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Shoji K, Nishiya K, Miyairi I, Saitoh A, Uematsu S, Ishiguro A, Engle JM, Saint S. Effective mentoring in pediatrics. Pediatr Int 2024; 66:e15731. [PMID: 38156516 DOI: 10.1111/ped.15731] [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] [Received: 09/25/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Katsumi Nishiya
- Center for Medical Education, Kansai Medical University, Osaka, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoko Uematsu
- Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Jason M Engle
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sanjay Saint
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Haq H, Rule ARL, Coria A, Thahane LK, Duperval RM, Barnes A, Condurache T, Ferrer K, Shenoy MJ, Mendoza J, Russ CM. Pediatric Hospital Medicine and Global Health: A Fitting Niche for an Emerging Subspecialty. Am J Trop Med Hyg 2021; 105:1152-1154. [PMID: 34491222 DOI: 10.4269/ajtmh.20-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 07/01/2021] [Indexed: 11/07/2022] Open
Abstract
As North American hospitals serve increasingly diverse patient populations, including recent immigrants, refugees, and returned travelers, all pediatric hospitalists (PHs) require foundational competency in global health, and a subset of PHs are carving out niches focused in global health. Pediatric hospitalists are uniquely positioned to collaborate with low- and middle-income country clinicians and child health advocates to improve the health of hospitalized children worldwide. Using the 2018 WHO standards for improving the quality of care for children and adolescents worldwide, we describe how PHs' skills align closely with what the WHO and others have identified as essential elements to bring high-quality, sustainable care to children in low- and middle-income countries. Furthermore, North American global health hospitalists bring home expertise that reciprocally benefits their home institutions.
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Affiliation(s)
- Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Houston, Texas
| | - Amy R L Rule
- Perinatal Institute and Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexandra Coria
- Division of Pediatric Hospital Medicine, Maimonides Children's Hospital at Maimonides Medical Center, Brooklyn, New York
| | - Lineo K Thahane
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Baylor College of Medicine Children's Foundation - Lesotho, Maseru, Lesotho
| | | | - Adelaide Barnes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tania Condurache
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Kathy Ferrer
- Children's National Hospital, Washington, District of Columbia
| | - Michelle J Shenoy
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Joanne Mendoza
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Christiana M Russ
- Division of Medical Critical Care, Boston Children's Hospital, Boston, Massachusetts
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Lester TR, Rassbach CE, Blankenburg R. What Are the Unique Mentorship Needs of Fourth-Year Medical Students Applying to Pediatrics Residency? Acad Pediatr 2020; 20:1206-1212. [PMID: 32389758 DOI: 10.1016/j.acap.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/24/2020] [Accepted: 05/03/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The qualities of good medical school mentors have been well described. However, there is little written about the mentoring needs of medical students applying to pediatrics residency. METHODS In order to characterize pediatrics interns' perspectives on the mentorship needs of fourth-year medical students applying to residency, the authors conducted an IRB-approved, qualitative-modified grounded-theory study using a brief survey and semistructured focus groups of pediatric interns in January and February 2018. Two investigators independently coded the focus group transcripts and reconciled codes to develop categories and themes using constant comparison, which were then reviewed by the third author for validation. To further ensure trustworthiness of analysis, participants were asked to comment on the themes' accuracy. RESULTS Eighteen pediatrics interns participated, representing 15 medical schools. Four major themes emerged: 1) effective mentors guide medical students to self-reflect and find their own answers about what is important to them in a residency program; 2) multiple mentors are helpful during the residency application process; 3) several key components of advising are often missing during the residency application process; 4) students find it difficult to be honest with their mentors if there is a perceived conflict of interest. CONCLUSIONS Medical students applying for pediatrics residency have specific mentorship needs and cite opportunities to improve this area of mentorship. Several key recommendations include utilizing multiple mentors and providing emotional support during the residency application process. In addition, near-peer mentorship is important for medical students applying to residency and should be facilitated by medical schools.
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Affiliation(s)
- Talia R Lester
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
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Skelly K, Kim P, Rosenbaum M, Wilbur J. Goldilocks and Entrustment: Finding the Amount of Learner Autonomy That's Just Right. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10987. [PMID: 33094155 PMCID: PMC7566225 DOI: 10.15766/mep_2374-8265.10987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Faculty and residents strive for appropriate autonomy and entrustment. Initial direct supervision of clinical care gradually shifts to increasing levels of resident independence over time. Faculty members are inconsistent in resident supervision leading to missed opportunities for resident independence. METHODS Family medicine faculty workshop participants completed teaching style self-evaluations prior to discussion of clinical examples with excessive or insufficient autonomy. Participants reviewed real resident feedback examples to increase insight into teaching styles. Participants were presented with cases to discuss varying degrees of resident autonomy and entrustment. Learners committed to one specific behavior to calibrate the degree of autonomy they provide. RESULTS Of the faculty, 113 members participated in the workshop with the majority (98%) finding the workshop relevant in helping them to identify strategies for reflecting on their degree of autonomy allowed and to look for appropriate situations for enhancing their resident entrustment. DISCUSSION This interactive workshop provided clear ways for addressing the issue of independence versus control in supervision of patient care. It provided a feedback mechanism for educators who provide too much or too little autonomy for the best resident learning. Additionally, this conversation encouraged participants to engage in self-reflection on the autonomy given to their resident.
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Affiliation(s)
- Kelly Skelly
- Associate Professor, Department of Family Medicine, University of Iowa Carver College of Medicine
| | - Parang Kim
- Research Assistant, Department of Family Medicine, University of Iowa Carver College of Medicine
| | - Marcy Rosenbaum
- Professor, Department of Family Medicine, University of Iowa Carver College of Medicine
| | - Jason Wilbur
- Professor, Department of Family Medicine, University of Iowa Carver College of Medicine
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McLaurin-Jiang S, Coletti HY, Spotts R, Halvorson EE, Bartlett K, Heath J, Potisek NM. Faculty and Resident Perspectives on Teaching Pediatric Evidence-Based Medicine in the Clinical Setting: A Qualitative Study. Acad Pediatr 2020; 20:549-557. [PMID: 31866459 DOI: 10.1016/j.acap.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe how pediatric educators effectively teach evidence-based medicine (EBM) in the clinical setting. Secondarily, to identify barriers hindering effective practice and teaching of EBM and strategies to overcome these barriers. METHODS The authors conducted a cross-sectional multi-institutional qualitative study from July 2016 to December 2017 in which they interviewed pediatric educators across many subspecialties who were identified as exemplary teachers of EBM at 3 academic pediatric residency programs. Pediatric residents who had recently worked with these faculty members were also interviewed to allow triangulation between participants. Qualitative analysis was complete once saturation was achieved. RESULTS Twenty-six pediatric educators identified as exemplary teachers of EBM and 10 residents who worked with those educators participated in the study. Thirteen explicit teaching strategies and 2 implicit teaching strategies, namely disclosure of uncertainty and role modeling, were identified. Barriers to practicing clinical EBM included balancing patient responsibilities, inadequate time, and personal knowledge. Barriers to teaching clinical EBM were inadequate time and learner engagement. To overcome these barriers, faculty limit and focus teaching points, attempt to make EBM relevant to patient care, and incorporate follow-up strategies. CONCLUSIONS Numerous teaching strategies are available to faculty to improve the clinical teaching of EBM and to overcome commonly encountered clinical EBM barriers. Familiarity with these clinical EBM teaching strategies can be used for faculty development and to enhance the teaching of EBM to learners.
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Affiliation(s)
- Skyler McLaurin-Jiang
- Department of Pediatrics, University of North Carolina School of Medicine (S McLaurin-Jiang, HY Coletti, and J Heath), Chapel Hill, NC
| | - Hannah Y Coletti
- Department of Pediatrics, University of North Carolina School of Medicine (S McLaurin-Jiang, HY Coletti, and J Heath), Chapel Hill, NC
| | - Ryan Spotts
- Department of Pediatrics, Duke University School of Medicine (R Spotts and K Bartlett), Durham, NC
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest School of Medicine (EE Halvorson and NM Potisek), Winston-Salem, NC. Dr Coletti is now with the Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC. Dr Spotts is now with the Department of Pediatrics, Penn State University College of Medicine, Hersey, PA
| | - Kathleen Bartlett
- Department of Pediatrics, Duke University School of Medicine (R Spotts and K Bartlett), Durham, NC
| | - Jonathon Heath
- Department of Pediatrics, University of North Carolina School of Medicine (S McLaurin-Jiang, HY Coletti, and J Heath), Chapel Hill, NC
| | - Nicholas M Potisek
- Department of Pediatrics, Wake Forest School of Medicine (EE Halvorson and NM Potisek), Winston-Salem, NC. Dr Coletti is now with the Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC. Dr Spotts is now with the Department of Pediatrics, Penn State University College of Medicine, Hersey, PA..
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Nishiya K, Sekiguchi S, Yoshimura H, Takamura A, Wada H, Konishi E, Saiki T, Tsunekawa K, Fujisaki K, Suzuki Y. Good clinical teachers in pediatrics: The perspective of pediatricians in Japan. Pediatr Int 2020; 62:549-555. [PMID: 31883414 DOI: 10.1111/ped.14125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/26/2019] [Accepted: 12/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to identify the attributes of good clinical teachers in pediatrics (CTPs) in Japan, and to elucidate pediatricians and pediatric trainees' perceptions of these attributes. METHODS The attributes of good CTPs were identified qualitatively by conducting a thematic analysis of questionnaires answered by board-certified pediatricians and pediatric trainees. The attributes identified were rated quantitatively by a large number of participants in both groups. RESULTS Forty-eight individual attributes of good CTPs were identified, which were classified into three domains: personal, pediatrician, and teacher. The three domains and most of the attributes were consistent with previous studies. However, a few additional attributes, including "is kind/thoughtful toward others" and "defends trainees", which may be unique to pediatricians in Japan, were identified. Significant differences in the pediatricians' and trainees' perceptions of these attributes were elucidated: The differences were most noticeable for teacher attributes and least for personal attributes. CONCLUSION Although most of the identified attributes of good CTPs in our study appear to be universal, there were significant differences in the pediatricians' and trainees' perceptions of good CTPs, especially in relation to teacher attributes. Our study provides additional bases for good CTPs and future faculty development, for enhanced pediatric clinical education.
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Affiliation(s)
- Katsumi Nishiya
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan.,Center for Medical Education, Kansai Medical University, Hirakata, Osaka, Japan
| | | | | | - Akiteru Takamura
- Department of Medical Education, Kanazawa Medical University, Kahoku, Japan
| | - Hiroshi Wada
- Department of Pediatrics, Kenwakai Hospital, Iida, Japan
| | - Eri Konishi
- Pediatrics, Hirakata General Hospital for Developmental Disorders, Hirakata, Osaka, Japan
| | - Takuya Saiki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Koji Tsunekawa
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiko Fujisaki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University Graduate School of Medicine, Gifu, Japan
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Kaneko K. The importance of clinical teacher development in cultivating excellent pediatric residency programs. Pediatr Int 2020; 62:520. [PMID: 32463577 DOI: 10.1111/ped.14198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
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Fuchs J, King M, Devon EP, Guffey D, Keeley M, Rocha MEM. Mitigating "Educational Groundhog Day" - The Role of Learner Handoffs Within Clinical Rotations: A Survey of Pediatric Educational Leaders. Acad Pediatr 2020; 20:113-118. [PMID: 31445968 DOI: 10.1016/j.acap.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 08/04/2019] [Accepted: 08/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical students decry frequent changes in faculty supervision, leading to the experience of "educational groundhog day." The discontinuity in supervision, cursory relationships, and uncoordinated feedback impede students' skill acquisition and delay entrustment decisions. Whereas patient handoff bundles are common, little is known about similarly structured approaches to learner handoffs (LHs). OBJECTIVE To describe current LH procedures and practices within pediatric clerkships and subinternships and to gauge interest in a future LH bundle. METHODS Nine items included in the 2016 Council on Medical Student Education in Pediatrics annual member survey were analyzed using mixed-methods. RESULTS The response rates were 66% (101 of 152) and 40% (165 of 411) for institutions and individuals, respectively. After limiting data to complete responses to programs with traditional block rotations, 54% of individual respondents (76 of 141) identified as inpatient faculty and about a quarter endorsed providing LHs. Inpatient faculty most commonly supervise medical students for 5 to 7 days. Most endorsed needing 1 to 3 days to determine a student's baseline performance and 5 days or more to make entrustment decisions. Three-quarters of inpatient faculty endorsed interest in LHs, while fewer than 16% of course directors currently provide LH expectations. Four themes emerged: instrument features, stakeholder buy-in, impact, and utility. CONCLUSIONS Typical inpatient faculty service days approximate the time required for making entrustment decisions about clinical students. While most inpatient faculty desire a LH bundle for use within a clinical rotation, few institutions and faculty currently use LHs. LHs could accelerate entrustment decisions by allowing coordinated feedback that might hasten learner clinical-skill development.
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Affiliation(s)
- Jennifer Fuchs
- Department of Pediatrics (J Fuchs), University of North Carolina and NC Children's Hospital, Chapel Hill, NC.
| | - Marta King
- Department of Pediatrics (M King), Division of General Academic Pediatrics GAP, St. Louis University School of Medicine, St. Louis, Mo
| | - Erin Pete Devon
- Department of Pediatrics (EP Devon), Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research (D Guffey), Baylor College of Medicine, Houston, Tex
| | - Meg Keeley
- Department of Pediatrics (M Keeley), University of Virginia, Charlottesville, Va
| | - Mary Esther M Rocha
- Department of Pediatrics (MEM Rocha), Baylor College of Medicine, Pediatric Hospital Medicine, Houston, Tex
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Factors and Behaviors Related to the Promotion of Pediatric Hospital Medicine Fellow Autonomy: A Qualitative Study of Faculty. Acad Pediatr 2019; 19:703-711. [PMID: 31077880 DOI: 10.1016/j.acap.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/24/2019] [Accepted: 05/04/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify factors that influence faculty to promote or reduce the expression of autonomy for pediatric hospital medicine (PHM) fellows and describe behaviors faculty employ to support fellow autonomy in the clinical setting. METHODS This was a multicenter, qualitative study using semistructured interviews with core faculty in PHM fellowships. Data were transcribed verbatim and analyzed using a phenomenological approach. Each transcript was coded independently by 2 trained reviewers who then met to reconcile differences. Codes were identified using an iterative approach and organized into themes. Investigators engaged in peer debriefing during data collection, and member checking confirmed the results. RESULTS Interviews were conducted December 2016 to January 2017 with 20 faculty from 5 PHM fellowships. Most participants were female (12, 60%) and assistant (13, 65%) or associate (6, 30%) professors. Data analysis yielded 6 themes. Themes reflect the importance of faculty experience, style, and approach to balancing patient care with education in the provision of autonomy for PHM fellows. Faculty appreciation for the role of autonomy in medical education, investment in their roles as educators, and investment in PHM fellowship training are also influential factors. Finally, fellow clinical, educational, leadership, and communication skills influence the provision of autonomy. Faculty employ various levels of supervision, scaffolding techniques, and direct observation with feedback to support fellow autonomy. Professional development was considered essential for developing these skills. CONCLUSIONS We identified 6 themes related to faculty provision of autonomy to PHM fellows, as well as strategies employed by faculty to support fellow autonomy.
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Allen M, Gawad N, Park L, Raîche I. The Educational Role of Autonomy in Medical Training: A Scoping Review. J Surg Res 2019; 240:1-16. [DOI: 10.1016/j.jss.2019.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/30/2019] [Accepted: 02/22/2019] [Indexed: 12/18/2022]
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Westcott AM, Wolpaw DR, Riddle JM. Pilot Qualitative Study of Informal Teachers in Interprofessional Collaboration and Practice. J Pain Symptom Manage 2019; 57:108-111. [PMID: 30367927 DOI: 10.1016/j.jpainsymman.2018.10.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022]
Abstract
CONTEXT Nonphysician members of the interprofessional palliative care team often participate in teaching physicians and others in the context of workplace learning due to the interprofessional collaborative nature of the specialty. OBJECTIVES This pilot study examines the beliefs of the nonphysician members of the interprofessional team about teaching physicians-in-training, the disciplinary training and expertise that informs their teaching, and approaches to teaching in the workplace. METHODS Semistructured interviews were conducted. All interviews were audio recorded and transcribed verbatim. Initial open coding by two researchers identified the codes, and then the constant comparative method was used to find patterns by axial coding, categories, and themes within the data. RESULTS Of the 10 health care professionals involved with palliative medical education at one academic medical center, six enrolled in the pilot. Those who participated included chaplains, nurses, a social worker, and a physician assistant. Three major themes were identified from the informal teachers: 1) using professional identity as a foundation for teaching, 2) teaching through experiential learning or debriefing, and 3) teaching to perceived gaps in physician training. CONCLUSION Nonphysician members of the interprofessional team interacted with physicians-in-training guided by their discipline-based skills and perspectives on patient care. They directed their informal teaching toward perceived educational gaps using reflection and debriefing. Future studies could explore the educational roles of health care professionals across diverse institutions and specialties.
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Affiliation(s)
- Amy M Westcott
- Penn State College of Medicine, Hershey, Pennsylvania, USA.
| | | | - Janet M Riddle
- University of Illinois - Chicago, Chicago, Illinois, USA
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Bochenek SH, Fugit AM, Cook AM, Smith KM. Pharmacy residents’ perception of preceptors as role models. Am J Health Syst Pharm 2016; 73:S94-9. [PMID: 27208146 DOI: 10.2146/ajhp150661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | - Kelly M. Smith
- University of Kentucky College of Pharmacy, Lexington, KY
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Abstract
Pediatric hospital medicine (PHM) is moving toward becoming an American Board of Pediatrics (ABP) subspecialty, roughly a decade after its formal inception in 2003. Education has played a central role as the field has evolved. Hospitalists are needed to educate trainees, medical students, residents, fellows, and nurse practitioner and physician assistant students in inpatient pediatric practice. Continuous professional development is needed for hospitalists currently in practice to augment clinical skills, such as providing sedation and placing peripherally inserted central catheter lines, and nonclinical skills in areas such as quality improvement methodology, hospital administration, and health service research. To address the educational needs of the current and future state of PHM, additional training is now needed beyond residency training. Fellowship training will be essential to continue to advance the field of PHM as well as to petition the ABP for specialty accreditation. Training in using adult educational theory, curriculum, and assessment design are critical for pediatric hospitalists choosing to advance their careers as clinician-educators. Several venues are available for gaining advanced knowledge and skill as an educator. PHM clinician-educators are advancing the field of pediatric education as well as their own academic careers by virtue of the scholarly approach they have taken to designing and implementing curricula for unique PHM teaching situations. PHM educators are changing the educational paradigm to address challenges to traditional education strategies posed by duty hour restrictions and the increasing drive to shorten the duration of the hospitalization. By embracing learning with technology, such as simulation and e-learning with mobile devices, PHM educators can address these challenges as well as respond to learning preferences of millennial learners. The future for PHM education is bright.
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Seltz LB, Montgomery A, Lane JL, Soep J, Hanson JL. Medical students' experiences working with frequently rotating pediatric inpatient attending physicians. Hosp Pediatr 2014; 4:239-246. [PMID: 24986994 DOI: 10.1542/hpeds.2014-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore medical students' experiences working with frequently rotating pediatric inpatient attending physicians. METHODS We performed a qualitative study using focus groups and individual interviews of medical students who rotated on the general pediatric inpatient service at Children's Hospital Colorado. The majority of inpatient pediatric attending physicians worked 1-week blocks. We used a semistructured interview guide and analyzed data using the constant comparative method. In accordance with the grounded theory method, codes were developed using an iterative approach, and major themes were identified. Analysis indicated theoretical saturation was achieved. We created a theory that arose from analysis of the data. RESULTS Twenty-seven medical students participated. Data analysis yielded 6 themes: learning climate, continuity, student resilience, opportunity to progress, growth into a physician, and evaluation. In the learning climate, the emotional environment was often stressful, although students valued exposure to different patient care and teaching styles. Senior resident continuity promoted student function; lack of continuity with attending physicians inhibited relationship development. Students were resilient in adjusting to changing faculty with different expectations. In the context of frequently rotating faculty, students had difficulty showing improvement to a single attending physician after feedback, which limited students' opportunities to progress. Students perceived summative evaluation as less meaningful in the absence of having a relationship with their attending physicians. CONCLUSIONS Medical students valued exposure to different patient care and teaching styles. However, frequently changing attending physicians caused students stress and limited students' perceived ability to achieve and show professional growth.
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Affiliation(s)
- L Barry Seltz
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - Alison Montgomery
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - J Lindsey Lane
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - Jennifer Soep
- Children's Hospital Colorado and University of Colorado School of Medicine
| | - Janice L Hanson
- Children's Hospital Colorado and University of Colorado School of Medicine
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Jochemsen-van der Leeuw HGAR, van Dijk N, Wieringa-de Waard M. Assessment of the clinical trainer as a role model: a Role Model Apperception Tool (RoMAT). ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:671-7. [PMID: 24556764 PMCID: PMC4885572 DOI: 10.1097/acm.0000000000000169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Positive role modeling by clinical trainers is important for helping trainees learn professional and competent behavior. The authors developed and validated an instrument to assess clinical trainers as role models: the Role Model Apperception Tool (RoMAT). METHOD On the basis of a 2011 systematic review of the literature and through consultation with medical education experts and with clinical trainers and trainees, the authors developed 17 attributes characterizing a role model, to be assessed using a Likert scale. In 2012, general practice (GP) trainees, in their first or third year of postgraduate training, who attended a curriculum day at four institutes in different parts of the Netherlands, completed the RoMAT. The authors performed a principal component analysis on the data that were generated, and they tested the instrument's validity and reliability. RESULTS Of 328 potential GP trainees, 279 (85%) participated. Of these, 202 (72%) were female, and 154 (55%) were first-year trainees. The RoMAT demonstrated both content and convergent validity. Two components were extracted: "Caring Attitude" and "Effectiveness." Both components had high reliability scores (0.92 and 0.84, respectively). Less experienced trainees scored their trainers significantly higher on the Caring Attitude component. CONCLUSIONS The RoMAT proved to be a valid, reliable instrument for assessing clinical trainers' role-modeling behavior. Both components include an equal number of items addressing personal (Heart), teaching (Head), and clinical (Hands-on) qualities, thus demonstrating that competence in the "3Hs" is a condition for positive role modeling. Educational managers (residency directors) and trainees alike can use the RoMAT.
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Affiliation(s)
- H G A Ria Jochemsen-van der Leeuw
- Dr. Jochemsen-van der Leeuw is general practitioner and PhD student, Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands. Dr. van Dijk is assistant professor, Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands. Dr. Wieringa-de Waard is professor, Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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Jochemsen-van der Leeuw HGAR, van Dijk N, van Etten-Jamaludin FS, Wieringa-de Waard M. The attributes of the clinical trainer as a role model: a systematic review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:26-34. [PMID: 23165277 DOI: 10.1097/acm.0b013e318276d070] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Medical trainees (interns and residents) and their clinical trainers need to be aware of the differences between positive and negative role modeling to ensure that trainees imitate and that trainers demonstrate the professional behavior required to provide high-quality patient care. The authors systematically reviewed the medical and medical education literature to identify the attributes characterizing clinical trainers as positive and negative role models for trainees. METHOD The authors searched the MEDLINE, EMBASE, ERIC, and PsycINFO databases from their earliest dates until May 2011. They included quantitative and qualitative original studies, published in any language, on role modeling by clinical trainers for trainees in graduate medical education. They assessed the methodological quality of and extracted data from the included studies, using predefined forms. RESULTS Seventeen articles met inclusion criteria. The authors divided attributes of role models into three categories: patient care qualities, teaching qualities, and personal qualities. Positive role models were frequently described as excellent clinicians who were invested in the doctor-patient relationship. They inspired and taught trainees while carrying out other tasks, were patient, and had integrity. These findings confirm the implicit nature of role modeling. Positive role models' appearance and scientific achievements were among their least important attributes. Negative role models were described as uncaring toward patients, unsupportive of trainees, cynical, and impatient. CONCLUSIONS The identified attributes may help trainees recognize which aspects of the clinical trainer's professional behavior to imitate, by adding the important step of apperception to the process of learning professional competencies through observation.
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Lang VJ, O'Connor AB, Blatt A, Gracey C. Collaborative development of teaching scripts: an efficient faculty development approach for a busy clinical teaching unit. J Hosp Med 2012; 7:644-8. [PMID: 23033224 DOI: 10.1002/jhm.1971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/08/2012] [Accepted: 07/14/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Exemplary teachers have been shown to use teaching scripts, ways of organizing the content and instructional approach for commonly encountered teachable moments. This study describes a busy hospitalist unit's early experience with the collaborative development of teaching scripts. METHODS In 2010, during monthly workshops, 10 faculty members each prepared and presented a teaching script for a different commonly encountered diagnosis. Open-ended surveys assessing the impact on faculty were analyzed using an iterative approach. Changes in faculty self-efficacy, and the frequency and applicability of teaching were measured. RESULTS The program required 10 hours of attendance time and a mean of 4.3 hours for each faculty member who prepared a teaching script. No significant differences in quantity or applicability of teaching were detected, but faculty self-efficacy improved significantly. In addition, faculty described beneficial effects in their individual professional development, development of a shared mental model of professional responsibility, and interpersonal relationships. A majority of comments were positive; negative comments focused on the time required to prepare scripts, and apprehension about presenting to peers. CONCLUSIONS The program was an efficient approach to improve self-rated teaching skills, enhance professional development, and build collegiality among clinician-teachers.
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Affiliation(s)
- Valerie J Lang
- Hospital Medicine Division, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Burgis JC, Lockspeiser TM, Stumpf EC, Wilson SD. Resident perceptions of autonomy in a complex tertiary care environment improve when supervised by hospitalists. Hosp Pediatr 2012; 2:228-234. [PMID: 24313030 DOI: 10.1542/hpeds.2011-0012-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Increasingly, academic hospitals have adopted hospitalist-based systems of inpatient pediatric care. Some studies comparing hospitalists with other attending physicians have suggested trainees are more satisfied with education from hospitalists. However, there are published concerns that the increased presence of hospitalists may reduce residents' autonomy. The objective of the current study was to evaluate pediatric residents' perceptions of their own autonomy after a broad ward restructuring to hospitalist-led teams. METHODS We analyzed data from standardized attending evaluations before and after a pediatric ward restructuring at an academic tertiary care hospital. Provision of most inpatient pediatric care changed from subspecialist-led teams to hospitalist-led teams. Numerical scores from evaluations before and after the restructuring were compared quantitatively. Comments from the evaluations were analyzed qualitatively to identify key themes. RESULTS Before the restructuring, there were 65 evaluations of 5 hospitalists and 602 evaluations of 32 subspecialists. After the restructuring, there were 188 evaluations of 8 hospitalists. Hospitalists were rated significantly higher on all teaching attributes compared with all attending physicians before the restructuring. The attending role in promoting autonomy was mentioned infrequently and reflected residents' perceived lack of autonomy before the restructuring. The primary theme after the restructuring was autonomy, specifically emphasizing resident leadership and decision-making and the appropriate balance of resident autonomy and supervision. CONCLUSIONS Although patient complexity was unchanged, a comparison of numerical ratings and resident comments before and after the restructuring indicates that hospitalists lead teams differently from subspecialists, with more emphasis on resident decision-making and autonomy.
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Affiliation(s)
- Jennifer C Burgis
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California 94304, USA.
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Heydarian C, Maniscalco J. Pediatric hospitalists in medical education: current roles and future directions. Curr Probl Pediatr Adolesc Health Care 2012; 42:120-6. [PMID: 22483082 DOI: 10.1016/j.cppeds.2012.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/16/2012] [Indexed: 11/25/2022]
Abstract
As the field of pediatric hospital medicine has evolved, pediatric hospitalists have become increasingly involved in medical student and resident education--providing direct education during clinical rotations, developing novel curricula to meet the demands of the new educational environment, occupying leadership roles in medical education, and more. The literature suggests that hospitalists possess the essential skills for teaching effectively, yet most hospitalists feel that additional training beyond residency is necessary to refine their knowledge and skills in education and in other essential domains. Several pediatric hospital medicine fellowships and continuing medical education activities have been developed in the last decade to meet this growing need. The recent publication of the Pediatric Hospital Medicine Core Competencies will help define the roles and expectations of practicing pediatric hospitalists, and will serve as a framework for future curriculum development in both graduate and continuing medical education.
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Affiliation(s)
- Cyrus Heydarian
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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