, and acceptability. After participating in the VAP-T, intervention parents (compared to controls) knew more about the adult service system, were more skilled/comfortable advocating, and felt more empowered.

What Do Pediatric Residents Gain From an Experience in Juvenile Justice? A Qualitative Analysis of Community-Based Learning.

BACKGROUND: Training in advocacy and community pediatrics often involves the use of community site visits. However, data on the specific knowledge, skills, and attitudes gained from these experiences are limited. In this study we used qualitative analysis of written narratives to explore the response of residents to a juvenile justice experience. METHODS: Pediatric residents participated in a week-long experience in the juvenile probation department and completed a written narrative. Narratives were analyzed using grounded theory to explore the effects of this experience on residents' views of youth in the juvenile justice system. RESULTS: Analysis of 29 narratives revealed 13 themes relating to 5 core concepts: social determinants of behavior, role of professionals and institutions, achieving future potential, resolving discrepancies, and distancing. A conceptual model was developed to explore the interactions of these concepts in the resident view of youth in the juvenile justice system. Of the themes only 3 (23%) were related to content explicitly covered in the assigned reading materials. CONCLUSIONS: Several important concepts emerged as elements of this experience, many of which were not covered in the explicit curriculum. Variability in attitudinal response to the experience raised important questions about the influence of the ideological framework of the learner and the hidden curriculum on the learning that occurs in community settings. We propose a theoretical model that delineates the factors that influence learning in community settings to guide educators in planning these types of experiences.

The Community Pediatrics Training Initiative Project Planning Tool: A Practical Approach to Community-Based Advocacy.

Introduction: To impact social determinants of health, physicians require knowledge, skills, and attitudes to work with communities beyond the clinical milieu. The American Academy of Pediatrics (AAP) Community Pediatrics Training Initiative (CPTI) project planning tool can guide health care professionals and trainees to identify and define issues, build coalitions, assess interventions, and ensure sustainability of successful programs. The Accreditation Council for Graduate Medical Education guidelines for pediatric training require experiences in community health. To date, there have been no widely available tools to ensure both robust learning and validated assessment for pediatric residents in community pediatrics and advocacy training. Methods: The AAP CPTI project planning tool engages learners with a step-by-step process involving investigation, guided reflection, and structured assessment. Learners practice the skills necessary to plan, implement, and evaluate a community pediatrics/child health advocacy proposal focused upon a learner-defined area of interest. An assessment rubric maps to milestones. Results: This project planning tool has been used in a number of programs with learners at multiple levels, including undergraduate education, graduate education, and practicing health care providers. It can be employed to design and implement a community advocacy intervention or as a thought exercise and can be incorporated in a single block rotation or as a longitudinal experience. It can be used with individual learners or as a group exercise. Discussion: The project planning tool can be used by residency programs to demonstrate resident competence in community health and advocacy, either as a learning exercise or to guide actual implemented projects.

Comprensiones del discurso normativo sobre inclusión educativa en Colombia / Realizations of the regulatory discourse on educational inclusion in Colombia

Se presenta un análisis cualitativo al discurso normativo colombiano en torno a la Inclusión Educativa producido entre los años 1991 y 2013, se identifican conceptos, criterios e imaginarios que lo atraviesan, algunas relaciones entre dicho discurso y sus condicionesde emergencia. Se destaca, entre otros asuntos, que el discurso normativo colombiano con respecto a la Inclusión Educativa tiende a desconfiar de sí mismo, aspira a abarcar todas las realidades humanas, en este sentido homogeniza e idealiza los fenómenos.

A qualitative analysis to the Colombian regulatory discourse around Educational Inclusion, produced between 1991 and 2013, is introduced. Besides, some concepts, criteria, and imaginaries which cross it, as well as some relations between that speech and emergencyconditions are identified. Among other issues, the Colombian normative discourse regarding Inclusive Education, which tends to distrust itself, is highlighted, and aims to encompassall human realities, which, in this sense homogenizes and idealizes the phenomena.

Recommended Curriculum for Training in Pediatric Transplant Infectious Diseases.

A working group representing the American Society of Transplantation, Pediatric Infectious Diseases Society, and International Pediatric Transplant Association has developed a collaborative effort to identify and develop core knowledge in pediatric transplant infectious diseases. Guidance for patient care environments for training and core competencies is included to help facilitate training directed at improving the experience for pediatric infectious diseases trainees and practitioners in the area of pediatric transplant infectious diseases.

Perspectiva de adolescentes sobre seus direitos e deveres / Perspectiva de los jóvenes sobre sus derechos y deberes / Perspective of adolescents about their rights and duties

O Estatuto da Criança e do Adolescente considera as crianças e os adolescentes como detentores de direitos e em desenvolvimento peculiar e, por isso, é importante que haja reconhecimento dos jovens sobre sua condição. O objetivo deste estudo quanti-qualitativo foi conhecer a percepção de adolescentes dos contextos urbano e rural acerca dos seus direitos e deveres. Participaram 47 adolescentes dos contextos urbano e rural, entre 12 e 15 anos de idade. Foi utilizado um questionário sobre conhecimento em direitos e grupos focais. A maioria dos participantes afirmou que crianças e adolescentes têm direitos e deveres, contudo, apenas alguns souberam citá-los. Constataram-se semelhanças e diferenças entre os grupos. As semelhanças entre os grupos condizem com concepções difundidas na sociedade e as diferenças, às particularidades de cada contexto. Estratégias de intervenção que promovam maior reconhecimento dos direitos e deveres junto às crianças, aos adolescentes e à sociedade são sugeridas...

El Estatuto del Niño y del Adolescente considera niños y adolescentes como poseedores de derechos y en desarrollo peculiar y es importante que haya un reconocimiento de los jóvenes acerca de su condición. El propósito del estudio cuantitativo y cualitativo fue comprender la percepción de los adolescentes de los contextos urbano y rural sobre los derechos y deberes. 47 adolescentes de los contextos urbano y rural participaron del estudio, entre 12 y 15 años de edad. Fue utilizado un cuestionario sobre el conocimiento de los derechos y grupos focales. La mayoría de los participantes dijeron que los niños y adolescentes tienen derechos y deberes, pero, algunos sabían citarlos. Se observó similitudes y diferencias entre los grupos. Las similitudes entre los grupos son coherentes con las concepciones generalizadas en la sociedad y las diferencias, a las particularidades de cada contexto. Se sugieren estrategias de intervención que promuevan un mayor reconocimiento de los derechos y deberes entre los niños, los adolescentes y la sociedad...

The Statute of the Child and Adolescent considers children and adolescents as holders of rights and in peculiar development situation and, therefore, it is adolescents' acknowledgment of their condition. The aim of this quantitative and qualitative study was to know the perception of young people from urban and rural contexts about rights and duties. 47 adolescents, age 12 to 15, from urban and rural contexts participated in this study. A survey about right's knowledge and focal groups was used for gathering data. Most of participants said that children and adolescents have rights and duties, however, a few participants knew mention them. Similarities and differences among the groups were found. The similarity is related to conceptions found in society and the difference is related to particularities of each context. Intervention's strategies with foment more recognition of rights and duties were suggested to young as well as society...

Improving sudden unexplained infant death investigation practices: an evaluation of the Centers for Disease Control and Prevention's SUID Investigation Training Academies.

Lack of thorough sudden unexplained infant death investigations (SUIDIs) has hindered accurate cause-of-death determination, infant mortality surveillance, and prevention strategies. To standardize SUIDI practices, the Centers for Disease Control and Prevention created a reporting form, guidelines, training curriculum, and SUIDI Training Academies using a train-the-trainer format. The training goal was to train teams of five in each state, who would reach an additional 1250 participants.The aim of this study is to evaluate the SUIDI Training Academies by determining professional characteristics of participants, assessing the level of confidence in infant death investigation components, enumerating the number of secondary trainings, and discussing recommendations for future trainings.To evaluate the training and the success of the train-the-trainer strategy, we used training evaluations, participant lists, and Web-based training logs to assess participant knowledge, skills, perceptions, and characteristics and number of secondary trainings.We trained 270 trainers at 5 SUIDI Training Academies. Greater than 96% of respondents reported confidence in case investigation skills and reported that hands-on laboratory sessions facilitated the practice of new skills. Academy trainers have trained greater than 23,000 medicolegal professionals, exceeding the training goal. This evaluation allowed us to identify opportunities to improve future SUIDI trainings.