Use of a Rubric for Pediatric Emergency Medicine Fellowship Application Review.

BACKGROUND: There is a need to review a large number of applications for pediatric emergency medicine fellowship in a holistic and systemic, unbiased manner. There exists a need to restructure the application process. We sought to develop and implement a rubric screening rubric for initial evaluation of pediatric emergency medicine fellowship applications that avoided traditionally used metrics that may be biased against racially underrepresented groups who are historically excluded from medicine. METHODS: An interactive process was used by key program leadership with review of prior literature and input from Diversity, Equity, and Inclusivity departmental chair to develop a holistic screening rubric with consensus reached around key factors that aligned with our fellowship program mission. All applications were reviewed with the rubric by the program director or the associate program director. A subset of applications being considered for review were additionally scored by members of the fellowship selection committee. RESULTS: Numerical scores ranged from 2 to 14, with the maximum potential score being 14. Seventy percent of those applicants invited for interview scored 9 or higher. Reliability of scores between the program director and the associate program director was high (intraclass coefficient, 0.89); however, reliability between the program director or associate program director and the selection committee members was low to moderate (intraclass coefficient, 0.46). CONCLUSIONS: Developmental and use of a rubric screening allowed our institution to reflect on our priorities, as well as avoid potential bias. The use of the tool allowed us to communicate about applications in an objective and consistent manner. As we continue to iterate on the rubric, we hope to incorporate additional criteria to better identify highly qualified applicants who may otherwise be overlooked in a traditional screening process and gain familiarity in reviewers use.

Updates in pediatric ultrasound.

PURPOSE OF REVIEW: Point-of-care ultrasound (POCUS) has various diagnostic and therapeutic applications in the pediatric acute care setting that have an impact on clinical outcomes. RECENT FINDINGS: POCUS can improve diagnostic efficiency and expedite management in pediatric patients who present to the emergency department with common complaints such as respiratory distress, abdominal pain, shock, and pain. SUMMARY: Rapid advancements in POCUS have allowed it to become a powerful tool in pediatric care. As the clinical applications of ultrasound diversify, research is needed to evaluate impacts on healthcare outcomes, delivery, and costs.

A Qualitative Study Assessing Haitian Pediatric Nursing Educational Needs in Port-au-Prince, Haiti.

After Port-au-Prince's 2010 earthquake, Hospital Bernard Mevs (HBM) developed a collaboration with international medical volunteers to provide clinical care and medical resources; that evolved to include medical education as local Haitian staffing developed. There has been limited coordination among volunteers and local providers about ways in which volunteers can best serve the hospital, and literature that addresses how to coordinate volunteer efforts to support the educational needs of the local nursing staff is scant. Our objectives were to complete an educational needs assessment of the most common diagnoses encountered, requested topics for education, and preferred learning modalities as reported by Haitian pediatric nurses, and categorize the strengths of HBM and barriers to care to understand more fully the context within which nurses function, and how education and international volunteers may be related. In October 2019, 10 HBM pediatric nurses participated in small-group interviews. Questions were based on an interview guide and responses were coded and analyzed for recurring themes. The most common diagnoses were sepsis, hydrocephalus, and hypoxic ischemic encephalopathy. Topics for review included chest tubes, ventilator management, and ventriculoperitoneal shunts. Preferred learning modalities were didactics and hands-on workshops. Strengths of the hospital were team dynamics and education provided by HBM and international volunteers, whereas the most common barrier to care was lack of clinical supplies. This information is useful to guide future educational interventions, and this model may inform other programs with a volunteer presence in resource-limited settings to promote collaboration and self-directed learning.

Colonic atresia and anorectal malformation in a Haitian patient: a case study of rare diseases.

INTRODUCTION: Colonic atresia and anorectal malformation are rare congenital anomalies individually. Few reports of the conditions combined in a single patient have been published in the literature. Neither colonic atresia, anorectal malformation or a combination of the disorders has previously been reported in the Haitian population. CASE PRESENTATION: A 5-day-old female presented with feculent emesis, failure to pass stool since birth and an imperforate and stenotic anus. Exploratory laparotomy revealed colorectal atresia distal to a malformed cecum and a Wingspread low subtype anorectal malformation without any associated urogenital fistulae. Temporizing percutaneous ileal drainage was followed by second-stage anal perforation and dilation, ileal J-pouch and pull through. DISCUSSION: This is the first reported case of colonic atresia, anorectal malformation or the combination of the disorders among the Haitian population and one of only a handful of such cases reported worldwide. Although vascular accidents in utero have been implicated as the etiology of colonic atresia, simultaneous presence of anorectal malformation suggests a multifactorial cause. Investigation for multisystem abnormalities is warranted. Two-staged operative correction is considered the best treatment; however, long-term postoperative outcomes are uncertain. CONCLUSION: The coexistence of colonic atresia and anorectal malformation is a very rare occurrence and presents unique clinical and operative challenges. Investigation for additional congenital abnormalities is appropriate, and although two-stage operative correction is considered the best treatment, long-term outcomes are uncertain.

Nuking the radiation: minimizing radiation exposure in the evaluation of pediatric blunt trauma.

PURPOSE OF REVIEW: Our objective is to highlight recent literature investigating low-radiation diagnostic strategies in the evaluation of pediatric trauma. RECENT FINDINGS: In the area of minor head injury, research has focused on implementation of validated clinical decision rules into practice to reduce unnecessary computed tomography scans. Clinical observation may also serve as an adjunct to initial assessment and a potential substitute for computed tomography imaging. Subgroups of children with special needs or severe injury mechanisms may also be safely characterized by the clinical decision rule and spared radiation exposure. Physical examination techniques may be useful in diagnosing mandibular fractures. In addition, evidence suggests that plain radiography for evaluation of blunt thoracic trauma may be sufficient in many cases, and computed tomography could be reserved for those with abnormal radiographs, high-risk mechanisms, or abnormal physical findings. Clinical decision rules are able to predict intra-abdominal injury with high sensitivity. Data suggest that skeletal surveys may be modified to limit radiation exposure in the case of suspected nonaccidental trauma. SUMMARY: More research is needed in development of pediatric-specific clinical decision rules and risk stratification and in testing low-radiation diagnostic modalities in the pediatric trauma population.