How to Teach Cross-Cultural Communication: A Workshop Using the Experiential Learning Model.

Introduction: The United States population is diversifying, leading to higher rates of cultural, ethnic, and racial discordance between medical teams and patients. Studies show that pediatric residents lack training in cross-cultural communication (CCC). Methods: We based learning objectives on the AAMC's Tool for Assessing Cultural Competency Training. The workshop design was based on Kolb's experiential learning model. In 2020-2021, we delivered this 2-hour workshop to trainees at two large, urban sites. We administered two surveys to evaluate our workshop: a retrospective pre-post survey following the workshop and a 3-month follow-up survey. Using 5-point Likert scales, participants rated their awareness of the effect of their own cultural identity on CCC and familiarity with and confidence using CCC models. We analyzed responses using Wilcoxon signed rank tests. Results: Sixty-two trainees participated in the workshop; 44 completed the retrospective pre-post survey (71%). After the workshop, 36% were extremely aware of the effect of their own cultural identity on CCC compared to 4% before the workshop (p < .001). Confidence managing cross-cultural misunderstandings when conveying a diagnosis and explaining disease management increased after the workshop (70% vs. 25%, p < .001; 70% vs. 20%, p < .001, respectively). Twelve participants completed a 3-month follow-up survey (27%). Discussion: A workshop using the experiential learning model to teach CCC increased participants' awareness of how their cultural identity impacted CCC and familiarity with and confidence in using two CCC models. This workshop offers pediatric program directors a tool to enhance their CCC curricula and meet ACGME requirements.

Where Do We Go from here? Post-pandemic Planning and the Future of Graduate Medical Education.

Background: As the pandemic wanes, there is an opportunity to reevaluate resultant changes in graduate medical education (GME), particularly from the viewpoints of those affected most. We aimed to assess both trainee and faculty perceptions on the educational changes and innovations resulting from the pandemic to inform future educational planning. Methods: We surveyed trainees and core education faculty at three New York City children's hospitals. Surveys assessed perceived changes to educational activities, skills, scholarship, effectiveness of virtual teaching, future desirability, and qualitative themes. Results: The survey was completed by 194 participants, including 88 (45.4%) faculty and 106 (54.6%) trainees. Trainees were more likely to report a negative impact of the pandemic compared with faculty (75.5% vs. 50%, p < 0.01). Most respondents reported a decrease in formal educational activities (69.8%), inpatient (77.7%) and outpatient (77.8%) clinical teaching. Despite this, most perceived clinical and teaching skills to have stayed the same. Most (93.4%) participated in virtual education; however, only 36.5% of faculty taught virtually. Only 4.2% of faculty had extensive training in virtual teaching and 28.9% felt very comfortable teaching virtually. In the future, most (87.5%) prefer a hybrid approach, particularly virtual didactic conferences and virtual grand rounds. Faculty themes included challenges to workflows and increased empathy for trainees, while trainee themes included increased work/life balance and support, but increased burnout. Conclusion: Many changes and innovations resulted from the pandemic. Hospital systems and GME programs should consider this data and incorporate viewpoints from trainees and faculty when adapting educational strategies in the future. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01737-8.

A step-by-step guide for mentors to facilitate team building and communication in virtual teams.

As collaborative work in medical education has increasingly moved online, team mentors have had to adapt their practices into the virtual environment. Fostering connection, communication and productivity on virtual teams requires specific skills and deliberate practice that differ from in-person teamwork. Drawing from best practices in business, education and medicine and also from our own experience as a virtual team, we present a guide for mentors to create and sustain successful virtual teams. Grounded in Tuckman's Five Stage Model of Team Development, we offer specific strategies for virtual team mentors to promote team cohesion, mitigate conflict, maintain productivity and leverage the benefits of the virtual environment.

Evaluating the Keystones of Development - An Online Curriculum for Residents to Promote Positive Parenting in Primary Care.

OBJECTIVE: This pilot outcome evaluation assesses the effectiveness of an online curriculum, the Keystones of Development, aimed at improving residents' knowledge, attitudes, and reported behaviors around promoting positive parenting and childhood development in well-child visits. METHODS: We used an explanatory mixed-methods approach, including a single-arm pre-posttest of intervention effects on self-reported behavioral outcomes (discussing, modeling, and praising) and secondary outcomes (knowledge, perceived barriers, attitudes, and self-efficacy). Following this, a subset of residents participated in in-depth interviews to describe participant responses to the intervention. RESULTS: The study was conducted at 8 pediatric residency programs across the United States with 67 pediatric residents (mean age = 29; 79% female; 57% PGY1). Within one month postintervention, there was a statistically significant increase in the behaviors that promote positive parenting: discussing (P < .01;d = 0.73) and modeling (P < .01;d = 0.61) but not praising (P = .05; d = 0.3). Significant changes in the secondary outcomes: knowledge (P < .01), perceived barriers, (P < .01), and retrospective self-efficacy (P < .01) were seen. Interviews revealed that integration of curriculum content into clinical practice was due to the relevance of the material to primary care and the modeling of how to apply in the clinical setting. Curriculum format, content, and clinical application helped participants weave recommendations into the well-child visit. CONCLUSIONS: In this study, we demonstrated that the online curriculum, Keystones of Development, increased resident behaviors, knowledge, and self-efficacy, and decreased perceived barriers to promote parenting behaviors associated with improved child development outcomes in well-child visits. These findings were observed across participants demonstrating equal success regardless of demographic characteristics or study site.

Integrating Graduates of a National Faculty Development Program Into a Community of Practice.

PURPOSE: The Educational Scholars Program (ESP) started as a national 3-year faculty development (FD) program for pediatric educators. Fourteen years later, the ESP has grown into a larger community of practice (CoP). The purpose of this study was to identify programmatic processes that serve as bridges or barriers to integrating ESP graduates into the CoP. METHODS: A cross-sectional survey was sent to 126 ESP graduates. Based on their self-reported level of engagement, graduates were categorized into 4 groups: Core, Active, Peripheral, and Outsider groups. Factors contributing to engagement with the ESP community, and the impact of varying levels of engagement on outcomes related to the organization and the graduate were ascertained. RESULTS: Half of the ESP graduates completed the survey. Thirty-five percent of the respondents were in the Core or Active groups. Almost all ESP graduates in the Core and Active groups felt a sense of belonging to the ESP community. Opportunities provided to network, collaborate, and receive mentorship were reported as highly significant influences on their decision to remain engaged. CONCLUSION: Purposeful integration of graduates of an FD program within a CoP, by allowing varying levels of involvement, enhances engagement within the CoP.

Disparities in Marijuana and Tobacco Smoke Incursions Among New York City Families During Early Months of the COVID-19 Pandemic.

OBJECTIVES: Once the COVID-19 pandemic arrived in New York City (NYC), stay-at-home orders led to more time spent indoors, potentially increasing exposure to secondhand marijuana and tobacco smoke via incursions from common areas or neighbors. The objective of this study was to characterize housing-based disparities in marijuana and tobacco incursions in NYC housing during the pandemic. DESIGN: We surveyed a random sample of families from May to July 2020 and collected sociodemographic data, housing characteristics, and the presence, frequency, and pandemic-related change in incursions. SETTING: Five pediatric practices affiliated with a large NYC health care system. PARTICIPANTS: In total, 230 caregivers of children attending the practices. MAIN OUTCOME MEASURES: Prevalence and change in tobacco and marijuana smoke incursions. RESULTS: Tobacco and marijuana smoke incursions were reported by 22.9% and 30.7%, respectively. Twenty-two percent of families received financial housing support (public housing, Section-8). Compared with families in private housing, families with financial housing support had 3.8 times the odds of tobacco incursions (95% CI, 1.4-10.1) and 3.7 times the odds of worsening incursions during pandemic (95% CI, 1.1-12.5). Families with financially supported housing had 6.9 times the odds of marijuana incursions (95% CI, 2.4-19.5) and 5 times the odds of worsening incursions during pandemic (95% CI, 1.9-12.8). Children in financially supported housing spent more time inside the home during pandemic (median 24 hours vs 21.6 hours, P = .02) and were more likely to have asthma (37% vs 12.9%, P = .001) than children in private housing. CONCLUSIONS: Incursions were higher among families with financially supported housing. Better enforcement of existing regulations (eg, Smoke-Free Public Housing Rule) and implementation of additional policies to limit secondhand tobacco and marijuana exposure in children are needed. Such actions should prioritize equitable access to cessation and mental health services and consider structural systems leading to poverty and health disparities.

Screening and managing obesity: understanding paediatric residents' knowledge, attitudes and practice.

STUDY PURPOSE: Prior studies have identified paediatric attending physicians' screening and management patterns related to overweight/obesity, but less is known about resident physicians' behaviour. The objective was to understand paediatric resident physicians' knowledge, attitude and practice patterns of overweight/obesity screening and management. STUDY DESIGN: We performed a retrospective chart review of preventive visits conducted by residents between August and October 2019. Charts of patients 2-18 years with body mass index ≥85th percentile at the visit were reviewed (85th-<95th for age and sex defined as overweight, ≥95th defined as obese). A survey was distributed to residents assessing knowledge, attitudes and barriers towards obesity management. RESULTS: Of 1250 visits reviewed, 405 (32%) patients met the criteria for overweight or obesity. 39% were identified correctly by the provider, 53% were not identified and 8% were identified incorrectly. 89% of patients had diet history, 31% had physical activity and 43% had family history documented. Patients with obesity received physical activity documentation/counselling, portion size counselling, at least one referral, laboratory tests and a diagnosis more often than overweight patients. 84% of residents completed the survey. Although the majority of residents felt 'somewhat' or 'very' well prepared to counsel families about overweight/obesity, the majority thought their counselling on overweight/obesity was 'not at all' or 'slightly' effective. CONCLUSION: Despite residents feeling prepared and comfortable discussing overweight/obesity with patients, these diagnoses were often under-recognised or incorrectly made and appropriate counselling was lacking. Future work will focus on specific strategies to improve diagnosis, screening and management of overweight/obesity and include educational interventions and electronic medical record adaptations.

Integrating a Social Determinants of Health Screener at an Outpatient Pediatric Clinic in East Harlem, New York City.

In this Report from the Field, we reflect on the first six months of the 2018 implementation of a screener aimed at identifying and addressing social determinants of health (SDH) at Pediatric Associates, an outpatient clinic in East Harlem, New York City. We share descriptive statistics and reflect on lessons learned.

Poverty Related Education in Pediatrics: Current State, Gaps and Call to Action.

Children are the poorest age group in our country, with 1 in 6, or 12 million, living in poverty. This sobering statistic became even more appalling in spring 2020 when COVID-19 magnified existing inequities. These inequities are particularly important to pediatricians, because poverty, along with racism and other interrelated social factors, significantly impact overall child health and well-being. It is imperative that pediatric educators redouble their efforts to train learners to recognize and address health inequities related to poverty and all of its counterparts. In this paper, we describe the current state of poverty-related training in pediatric undergraduate, graduate, and continuing medical education as well as opportunities for growth. We highlight gaps in the current curricula, particularly around the intersectionality between poverty and racism, as well as the need for robust evaluation. Using a logic model framework, we outline content, learning strategies, and outcomes for poverty-related education. We include opportunities for the deployment of best practice learning strategies and the incorporation of newer technologies to deliver the content. We assert that collaboration with community partners is critical to shape the depth and breadth of education. Finally, we emphasize the paramount need for high-quality faculty development and accessible career paths to create the cadre of role models and mentors necessary to lead this work. We conclude with a call for collaboration between institutions, accrediting bodies, and policymakers to promote meaningful, outcome-oriented, poverty-related education, and training throughout the medical education continuum.

Assessment of Pediatric Resident Knowledge and Comfort in Addressing Childhood Obesity in Clinical Practice.

Background: Recent data estimate the prevalence of pediatric obesity at 19.3%. Emphasis on primary prevention and early identification is needed to avoid development of serious medical and psychosocial sequelae. The objective of this initiative is to assess baseline knowledge and comfort among trainees at an inner-city pediatric residency program in identifying children with overweight/obesity, evaluating associated risk factors and comorbidities, and providing effective counseling. Methods: Key topics from 2 major guidelines on pediatric obesity assessment, prevention, and treatment were incorporated into the development of a resident questionnaire, which consisted of 12 knowledge-based questions and a Likert scale evaluating self-perceived knowledge and comfort on 7 skills. Results: Forty-six percent of eligible residents completed the questionnaire (n = 28). The mean score on the objective knowledge-based section was 44% ± 13%, with no differences by training year. The percentage of residents with correct responses by topic ranged from 14% to 79%. The mean self-perceived knowledge rating was 3.56 ± 0.86. The mean self-perceived comfort rating was 3.53 ± 0.89. Neither the self-perceived knowledge nor comfort rating was a significant predictor of performance on the objective knowledge-based section when controlling for postgraduate year status. Conclusions: Significant gaps in knowledge were discovered among pediatric residents with regard to appropriate screening, assessment, and counseling practices related to pediatric overweight/obesity. These deficits were not consistently reflected in residents' self-perceived knowledge and comfort ratings. The results of this initiative highlight the need for incorporation of standardized curricula on childhood overweight/obesity into pediatric resident education.

CORNET Card Study #1: Do You See What I See? Provider Confidence in Caring for Children With Special Health Care Needs.

OBJECTIVE: Understanding differences between trainee and faculty experience with and confidence caring for children with special health care needs (CSHCN) can inform pediatric resident education. METHODS: Residents and faculty across the continuity research network (CORNET) reported on a consecutive series of 5 primary care encounters. Respondents answered questions about visit characteristics, patient demographics, and applied the CSHCN Screener. Respondents also reported on how confident they felt addressing the patient's health care needs over time. We dichotomized confidence at "very confident" versus all other values. We used logistic regression to describe the correlates of provider confidence managing the patient's care. RESULTS: We collected data on 381 (74%) resident-patient and 137 (26%) attending-patient encounters. A higher proportion of attending encounters compared to resident encounters were with CSHCN (49% vs 39%, P < .05), including children with complex needs (17% vs 10%, P < .05). The odds of feeling "very confident" (AOR [95% CI]) was lower with increasing CSHCN score (0.61[0.51-0.72]) and was lower for resident versus attending encounters (0.39 [0.16-0.95]). Confidence was higher if the provider had previously seen that patient (2.07 [1.15-3.72]), and for well (2.50 [1.35-4.64]) or sick visits (3.18 [1.46-6.94]) (vs follow-up). Differences between residents and attending pediatricians regarding the relationship between confidence and visit characteristics for subsets of CSHCN are reported. CONCLUSION: All providers felt less confident caring for CSHCN; however, for certain needs, resident confidence did not increase with level of training. The data suggest potential educational/programmatic opportunities.

Key Studies in Medical Education from 2017: ANarrative Review.

Education, like clinical medicine, should be based on the most current evidence in the field. Despite the overwhelming breadth of literature in medical education, pediatric educators desire and need to incorporate best practices into their educational approaches. This article provides an overview of 18 articles from the literature in 2017 that the authors consider to be key articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership experience and expertise across the continuum of pediatric medical education, used an iterative, staged process to review more than 1682 abstracts published in 2017. This process aimed to identify a subset of articles that were most relevant to educational practice and most applicable to pediatric medical education. In the process, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the abstracts that best met these criteria. Selected abstracts were discussed using different pairs to select the final articles included in this review. This paper presents summaries of the 18 articles that were selected. The results revealed a cluster of studies related to feedback, coaching, and observation; trainee progression, educator development, trainee entrustment, culture, and climate; and the medical student experience. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field of medical education.

Top Medical Education Studies of 2016: A Narrative Review.

Education, like clinical medicine, should be based on the most current evidence in the field. Unfortunately, medical educators can be overwhelmed by the sheer volume and range of resources for this literature. This article provides an overview of 15 articles from 2016 that the authors consider the top articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership and expertise across the continuum of pediatric medical education, used an iterative 3-stage process to review more than 6339 abstracts published in 2016. This process was designed to identify a small subset of articles that were most relevant to educational practices and most applicable to pediatric medical education. In the first 2 stages, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the articles that best met these criteria. In the final stage, all articles were discussed using a group consensus model to select the final articles included in this review. This article presents summaries of the 15 articles that were selected. The results revealed a cluster of studies related to observed standardized clinical encounters, self-assessment, professionalism, clinical teaching, competencies/milestones, and graduate medical education management strategies. We provide suggestions on how medical educators can apply the findings to their own practice and educational settings. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field.

Parental Knowledge of AAP Juice Guidelines Is Associated With Parent and Children's Consumption of Juice and Sugar-Sweetened Beverages in an Underserved Population.

This study tested whether parental knowledge of the American Academy of Pediatrics' (AAP) recommendations on juice limits for children is associated with decreased consumption of juice and sugar-sweetened beverages (SSBs) among parents and children. Fifty-two parents with children 2 to 12 years old in a resident continuity clinic in East Harlem, New York, completed a survey asking about children's and parent's practice and quantitative consumption of juice and SSBs as well as parental knowledge of the AAP recommendations on juice limits. Parent's total daily consumption of juice and SSBs ( P < .01), parent's score on the test of AAP guidelines ( P = .04), and parent's post-high school education ( P = .01) were associated with children's juice and SSB consumption in a multivariable linear regression model. Children's consumption of juice and SSBs is positively associated with parental consumption of juice and SSBs and negatively associated with parental formal education and knowledge of the AAP recommendations on juice limits.

Postpartum Depression in a General Pediatric Practice: Practical Methods for Improving Screening and Referrals.

Postpartum depression (PPD) is a common problem in new mothers. Untreated PPD is associated with behavioral and developmental problems in children. We examined the effects of an educational session about PPD and modification of the electronic medical record (EMR) on providers' screening for PPD. An education session was given to the physicians and pre and post surveys compared comfort and self-reported screening. Following the EMR change, a retrospective chart review was conducted from three time periods: group 1-before the conference, group 2-after the conference but before EMR change, and group 3-after screening in the EMR. Documented screening increased from 0% in group 1, to 2% in group 2, to 74% in group 3 (P < .001). Ten percent screened positive, but only 14% had documented referrals to a provider for treatment. The combination of provider education and screening questions integrated into the EMR enhanced PPD screening rates among physicians in a busy practice.