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1.
Pediatr Rheumatol Online J ; 18(1): 85, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129319

RESUMO

BACKGROUND: The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION: This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.


Assuntos
Infecções por Coronavirus , Pandemias , Pediatria/métodos , Exame Físico/métodos , Pneumonia Viral , Reumatologia/métodos , Telemedicina/métodos , Comunicação por Videoconferência , Betacoronavirus , Assistência à Saúde , Europa (Continente) , Humanos , Seleção de Pacientes , Pediatria/educação , Pediatria/organização & administração , Reumatologia/educação , Reumatologia/organização & administração , Telemedicina/legislação & jurisprudência , Telemedicina/organização & administração , Estados Unidos
2.
PLoS One ; 15(9): e0236484, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877419

RESUMO

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) have been used to assess the clinical competence of medical students for decades. Limited data are available on the factors that predict students' performance on the OSCEs. The aim of our study was to evaluate the factors predicting performance on the pediatrics final OSCE, including the timing of students' clerkship and their performance on the in-training OSCE and written examinations. METHODS: Grades in pediatrics for 3 consecutive academic years (2013-2016) were included. The average scores of the in-training OSCEs, written and final OSCEs and written exams were compared among the three years using the analysis of variance (ANOVA) test. The correlations between performance on the final OSCEs and the in-training OSCEs, in-training written exams and final written exams were studied using Spearman's Rho correlation test. The effect of the timing of the clerkship on the final OSCE performance was evaluated. RESULTS: A total of 286 students' records were included. There were 115 male students and 171 female students (M:F 1:1.5). There were strong positive correlations between students' performance on the in-training examinations (OSCE and written) and the final OSCE (correlation coefficients of 0.508 and 0.473, respectively). The final written exam scores were positively correlated with the final OSCEs (r = 0.448). There was no significant effect of the timing of the clerkship. CONCLUSIONS: Students' performance on in-training examinations might predict their final OSCE scores. Thus, it is important to provide students with the necessary intervention at an early stage to reduce failure rates. The final OSCE performance does not seem to be affected by the timing of the clerkship.


Assuntos
Sucesso Acadêmico , Pediatria/educação , Estágio Clínico , Avaliação Educacional , Feminino , Humanos , Masculino , Estudantes de Medicina
3.
Anesth Analg ; 131(4): 1201-1209, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925341

RESUMO

BACKGROUND: The critical question of racial and gender diversity in pediatric anesthesia training programs has not been previously explored. The primary objective of this study was to evaluate trends by race/ethnicity and gender in pediatric anesthesiology fellowship training programs in the United States for the years 2000 to 2018. METHODS: Demographic data on pediatric anesthesiology fellows and anesthesiology residents were obtained from the self-reported data collected for the Journal of the American Medical Association's annual report on Graduate Medical Education for the years 2000 to 2018. Diversity was assessed by calculating the proportions of trainees per year by gender and racial/ethnic groups in pediatric anesthesiology fellowship and anesthesiology residency programs. Logistic regression equations were developed to estimate the annual growth rate of each racial/ethnic groups. RESULTS: The number of pediatric anesthesiology fellows increased from 57 trainees in 2000-2001 to 202 in 2017-2018 at an average rate of 9 fellows per year (95% confidence interval [CI], 8-10). These increases were primarily due to white trainees (54.4%-63.4%) as the proportions of black (7.0%-4.5%), Asian (26.3%-21.3%), and other minority (12.3%-10.9%) trainees have remained low. The number of anesthesiology residents increased from 3950 trainees in 2000-2001 to 5940 in 2017-2018 at an average rate of 99 residents per year (95% CI, 88-111). Within all anesthesiology trainees, these increases were due to white trainees (55.7%-61.3%) as the proportion of black (5.0%-6.0%), Asian (25.8%-24.1%), and other minority trainees (8.2%-8.5%) has remained fairly constant over the time period. Despite the overall lower proportion of female anesthesiology residents (range: 27.0%-37.5%), a steady increase in the number of women in pediatric anesthesiology fellowship programs has reversed the gender imbalance in this population as of 2010. CONCLUSIONS: While historic gains have been made in gender diversity in pediatric anesthesiology, there is persistent underrepresentation of black and Hispanic trainees in pediatric anesthesiology. It appears that their low numbers in anesthesiology residency programs (the reservoir) may be partly responsible. Efforts to increase ethnic/racial diversity in pediatric anesthesiology fellowship and anesthesiology residency training programs are urgently needed.


Assuntos
Anestesiologia/educação , Grupos Étnicos/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Pediatria/educação , Sexismo/estatística & dados numéricos , Adulto , Afro-Americanos , Americanos Asiáticos , Criança , Estudos de Coortes , Educação de Pós-Graduação em Medicina , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Grupos Minoritários , Apoio ao Desenvolvimento de Recursos Humanos , Estados Unidos , Adulto Jovem
5.
Rev. cuba. pediatr ; 92(3): e1010, jul.-set. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126775

RESUMO

En las últimas décadas se ha prestado mayor atención a los resultados de la actividad quirúrgica debido a factores económicos, la mejora de los cuidados perioperatorios y la preocupación por la calidad de la asistencia y satisfacción de la población. A este propósito han contribuido el desarrollo y aplicación de guías de práctica clínica. Estas guías reducen la variación en los cuidados del paciente quirúrgico, aumentan la eficiencia de dicho cuidado y proporcionan que los pacientes se beneficien de iniciativas institucionales encaminadas a mejorar la calidad de la asistencia sanitaria. La cirugía de alta precoz es un modelo de atención médico-quirúrgica encaminado a disminuir los costos de la atención médica mediante esfuerzos coordinados que permitan la reducción de la estancia hospitalaria en los pacientes, sin que ocurra incremento de complicaciones posoperatorias, ni insatisfacción de pacientes y familiares con el servicio prestado. Su empleo ha ido incrementándose en afecciones pediátricas. En el hospital pediátrico de Cienfuegos se aplica el modelo hace varios años y la guía fue aprobada en el Servicio de Cirugía Pediátrica en diciembre de 2018. Compartir esta guía mediante su publicación permitiría a otros servicios de cirugía pediátrica del país emplearla como referencia para la aplicación del modelo en sus propias instituciones y beneficiar a un mayor número de pacientes(AU)


In the last decades, there has been more attention on the results of the surgical activity due to economic factors, the improvement of perioperative cares and the concern on the quality of the care and the population´s satisfaction. The development and implementation of the clinical pratice´s guides had contributed to that purpose. These guides reduce the variations in the cares to the surgical patients, increase efficiency in that kind of care and foster that the patients are benefited with institutional initiatives addressed to improve health care quality. The Fast Track Pediatric Surgery is a model of medical-surgical care directed to lower the costs of medical care by means of coordinated efforts that allow the reduction of the hospital stay in patients without increasing the rates of postoperative complications, or dissatisfaction of the patients and relatives with the service given. The use of this procedure has been increasing in pediatric conditions. It has been implemented since some years ago in the Pediatric Hospital of Cienfuegos province, and the guide was approved in the Pediatric Surgery service in December, 2018.To share this guide by publishing it will be a way to allow other pediatric surgery services in the country to use it as a reference for the implementation of that model in their institutions and in that way to benefit a higher number of patients(AU)


Assuntos
Humanos , Masculino , Feminino , Pediatria/educação , Procedimentos Cirúrgicos Ambulatórios/métodos , Alta do Paciente/normas
6.
Pediatr Emerg Care ; 36(9): 455-458, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32868551

RESUMO

The global pandemic novel coronavirus 2019 has upended healthcare and medical education, particularly in disease epicenters such as New York City. In this piece, we seek to describe the collective experiences and lessons learned by the New York City pediatric emergency medicine fellowship directors in clinical, educational, investigative, and psychological domains, in hopes of engendering conversation and informing future disaster response efforts.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Educação de Pós-Graduação em Medicina/métodos , Pandemias , Medicina de Emergência Pediátrica/educação , Pediatria/educação , Pneumonia Viral/epidemiologia , Criança , Humanos , Cidade de Nova Iorque/epidemiologia
9.
Eur J Clin Invest ; 50(10): e13367, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735699

RESUMO

Producing excellent physician scientists starts with the active discovery of talent and dedication, supported by the strong belief that physician involvement in biomedical research is essential to make fundamental discoveries that improve human health. The revolution of surgical and interventional therapy of structural heart disease has had 'profoundly positive effects on survival and quality of life over the decades. (…) Small increments in clinical improvement will still be possible in the future, but for the most part, the potential for major advancement using these techniques has been exhausted' (Frank Hanley, MD; Stanford). Personalized medicine, rapid genetic diagnostics, RNA and extracellular vesicle biology, epigenetics, gene editing, gene and stem cell-derived therapy are exemplary areas where specialized training for paediatric/congenital cardiology physician scientists will be increasingly needed to further advance the field. About a decade ago, a series in Circulation discussed academic career models and highlighted the major challenges facing the cardiovascular 'clinician scientist' (syn. physician scientist), which have not abated since. To develop the skills and expertise in both clinical congenital cardiology and basic research, the training of fellows must be focused and integrated. The current pandemic COVID-19 puts additional pressure and hurdles on fellows-in-training (FIT) and early career investigators (ECI) who aim to establish, consolidate or expand their own research group. Here, we discuss the major challenges, opportunities and necessary changes for academic institutions to sustain and recruit physician scientists in paediatric/congenital cardiology in the years to come.


Assuntos
Pesquisa Biomédica , Cardiologistas/provisão & distribução , Escolha da Profissão , Cardiopatias Congênitas/terapia , Pediatras/provisão & distribução , Seleção de Pessoal , Pesquisadores/provisão & distribução , Centros Médicos Acadêmicos , Betacoronavirus , Cardiologistas/educação , Cardiologia/educação , Infecções por Coronavirus , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Humanos , Pandemias , Pediatras/educação , Pediatria/educação , Pneumonia Viral , Pesquisadores/educação
10.
J Pediatr Health Care ; 34(6): 619-629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32859434

RESUMO

Since the rapid emergence of the novel coronavirus in December of 2019 and subsequent development of a global pandemic, clinicians around the world have struggled to understand and respond effectively in health care systems already strained before this latest viral outbreak. Leaders are making policy decisions while balancing the slow and precise nature of science with the rapid need for life-saving information.Pediatric nurse practitioners are ideally situated as a trusted source of health information for children. This continuing education article summarizes the latest evidence on the rapidly developing coronavirus pandemic.


Assuntos
Infecções por Coronavirus , Pandemias , Pediatria/educação , Pediatria/métodos , Pneumonia Viral , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Infecção Hospitalar/prevenção & controle , Assistência à Saúde/organização & administração , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia
11.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32727825

RESUMO

OBJECTIVES: The American Board of Pediatrics (ABP) and the Pediatric Hospital Medicine (PHM) subboard developed a content outline to serve as a blueprint for the inaugural certification examination through practice analysis. The systematic approach of practice analyses process is described in the study. METHODS: A diverse, representative panel of 12 pediatric hospitalists developed the draft content outline using multiple resources (publications, textbooks, PHM Core Competencies, PHM fellow's curriculum, etc). The panel categorized practice knowledge into 13 domains and 202 subdomains. By using the ABP database self-defined practicing pediatric hospitalists were identified. Participants rated the frequency and criticality of content domains and subdomains along with providing open-ended comments. RESULTS: In total, 1449 (12.1%) generalists in the ABP database self-identified as pediatric hospitalists, and 800 full-time pediatric hospitalists responded. The content domains that were rated as highly critical and frequently required in practice were weighted more heavily (ie, the percentage of examination questions associated with a domain) than the less critical and less frequently rated. Both community and noncommunity pediatric hospitalists rated domains similarly (P = .943). Subdomain and preliminary weights were rated with similar means and SDs in the majority of topics. CONCLUSIONS: There was concordance in the rating of domain and universal tasks among both community and noncommunity hospitalists. The areas of significant differences, although minor, could be explained by difference in practice settings. The practice analysis approach was structured, engaged the PHM community, reflected the breadth and depth of knowledge required for PHM practice, and used an iterative process to refine the final product.


Assuntos
Certificação , Currículo , Medicina Hospitalar/educação , Médicos Hospitalares/educação , Hospitais Pediátricos , Pediatria/educação , Competência Clínica , Currículo/normas , Avaliação Educacional/normas , Hospitais Comunitários , Humanos
14.
Pediatr Cardiol ; 41(6): 1081-1091, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32656626

RESUMO

Due to the COVID-19 pandemic, there has been an increased interest in telehealth as a means of providing care for children by a pediatric cardiologist. In this article, we provide an overview of telehealth utilization as an extension of current pediatric cardiology practices and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. Our panel will review helpful tips into the selection of appropriate patient populations and specific cardiac diagnoses for telehealth that put patient and family safety concerns first. Numerous practical considerations in conducting a telehealth visit must be taken into account to ensure optimal use of this technology. The use of adapted staffing and billing models and expanded means of remote monitoring will aid in the incorporation of telehealth into more widespread pediatric cardiology practice. Future directions to sustain this platform include the refinement of telehealth care strategies, defining best practices, including telehealth in the fellowship curriculum and continuing advocacy for technology.


Assuntos
Cardiologia , Infecções por Coronavirus , Cardiopatias/terapia , Monitorização Fisiológica , Pandemias , Pediatria , Pneumonia Viral , Consulta Remota , Telemedicina , Betacoronavirus , Cardiologia/educação , Cardiologia/tendências , Criança , Currículo , Previsões , Cardiopatias/diagnóstico , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/tendências , Pediatria/educação , Pediatria/tendências , Consulta Remota/métodos , Consulta Remota/tendências , Telemedicina/métodos , Telemedicina/tendências
18.
Acad Pediatr ; 20(6): 735-741, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32512054

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic challenged program leaders to respond rapidly to changes in health care delivery, protect trainee safety, and transform educational activities. The pandemic demanded that program directors prioritize and address myriad threats to trainees' well-being. In this paper, we adapt Maslow's needs framework to systematically address trainee well-being during the COVID-19 pandemic and identify potential interventions to meet trainee needs at the program, institution, and extrainstitutional levels. Transforming education to effectively respond to trainee well-being needs requires leadership, and we use Kotter's 8-step change management model as an example of a framework to effectively lead change. Program leaders can take this opportunity to reflect upon their training programs and take the opportunity to improve them. Some of the systems of education we develop during the COVID-19 pandemic, such as telehealth, tele-education, and ways to stay connected may provide advantages and will be important to continue and expand upon post-COVID-19.


Assuntos
Gestão de Mudança , Infecções por Coronavirus , Educação de Pós-Graduação em Medicina/métodos , Nível de Saúde , Saúde Mental , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pediatria/educação , Pneumonia Viral , Segurança , Betacoronavirus , Educação de Pós-Graduação em Medicina/organização & administração , Empoderamento , Alimentos , Humanos , Internato e Residência , Política Organizacional , Equipamento de Proteção Individual , Autoimagem , Sono , Apoio Social
19.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32487591

RESUMO

OBJECTIVES: A large portion of residency education occurs in inpatient teaching services without widely accepted consensus regarding the essential components that constitute a teaching service. We sought to generate consensus around this topic, with the goal of developing criteria programs that can be used when creating, redesigning, or evaluating teaching services. METHODS: A list of potential components of teaching services was developed from a literature search, interviews, and focus groups. Eighteen pediatric medical education experts participated in a modified Delphi method, responding to a series of surveys rating the importance of the proposed components. Each iterative survey was amended on the basis of the results of the previous survey. A final survey evaluating the (1) effort and (2) impact of implementing components that had reached consensus as recommended was distributed. RESULTS: Each survey had 100% panelist response. Five survey rounds were conducted. Fourteen attending physician characteristics and 7 system characteristics reached consensus as essential components of a teaching service. An additional 25 items reached consensus as recommended. When evaluating the effort and impact of these items, the implementation of attending characteristics was perceived as requiring less effort than system characteristics but as having similar impact. CONCLUSIONS: Consensus on the essential and recommended components of a resident teaching service was achieved by using the modified Delphi method. Although the items that reached consensus as essential are similar to those proposed by the Accreditation Council for Graduate Medical Education, those that reached consensus as recommended are less commonly discussed and should be strongly considered by institutions.


Assuntos
Assistência à Saúde , Internato e Residência/métodos , Internato e Residência/organização & administração , Pediatria/educação , Técnica Delfos
20.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32561612

RESUMO

BACKGROUND AND OBJECTIVES: There is an urgent need to prepare pediatricians to care for children with behavioral and mental health (B/MH) conditions. In this study, we evaluate the perceived competence of pediatric residents and recent graduates in the assessment and treatment of B/MH conditions, characterize variation in competence across residency programs, and identify program characteristics associated with high competence. METHODS: Cross-sectional survey of applicants for the initial certifying examination in pediatrics. Questions were focused on (1) who should be competent in B/MH skills, (2) institutional support around B/MH training, and (3) perceived competence in 7 B/MH assessment skills and 9 treatment skills. Competence was rated on a 5-point scale, and high levels of assessment and treatment competence were defined as scores of ≥4. Composite measures for B/MH assessment and treatment were calculated as mean scores for each domain. We examined variation in residents' self-reported competence across programs and used linear regression to identify factors associated with high levels of competence at the program level. RESULTS: Of applicants, 62.3% responded to the survey (n = 2086). Of these, 32.8% (n = 595) reported high competence in assessment skills and 18.9% (n = 337) in treatment skills. There were large variations in reported competence across programs. Respondents from smaller programs (<30 trainees) reported higher competence in assessment and treatment than those from large programs (P < .001). CONCLUSIONS: Current and recent pediatric trainees do not report high levels of perceived competence in the assessment and treatment of children with B/MH conditions. The substantial variation across programs indicates that the pediatric community should create standards for B/MH training.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Internato e Residência , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Pediatria/educação , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Autorrelato
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