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Jurgens V, Librizzi J, Shah N, Bhansali P, Balmer DF, Beck J. Pediatric Hospital Medicine Fellows' Perspectives on Autonomy Through Time. Hosp Pediatr 2024; 14:682-689. [PMID: 39049744 DOI: 10.1542/hpeds.2024-007855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Promoting autonomy is at the core of fellowship education. Pediatric hospital medicine (PHM) fellowship programs are relatively new, and many supervising physicians are not trained on how to promote fellow autonomy. Moreover, no studies have explored fellows' perception of autonomy throughout training. To fill this gap, we explored PHM fellows' perceptions of autonomy throughout training. METHODS PHM fellows starting fellowship in July 2021 were recruited to participate in a longitudinal qualitative study. Using self-determination theory as a sensitizing framework, the authors conducted semistructured interviews with 14 fellows throughout fellowship. Incoming data were iteratively analyzed, and codes were created from patterns in the data. Coded data were clustered into themes. RESULTS Four themes developed: (1) at the beginning of fellowship, fellows valued direct observation and close supervision from their attending. (2) Initially, fellows felt pressured to make the identical clinical decision as their attending, but over the course of training, they realized their autonomous decisions could coexist with different decisions from their attending physicians. (3) At first, fellows desired attending presence to support and guide their decision making. Over time, fellows desired a coach who could provide valuable formative feedback. (4) Because of the hierarchical nature of medicine, conversations between fellows and attending physicians about autonomy were challenging to initiate. CONCLUSIONS Fellows' perceptions of autonomy change throughout fellowship, which should be taken into consideration as provisions of autonomy evolve through training. Our findings can inform PHM fellowship curricula and professional development around the promotion of autonomy in fellowship.
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Affiliation(s)
- Valerie Jurgens
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Neha Shah
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Priti Bhansali
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Dorene F Balmer
- The Perelman School of MedicineUniversity of Pennsylvania, Philadelphia, Pennsylvania
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jimmy Beck
- Seattle Children's Hospital, Seattle, Washington
- The University of Washington School of Medicine, Seattle, Washington
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2
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Miller BG, Mike TB, Fromme HB. We're All in This Together: The Future of PHM Workforce. Hosp Pediatr 2024; 14:e362-e364. [PMID: 39034844 DOI: 10.1542/hpeds.2024-007857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Benjamin G Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas B Mike
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - H Barrett Fromme
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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3
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Fuchs J, Rajbhandari P, Webb N, Walker J. Expanding PHM Fellowships: Current Landscape, Challenges, and Potential Solutions. Hosp Pediatr 2024; 14:e116-e119. [PMID: 38282530 DOI: 10.1542/hpeds.2023-007416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Jennifer Fuchs
- University of North Carolina Children's Hospital, Chapel Hill, North Carolina
| | | | - Nicole Webb
- Valley Children's Healthcare, Madera, California
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4
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Harrison WN, Mittal VS, O'Toole JK, Quinonez RA, Mink R, Leyenaar JK. Child Health Needs and the Pediatric Hospital Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678M. [PMID: 38300016 DOI: 10.1542/peds.2023-063678m] [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] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric hospital medicine (PHM) established a new model of care for hospitalized children in the United States nearly 3 decades ago. In that time, the field experienced rapid growth while distinguishing itself through contributions to medical education, quality improvement, clinical and health services research, patient safety, and health system leadership. Hospital systems have also invested in using in-house pediatricians to manage various inpatient care settings as patient acuity has accelerated. National PHM leaders advocated for board certification in 2014, and the first certification examination was administered by the American Board of Pediatrics in 2019. In this article, we describe the development of the subspecialty, including evolving definitions and responsibilities of pediatric hospitalists. Although PHM was not included in the model forecasting future pediatric subspecialties through 2040 in this supplement because of limited historical data, in this article, we consider the current and future states of the workforce in relation to children's health needs. Expected challenges include potential alterations to residency curriculum, changes in the number of fellowship positions, expanding professional roles, concerns related to job sustainability and burnout, and closures of pediatric inpatient units in community hospitals. We simultaneously forecast growing demand in the PHM workforce arising from the increasing prevalence of children with medical complexity and increasing comanagement of hospitalized children between pediatric hospitalists and other subspecialists. As such, our forecast incorporates a degree of uncertainty and points to the need for ongoing investments in future research to monitor and evaluate the size, scope, and needs of pediatric hospitalists and the PHM workforce.
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Affiliation(s)
- Wade N Harrison
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vineeta S Mittal
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Jennifer K O'Toole
- Division of Hospital Medicine, Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ricardo A Quinonez
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Mink
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center and the David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - JoAnna K Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Health, Lebanon, New Hampshire
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Lauffer AM, Noble A, Fish D, Peterson R, Matthiesen M. COVID-19 and Its Potential Impact on Achieving Pediatric Hospital Medicine Board Certification for Established Internal Medicine-Pediatrics (Med-Peds) Hospitalists. Cureus 2024; 16:e54708. [PMID: 38523998 PMCID: PMC10960611 DOI: 10.7759/cureus.54708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
With the onset of the COVID-19 pandemic and the subsequent rise in adult hospitalized patients, many internal medicine and pediatrics (Med-Peds) hospitalists volunteered or were required by their hospital employers to transition their practice to caring for hospitalized adult patients only. Some Med-Peds hospitalists had a disruption in their practice that may affect their board eligibility for the pediatric hospital medicine (PHM) subspecialty exam in 2024. In this editorial, we review the rise of Med-Peds hospitalist careers, the evolution of PHM becoming a subspecialty, and the effect of the COVID-19 pandemic on some Med-Peds hospitalists in their quest to become board certified in PHM via the practice pathway.
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Affiliation(s)
- Andrea M Lauffer
- Hospital Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Angela Noble
- Hospital Medicine, Allina Health, Minneapolis, USA
| | - David Fish
- Internal Medicine-Pediatrics, University of Massachusetts, Worcester, USA
| | - Rachel Peterson
- Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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6
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Rauch D. Teaching Scholarship and Who Needs to Learn It. Hosp Pediatr 2024; 14:e13-e14. [PMID: 38073336 DOI: 10.1542/hpeds.2023-007534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Affiliation(s)
- Daniel Rauch
- Department of Pediatrics, Hackensack Meridian School of Medicine, and Divisions of Pediatric Hospital Medicine and General Academic Pediatrics, Hackensack Meridian Children's Health, Hackensack, New Jersey
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Kuchipudi YS, Rule A, Caldwell A, Fenchel M, Bosse D, Schuler CL, Jones YO. Pediatric Hospitalists' Performance of Recommended Minor Procedures: A Multicenter Study. Hosp Pediatr 2023; 13:1039-1047. [PMID: 37927058 DOI: 10.1542/hpeds.2023-007202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Performance of minor procedures is highly variable among pediatric hospitalists. Our objective was to describe procedural frequency and measure self-assessed competence in recommended minor procedures among practicing hospitalists. METHODS An electronic survey was administered across 20 US institutions. An individual survey assessed training, frequency, independence, and success in performing 11 minor procedures. The site survey described practice settings at participating study sites. The primary outcome was respondents' self-assessed competence (SAC), derived by averaging self-assessed independence and success scores (each on a 5-point Likert scale) across all 11 minor procedures. Associations between predictor variables and SAC were determined through analysis of variance for categorical variables and fitted regression models for continuous variables. RESULTS Of the 360 survey respondents, the majority were female (70%), not fellowship trained (78%), and had 10 years or fewer experience as a hospitalist (72%). Lumbar puncture and bag mask ventilation were most frequently performed. Greater procedural frequency and time since graduation from training were associated with higher SAC scores among respondents. Practice characteristics, including comanagement of patients and reserved time for practicing procedures, were associated with higher SAC scores. The presence of a simulation center and fellowship program was not associated with higher SAC scores. CONCLUSIONS Pediatric hospitalists that performed procedures more frequently had higher self-assessed procedural competence. Tailored opportunities with increased hands-on experience in performing minor procedures may be important to develop and maintain procedural skills.
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Affiliation(s)
| | - Amy Rule
- Divisions of Neonatology and Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory School of Medicine, Atlanta, Georgia
| | - Alicia Caldwell
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew Fenchel
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Christine L Schuler
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Yemisi O Jones
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Barak G, Dean A, Haq H, Falco C, Singhal G. The Senior Resident-Fellow Dynamic on Pediatric Hospital Medicine Teams: A Qualitative Study. Hosp Pediatr 2023; 13:912-921. [PMID: 37701970 DOI: 10.1542/hpeds.2022-006992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND AND OBJECTIVES With the Accreditation Council for Graduate Medical Education accreditation in place for pediatric hospital medicine (PHM) fellowships, fellows are playing a larger role in resident education. However, the impact of PHM fellows on pediatric residency training is not well described. We aimed to identify the factors that affect the dynamic between senior residents and fellows working together on PHM teams. METHODS In this qualitative study, we used purposive sampling and interviewed 15 senior residents and 8 PHM fellows between April and September 2020. We created a conceptual framework for the senior resident-fellow dynamic to develop the interview guide. Using verbatim transcripts uploaded into Dedoose software, 2 authors coded responses and identified themes using directed content analysis. RESULTS Twelve themes emerged as factors that impact the senior resident-fellow dynamic and fell into 6 categories: Team organization, role clarity, teaching, fellow approachability, decision-making, and attending involvement. Both senior residents and PHM fellows described an optimal dynamic in which a hierarchal approach to team structure, teaching, and decision-making is counterbalanced by fellow approachability. Role uncertainty, especially with increased attending involvement, led to conflict between residents and fellows. CONCLUSIONS This study demonstrated that a structured hierarchy surrounding supervision, decision-making, and teaching promoted level-appropriate autonomy for both senior residents and fellows. These findings can be used to design an intervention, such as a leadership curriculum for fellows and senior residents, to target behaviors that facilitate a stepwise approach to supervision and patient care.
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Affiliation(s)
- Gal Barak
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Andrea Dean
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Carla Falco
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Geeta Singhal
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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Russ CM, Gao Y, Karpowicz K, Lee S, Stephens TN, Trimm F, Yu H, Jiang F, Palfrey J. The Pediatrician Workforce in the United States and China. Pediatrics 2023:191246. [PMID: 37158018 DOI: 10.1542/peds.2022-059143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.
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Affiliation(s)
- Christiana M Russ
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | | | - Shoo Lee
- Mount Sinai Hospital, New York City, New York
- University of Toronto, Toronto, Canada
| | - Timothy Noel Stephens
- Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, China
| | - Franklin Trimm
- University of South Alabama College of Medicine, Mobile, Alabama; and
| | - Hao Yu
- Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Judith Palfrey
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Willingham E, Shelly S, Wise SK. Trends Following Implementation of an Otolaryngology Hospitalist Model in a Tertiary Care Setting. Otolaryngol Head Neck Surg 2023; 168:720-728. [PMID: 36939619 DOI: 10.1002/ohn.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The otolaryngology hospitalist (OH) model is an emerging paradigm for inpatient and acute patient care. This study presents encounter volume before and after the implementation of an OH service. Postimplementation trends are evaluated. STUDY DESIGN Retrospective administrative and clinical database review. SETTING Tertiary care university hospital. METHODS This review includes 2 distinct time frames (2008-2012, 2014-2018), representing periods before and after OH implementation. The number of billed patient encounters is compared between these 2 periods using the hospital data warehouse. Additional data is evaluated for the postimplementation period, using a clinical database. Encounter type, the reason for consultation, procedures, and requesting service/location are described. RESULTS After the OH implementation, there was a 451% increase in evaluation and management encounters submitted for billing. Since the OH model inception, there was an overall increase in encounters (849-910), procedures performed (319-345), and operative cases (46-54) per year. Each inpatient consultation request generates one or more procedures on average. Common reasons for consultation include sinonasal pathology (20.3%), dysphonia/dysphagia (17.5%), and airway evaluation (15%). Critical Care (24%), Emergency Medicine (21%), and Hospital Medicine (21%) requested most of the Otolaryngology consults. Most consults were seen on the inpatient medical/surgical floor (46%), with the ICU (27%) and the Emergency Department (22%) being the next most common locations. CONCLUSIONS The OH model is an evolving paradigm that is viable and offers timely, specialized care for patients in a hospital or acute care setting.
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Affiliation(s)
- Elizabeth Willingham
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sandeep Shelly
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
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Myers AL, Fussell JJ, Moffatt ME, Boyer D, Ross R, Dammann CEL, Degnon L, Weiss P, Sauer C, Vinci RJ. The Importance of Subspecialty Pediatricians to the Health and Wellbeing of the Nation's Children. J Pediatr 2023:13365. [PMID: 36894130 DOI: 10.1016/j.jpeds.2023.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
Through this review of published literature, it is clear that children benefit in measurable ways when they receive care from trained pediatric subspecialists. The improved outcomes provided by pediatric subspecialists supports the care provided in the patient's pediatric medical home and emphasizes the importance of care coordination between all components of the pediatric workforce. The AAP highlights this in a recent policy statement by stating the care provided by pediatric clinicians "encompasses diagnosis and treatment of acute and chronic health disorders; management of serious and life-threatening illnesses; and when appropriate, referral of patients with more complex conditions for medical subspecialty or surgical specialty care" Explicit in this statement is the emphasis on the role of complex care coordination between pediatric specialist and primary care pediatricians and that collaboration and guidance by the pediatrician is central to providing optimal care of patients. 65 Improving health outcomes early in life is an important public health strategy for modifying the complications from childhood chronic disease and highlights the role of pediatricians in mitigating the long-term consequences of antecedents of adult disease. 66 The recent announcement of the National Academies of Science, Engineering, and Medicine (NASEM)'s plan for a Consensus Study on The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-being is a related and exciting development, on a national scale. 67 In response to shortages and geographic maldistributions of pediatric subspecialists, the NASEM committee intends to assess the impact of current pediatric clinical workforce trends on child health and well-being, in order to develop informed strategies to ensure an adequate, high-quality pediatric workforce, with a robust research portfolio that informs those recommendations. While this large, national initiative will surely lead to a better understanding of and strategies to implement across the pediatric subspecialty workforce, more well-designed studies that specifically measure child outcomes related to access to pediatric subspecialty care, would add meaningfully to the body of pediatric literature and to our national pediatric advocacy initiatives.
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Affiliation(s)
- Angela L Myers
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Jill J Fussell
- Professor, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR
| | - Mary E Moffatt
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Debra Boyer
- DIO/Chief Medical Education Officer, Professor of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Robert Ross
- Children's Hospital of Michigan, Professor of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | | | | | - Pnina Weiss
- Professor of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Cary Sauer
- Professor of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Robert J Vinci
- Professor of Pediatrics, Boston University School of Medicine, Boston, MA
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Kern-Goldberger AS, Dalton EM, Rasooly IR, Congdon M, Gunturi D, Wu L, Li Y, Gerber JS, Bonafide CP. Factors Associated With Inpatient Subspecialty Consultation Patterns Among Pediatric Hospitalists. JAMA Netw Open 2023; 6:e232648. [PMID: 36912837 PMCID: PMC10011930 DOI: 10.1001/jamanetworkopen.2023.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
IMPORTANCE Subspecialty consultation is a frequent, consequential practice in the pediatric inpatient setting. Little is known about factors affecting consultation practices. OBJECTIVES To identify patient, physician, admission, and systems characteristics that are independently associated with subspecialty consultation among pediatric hospitalists at the patient-day level and to describe variation in consultation utilization among pediatric hospitalist physicians. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of hospitalized children used electronic health record data from October 1, 2015, through December 31, 2020, combined with a cross-sectional physician survey completed between March 3 and April 11, 2021. The study was conducted at a freestanding quaternary children's hospital. Physician survey participants were active pediatric hospitalists. The patient cohort included children hospitalized with 1 of 15 common conditions, excluding patients with complex chronic conditions, intensive care unit stay, or 30-day readmission for the same condition. Data were analyzed from June 2021 to January 2023. EXPOSURES Patient (sex, age, race and ethnicity), admission (condition, insurance, year), physician (experience, anxiety due to uncertainty, gender), and systems (hospitalization day, day of week, inpatient team, and prior consultation) characteristics. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of inpatient consultation on each patient-day. Risk-adjusted consultation rates, expressed as number of patient-days consulting per 100, were compared between physicians. RESULTS We evaluated 15 922 patient-days attributed to 92 surveyed physicians (68 [74%] women; 74 [80%] with ≥3 years' attending experience) caring for 7283 unique patients (3955 [54%] male patients; 3450 [47%] non-Hispanic Black and 2174 [30%] non-Hispanic White patients; median [IQR] age, 2.5 ([0.9-6.5] years). Odds of consultation were higher among patients with private insurance compared with those with Medicaid (adjusted odds ratio [aOR], 1.19 [95% CI, 1.01-1.42]; P = .04) and physicians with 0 to 2 years of experience vs those with 3 to 10 years of experience (aOR, 1.42 [95% CI, 1.08-1.88]; P = .01). Hospitalist anxiety due to uncertainty was not associated with consultation. Among patient-days with at least 1 consultation, non-Hispanic White race and ethnicity was associated with higher odds of multiple consultations vs non-Hispanic Black race and ethnicity (aOR, 2.23 [95% CI, 1.20-4.13]; P = .01). Risk-adjusted physician consultation rates were 2.1 times higher in the top quartile of consultation use (mean [SD], 9.8 [2.0] patient-days consulting per 100) compared with the bottom quartile (mean [SD], 4.7 [0.8] patient-days consulting per 100; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, consultation use varied widely and was associated with patient, physician, and systems factors. These findings offer specific targets for improving value and equity in pediatric inpatient consultation.
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Affiliation(s)
- Andrew S. Kern-Goldberger
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Evan M. Dalton
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Irit R. Rasooly
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Morgan Congdon
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Deepthi Gunturi
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lezhou Wu
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yun Li
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jeffrey S. Gerber
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Christopher P. Bonafide
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Mank VM, Wiggins A, Lowe D, Breighner C. Evaluation of an Education-based Training Orientation for Resident Physicians in an Intensive Care Unit in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:223-227. [PMID: 35923384 PMCID: PMC9344538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The need for multidisciplinary teams to provide complex care has increased as the population ages. As these teams become increasingly integrated, the knowledge, skills, and attitudes of resident physicians to practice safe and effective care in intensive care units (ICUs) evolves. A structured and multidisciplinary orientation day for resident physicians was implemented to assess improvements in physician confidence at Tripler Army Medical Center in Hawai'i from July 2019 to June 2020. ICU residents received an orientation day from a multidisciplinary team, with an emphasis on practical knowledge for common disease processes in a system-based fashion and competency in procedural skills. A total of 30 residents were asked to complete a pre- and post- orientation survey over a 1-year period, with 17 pre and post surveys completed for a response rate of 57%. The survey measured residents' perceived confidence in various tasks. Scores were compared using a paired 2-sampled t-test to assess statistical significance. The majority of resident physicians (76%) had at least 1 month of prior ICU experience. Statistically significant improvement was seen in self-reported abilities in performing 6 of the 10 elements assessed. With the diverse pathophysiology in critical care, it was essential to create a broad orientation with didactic and simulation-based learning, which resulted in observed improvement in more than half of the areas of interest. Adopting an orientation day for resident physicians rotating through the ICU can improve resident physician confidence, review important knowledge and skills, and highlight the role of each contributing multidisciplinary team member.
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Affiliation(s)
- Victoria M.F. Mank
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (VMFM, CB)
| | - Amanda Wiggins
- Department of Pulmonary and Critical Care, Emory University, Atlanta, GA (AW)
| | - Derek Lowe
- Bassett Army Community Hospital, 1-24 IN 1/25 SBCT, Ft. Wainwright, AK (DL)
| | - Crystal Breighner
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (VMFM, CB)
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Affiliation(s)
- Peter J. Carek
- Peter J. Carek, MD, MS, is Campus Dean and Professor, Department of Family Medicine, Medical University of South Carolina, AnMed Health Clinical Campus, Director of Medical Education, AnMed Health, and Associate Editor, Journal of Graduate Medical Education
| | - Arch G. Mainous
- Arch G. Mainous III, PhD, is Professor, Department of Health Services Research Management and Policy, and Department of Community Health and Family Medicine, University of Florida
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15
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McCarthy JJ, Swartz S, Liljestrom T, Menigo J, Cotter L, Toth H. Med-Peds Residents' Career Plans and the Impact of Pediatric Hospital Medicine Fellowship: A Nationwide Survey. Hosp Top 2022; 101:336-343. [PMID: 35414350 DOI: 10.1080/00185868.2022.2063775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The establishment of pediatric hospital medicine (PHM) as a fellowship-trained subspecialty represents a major change in the practice landscape, particularly for combined internal medicine-pediatrics (med-peds) residents. The most recent literature on med-peds residents' career choices predates PHM fellowship and its impact has not been well studied. We aimed characterize med-peds residents' career plans and the factors influencing their choices. METHODS We distributed an electronic survey to the 1,505 resident members of the National Med-Peds Resident Association. In addition to sociodemographic data, participants reported their career plans, how well their residency prepared them for various aspects of practice, and their perceptions of PHM fellowship and its effect on their career choices. RESULTS Among the 228 participants, the most planned careers were combined hospital medicine (36.8%, 84/228), combined subspecialty practice (32.5%, 74/228), and primary care (31.1%, 71/228). Residents felt well prepared for patient care and significantly more prepared for inpatient practice than for primary care. Participants rated the potential disadvantages of PHM fellowship as major deterrents and did not view the possible advantages as strong incentives. Among those who had considered a hospital medicine careers, 91.2% (186/203) were less likely to pursue PHM after its certification as a subspecialty. CONCLUSION Med-peds residents have a wide range of career interests but fellowship has made them less likely to pursue PHM careers. These findings emphasize the importance of addressing the needs of med-peds trained providers as PHM certification pathways and fellowship curricula develop to avoid adverse effects on the workforce.
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Affiliation(s)
- James J McCarthy
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sheila Swartz
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tracey Liljestrom
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Menigo
- Internal Medicine-Pediatrics Residency Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leah Cotter
- Internal Medicine-Pediatrics Residency Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heather Toth
- Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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16
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Gill PJ, Bayliss A, Sozer A, Buchanan F, Breen-Reid K, De Castris-Garcia K, Green M, Quinlan M, Wong N, Frappier S, Cowan K, Chan C, Arafeh D, Anwar MR, Macarthur C, Parkin PC, Cohen E, Mahant S. Patient, Caregiver, and Clinician Participation in Prioritization of Research Questions in Pediatric Hospital Medicine. JAMA Netw Open 2022; 5:e229085. [PMID: 35471568 PMCID: PMC9044112 DOI: 10.1001/jamanetworkopen.2022.9085] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE The research agenda in pediatric hospital medicine has seldom considered the perspectives of young people, parents and caregivers, and health care professionals. Their perspectives may be useful in identifying questions on topics for research. OBJECTIVE To prioritize unanswered research questions in pediatric hospital medicine from the perspectives of young people, parents/caregivers, and health care professionals. DESIGN, SETTING, AND PARTICIPANTS Between August 4, 2020, and August 19, 2021, two online surveys and a virtual workshop were conducted, using modified Delphi technique and nominal group technique. Young people, parents/caregivers, and health care professionals with experiences in pediatric hospital medicine in Canada were included. INTERVENTIONS The established James Lind Alliance Priority Setting Partnership method was used. In phase 1, a survey collected unanswered questions regarding pediatric hospital medicine via 3 open-ended questions. Survey responses were used to develop summary questions that went through an evidence-checking process. Unanswered questions were brought to a phase 2 interim prioritization survey. The top 10 unanswered research questions in pediatric hospital medicine were established at the final priority setting workshop. MAIN OUTCOMES AND MEASURES Survey responses, top 10 research questions. RESULTS The phase 1 survey was completed by 188 participants (148 of 167 [89%] females; 17 of 167 [10%] males; mean [SD] age, 39.5 [12.4] years) and generated 495 unanswered research questions and comments, of which 58 were deemed out of scope. The remaining 437 responses were grouped into themes (eg, communication, shared decision-making, health service delivery, and health service management) and then refined to 75 unanswered research questions. Of these 75, only 4 questions had sufficient evidence. To make the number of questions in phase 2 manageable, 21 questions submitted by only 1 respondent were eliminated. Fifty unanswered research questions were included in the phase 2 survey, which was completed by 201 participants (165 of 186 [89%] females; 19 of 186 [10%] males; mean [SD] age, 40.0 [11.0] years). A short list of 16 questions-the top 10 questions from patient partners (youths, parents/caregivers) and clinicians-was presented at the final priority setting workshop and the top 10 questions were prioritized. The top 10 questions focused on the care of special inpatient populations (eg, children with medical complexity), communication, shared decision-making, support strategies in the hospital, mental health supports, shortening length of stay, and supporting Indigenous patients, parents/caregivers, and families. CONCLUSIONS AND RELEVANCE This patient-oriented pediatric hospital medicine priority setting partnership identified the most important unanswered research questions focused on the care of children in the hospital. These questions provide a possible roadmap for research on areas deemed important to young people, parents/caregivers, and clinicians.
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Affiliation(s)
- Peter J. Gill
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, Department of Pediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Aubrey Sozer
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Francine Buchanan
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Research Family Advisory Committee, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Breen-Reid
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Mairead Green
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Michelle Quinlan
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Noel Wong
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shelley Frappier
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | | | - Carol Chan
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Dana Arafeh
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Rashid Anwar
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Colin Macarthur
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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17
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Salada KO, Rodriguez VA, Norton Z, Jackson KL, Bockrath RA. Pediatric Hospital Medicine Resident Elective: A Novel Resident Curriculum for an Evolving Field. Cureus 2022; 14:e23451. [PMID: 35481331 PMCID: PMC9034736 DOI: 10.7759/cureus.23451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Although 8-10% of pediatric residents pursue a career in Pediatric Hospital Medicine (PHM), many report an incomplete understanding of PHM careers and would benefit from a PHM elective. Methodology We followed Kern’s six-step curriculum development framework. A general needs assessment via literature review revealed a lack of published PHM elective curricula. A targeted needs assessment was conducted by surveying national PHM fellowship program directors, national PHM fellows, local junior PHM attendings, and local pediatric residents. Content analysis from these surveys was used to develop a PHM resident elective curriculum. The curriculum was implemented and evaluated through an experience log and written reflections. Results Needs assessment surveys were completed by fellowship directors (22/61, 36%), fellows (36/103, 35%), attendings (10/26, 38%), and residents (15/98, 15%). Common themes included the importance of academic experiences, mentorship, non-teaching and non-inpatient clinical experiences, community hospital experience, and the desire to address knowledge gaps. Significant variability in survey responses suggested the importance of an individualized curriculum. Goals, objectives, and aligned educational strategies were developed to provide a breadth of clinical experiences, mentorship, and PHM-focused academic activities, with an emphasis on individualization. Implementation of the curriculum began in July 2021 and four residents enrolled in 2021-2022. The curricular evaluation demonstrated the achievement of objectives and improved resident awareness of PHM opportunities, clinical skill development, ancillary shadowing, and academic opportunities. Conclusions A PHM resident elective was developed using Kern’s six-step approach with input from national fellows and fellowship program directors to address educational gaps and increase exposure to PHM careers. The next steps include the evaluation of the impact of the PHM elective on career choice and preparedness of residents.
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18
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Rassbach CE, Fiore D. Research and Career Outcomes for Pediatric Hospital Medicine Fellowship Graduates. Hosp Pediatr 2021; 11:1082-1114. [PMID: 34561241 DOI: 10.1542/hpeds.2021-005938] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pediatric hospital medicine (PHM) fellowships have rapidly developed to meet established needs. The purpose of this research was to describe the research and career outcomes of PHM fellowship graduates. We hypothesized that graduates would report significant research and academic productivity. METHODS This was an institutional review board-approved, cross-sectional survey of PHM fellowship graduates in 2018. The 88-item survey was modified from an existing survey, developed by experts to address study objectives and pilot tested, and it included quantitative and qualitative items to assess characteristics of fellowship training and research and career outcomes. RESULTS A total of 63% of PHM fellowship graduates (143 of 228) completed the survey (graduation dates, 2000-2018). In total, 89% graduated from dedicated PHM fellowship programs, with 59% completing a 2-year fellowship and 78% now practicing primarily at a university or children's hospital. Fellows conducted research in clinical research (53%), quality improvement (41%), health services (24%), and medical education (19%). A total of 77% of graduates continued to do research after graduation, with 63% publishing and 25% obtaining grant funding. Graduates of 2- and 3-year fellowships and those with a master's degree were significantly more productive. Graduates now hold important roles in academic and health systems leadership. Graduates are highly satisfied with their decision to do PHM fellowship and identified 5 themes regarding how fellowship impacted their career outcomes. CONCLUSIONS In this study, we document robust research activity and leadership positions among PHM fellowship graduates and can serve as a benchmark for metrics that PHM educational leaders can use to assess outcomes and improve training regarding research and career development.
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Affiliation(s)
- Caroline E Rassbach
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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19
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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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20
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Rooholamini SN, Smith S, Beck J. The Best of Both Worlds: Strengthening Medical Education Research and Evaluation Using Quality Improvement. Hosp Pediatr 2021; 11:e349-e351. [PMID: 34155083 DOI: 10.1542/hpeds.2021-006122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Sherilyn Smith
- Department of Pediatrics, University of Washington, Seattle, WA.,Aquifer, Lebanon, NH
| | - Jimmy Beck
- Department of Pediatrics, University of Washington, Seattle, WA
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21
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Librizzi J, Frank E, Jerardi K, Maniscalco J, Rassbach C, Shah N, Walker J. Development of Goals and Objectives for Pediatric Hospital Medicine Fellowship Curricula. Hosp Pediatr 2021; 11:650-655. [PMID: 34049964 DOI: 10.1542/hpeds.2020-003681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jamie Librizzi
- Department of Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona;
| | - Erin Frank
- University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Karen Jerardi
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Carrie Rassbach
- Lucile Packard Children's Hospital at Stanford, Palo Alto, California
| | - Neha Shah
- Children's National Hospital, Washington, District of Columbia; and
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22
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Jeffers AM. Safe transitions from the hospital to home: A review of the pediatric hospitalist's discharge workflow. Curr Probl Pediatr Adolesc Health Care 2021; 51:101021. [PMID: 34172418 DOI: 10.1016/j.cppeds.2021.101021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For children to have safe transitions from the hospital to home, inpatient physicians, nurse practitioners, and physician assistants, should use a standardized discharge process that focuses on thorough discharge planning, multidisciplinary teamwork, communication, and effective hand-offs of care. Using quality improvement science will help physicians analyze and improve their discharge process and ensure safe discharges.
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Affiliation(s)
- Amy M Jeffers
- Dayton Children's Hospital, United States; Pediatric Medical Student Education, Boonshoft school of Medicine at Wright State University, United States; Boonshoft School of Medicine at Wright State University, United States.
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23
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Catenaccio E, Rochlin JM, Simon HK. Differences in Lifetime Earning Potential for Pediatric Subspecialists. Pediatrics 2021; 147:peds.2020-027771. [PMID: 33685988 DOI: 10.1542/peds.2020-027771] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our 2011 report, reflecting data from 2007-2008, demonstrated that, for many pediatric subspecialties, pursuing fellowship training was a negative financial decision when compared with practicing as a general pediatrician. We provide an updated analysis on the financial impact of pediatric fellowship training and model interventions that can influence the results. METHODS We estimated the financial returns a graduating pediatric resident might anticipate from fellowship training followed by a career as a pediatric subspecialist and compared them with the returns expected from starting a career as a general pediatrician immediately after residency. We evaluated the potential effects of eliminating medical school debt, shortening the length of fellowship training, and implementing a federal loan repayment program for pediatric subspecialists. We compared the financial returns of subspecialty training in 2018-2019 to those from our previous report. RESULTS Pursuing fellowship training generated widely variable financial returns when compared with general pediatrics that ranged from +$852 129 for cardiology to -$1 594 366 for adolescent medicine. Twelve of 15 subspecialties analyzed yielded negative financial returns. The differences have become more pronounced over time: the spread between the highest and lowest earning subspecialties widened from >$1.4 million in 2007-2008 to >$2.3 million in 2018-2019. The negative financial impact of fellowship training could be partially ameliorated by shortening the length of training or by implementing pediatric subspecialist specific loan repayment programs. CONCLUSIONS This report can be used to help guide trainees, educators, and policy makers. The interventions discussed could help maintain an adequate and balanced pediatric workforce.
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Affiliation(s)
- Eva Catenaccio
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland;
| | - Jonathan M Rochlin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York; and
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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24
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Bingoler Pekcici EB, Gumus Dogan D, Ozalp Akin E, Buyukavci A, Akpinar F, Hayran G, Arslan N, Doganay B, Ozturk Ertem I. Referral Trends in Two Pioneering Developmental-Behavioral Pediatric Centers in Turkey. J Dev Behav Pediatr 2021; 42:227-233. [PMID: 33093303 DOI: 10.1097/dbp.0000000000000881] [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] [Received: 03/01/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To inform professionals pioneering developmental-behavioral pediatrics (DBP) services in low- and middle-income countries (LMICs), we aimed to examine referral trends in 2 pioneering DBP centers at different locations in Turkey and to ascertain whether the official establishment of DBP as a subspecialty affected these trends. METHOD This longitudinal observational study included all children referred to Ankara (AUDPD) and Inonu (IUDPD) Universities' Developmental Pediatrics Divisions between 2010 and 2018. We examined the sources of referrals and the independent effects of time and the establishment of DBP as a subspecialty on referral volume using Negative Binomial Regression (NBR) models. RESULTS Of 8,051 children, most were boys (58%) and under 24 months of age (72%). Most referrals were from the pediatric and pediatric surgery department clinics (85%); less than 1% were from child and adolescent psychiatry, and none were from family physicians. The NBR models showed that yearly, the referral volume increased significantly, 1.18-fold (95% confidence interval [CI] = 1.09-1.28) and 1.48-fold (95% CI = 1.20-1.82) for AUDPD and IUDPD, respectively. Compared with the trend of referrals before, the trend after the establishment of DBP as a subspecialty increased significantly at AUDPD, but not IUDPD. CONCLUSION The increase in referrals to DBP over time is encouraging to professionals working to advance DBP services and training in LMICs even if DBP is not officially established as a subspecialty. Additional efforts may be needed to improve recognition and use of DBP services by community physicians and allied disciplines that provide services to children.
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Affiliation(s)
- Emine Bahar Bingoler Pekcici
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Derya Gumus Dogan
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Inonu University School of Medicine, Malatya, Turkey
| | - Ezgi Ozalp Akin
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Akif Buyukavci
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Inonu University School of Medicine, Malatya, Turkey
| | - Funda Akpinar
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Gamze Hayran
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Necati Arslan
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Inonu University School of Medicine, Malatya, Turkey
| | - Beyza Doganay
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Ilgi Ozturk Ertem
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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25
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Harrington JW. Integrated pediatric urgent care: A perfect fit into patient-centered medical home and meeting the needs of population health and our profession. Curr Probl Pediatr Adolesc Health Care 2021; 51:100969. [PMID: 33676841 DOI: 10.1016/j.cppeds.2021.100969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
General Pediatricians have been constrained into a narrower band of primary care practice with the advent of hospitalists, advanced practice professionals and pediatric specific urgent cares. This new patient care structure will require electronic medical records and institutional systems to decrease interfaces and increase integration, thereby allowing a free flow of information that will provide more efficient and safe care. Pediatric specific urgent cares that are integrated will be able to utilize both efficient system level 1 thinking and deeper more thoughtful system level 2 thinking, which will benefit the pediatric patient by decreasing diagnostic errors. If done appropriately, everywhere a pediatric patient contacts the healthcare system, including pediatric specific urgent cares, the patient should be provided a longitudinal, seamless and specific high quality of care that fits the venue they contact.
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Affiliation(s)
- John W Harrington
- Children's Hospital of The King's Daughters, Norfolk, Virginia, United States.
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26
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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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27
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Nelson A, Fox J, Toth H, Stephany A. Ramping Up a Pediatric Hospital Medicine Advanced Practice Provider Team Rapidly. Hosp Top 2020; 99:44-47. [PMID: 33357127 DOI: 10.1080/00185868.2020.1848397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pediatric Hospital Medicine (PHM) is a growing subspecialty with a broad scope. The Covid-19 pandemic demands flexible staffing models. Advanced practice providers (APPs) can be a valuable addition to hospital medicine teams, although there is no established training program for APPs within PHM. The authors' purpose is to describe how one institution rapidly established a PHM APP team by collaborating with experienced APPs working in other areas of the hospital. This APP team cared for 16% of the average daily census during the pilot period with no significant difference in length of stay compared to traditional teams.
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Affiliation(s)
- Anika Nelson
- Children's Wisconsin, Milwaukee, WI, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jaime Fox
- Children's Wisconsin, Milwaukee, WI, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heather Toth
- Children's Wisconsin, Milwaukee, WI, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Roberts KB. The Intertwined Histories of Resident Education and Pediatric Hospital Medicine in the US. Pediatrics 2020; 146:peds.2020-017210. [PMID: 33144497 DOI: 10.1542/peds.2020-017210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
The histories of pediatric resident education and pediatric hospital medicine (PHM) are intertwined. PHM, now a new subspecialty, is generally considered to have emerged from the hospitalist movement in the late 1990s but is actually what some influential pediatricians in the 19th century envisioned for pediatrics in the United States, comparable to the British model. The prime focus of resident education during the 20th century remained hospital care, even during the years of national concern regarding the need for more primary care physicians. Various changes in resident education have contributed to the rise of PHM as a subspecialty. Requirements for subspecialty certification in PHM have implications for general residency training in pediatrics.
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Affiliation(s)
- Kenneth B Roberts
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Mittal V, Shah N, Dwyer AC, O'Toole JK, Percelay J, Carlson D, Woods S, Lee V, Russo C, Black N, Rauch D, Chase L, Quinonez R, Fisher ES. Developing Content for Pediatric Hospital Medicine Certification Examination Using Practice Analysis. Pediatrics 2020; 146:peds.2019-3186. [PMID: 32727825 DOI: 10.1542/peds.2019-3186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The American Board of Pediatrics (ABP) and the Pediatric Hospital Medicine (PHM) subboard developed a content outline to serve as a blueprint for the inaugural certification examination through practice analysis. The systematic approach of practice analyses process is described in the study. METHODS A diverse, representative panel of 12 pediatric hospitalists developed the draft content outline using multiple resources (publications, textbooks, PHM Core Competencies, PHM fellow's curriculum, etc). The panel categorized practice knowledge into 13 domains and 202 subdomains. By using the ABP database self-defined practicing pediatric hospitalists were identified. Participants rated the frequency and criticality of content domains and subdomains along with providing open-ended comments. RESULTS In total, 1449 (12.1%) generalists in the ABP database self-identified as pediatric hospitalists, and 800 full-time pediatric hospitalists responded. The content domains that were rated as highly critical and frequently required in practice were weighted more heavily (ie, the percentage of examination questions associated with a domain) than the less critical and less frequently rated. Both community and noncommunity pediatric hospitalists rated domains similarly (P = .943). Subdomain and preliminary weights were rated with similar means and SDs in the majority of topics. CONCLUSIONS There was concordance in the rating of domain and universal tasks among both community and noncommunity hospitalists. The areas of significant differences, although minor, could be explained by difference in practice settings. The practice analysis approach was structured, engaged the PHM community, reflected the breadth and depth of knowledge required for PHM practice, and used an iterative process to refine the final product.
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Affiliation(s)
- Vineeta Mittal
- Division of Pediatric Hospital Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas;
| | - Neha Shah
- Hospitalist Division, Children's National Hospital and School of Medicine & Health Sciences, George Washington University, Washington, District of Columbia
| | | | - Jennifer K O'Toole
- Division of Hospital Medicine, Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jack Percelay
- Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital and Stanford Medicine, Stanford University, Palo Alto, California
| | - Douglas Carlson
- Department of Pediatrics, School of Medicine, Southern Illinois University, Springfield, Illinois
| | - Suzanne Woods
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Vivian Lee
- Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital and Stanford Medicine, Stanford University, Palo Alto, California
| | - Christopher Russo
- Hospitalists, Centra Medical Group, Centra Health, Lynchburg, Virginia
| | - Nichole Black
- Hospitalist Division, Children's National Hospital and School of Medicine & Health Sciences, George Washington University, Washington, District of Columbia
| | - Daniel Rauch
- Division of Hospital Medicine, Floating Hospital for Children at Tufts Medical Center and School of Medicine, Tufts University, Boston, Massachusetts
| | - Lindsay Chase
- Section of Pediatric Hospital Medicine, North Carolina Children's Hospital and University of North Carolina, Chapel Hill, North Carolina
| | - Ricardo Quinonez
- Division of Pediatric Hospital Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Erin S Fisher
- Division of Pediatric Hospital Medicine, Rady Children's Hospital-San Diego and University of San Diego, San Diego, California
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Gross CJ, Chiel LE, Gomez AR, Marcus CH, Michelson CD, Winn AS. Defining the Essential Components of a Teaching Service. Pediatrics 2020; 146:peds.2020-0651. [PMID: 32487591 DOI: 10.1542/peds.2020-0651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES A large portion of residency education occurs in inpatient teaching services without widely accepted consensus regarding the essential components that constitute a teaching service. We sought to generate consensus around this topic, with the goal of developing criteria programs that can be used when creating, redesigning, or evaluating teaching services. METHODS A list of potential components of teaching services was developed from a literature search, interviews, and focus groups. Eighteen pediatric medical education experts participated in a modified Delphi method, responding to a series of surveys rating the importance of the proposed components. Each iterative survey was amended on the basis of the results of the previous survey. A final survey evaluating the (1) effort and (2) impact of implementing components that had reached consensus as recommended was distributed. RESULTS Each survey had 100% panelist response. Five survey rounds were conducted. Fourteen attending physician characteristics and 7 system characteristics reached consensus as essential components of a teaching service. An additional 25 items reached consensus as recommended. When evaluating the effort and impact of these items, the implementation of attending characteristics was perceived as requiring less effort than system characteristics but as having similar impact. CONCLUSIONS Consensus on the essential and recommended components of a resident teaching service was achieved by using the modified Delphi method. Although the items that reached consensus as essential are similar to those proposed by the Accreditation Council for Graduate Medical Education, those that reached consensus as recommended are less commonly discussed and should be strongly considered by institutions.
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Affiliation(s)
- Caroline J Gross
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and .,Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Laura E Chiel
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Amanda R Gomez
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Carolyn H Marcus
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
| | - Catherine D Michelson
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Ariel S Winn
- Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts; and
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31
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Roberts KB, Fisher ERS, Rauch DA. The History of Pediatric Hospital Medicine in the United States, 1996-2019. J Hosp Med 2020; 15:424-427. [PMID: 32195659 DOI: 10.12788/jhm.3381] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kenneth B Roberts
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Erin Ragan-Stucky Fisher
- Department of Pediatrics, University of California San Diego School of Medicine/Rady Children's Hospital, San Diego, California
- Rady Children's Hospital, San Diego, California
| | - Daniel A Rauch
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
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32
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Wang ME, Shaughnessy EE, Leyenaar JK. The Future of Pediatric Hospital Medicine: Challenges and Opportunities. J Hosp Med 2020; 15:428-430. [PMID: 32118553 DOI: 10.12788/jhm.3373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Marie E Wang
- Division of Pediatric Hospital Medicine, Stanford University School of Medicine, and Lucile Packard Children's Hospital Stanford, Stanford, California
| | - Erin E Shaughnessy
- Division of Hospital Medicine, Phoenix Children's Hospital, and Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - JoAnna K Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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33
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Vetere P, Cooke S. Preparedness to practice paediatric hospital medicine. Paediatr Child Health 2019; 25:447-454. [PMID: 33173556 DOI: 10.1093/pch/pxz113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background The field of paediatric hospital medicine (PHM) is evolving to meet the needs of an increasingly complex paediatric population, lead quality improvement initiatives, and conduct field-specific teaching and research. Over 50 subspecialty PHM fellowship programs exist in the USA and Canada and more are under active development to ensure trainees are prepared to perform competencies specific to the field following transition to independent practice. Objective The objective of this study was to assess the perceived preparedness of recently graduated general paediatric residents and recently certified staff paediatricians in Canada with respect to the practice of PHM. Methods A survey based on the 'Objectives of Training in Pediatrics' of the Royal College of Physicians and Surgeons of Canada (RCPSC) was distributed to graduating paediatric residents and recently graduated staff paediatricians (2013 to 2017) practicing in the hospital setting. Qualitative comments were also obtained. Results Fifty-five surveys were completed (50%). Respondents perceived that, at the on-set of starting practice, they would require assistance or consultation with the majority of representative PHM task competencies. Differences in perception between the two groups were minimal. Our study identified sub-sets of perceived areas of particular strengths (Professional) and deficiencies (Medical Expert, Manager, and Scholar). Conclusions Results may help inform future curricula for general paediatric residency programs and provide insight into competencies that may be better targeted for PHM fellowship training programs. This study may also stimulate discussion regarding entrustable professional activities for paediatric curricula as the medical community shifts to a new paradigm of outcome-based assessment.
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Affiliation(s)
- Peter Vetere
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Section of Hospital Pediatrics, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta
| | - Suzette Cooke
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta.,Section of Hospital Pediatrics, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta
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34
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Pediatric Hospital Medicine: Where We Are, Where We Are Headed: State of the Specialty, Looking Forward. Pediatr Clin North Am 2019; 66:891-895. [PMID: 31230630 DOI: 10.1016/j.pcl.2019.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although pediatric hospital medicine (PHM) is in its adolescence, it is already having a major impact on patient care, quality, safety, and education. Pediatric hospitalists have been front-and-center in the safety and quality movement, driving change as clinicians, applying evidence-based medicine to standardize practice and promulgate evidence-based guidelines, and playing a central role in optimizing the function of inter-professional teams. Pediatric hospitalists have championed the importance of patient-and family-centeredness of care and the need to incorporate principles of health literacy into all aspects of clinical care and research. Beyond delivering care, pediatric hospitalists have prominent roles as hospital leaders, educators, and researchers and have played a critical role in promoting improvements in health and health care outcomes. In its continued evolution, clinical care will undoubtedly remain the major focus, though with subspecialty status, the field will be expected to accelerate innovations in systems-based practice, advance clinical learning environments, and drive further improvements in quality of care.
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35
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Starmer AJ, Ramotar MW, Spector ND. An Evolving Clinical Setting for Education: Pediatric Hospital Medicine. Pediatr Clin North Am 2019; 66:xix-xx. [PMID: 31230631 DOI: 10.1016/j.pcl.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Amy J Starmer
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston MA 02115, USA.
| | - Matthew W Ramotar
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Nancy D Spector
- Drexel University College of Medicine, 245 North 15th Street, Mail Stop 400, Philadelphia, PA 19102, USA.
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36
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Desai AD, Starmer AJ. Process Metrics and Outcomes to Inform Quality Improvement in Pediatric Hospital Medicine. Pediatr Clin North Am 2019; 66:725-737. [PMID: 31230619 DOI: 10.1016/j.pcl.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides an overview of the selection, development, and use of process and outcome measures for pediatric hospital medicine quality improvement initiatives. It reviews commonly used categories of process and outcome measures and provides a list of common sources and repositories of previously validated measures. It also provides a blueprint for the development of novel measures. The relative merits of various data collection methods are discussed (eg, medical record abstraction, administrative, surveys), along with guiding principles for disseminating the results of quality improvement evaluations on a local and national level.
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Affiliation(s)
- Arti D Desai
- University of Washington, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA.
| | - Amy J Starmer
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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37
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Burke RE, Myers JS. Waiting for Godot: The Quest to Promote Scholarship in Hospital Medicine. J Hosp Med 2019; 14:508-509. [PMID: 31386618 DOI: 10.12788/jhm.3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Hospital Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer S Myers
- Hospital Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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38
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Abstract
Bedside rounds have evolved concurrently with hospitalist medicine and patient-centered care. Family-centered rounds are the foundation of effective communication in the in-patient pediatric setting. Participant perspectives (family members, patients, nurses, faculty, and trainees) on family-centered rounds differ and goals may not always align. Further, the practical components of how rounds are conducted varies and have continued opportunities for improvement. This article summarizes the most recent experience with rounds in an attempt to identify unified and effective strategies moving forward.
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Affiliation(s)
- Lauren A Destino
- Stanford University, Lucile Packard Children's Hospital, 300 Pasteur MC 5776, Palo Alto, CA 94034, USA.
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue ML 9016, Cincinnati, OH 45229, USA
| | - Brian Good
- University of Utah, Primary Children's Hospital, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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39
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Austin JP, Foster BA. How Pediatric Hospitalists Must Contend With the Expert Halo Effect. Hosp Pediatr 2019; 9:560-562. [PMID: 31175143 DOI: 10.1542/hpeds.2019-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Byron A Foster
- Departments of Pediatrics and
- Dermatology, Oregon Health & Science University, Portland, Oregon
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40
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Rappaport DI, Ierardi J, Greenspan JS. Pediatric Hospital Medicine Board Certification: A Solution, but to Which Problem? J Pediatr 2019; 210:5-7.e1. [PMID: 31133281 DOI: 10.1016/j.jpeds.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Affiliation(s)
- David I Rappaport
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Jane Ierardi
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Pediatrics, Nemours Children's Hospital, Orlando, Florida
| | - Jay S Greenspan
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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41
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Atkinson MK, Schuster MA, Feng JY, Akinola T, Clark KL, Sommers BD. Adverse Events and Patient Outcomes Among Hospitalized Children Cared for by General Pediatricians vs Hospitalists. JAMA Netw Open 2018; 1:e185658. [PMID: 30646280 PMCID: PMC6324330 DOI: 10.1001/jamanetworkopen.2018.5658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Pediatric hospital medicine is a relatively new and growing specialty. However, research remains inconclusive on outcomes for inpatients cared for by pediatric hospitalists compared with those cared for by general pediatricians. OBJECTIVE To analyze outcomes, adverse events (AEs), and types of AEs associated with care provided for pediatric patients by hospitalists vs general pediatricians. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the medical records of a US urban academic children's hospital comprising 1423 hospitalizations between January 1, 2009, and August 31, 2015, for 57 diagnoses of patients cared for by either a hospitalist or general pediatrician. General pediatricians worked primarily in the hospital's outpatient clinic, serving a few inpatient weeks per year, and were not the patients' primary care physician. Data analysis was performed from July 1, 2017, to October 10, 2018. MAIN OUTCOMES AND MEASURES Outcomes were length of stay, total costs, 30-day readmission rates, and AEs. Adverse events were documented by International Classification of Diseases, Ninth Revision, Clinical Modification codes determined by review of medical records. Adverse event categories were drug events, infections, and device-related AEs. Generalized linear models were used to analyze patient outcomes, with standard errors clustered by physician. Models were adjusted for patient characteristics, including Chronic Condition Indicators. Models were estimated with and without adjustment for physician characteristics. RESULTS The data set contained 1423 hospitalizations among 726 female patients and 697 male patients (mean [SD] age, 6.1 [6.3] years). Hospitalists cared for 870 patients, and general pediatricians cared for 553 patients. Among the physicians, there were 57 women and 38 men; physicians were a mean (SD) 11.1 (8.1) years out of medical school. Patients cared for by general pediatricians were younger than those cared for by hospitalists (mean [SD] age, 5.4 [6.0] vs 6.5 [6.4] years; P = .001) but had similar mean (SD) Chronic Condition Indicator scores (1.5 [1.0] vs 1.5 [1.0]). A total of 33 of 56 general pediatricians (58.9%) and 24 of 39 hospitalists (61.5%) were women (P = .006), and general pediatricians were in practice twice as long as hospitalists on average (mean [SD], 16.0 [10.3] vs 7.9 [3.8] years out of medical school; P < .001). In multivariate models adjusting for patient-level features, there were no significant differences between general pediatricians and hospitalists for mean length of stay (4.7 vs 4.6 days), total costs ($14 490 vs $15 200), and estimated 30-day readmission rate (8.9% vs 6.4%), and results were similar with adjustments for physician characteristics. Device-related AEs were higher among hospitalists (3.0% vs 1.1%; odds ratio, 0.34; 95% CI, 0.12-1.00); this association became nonsignificant after adjusting for physician experience. CONCLUSIONS AND RELEVANCE General pediatrician and hospitalist inpatient care had similar length of stay, total costs, and readmission rates. However, AEs differed between hospitalists and general pediatricians, with device-related AEs more common among hospitalists, which may be associated with hospitalists' fewer years in practice. Such findings can inform hospitals in planning their inpatient staffing and patient safety oversight.
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Affiliation(s)
- Mariam Krikorian Atkinson
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Jeremy Y. Feng
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston
| | - Temilola Akinola
- Department of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Kathryn L. Clark
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Benjamin D. Sommers
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Division of General Medicine & Primary Care, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
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42
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Basco WT. Comparing the Care of Pediatric Hospitalists With That of General Pediatricians: Is It a Question With Waning Relevance? JAMA Netw Open 2018; 1:e185686. [PMID: 30646273 DOI: 10.1001/jamanetworkopen.2018.5686] [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: 11/14/2022] Open
Affiliation(s)
- William Thomas Basco
- Division of General Pediatrics, The Medical University of South Carolina, Charleston
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43
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Wheeler DS, Dewan M, Maxwell A, Riley CL, Stalets EL. Staffing and workforce issues in the pediatric intensive care unit. Transl Pediatr 2018; 7:275-283. [PMID: 30460179 PMCID: PMC6212383 DOI: 10.21037/tp.2018.09.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The health care industry is in the midst of incredible change, and unfortunately, change is not easy. The intensive care unit (ICU) plays a critical role in the overall delivery of care to patients in the hospital. Care in the ICU is expensive. One of the best ways of improving the value of care delivered in the ICU is to focus greater attention on the needs of the critical care workforce. Herein, we highlight three major areas of concern-the changing model of care delivery outside of the traditional four walls of the ICU, the need for greater diversity in the pediatric critical care workforce, and the widespread problem of professional burnout and its impact on patient care.
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Affiliation(s)
- Derek S Wheeler
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maya Dewan
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrea Maxwell
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carley L Riley
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Erika L Stalets
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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44
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Hospitalist Medicine-Chairs' Perspective of Specialty Status and Training Requirements. J Pediatr 2018; 193:4-8.e1. [PMID: 29389453 DOI: 10.1016/j.jpeds.2017.11.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/24/2022]
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45
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Tarchichi TR, Garrison J, Jeong K, Fabio A. Comparison of Patient Outcome Measures between a Traditional Teaching Hospitalist Service and a Non-Teaching Hospitalist Service at an Academic Children's Hospital. ACTA ACUST UNITED AC 2017; 7. [PMID: 29354324 PMCID: PMC5771429 DOI: 10.4172/2161-0665.1000336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background and objectives Inpatient pediatric care is increasingly provided by pediatric hospitalists. This, in addition to changes in resident duty hour restrictions, has led to the creation of new models of care for inpatient pediatric patients. The objective of this study was to compare traditional outcome measures between a pediatric hospitalist-only service and a more traditional academic service in which care was provided by pediatric hospitalists, residents, and medical students. Attending physicians on the hospitalist-only service had an average of 1.7 years of post-residency experience compared to an average 16 years of experience for those working on the traditional academic service. Methods This retrospective cohort study (hospitalist-only v. teaching service) used electronic medical records data of patients (n=1,059) admitted to a quaternary care, academic, children’s hospital in Pittsburgh Pennsylvania with diagnoses of bronchiolitis, viral syndrome, and gastroenteritis from July 2011 to June 2014. Primary outcome measures included length of stay, hospital costs, and readmission rates. Results Patients with a diagnosis of bronchiolitis admitted to the hospitalist-only service had a significantly higher severity-of-illness-score than those admitted to the teaching service. A decreased length of stay and lower hospital costs were seen for patients admitted to the hospitalist-only service; however, these differences did not reach a level of statistical significance. Conclusion There were no statistically significant differences in the outcome measures of patients with common pediatric illnesses admitted to a hospitalist-only versus a teaching hospitalist service. The model of a hospitalist-only service staffed by recent residency graduates may provide an efficient and effective model of care as patients admitted to this service had similar outcome measures to those patients cared for by more-experienced attending physicians.
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Affiliation(s)
- Tony R Tarchichi
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Jessica Garrison
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, USA.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Kwonho Jeong
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Anthony Fabio
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA
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46
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Hageman JR. Community Primary Provider Involvement in Hospital Care. Pediatr Ann 2017; 46:e245. [PMID: 28697263 DOI: 10.3928/19382359-20170619-01] [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: 11/20/2022]
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