Linguistic analysis of pediatric residency personal statements: gender differences.

BACKGROUND: All US residency programs require applicants to submit personal statements. Prior studies showed gender differences in personal statement writing, which has implications for gender bias in the application process, but previous studies have not considered the dual influence of specialty-specific values on personal statement writing by applicants of each gender. OBJECTIVE: To understand gender differences in pediatric residency personal statements. METHODS: From 2017 to 2018, we performed linguistic analysis of personal statements written by interviewees at a mid-size US pediatrics residency during two prior academic years. We assessed writing tone, communal language, and agentic language. We performed t-tests to evaluate for gender differences, p < 0.05. RESULTS: We analyzed personal statements from 85 male and 85 female interviewees. Average word count was 676 words. Personal statements demonstrated analytic writing style with authentic and positive emotional tone. We found no gender differences in communal language for social affiliation (p = 0.31), adjectives (p = 0.49), or orientation (p = 0.48), which deviates from typical gender norms for male language use. Males used agentic language of reward more frequently (p = 0.02). CONCLUSIONS: Findings suggest that social language is valued in pediatrics, a predominantly female specialty, regardless of applicant gender. Use of reward language by males is consistent with previous findings. Future studies should evaluate gender differences in residency applications across specialties to advance understanding of the role gender plays in the application process.

Thresholds and interpretations: How clinical competency committees identify pediatric residents with performance concerns.

BACKGROUND: Clinical competency committee (CCC) identification of residents with performance concerns is critical for early intervention. METHODS: Program directors and 94 CCC members at 14 pediatric residency programs responded to a written survey prompt asking them to describe how they identify residents with performance concerns. Data was analyzed using thematic analysis. RESULTS: Six themes emerged from analysis and were grouped into two domains. The first domain included four themes, each describing a path through which residents could meet or exceed a concern threshold:1) written comments from rotation assessments are foundational in identifying residents with performance concerns, 2) concerning performance extremes stand out, 3) isolated data points may accumulate to raise concern, and 4) developmental trajectory matters. The second domain focused on how CCC members and program directors interpret data to make decisions about residents with concerns and contained 2 themes: 1) using norm- and/or criterion-referenced interpretation, and 2) assessing the quality of the data that is reviewed. CONCLUSIONS: Identifying residents with performance concerns is important for their education and the care they provide. This study delineates strategies used by CCC members across several programs for identifying these residents, which may be helpful for other CCCs to consider in their efforts.

Using educational prescriptions to teach medical students evidence-based medicine.

PURPOSE: To evaluate feasibility and impact of evidence-based medicine (EBM) educational prescriptions (EPs) in medical student clerkships. METHODS: Students answered clinical questions during clerkships using EPs, which guide learners through the "four As" of EBM. Epidemiology fellows graded EPs using a rubric. Feasibility was assessed using descriptive statistics and student and fellow end-of-study questionnaires, which also measured impact. In addition, for each EP, students reported patient impact. Impact on EBM skills was assessed by change in EP scores over time and scores on an EBM objective structured clinical exam (OSCE) that were compared to controls from the prior year. RESULTS: 117 students completed 402 EPs evaluated by 24 fellows. Average score was 7.34/9.00 (SD 1.58). 69 students (59%) and 21 fellows (88%) completed questionnaires. Most students thought EPs improved "Acquiring" and "Appraising". Almost half thought EPs improved "Asking" and "Applying". Fellows did not value grading EPs. For 18% of EPs, students reported a "change" or "potential change" in treatment. 56% "confirmed" treatment. EP scores increased by 1.27 (95% CI: 0.81-1.72). There were no differences in OSCE scores between cohorts. CONCLUSIONS: Integrating EPs into clerkships is feasible and has impact, yet OSCEs were unchanged, and research fellows had limitations as evaluators.

The #PedsMatch21 Webinar Series: Coordinated Specialty-Level Communication During the Virtual Residency Application Cycle.

PROBLEM: The landscape of pediatric medical education changed significantly in the wake of the COVID-19 pandemic. Fourth-year medical students applying to pediatric residency programs were particularly affected by alterations to traditional away rotations, the inability to conduct in-person visits, and resulting changes in ways of communicating with residency programs. Applicants were concerned about the virtual component of the application cycle and worried as to how to manage the COVID-19-related changes. Program leaders also faced apprehension at how to close communication gaps and effectively use virtual tools to reach applicants. APPROACH: Founders of the Twitter-based @FuturePedsRes (FPR) organization recognized these concerns and developed a webinar series during the 2020-2021 academic year to create opportunities for programs and applicants to communicate. Leaders of the Association of Pediatric Program Directors and the Council on Medical Student Education in Pediatrics joined as sponsors and co-hosts. The #PedsMatch21 webinar series consisted of 9 total webinars: 2 overviews, 5 regional, 1 for osteopathic students, and 1 for international medical graduates. OUTCOMES: A total of 138 pediatric residency programs across the country participated in the #PedsMatch21 webinar series. Each webinar brought in a mean of 431 attendees, from the United States and several other countries. Follow-up surveys immediately after each webinar and again at the end of the interview season demonstrated that the webinars decreased applicants' anxiety, provided helpful information on the virtual season, and increased their awareness of programs. NEXT STEPS: The #PedsMatch21 webinar series demonstrated utility in addressing applicants' concerns and allowing applicants access to a greater number of programs. Webinar-based strategies should be considered across all medical specialties as a useful method of providing accessible forums for programs and applicants.

The Impact of the COVID-19 Pandemic on Pediatric Graduate Medical Education: Lessons Learned and Pathways Forward.

In this article, the authors describe the impact of the COVID-19 pandemic on pediatric graduate medical education (GME), including the impact on clinical experiences for trainees, teaching methods used, trainee wellness, GME leader wellness and support, and the traditional interview process. A thorough literature review was done to identify impacts of the COVID-19 pandemic on pediatric GME. In addition, information was collected through Association of Pediatric Program Directors virtual cafes and conferences. Positive changes for GME from the COVID-19 pandemic included: the rapid transition to telehealth; asynchronous learning allowing for increased cross-program collaboration; innovative online teaching modalities; increased flexibility and decreased cost of online recruitment; and shared innovations across pediatric GME. Challenging aspects of the COVID-19 pandemic included: decreased learning about common childhood illnesses, such as bronchiolitis, acute otitis media, and influenza; decreased patient volumes and patient complexity in clinics and inpatient wards, leading to less practice developing efficiency, time management, and triaging skills; and an increased burden on trainees, including moral distress and decreased support from one another and other social supports. The COVID-19 pandemic has highlighted important opportunities in U.S. educational systems. As medical educators move forward, it will be important to learn from these while mitigating the negative impacts.

Teaching primary care in community health centers: addressing the workforce crisis for the underserved.

Universal coverage and multiple initiatives to improve health care delivery are crucial components of health care reform. However, the missing link has been a plan to rapidly address the primary care workforce crisis for the underserved. The authors propose a link between primary care graduate medical education and care for the underserved in community health centers, where expansion will be necessary for the anticipated increase in Medicaid and insured patients. This can be achieved by establishing primary care teaching health centers in expanded community health centers, which have established a patient-centered medical home practice environment. Residents would receive their final year of training in these centers, and then have the incentive of National Health Service Corps debt repayment if they subsequently practice in an underserved area. Primary care residents being trained in this setting would immediately increase the clinical capacity of community health centers and ultimately expand the primary care physician workforce. This proposal addresses the primary care physician workforce crisis and the associated key problems of limited access for the underserved and suboptimal primary care graduate medical education.

A validated search assessment tool: assessing practice-based learning and improvement in a residency program.

OBJECTIVE: The objective of this study was to validate an assessment instrument for MEDLINE search strategies at an academic medical center. METHOD: Two approaches were used to investigate if the search assessment tool could capture performance differences in search strategy construction. First, data from an evaluation of MEDLINE searches from a pediatric resident's longitudinal assessment were investigated. Second, a cross-section of search strategies from residents in one incoming class was compared with strategies of residents graduating a year later. MEDLINE search strategies formulated by faculty who had been identified as having search expertise were used as a gold standard comparison. Participants were presented with a clinical scenario and asked to identify the search question and conduct a MEDLINE search. Two librarians rated the blinded search strategies. RESULTS: Search strategy scores were significantly higher for residents who received training than the comparison group with no training. There was no significant difference in search strategy scores between senior residents who received training and faculty experts. CONCLUSION: The results provide evidence for the validity of the instrument to evaluate MEDLINE search strategies. This assessment tool can measure improvements in information-seeking skills and provide data to fulfill Accreditation Council for Graduate Medical Education competencies.

The Development, Implementation, and Evaluation of an Acute Otitis Media Education Website.

OBJECTIVE: To develop, implement, and evaluate an acute otitis media (AOM) education website for clinician-educators. METHODS: We developed an education website following Kern's curriculum model. RESULTS: The website contained peer-reviewed content, educational objectives, library search pages to identify evidence-based resources, and a faculty toolbox with instructional and evaluation instruments. Pediatric clinician-educators were purposefully sampled from different clinic sites to evaluate the website. Semistructured interviews explored key website components for content and usability in clinical teaching. In grounded theory tradition, investigators used the constant comparative method with qualitative analysis software to identify themes and representative quotations. Eleven faculty members (9 females and 2 males with teaching experience from 6 to 26 years) participated in the study. Identified themes were: 1) value of visual impact for learning specific topics, 2) promotion of efficiency in teaching clinical topics, 3) varying approaches for using website, and 4) faculty's self-report of knowledge and self-efficacy needs. CONCLUSIONS: An education website may enhance the teaching of AOM, accommodate different teaching preferences, promote efficiency in teaching, and advance clinician-educator knowledge and skills. Next steps include evaluation of learners' perspectives, generalizability in varied teaching settings, and assessment of higher learning outcomes including impact on knowledge, skills, and patient outcomes.

National Pediatric Experience With Virtual Interviews: Lessons Learned and Future Recommendations.

The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community's innovations, including the use of virtual cafés to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.

Key Factors in Clinical Competency Committee Members' Decisions Regarding Residents' Readiness to Serve as Supervisors: A National Study.

PURPOSE: Entrustment has become a popular assessment framework in recent years. Most research in this area has focused on how frontline assessors determine when a learner can be entrusted. However, less work has focused on how these entrustment decisions are made. The authors sought to understand the key factors that pediatric residency program clinical competency committee (CCC) members consider when recommending residents to a supervisory role. METHOD: CCC members at 14 pediatric residency programs recommended residents to one of five progressive supervisory roles (from not serving as a supervisory resident to serving as a supervisory resident in all settings). They then responded to a free-text prompt, describing the key factors that led them to that decision. The authors analyzed these responses, by role recommendation, using a thematic analysis. RESULTS: Of the 155 CCC members at the participating programs, 84 completed 769 supervisory role recommendations during the 2015-2016 academic year. Four themes emerged from the thematic analysis: (1) Determining supervisory ability follows from demonstrated trustworthiness; (2) demonstrated performance matters, but so does experience; (3) ability to lead a team is considered; and (4) contextual considerations external to the resident are at play. CONCLUSIONS: CCC members considered resident and environmental factors in their summative entrustment decision making. The interplay between these factors should be considered as CCC processes are optimized and studied further.

The use of evidence-based medicine in pediatrics: past, present and future.

PURPOSE OF REVIEW: Evidence-based medicine is a process that seeks to integrate the best research evidence with clinical expertise and patient values in order to optimize clinical outcomes for our patients. This article will review the benefits of and barriers to the use of evidence-based medicine in pediatrics in the twenty-first century, discuss various implementation strategies and outline the resources that pediatricians could use to increase their knowledge and skills and apply them to their clinical practice. RECENT FINDINGS: Although physicians have generally welcomed evidence-based medicine, the benefits and limitations are often debated, and studies reveal that physicians feel that practicing evidence-based medicine could be difficult in a busy clinical practice because they lack the time, knowledge and resources. There have been many recent developments to help pediatricians overcome these barriers and to use best evidence in their practice. SUMMARY: Pediatricians must be able to use the evidence-based medicine process to identify, access, apply and integrate new knowledge into their practice to provide high-quality care for their patients. The resources discussed in this review will help pediatricians make clinical decisions about patient care that are based on the best, most current, valid, and relevant evidence available.

Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: A Cross-Institutional Study.

OBJECTIVE: To evaluate a pediatric otoscopy curriculum with the use of outcome measures that included assessment of skills with real patients. METHODS: Thirty-three residents in an intervention group from 2 institutions received the curriculum. In the previous year, 21 residents in a nonintervention group did not receive the curriculum. Both groups were evaluated at the beginning and end of their internship years with the use of the same outcome assessments: 1) a written test, 2) an objective standardized clinical examination (OSCE), and 3) direct observation of skills in real patients with the use of a checklist with established validity. RESULTS: The intervention group had a significant increase in percentage reaching minimum passing levels between the beginning and end of the internship year for the written test (12% vs 97%; P < .001), OSCE (0% vs 78%; P < .001), and direct observation (0% vs 75%; P < .001); significant mean percentage gains for the written test (21%; P < .001), OSCE (28%; P < .001), and direct observation (52%; P = .008); and significantly higher (P < .001) mean percentage gains than the nonintervention group on the written test, OSCE, and direct observation. The nonintervention group did not have a significant increase (P = .99) in percentage reaching minimum passing levels, no significant mean percentage gains in the written test (2.7%; P = .30) and direct observation (6.7%; P = .61), and significant regression in OSCE (-5.2%; P = .03). CONCLUSIONS: A pediatric otoscopy curriculum with multimodal outcome assessments was successfully implemented across different specialties at multiple institutions and found to yield gains, including in skills with real patients.

Choosing a career in combined internal medicine-pediatrics: insights from interns.

BACKGROUND: Combined internal medicine-pediatrics (med-peds) programs may be competing for the same students who would have otherwise chosen family medicine. The degree to which this is happening is not known. METHODS: We sent an eight-item questionnaire to new med-peds interns to assess their career plans at different stages of their decision making. Questionnaires were mailed to the directors of all US med-peds programs in 2002. RESULTS: A total of 288/333 (87%) responded. The med-peds interns were more likely to be interested in internal medicine or pediatrics than they were in family medicine. If med-peds were not available, only 52/286 (18%) would have chosen family medicine as an alternative. A total of 55/288 (19%) anticipated practicing in rural areas. CONCLUSIONS: The majority of med-peds interns would have chosen internal medicine or pediatrics if med-peds was not available. A small percentage would have chosen family medicine, thus having a minor impact on recruitment. An even smaller proportion would have chosen a non-primary care specialty. A sizable number anticipate practicing in rural areas.

Patient safety and quality improvement: a 'CLER' time to move beyond peripheral participation.

In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has instituted a new program, the Clinical Learning Environment Review (CLER), that places focus in six important areas of the resident and fellow working and learning environment. Two of these areas are patient safety and quality improvement (QI). In their early CLER reviews of institutions housing ACGME-accredited training programs, ACGME has found that despite significant progress in patient safety and QI to date much work remains, especially when it comes to meaningful engagement of medical trainees in this work. In this article, the authors argue that peripheral involvement of trainees in patient safety and QI work does not allow the experiential learning that is necessary for professional development and the ultimate ability to execute performance that meets the needs of patients in contemporary clinical practice. Rather, as leaders in patient safety and QI have advocated since early in this movement, embedded and immersed experiences are necessary for learning and success.

Standardized Checklist for Otoscopy Performance Evaluation: A Validation Study of a Tool to Assess Pediatric Otoscopy Skills.

INTRODUCTION: Acute otitis media (AOM) is the most frequently diagnosed pediatric illness in the United States and the most common indication for antibiotic prescription. Skill in pediatric otoscopy is essential to correctly identify children with AOM. However, studies have found diagnostic inconsistency and significant overdiagnosis among practitioners. Given the potential public and individual health consequences, there has been a call for improved education regarding the diagnostic certainty of AOM. Yet educational efforts continue to be limited, particularly in regard to competency assessment. The lack of a validated tool to assess otoscopy skill attainment objectively diminishes the instructor's ability to provide useful feedback and direction to the learner. METHODS: We have undertaken an educational intervention with the goal of developing a validated Standardized Checklist for Otoscopy Performance Evaluation (SCOPE), building on key principles of the general pediatric ear exam. The SCOPE was developed with the input of process and content experts with attention to specific domains of validity. RESULTS: Our analysis provides important validity evidence for the SCOPE assessment tool. The instrument was piloted and successfully implemented with medical students and varying levels of residents in pediatrics and emergency medicine over a 5-year period in varied settings: urgent care, large and small pediatric clinics, and the emergency departments at two institutions. It has been used for both instruction and assessment purposes. DISCUSSION: Because the SCOPE can be used in teaching demonstration purposes, in formative and summative assessment settings, and across the continuum of learners, this instrument offers the potential for more educational efforts in the field of assessment in direct patient care. We anticipate that the SCOPE will foster an environment of efficient yet high-yield review and discussion of otoscopy and diagnostic competency.