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Deveau-Rosen SH, McKnight NG. Safely Doing Less in Pediatrics and Pediatric Hospital Medicine. Pediatr Ann 2024; 53:e200-e201. [PMID: 38852081 DOI: 10.3928/19382359-20240407-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
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Chandrasekar H, White YN, Ribeiro C, Landrigan CP, Marcus CH. A Changing Landscape: Exploring Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships. Hosp Pediatr 2021; 11:109-115. [PMID: 33397817 DOI: 10.1542/hpeds.2020-0034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pediatric Hospital Medicine (PHM) was approved as a subspecialty in 2016. Perspectives of pediatric and combined pediatric residents regarding barriers and facilitators to pursuing PHM fellowships have not previously been assessed. METHODS A survey to explore residents' perspectives on PHM fellowships, with questions regarding demographics, likelihood of pursuing PHM after fellowship introduction, and influencing factors was distributed to pediatric and combined pediatric residents via program directors. RESULTS The survey was distributed to an estimated 2657 residents. A total of 855 (32.2%) residents completed the survey; 89% of respondents had at least considered a career in PHM, and 79.4% reported that the introduction of the PHM fellowship requirement for subspecialty certification made them less likely to pursue PHM. Intent to practice in a community setting or only temporarily practice PHM, Combined Internal Medicine and Pediatric trainee status, and high student loan burden were associated with decreased likelihood of pursuing PHM (P < .05). Most respondents reported that forfeited earnings during fellowship, family and student loan obligations, and perceived sufficiency of residency training discouraged them from pursuing PHM fellowship. Half of respondents valued additional training in medical education, quality improvement, hospital administration, research, and clinical medicine. CONCLUSIONS Many survey respondents expressed interest in the opportunity to acquire new skills through PHM fellowship. However, the majority of respondents reported being less likely to pursue PHM after the introduction of fellowship requirement for board certification, citing financial and personal opportunity costs. Understanding factors that residents value and those that discourage residents from pursuing PHM fellowship training may help guide future iterations of fellowship design.
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Affiliation(s)
- Hamsika Chandrasekar
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California;
| | - Yasmine N White
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Christopher P Landrigan
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and.,Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Carolyn H Marcus
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and.,Harvard Medical School, Harvard University, Boston, Massachusetts
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Fenster ME, Hersh AL, Srivastava R, Keren R, Wilkes J, Coon ER. Trends in Use of Postdischarge Intravenous Antibiotic Therapy for Children. J Hosp Med 2020; 15:731-733. [PMID: 32966197 PMCID: PMC9514303 DOI: 10.12788/jhm.3422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/31/2020] [Indexed: 11/20/2022]
Abstract
Children with complicated appendicitis, osteomyelitis, and complicated pneumonia have historically been treated with postdischarge intravenous antibiotics (PD-IV) using peripherally inserted central catheters (PICCs). Recent studies have shown no advantage and increased complications of PD-IV, compared with oral therapy, and the extent to which use of PD-IV has since changed for these conditions is not known. We used a national children's hospital database to evaluate trends in PD-IV during 2000-2018 for each of these three conditions. PD-IV decreased from 13% to 2% (risk ratio [RR], 0.15; 95% CI, 0.14-0.16) for complicated appendicitis, 61% to 22% (RR, 0.41; 95% CI, 0.39-0.43) for osteomyelitis, and 29% to 19% (RR, 0.63; 95% CI, 0.58-0.69) for complicated pneumonia. Despite these overall reductions, substantial variation in PD-IV use by hospital remains in 2018.
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Affiliation(s)
- Michael E Fenster
- Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUtah
| | - Adam L Hersh
- Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUtah
| | - Rajendu Srivastava
- Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUtah
- Intermountain HealthcareSalt Lake CityUtah
| | - Ron Keren
- Division of General PediatricsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania
| | | | - Eric R Coon
- Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUtah
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Oshimura JM, Bauer BD, Shah N, Nguyen E, Maniscalco J. Current Roles and Perceived Needs of Pediatric Hospital Medicine Fellowship Graduates. Hosp Pediatr 2016; 6:633-637. [PMID: 27664087 DOI: 10.1542/hpeds.2016-0031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pediatric hospitalists report the need for additional training in clinical and nonclinical domains. Pediatric hospital medicine (PHM) fellowships seek to provide this training and produce leaders in the field. Our objective is to describe current roles and perceived training needs of PHM fellowship graduates. METHODS In 2014, all PHM fellowship graduates were asked to complete a Web-based survey. Survey questions addressed demographics, past training, current roles, and training needs in clinical care, research, education, and administration. Associations between fellowship experiences and outcomes were examined. RESULTS Fifty-one of 61 eligible individuals completed the survey. Average duration as a pediatric hospitalist was 5 years. Ninety percent completed pediatric categorical residency, whereas 10% completed an Internal Medicine-Pediatrics Residency. Most respondents completed a 1- (38%) or 2-year (46%) fellowship program. Ninety-six percent of respondents currently work in academic environments. The perceived need for additional clinical training was low, except procedures (44%). Nearly all teach medical students and pediatric residents, reporting adequate training in variety of teaching strategies. The majority of respondents conduct research, most commonly quality improvement (QI; 67%) and education (52%). Two-thirds are first authors on at least 1 peer-reviewed article. Research training needs include QI methodology (44%), biostatistics (43%), and obtaining funding (54%). A considerable number of respondents have academic leadership positions. CONCLUSIONS PHM fellowship graduates are academic hospitalists with diverse responsibilities. Despite a short average career span, many have achieved leadership roles and been academically productive. Future curriculum development should focus on procedures, QI, and research training.
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Affiliation(s)
- Jennifer M Oshimura
- Division of Hospital Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana; Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia;
| | - Benjamin D Bauer
- Division of Hospital Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Neha Shah
- Division of Hospitalist Medicine, Children's National Health System, Washington, District of Columbia; and
| | - Eugene Nguyen
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer Maniscalco
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
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McCulloh RJ, Queen MA, Lee B, Yu D, Stach L, Goldman J, Myers A, Pate B, Newland JG. Clinical Impact of an Antimicrobial Stewardship Program on Pediatric Hospitalist Practice, a 5-Year Retrospective Analysis. Hosp Pediatr 2015; 5:520-7. [PMID: 26427920 DOI: 10.1542/hpeds.2014-0250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Hospitalists increasingly serve as the primary physicians for children hospitalized with infections. Consequently, hospitalists frequently interact with institutional antimicrobial stewardship programs (ASPs). Understanding how these services interact can inform ongoing practice improvement efforts. The objectives of this study were to identify factors associated with ASP recommendations among hospitalist-managed children, and to determine the association of ASP interventions with clinical outcomes for hospitalist-managed patients. METHODS We retrospectively analyzed ASP reviews of hospitalist patients from a children's hospital from March 2008 to June 2013. Clinical factors associated with an ASP recommendation were determined. Length of stay and 30-day readmission were compared between cases of agreement and disagreement with ASP recommendations. RESULTS The ASP reviewed 2163 hospitalist patients, resulting in 350 recommendations (16.2% of reviews). Hospitalists agreed with ASP recommendations in 86.9% of cases. The odds of an ASP recommendation decreased during the study period. Ceftriaxone was the most common antibiotic associated with a recommendation (154/350, 44.0%); community-acquired pneumonia was the most common diagnosis (105/350, 30.0%). Antibiotic discontinuation was the most often recommendation; hospitalists most often disagreed with consulting infectious diseases. Disagreement with ASP recommendations was associated with a decreased length of stay of 15.4 (95% confidence interval -33.2 to 1.1) hours but not 30-day readmission prevalence. CONCLUSIONS Pediatric hospitalists and ASPs can form an effective collaboration that improves antibiotic use while providing safe care. Better characterization of the areas of disagreement between hospitalists and ASPs is needed. Future studies are needed to identify ASP strategies that will be beneficial in other hospitalist settings.
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Affiliation(s)
| | | | | | - Diana Yu
- Pharmacy, Children's Mercy Hospital, Kansas City, Missouri
| | - Leslie Stach
- Department of Pharmacy, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and
| | | | | | - Brian Pate
- Department of Pediatrics, University of Kansas School of Medicine Wichita, Kansas
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O'Toole JK, Friedland AR, Gonzaga AMR, Hartig JR, Holliday S, Lukela M, Moutsios SA, Kolarik R. The practice patterns of recently graduated internal medicine-pediatric hospitalists. Hosp Pediatr 2015; 5:309-14. [PMID: 26034162 DOI: 10.1542/hpeds.2014-0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify the current practice patterns and professional activities of internal medicine-pediatrics (med-peds) hospitalists who have graduated in the past 5 years (June 2009-June 2013). METHODS The national Medicine-Pediatrics Program Directors Association (MPPDA) conducted a cross-sectional survey study of the 79 residency program directors who are members of the MPPDA regarding the practice patterns of recent graduates (from 2009-2013) currently practicing as hospitalists. The survey was distributed in the spring of 2014 on the MPPDA listserv. The survey inquired about time spent caring for hospitalized adults and children, medical school appointments, practice in freestanding children's hospitals, and completion of hospital medicine (HM) fellowships. RESULTS Forty-nine program directors (62%) completed the survey and provided data on 1042 graduates from 46 programs. Of those graduates, 26.4% (n=275) practice as hospitalists, and none had completed an HM fellowship. Approximately two-thirds (65%) of med-peds hospitalists provide care to hospitalized children and adults, with one-third providing care solely to hospitalized adults. Approximately one-half (53.5%) have an appointment with a medical school and roughly one-quarter (28%) practice in a freestanding children's hospital. CONCLUSIONS An increasing percentage of recent med-peds graduates are pursuing careers in HM, and two-thirds are providing care to hospitalized children. As consideration for an accredited pediatric HM fellowship continues, certifying and accrediting bodies should consider how this will impact the med-peds workforce and allow med-peds graduates flexibility in their training requirements that will permit them to acquire the necessary skills to care for hospitalized children and adults.
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Affiliation(s)
- Jennifer K O'Toole
- Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio;
| | - Allen R Friedland
- Departments of Internal Medicine and Pediatrics, Christiana Care Health System, Wilmington, Delaware
| | - Alda Maria R Gonzaga
- Departments of Pediatrics and Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jason R Hartig
- Divisions of General Internal Medicine and General Pediatrics, University of Alabama School of Medicine, Birmingham, Alabama
| | - Scott Holliday
- Department of Pediatrics, Section of Hospital Medicine, Department of Internal Medicine, Division of General Internal Medicine, The Ohio State University College of Medicine/Nationwide Children's Hospital, Columbus, Ohio
| | - Michael Lukela
- Departments of Internal Medicine and Pediatrics, University of Michigan Health System, Ann Arbor, Michigan
| | - Sandra A Moutsios
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Russ Kolarik
- Department of Med-Peds, Greenville Health System/University of South Carolina Greenville, Greenville, South Carolina
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Librizzi J, Winer JC, Banach L, Davis A. Perceived core competency achievements of fellowship and non-fellowship-trained early career pediatric hospitalists. J Hosp Med 2015; 10:373-9. [PMID: 25755166 DOI: 10.1002/jhm.2337] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/28/2015] [Accepted: 02/10/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND The pediatric hospital medicine (PHM) core competencies were established in 2010 to identify the specific knowledge base and skill set needed to provide the highest quality of care for hospitalized children. The objectives of this study were to examine the perceived core competency achievements of fellowship-trained and non-fellowship-trained early career pediatric hospitalists and identify perceived gaps in our current training models. METHODS An anonymous Web-based survey was distributed in November 2013. Hospitalists within 5 years of their residency graduation reported their perceived competency in select PHM core competencies. χ(2) and multiprobit regression analyses were utilized. RESULTS One hundred ninety-seven hospitalists completed the survey and were included; 147 were non-fellowship-trained and 50 were PHM fellowship graduates or current PHM fellows. Both groups reported feeling less than competent in sedation and aspects of business practice. Non-fellowship-trained hospitalists also reported mean scores in the less than competent range in intravenous access/phlebotomy, technology-dependent emergencies, performing Plan-Do-Study-Act process and root cause analysis, defining basic statistical terms, and identifying research resources. Non-fellowship-trained hospitalists reported mean competency scores greater than fellowship-trained hospitalists in pain management, newborn care, and transitions in care. CONCLUSIONS Early career pediatric hospitalists report deficits in several of the PHM core competencies, which should be considered when designing PHM-specific training in the future. Fellowship-trained hospitalists report higher levels of perceived competency in many core areas.
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Affiliation(s)
- Jamie Librizzi
- Department of Hospital Medicine, Children's National Health Systems, Washington, DC
- George Washington School of Medicine and Health Science, Washington, DC
| | - Jeffrey C Winer
- Department of Hospital Medicine, Children's National Health Systems, Washington, DC
- George Washington School of Medicine and Health Science, Washington, DC
| | - Laurie Banach
- Department of Hospital Medicine, Children's National Health Systems, Washington, DC
- George Washington School of Medicine and Health Science, Washington, DC
| | - Aisha Davis
- Department of Hospital Medicine, Children's National Health Systems, Washington, DC
- George Washington School of Medicine and Health Science, Washington, DC
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Gosdin C, Simmons J, Yau C, Sucharew H, Carlson D, Paciorkowski N. Survey of academic pediatric hospitalist programs in the US: organizational, administrative, and financial factors. J Hosp Med 2013; 8:285-91. [PMID: 23447445 DOI: 10.1002/jhm.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/23/2012] [Accepted: 01/12/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many pediatric academic centers have hospital medicine programs. Anecdotal data suggest that variability exists in program structure. OBJECTIVE To provide a description of the organizational, administrative, and financial structures of academic pediatric hospital medicine (PHM). METHODS This online survey focused on the organizational, administrative, and financial aspects of academic PHM programs, which were defined as hospitalist programs at US institutions associated with accredited pediatric residency program (n = 246) and identified using the Accreditation Council for Graduate Medical Education (ACGME) Fellowship and Residency Electronic Interactive Database. PHM directors and/or residency directors were targeted by both mail and the American Academy of Pediatrics Section on Hospital Medicine LISTSERV. RESULTS The overall response rate was 48.8% (120/246). 81.7% (98/120) of hospitals reported having an academic PHM program, and 9.1% (2/22) of hospitals without a program reported plans to start a program in the next 3 years. Over a quarter of programs provide coverage at multiple sites. Variability was identified in many program factors, including hospitalist workload and in-house coverage provided. Respondents reported planning increased in-house hospitalist coverage coinciding with the 2011 ACGME work-hour restrictions. Few programs reported having revenues greater than expenses (26% single site, 4% multiple site). CONCLUSIONS PHM programs exist in the majority of academic centers, and there appears to be variability in many program factors. This study provides the most comprehensive data on academic PHM programs and can be used for benchmarking as well as program development.
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Affiliation(s)
- Craig Gosdin
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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