Discrepancies in After-Hours Communication Attitudes between Pediatric Residents and Supervising Physicians.

OBJECTIVE: To examine differences in expectations when a resident should contact a supervising physician in several hospital-based, after-hours clinical circumstances. STUDY DESIGN: We developed 34 scenarios collectively considered the most common or serious issues encountered by on-call residents, and incorporated them into a survey of pediatric residents, fellows, and attendings. For each scenario, participants were asked whether the resident should talk to the attending/fellow immediately or delay communication until the next day. ORs comparing attendings/fellows and residents were calculated, and subgroup analyses were performed examining differences among the study populations. RESULTS: A total of 112 participants completed the survey (91% response rate). In 17 of the 34 scenarios (50%), more attendings/fellows than residents asked for immediate communication (OR >1; P < .05). Most discrepant scenarios were in uncertain areas in which residents may feel comfortable managing the issue without supervisory input or, alternatively, fail to recognize an evolving matter or a deteriorating clinical status. In subgroup analyses, residents were homogeneous in their responses; however, responses of fellows and junior faculty differed from those of senior faculty in 7 of the 34 scenarios, with senior attendings more likely desiring immediate communication. CONCLUSION: We found differences in expectations of when a pediatric resident should contact a supervising physician after hours not only between residents and attendings/fellows, but among attendings themselves. These differences could lead to medical errors, miscommunication, and inconsistent supervision for overnight residents.

Simulation for Milestone Assessment: Use of a Longitudinal Curriculum for Pediatric Residents.

INTRODUCTION: Determining clinical competency on the milestones requires direct observation of residents, which is difficult for faculty members who are also providing patient care. Simulation can potentially represent an effective standardized tool for high-stakes assessment. Using a longitudinal simulation curriculum with formative and summative components, we conducted a pilot investigation to examine whether (1) performance on the formative cases predicted performance on the summative cases and (2) performance on the summative cases correlated with the clinical competency committee's (CCC) milestone placement. METHODS: We developed 6 formative and 6 matched summative cases for pediatric interns that covered core pediatric topics. The interns progressed through the formative cases in pairs during the course of the academic year and then through the summative cases back to back individually at the end of the year. The interns were evaluated using a competency-based simulation evaluation. We determined the relationship between the formative and summative scores and between the summative scores and those from the CCC. RESULTS: The relationship between formative and summative scores was not statistically significant. There was a statistically significant relationship between summative and CCC scores. CONCLUSIONS: Significant methodological limitations preclude definite conclusions about the predictive power of simulation cases for Pediatric Milestones-based assessment. However, our work is an example of how simulation is a potentially useful tool for assessing residents' skill development on the Pediatric Milestones. More rigorous research is needed to determine the extent to which simulation can be used for high-stakes, milestones-based assessment.

Anticonvulsant hypersensitivity syndrome treated with intravenous immunoglobulin.

Anticonvulsant hypersensitivity syndrome is a severe, potentially life-threatening, reaction to the aromatic anticonvulsant medications. Reported here is a case of anticonvulsant hypersensitivity syndrome secondary to phenobarbital in a 2-year-old boy; he responded to drug withdrawal, corticosteroids, and intravenous immunoglobulin. The literature regarding treatment of this syndrome is reviewed.