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Lees AF, Beni C, Lee A, Wedgeworth P, Dzara K, Joyner B, Tarczy-Hornoch P, Leu M. Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1326-1336. [PMID: 37267042 PMCID: PMC10615720 DOI: 10.1097/acm.0000000000005288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This study systematically reviews the uses of electronic health record (EHR) data to measure graduate medical education (GME) trainee competencies. METHOD In January 2022, the authors conducted a systematic review of original research in MEDLINE from database start to December 31, 2021. The authors searched for articles that used the EHR as their data source and in which the individual GME trainee was the unit of observation and/or unit of analysis. The database query was intentionally broad because an initial survey of pertinent articles identified no unifying Medical Subject Heading terms. Articles were coded and clustered by theme and Accreditation Council for Graduate Medical Education (ACGME) core competency. RESULTS The database search yielded 3,540 articles, of which 86 met the study inclusion criteria. Articles clustered into 16 themes, the largest of which were trainee condition experience (17 articles), work patterns (16 articles), and continuity of care (12 articles). Five of the ACGME core competencies were represented (patient care and procedural skills, practice-based learning and improvement, systems-based practice, medical knowledge, and professionalism). In addition, 25 articles assessed the clinical learning environment. CONCLUSIONS This review identified 86 articles that used EHR data to measure individual GME trainee competencies, spanning 16 themes and 6 competencies and revealing marked between-trainee variation. The authors propose a digital learning cycle framework that arranges sequentially the uses of EHR data within the cycle of clinical experiential learning central to GME. Three technical components necessary to unlock the potential of EHR data to improve GME are described: measures, attribution, and visualization. Partnerships between GME programs and informatics departments will be pivotal in realizing this opportunity.
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Affiliation(s)
- A Fischer Lees
- A. Fischer Lees is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Catherine Beni
- C. Beni is a general surgery resident, Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Albert Lee
- A. Lee is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Patrick Wedgeworth
- P. Wedgeworth is a clinical informatics fellow, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Kristina Dzara
- K. Dzara is assistant dean for educator development, director, Center for Learning and Innovation in Medical Education, and associate professor of medical education, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Byron Joyner
- B. Joyner is vice dean for graduate medical education and a designated institutional official, Graduate Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Peter Tarczy-Hornoch
- P. Tarczy-Hornoch is professor and chair, Department of Biomedical Informatics and Medical Education, and professor, Department of Pediatrics (Neonatology), University of Washington School of Medicine, and adjunct professor, Allen School of Computer Science and Engineering, University of Washington, Seattle, Washington
| | - Michael Leu
- M. Leu is professor and director, Clinical Informatics Fellowship, Department of Biomedical Informatics and Medical Education, and professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Odum JD, Real FJ, Rice J, Meisman A, Sahay R, Zhang B, Zackoff MW. Virtual Reality to Assess Resident Recognition of Impending Respiratory Failure During COVID-19. Hosp Pediatr 2023; 13:e135-e139. [PMID: 37232100 DOI: 10.1542/hpeds.2022-006917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To assess the performance of pediatric residents in recognizing a decompensating patient with impending respiratory failure and appropriately escalating care using a virtual reality (VR) simulated case of an infant with bronchiolitis after an extended period of decreased clinical volumes during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Sixty-two pediatric residents at a single academic pediatric referral center engaged in a 30-minute VR simulation on respiratory failure in a 3-month-old admitted to the pediatric hospital medicine service with bronchiolitis. This occurred in a socially distant manner across the Zoom platform during the COVID-19 pandemic (January-April 2021). Residents were assessed on their ability to (1) recognize altered mental status (AMS), (2) designate clinical status as "(impending) respiratory failure," and (3) escalate care. Statistical differences between and across postgraduate year (PGY) levels were examined using χ2 or Fisher's exact test, followed by pairwise comparison and posthoc multiple testing using the Hochberg test. RESULTS Among all residents, 53% successfully recognized AMS, 16% identified respiratory failure, and 23% escalated care. No significant differences were seen across PGY levels for recognizing AMS or identifying respiratory failure. PGY3+ residents were more likely to escalate care than PGY2 residents (P = .05). CONCLUSIONS In the setting of an extended period with decreased clinical volumes during the COVID-19 pandemic, pediatric residents across all PGY levels demonstrated challenges with identifying (impending) respiratory failure and appropriately escalating care during VR simulations. Though limited, VR simulation may serve as a safe adjunct for clinical training and assessment during times of decreased clinical exposure.
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Affiliation(s)
- James D Odum
- Division of Critical Care
- Department of Pediatrics
| | - Francis J Real
- Division of General and Community Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Rashmi Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew W Zackoff
- Division of Critical Care
- Department of Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Roth LT, Mogilner L, Talib H, Silver EJ, Friedman S. Where Do We Go from here? Post-pandemic Planning and the Future of Graduate Medical Education. MEDICAL SCIENCE EDUCATOR 2023; 33:375-384. [PMID: 36778672 PMCID: PMC9900559 DOI: 10.1007/s40670-023-01737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Lauren T. Roth
- Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Leora Mogilner
- Icahn School of Medicine at Mount Sinai, 1184 5th Ave, New York, NY 10029 USA
| | - Hina Talib
- Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Ellen J. Silver
- Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Suzanne Friedman
- Columbia University Vagelos College of Physicians & Surgeons, 622 West 168th Street, NY New York, 10032 USA
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Mai MV, Muthu N, Carroll B, Costello A, West DC, Dziorny AC. Measuring Training Disruptions Using an Informatics Based Tool. Acad Pediatr 2023; 23:7-11. [PMID: 35306187 DOI: 10.1016/j.acap.2022.03.006] [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: 11/23/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Training disruptions, such as planned curricular adjustments or unplanned global pandemics, impact residency training in ways that are difficult to quantify. Informatics-based medical education tools can help measure these impacts. We tested the ability of a software platform driven by electronic health record data to quantify anticipated changes in trainee clinical experiences during the COVID-19 pandemic. METHODS We previously developed and validated the Trainee Individualized Learning System (TRAILS) to identify pediatric resident clinical experiences (i.e. shifts, resident provider-patient interactions (rPPIs), and diagnoses). We used TRAILS to perform a year-over-year analysis comparing pediatrics residents at a large academic children's hospital during March 15-June 15 in 2018 (Control #1), 2019 (Control #2), and 2020 (Exposure). RESULTS Residents in the exposure cohort had fewer shifts than those in both control cohorts (P < .05). rPPIs decreased an average of 43% across all PGY levels, with interns experiencing a 78% decrease in Continuity Clinic. Patient continuity decreased from 23% to 11%. rPPIs with common clinic and emergency department diagnoses decreased substantially during the exposure period. CONCLUSIONS Informatics tools like TRAILS may help program directors understand the impact of training disruptions on resident clinical experiences and target interventions to learners' needs and development.
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Affiliation(s)
- Mark V Mai
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia (MV Mai), Philadelphia, Pa.
| | - Naveen Muthu
- Department of Pediatrics, Children's Hospital of Philadelphia (N Muthu, B Carroll, A Costello, and DC West), Philadelphia, Pa
| | - Bryn Carroll
- Department of Pediatrics, Children's Hospital of Philadelphia (N Muthu, B Carroll, A Costello, and DC West), Philadelphia, Pa
| | - Anna Costello
- Department of Pediatrics, Children's Hospital of Philadelphia (N Muthu, B Carroll, A Costello, and DC West), Philadelphia, Pa
| | - Daniel C West
- Department of Pediatrics, Children's Hospital of Philadelphia (N Muthu, B Carroll, A Costello, and DC West), Philadelphia, Pa
| | - Adam C Dziorny
- Departments of Pediatrics & Biomedical Engineering, University of Rochester School of Medicine (AC Dziorny), Rochester, NY
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Li STT, Turner AL, Naifeh MM, Stevenson MD, Abramson EL, Winn AS, Gregg C, Leslie LK. COVID-19 Pandemic Impact on Pediatricians Entering the Pediatric Workforce. Acad Pediatr 2022:S1876-2859(22)00627-1. [PMID: 36566950 PMCID: PMC9773697 DOI: 10.1016/j.acap.2022.11.017] [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: 04/15/2022] [Revised: 11/04/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Determine extent of impact of coronavirus disease 2019 (COVID-19) pandemic on career choice and employment of pediatricians entering pediatric workforce. METHODS A national, cross-sectional electronic survey of pediatricians registering for the 2021 American Board of Pediatrics initial general certifying examination on the impact of the COVID-19 pandemic on 3 aspects of career (career choice, employment search, employment offers) was performed. Data were analyzed using descriptive statistics and multivariate logistic regression to determine factors associated with the pandemic's impact on career. Thematic analysis was used to generate themes for open-ended survey questions. RESULTS Over half (52.3%, 1767 of 3380) of pediatricians responded. Overall, 29.1% reported that the pandemic impacted their career (career choice [10.4%], employment search [15.6%], or employment offers [19.0%]); applicants to general pediatrics (GP) (52.9%) or pediatric hospitalist (PH) positions (49.3%) were most affected. Multivariate logistic regression modeling found those applying to GP (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 2.22-6.60), PH (OR: 9.02, 95% CI: 5.60-14.52), and International Medical Graduates (IMGs) (OR: 1.90; 95% CI: 1.39-2.59) most likely to experience any career impact. CONCLUSIONS Almost one third of pediatricians registering for the initial general pediatrics certifying examination reported their careers were impacted by the COVID-19 pandemic, with 10% of respondents reporting the pandemic impacted their career choice. Half of new pediatricians seeking employment reported being impacted by the pandemic, particularly IMGs. As the pandemic evolves, career advising will continue to be critical to support trainees in their career choices and employment.
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Affiliation(s)
- Su-Ting T. Li
- Department of Pediatrics, University of California Davis (S-TT Li), Sacramento, Calif,Address correspondence to Su-Ting T. Li, MD, MPH; Department of Pediatrics, University of California Davis, 2156 Stockton Blvd, Sacramento, CA 95817
| | - Adam L. Turner
- Department of Pediatrics, American Board of Pediatrics (AL Turner, C Gregg, and LK Leslie), Chapel Hill, NC
| | - Monique M. Naifeh
- Department of Pediatrics, University of Oklahoma Health Sciences Center (MM Naifeh), Oklahoma City, Okla
| | - Michelle D. Stevenson
- Norton Children's Affiliated With the University of Louisville School of Medicine (MD Stevenson), Louisville, Ky
| | - Erika L. Abramson
- Department of Pediatrics, Weill Cornell Medical Graduate School of Medical Sciences, Cornell University (EL Abramson), New York, NY
| | - Ariel S. Winn
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School (AS Winn), Boston, Mass
| | - Crista Gregg
- Department of Pediatrics, American Board of Pediatrics (AL Turner, C Gregg, and LK Leslie), Chapel Hill, NC
| | - Laurel K. Leslie
- Department of Pediatrics, American Board of Pediatrics (AL Turner, C Gregg, and LK Leslie), Chapel Hill, NC
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Myers RE, Thoreson L, Howell HB, Poitevien P, Wroblewski MB, Ponitz K, Lewis J. Three Years of X + Y Scheduling: Longitudinal Assessment of Resident and Faculty Perceptions. Acad Pediatr 2022; 22:1097-1104. [PMID: 35227911 DOI: 10.1016/j.acap.2022.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Five pediatric residency programs implemented true X + Y scheduling in 2018 where residents have continuity clinic in "blocks" rather than half-day per week experiences. We report the impact X + Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences over a 3-year timeframe. METHODS Electronic surveys were sent to residents and faculty of the participating programs prior to implementing X + Y scheduling and annually thereafter (2018-2021). Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotations. Data were analyzed using z-tests for proportion differences. RESULTS One hundred and eight six residents were sent the survey preimplementation and 254 to 289 postimplementation with response rates ranging from 47% to 69%. Three hundred and seventy-eight to 395 faculty members were sent the survey with response rates ranging from 26% to 51%. Statistically significant (P < .05) sustained perceived improvements over 3 years with X+Y were seen in outpatient continuity, inpatient workflow, and time for teaching both inpatient and in continuity clinic. CONCLUSIONS X + Y scheduling can lead to perceived improvements in various aspects of pediatric residency programs. Our study demonstrates these improvements have been sustained over 3 years in the participating programs.
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Affiliation(s)
- Ross E Myers
- Department of Pediatrics (RE Myers, K Ponitz), Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Lynn Thoreson
- Department of Pediatrics (L Thoreson), The University of Texas at Austin Dell Medical School and Dell Children's Medical Center, Austin, Tex
| | - Heather B Howell
- Department of Pediatrics (HB Howell), New York University Grossman School of Medicine, New York, NY
| | - Patricia Poitevien
- Department of Pediatrics (P Poitevien), Hasbro Children's Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | - Mary Beth Wroblewski
- Department of Pediatrics (MB Wroblewski), The University of Toledo, Toledo, Ohio
| | - Keith Ponitz
- Department of Pediatrics (RE Myers, K Ponitz), Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joanna Lewis
- Department of Pediatrics (J Lewis), Advocate Children's Hospital - Park Ridge in Park Ridge, Park Ridge, Ill
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Blankenburg R, Gonzalez del Rey J, Aylor M, Frohna JG, McPhillips H, Myers RE, Waggoner-Fountain LA, Degnon L, Poitevien P. The Impact of the COVID-19 Pandemic on Pediatric Graduate Medical Education: Lessons Learned and Pathways Forward. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S35-S39. [PMID: 34817400 PMCID: PMC8855778 DOI: 10.1097/acm.0000000000004532] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article, the authors describe the impact of the COVID-19 pandemic on pediatric graduate medical education (GME), including the impact on clinical experiences for trainees, teaching methods used, trainee wellness, GME leader wellness and support, and the traditional interview process. A thorough literature review was done to identify impacts of the COVID-19 pandemic on pediatric GME. In addition, information was collected through Association of Pediatric Program Directors virtual cafes and conferences. Positive changes for GME from the COVID-19 pandemic included: the rapid transition to telehealth; asynchronous learning allowing for increased cross-program collaboration; innovative online teaching modalities; increased flexibility and decreased cost of online recruitment; and shared innovations across pediatric GME. Challenging aspects of the COVID-19 pandemic included: decreased learning about common childhood illnesses, such as bronchiolitis, acute otitis media, and influenza; decreased patient volumes and patient complexity in clinics and inpatient wards, leading to less practice developing efficiency, time management, and triaging skills; and an increased burden on trainees, including moral distress and decreased support from one another and other social supports. The COVID-19 pandemic has highlighted important opportunities in U.S. educational systems. As medical educators move forward, it will be important to learn from these while mitigating the negative impacts.
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Affiliation(s)
- Rebecca Blankenburg
- R. Blankenburg is president, Association of Pediatric Program Directors, and associate chair of education and clinical professor, Stanford University School of Medicine, Palo Alto, California
| | - Javier Gonzalez del Rey
- J. Gonzalez del Rey is past president, Association of Pediatric Program Directors, and associate chair for education and professor, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Megan Aylor
- M. Aylor is secretary-treasurer, Association of Pediatric Program Directors, director, Pediatrics Residency Program, and associate professor, Oregon Health & Science University, Portland, Oregon
| | - John G. Frohna
- J.G. Frohna is a past member-at-large, Association of Pediatric Program Directors Board, vice chair of education and director, Pediatrics Residency Program, and professor, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Heather McPhillips
- H. McPhillips is a member-at-large, Association of Pediatric Program Directors Board, director, Pediatrics Residency Program, and professor, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Ross E. Myers
- R.E. Myers is a member-at-large, Association of Pediatric Program Directors Board, associate director, Pediatrics Residency Program, and associate professor, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - Linda A. Waggoner-Fountain
- L.A. Waggoner-Fountain is a member-at-large, Association of Pediatric Program Directors Board, associate director, Pediatrics Residency Program, and professor, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Laura Degnon
- L. Degnon is executive director, Association of Pediatric Program Directors, McLean, Virginia
| | - Patricia Poitevien
- P. Poitevien is president-elect, Association of Pediatric Program Directors, director, Residency Program, and assistant professor, Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Yarahuan JW, Bass L, Hess LM, Singhal G, Lo HY. COVID-19 Impact on Intern Exposure to Common Inpatient Diagnoses. Hosp Pediatr 2021:hpeds.2021-006077. [PMID: 34807972 DOI: 10.1542/hpeds.2021-006077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We sought to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical exposure of pediatric interns to common pediatric inpatient diagnoses. METHODS We analyzed electronic medical record data to compare intern clinical exposure during the COVID-19 pandemic from June 2020 through February 2021 with the same academic blocks from 2017 to 2020. We attributed patients to each pediatric intern on the basis of notes written during their pediatric hospital medicine rotation to compare intern exposures with common inpatient diagnoses before and during the pandemic. We compared the median number of notes written per intern per block overall, as well as for each common inpatient diagnosis. RESULTS Median counts of notes written per intern per block were significantly reduced in the COVID-19 group compared with the pre-COVID-19 group (96 [interquartile range (IQR): 81-119)] vs 129 [IQR: 110-160]; P < .001). Median intern notes per block was lower in the COVID-19 group for all months except February 2021. Although the median number of notes for many common inpatient diagnoses was significantly reduced, they were higher for mental health (4 [IQR: 2-9] vs 2 [IQR: 1-6]; P < .001) and suicidality (4.5 [IQR: 2-8] vs 0 [IQR: 0-2]; P < .001). Median shifts worked per intern per block was also reduced in the COVID-19 group (22 [IQR: 21-23] vs 23 [IQR: 22-24]; P < .001). CONCLUSIONS Our findings reveal a significant reduction in resident exposure to many common inpatient pediatric diagnoses during the COVID-19 pandemic. Residency programs and pediatric hospitalist educators should consider curricular interventions to ensure adequate clinical exposure for residents affected by the pandemic.
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Affiliation(s)
- Julia Whitlow Yarahuan
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Lanessa Bass
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Lauren M Hess
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Geeta Singhal
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Huay-Ying Lo
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Winn AS, Myers R, Grow HM, Hilgenberg S, Lieberman R, Naifeh MM, Unaka NI, Schwartz A. Pediatric Resident Perspectives on the Impact of COVID-19 on Training. Hosp Pediatr 2021; 11:hpeds.2021-005994. [PMID: 34808671 DOI: 10.1542/hpeds.2021-005994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES At the onset of the coronavirus disease 2019 pandemic, disruptions to pediatric care and training were immediate and significant. We sought to understand the impact of the pandemic on residency training from the perspective of pediatric residents. METHODS We conducted a cross-sectional survey of categorical pediatric residents at US training programs at the end of the 2019-2020 academic year. This voluntary survey included questions that explored the impact of the coronavirus disease 2019 pandemic on resident training experiences, postresidency employment plans, and attitudes and perceptions. Data were analyzed by using descriptive statistics and mixed-effects regression models. We performed a sensitivity analysis using respondents from programs with a >40% response rate for questions regarding resident attitudes and perceptions. RESULTS Residents from 127 of 201 training programs (63.2%) completed the survey, with a response rate of 18.9% (1141 of 6032). Respondents reported multiple changes to their training experience including rotation schedule adjustments, clinic cancellations, and an increase in the use of telemedicine. Respondents also reported inconsistent access to personal protective equipment and increased involvement in the care of adult patients. Graduating resident respondents reported concerns related to employment. Respondents also noted a negative impact on their personal wellness. CONCLUSIONS Responding residents reported that nearly every aspect of their training was impacted by the pandemic. Describing their experiences may help residency program and hospital leaders supplement missed educational experiences, better support residents through the remaining months of the pandemic, and better prepare for extraordinary circumstances in the future.
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Affiliation(s)
- Ariel S Winn
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ross Myers
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital and School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - H Mollie Grow
- Division of General Pediatrics, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Sarah Hilgenberg
- Division of Hospital Medicine, Department of Pediatrics, Lucile Packard Children's Hospital and School of Medicine, Stanford University, Stanford, California
| | - Rhett Lieberman
- Division of Pediatric Emergency Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Monique M Naifeh
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network, McLean, Virginia
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Reich P, White AJ. Pediatric Residency Education During the COVID-19 Pandemic. Pediatr Ann 2021; 50:e509-e514. [PMID: 34889133 DOI: 10.3928/19382359-20211111-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had profound effects on society and, in particular, on many aspects of medical care. Residency training programs are often integral parts of our medical community and consequently have experienced changes in structure, format, and content. The conversion to virtual or online learning has been nearly universal. Decreases in common pediatric diagnoses such as respiratory syncytial virus and asthma have led to less first-hand experience for residents. Limitations designed to minimize the spread of COVID-19, such as use of personal protective equipment and group size limits, have led to fewer clinic rotations, fewer clinic sessions, and fewer patient experiences. Infections of residents themselves have led to an increase in back-up call system usage and a strain on staffing. Mandatory limits on group gatherings have also impaired camaraderie and the overall well-being of trainees. [Pediatr Ann. 2021;50(12):e509-e514.].
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11
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Nguyen B, Barber A, Rassbach CE. Resident Clinical Experience During the Pandemic: What Has It Cost Us and What Have We Gained? Hosp Pediatr 2021; 11:e120-e122. [PMID: 33863815 DOI: 10.1542/hpeds.2021-005970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Bradford Nguyen
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Aisha Barber
- Department of Pediatrics, Children's National Hospital and School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Caroline E Rassbach
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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