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Chiel L, Gans HA, Bales M, King S, Mason K, Schwartz A, Kesselheim J, Boyer D. A Pilot Survey on the Perceptions of Pediatric Subspecialty Fellows and Program Directors on Virtual Compared with In-Person Interview Experiences. J Pediatr 2024; 270:114019. [PMID: 38514003 DOI: 10.1016/j.jpeds.2024.114019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/25/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
Pediatric fellowship programs have conducted virtual interviews since the start of the COVID-19 pandemic in 2020. In this national survey of fellowship program directors and fellows interviewed in-person and virtually, fellowship program directors and fellows formed accurate impressions, regardless of format, but our data did not clearly support one interview format over another.
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Affiliation(s)
- Laura Chiel
- Instructor, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Hayley A Gans
- Stanford University Medical Center, Department of Pediatrics, Center for Academic Medicine, Palo Alto, CA
| | - Melissa Bales
- Pediatric Subspecialty Program Coordinator, Department of Pediatric, Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, IN
| | - Sarah King
- Director of Fellowship Programs, Department of Graduate Medical Education, Children's Mercy Kansas City, Kansas City, MO
| | - Katherine Mason
- Assistant Dean Faculty Development, Warren Alpert Medical School at Brown University, Vice Chair of Education, Department of Pediatrics, Providence, RI
| | - Alan Schwartz
- The Michael Reese Endowed Professor of Medical Education, Department of Medical Education, University of Illinois at Chicago, Chicago, IL; Research Professor, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL; Director, Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN), McLean, VA
| | - Jennifer Kesselheim
- Associate Professor and Designated Institutional Official, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Debra Boyer
- Designated Institutional Official and Chief Medical Education Officer, Nationwide Children's Hospital, Columbus, OH
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2
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Mink RB, Carraccio CL, Herman BE, Weiss P, Turner DA, Stafford DEJ, McGann KA, Kesselheim J, Hsu DC, High PC, Fussell JJ, Curran ML, Chess PR, Sauer C, Pitts S, Myers AL, Mahan JD, Dammann CEL, Aye T, Schwartz A. Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment. BMC Med Educ 2023; 23:720. [PMID: 37789289 PMCID: PMC10548580 DOI: 10.1186/s12909-023-04689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment. OBJECTIVES We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME). METHODS In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale. RESULTS One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05). CONCLUSIONS We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.
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Affiliation(s)
- Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA.
| | | | - Bruce E Herman
- University of Utah School of Medicine, Salt Lake, UT, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Diane E J Stafford
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | | | - Pamela C High
- Alpert Medical School of Brown University, Providence, RI, USA
- Developmental-Behavioral Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
| | - Jill J Fussell
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA
| | - Megan L Curran
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cary Sauer
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Angela L Myers
- Center for Wellbeing, Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Tandy Aye
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alan Schwartz
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
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3
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Abstract
This cross-sectional study evaluates the extent of housing unaffordability among US residency programs.
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Affiliation(s)
- Ryan C L Brewster
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Alex Butler
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Jennifer Kesselheim
- Department of Pediatric Oncology, Dana-Farber Cancer institute, Boston, Massachusetts
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4
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Nishitani M, Moerdler S, Kesselheim J. Perceptions of the stressful job search for pediatric hematology/oncology fellows. Pediatr Blood Cancer 2023; 70:e30226. [PMID: 36715452 DOI: 10.1002/pbc.30226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/05/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
The pediatric hematology and oncology (PHO) workforce landscape has been evolving over the past decades, with concern for waning interest in the subspecialty. We aimed to evaluate the impact of the initial PHO job search on fellow stress and anxiety, in addition to perceptions of the job search experience and potential areas of improvement. An anonymous survey consisting of demographics, emotional health impacts such as stress and anxiety, and job search experiences was developed and distributed to program leadership at all 74 PHO fellowship programs. At least one representative from 49 (66%) programs responded. Faculty were less likely than fellows to perceive that fellows are struggling to find jobs (p = .0198). However, faculty were more likely than fellows to perceive that fellows are either "extremely stressed" or "stressed" due to job search (p = .0003). By June 2021, 30 of 44 (68%) candidates had been offered a position, and 80% of those had accepted. There were no significant associations between fellow stress level and job offering, proximity to their ideal goals, or change in career type. Common barriers to the job search included geographic constraints and partner employment. Respondents identified centralized job listings, formal training on career development strategies, introduction to various career paths, and more transparency about the search as needed interventions. The perception of difficulty and stress regarding the job search is endorsed by most, identifying a need for more interventions to improve the experience. These data also highlight unmet mentorship and educational needs among PHO fellows in preparing for the job search.
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Affiliation(s)
- Miki Nishitani
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Scott Moerdler
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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5
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Gleicher ST, Chalmiers MA, Aiyanyor B, Jain R, Kotha N, Scott K, Song RS, Tram J, Vuong CL, Kesselheim J. Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula. BMC Med Educ 2022; 22:696. [PMID: 36175856 PMCID: PMC9520104 DOI: 10.1186/s12909-022-03720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Physicians' behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula. METHODS The authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary. RESULTS Of the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments. CONCLUSIONS This review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.
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Affiliation(s)
- S T Gleicher
- Neurology, University of Washington, Seattle, USA.
| | - M A Chalmiers
- School of Medicine, University of California San Diego, San Diego, USA
| | - B Aiyanyor
- Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - R Jain
- Pediatric Hematology/Oncology, University of California San Francisco, San Francisco, USA
| | - N Kotha
- School of Medicine, University of California San Diego, San Diego, USA
| | - K Scott
- Neonatal Intensive Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - J Tram
- School of Medicine, University of California San Diego, San Diego, USA
| | - C L Vuong
- Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, USA
| | - J Kesselheim
- DFCI/BCH Cancer and Blood Disorders Center, Harvard Medical School, Boston, USA
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6
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Moerdler S, Steinberg DM, Jin Z, Cole PD, Kesselheim J, Levy AS, Roth M, Rosenthal SL. Provider and staff crisis well-being associated with trust in leadership and baseline burnout. Pediatr Blood Cancer 2022; 69:e29497. [PMID: 34890105 DOI: 10.1002/pbc.29497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of the coronavirus 2019 (COVID-19) pandemic on the emotional health of health care workers continues to be an area of active research. However, few studies have focused on those working in pediatrics and its subspecialties, as well as ancillary and non-patient-facing staff. The purpose of this study was to determine the prevalence and associated predictors of burnout and emotional well-being of providers and staff. METHODS An anonymous electronic survey was developed evaluating demographics, pandemic experiences, possible predictor variables, and three main outcomes of burnout, psychological distress, and perceived stress. Pediatric hematology oncology (PHO) chiefs and program directors across the country were invited to participate and disseminate the survey to their programs. RESULTS A total of 682/1950 (35% of invited) individuals responded to all predictor and outcome variables. Over half reported high levels of burnout and some reported moderate/high levels of distress. Prepandemic burnout and decreased trust in leadership were associated with all three outcomes. Additional predictors included having a child ≤18 years at home, hospital role, and worrying about patient care or relationship with their patients. The majority (n = 444/682, 65.5%) reported that their institution had made COVID-19-related mental health resources available. However, only 6.5% (n = 44/682) reported utilizing these resources. CONCLUSIONS While the majority of PHO providers and staff were resilient during the early stages of the COVID-19 pandemic, many reported high levels of burnout, yet few are utilizing institutional resources. This study has highlighted several actionable areas to help identify and address factors that are wearing down the emotional well-being of providers and staff.
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Affiliation(s)
- Scott Moerdler
- Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Dara M Steinberg
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Peter D Cole
- Pediatric Hematology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.,Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam S Levy
- Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Brons, New York City, New York, USA
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L Rosenthal
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
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7
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Weiss PG, Schwartz A, Carraccio CL, Herman BE, Turner DA, Aye T, Fussell JJ, Kesselheim J, Mahan JD, McGann KA, Myers A, Stafford DEJ, Chess PR, Curran ML, Dammann CEL, High P, Hsu DC, Pitts S, Sauer C, Srivastava S, Mink RB. Achieving Entrustable Professional Activities During Fellowship. Pediatrics 2021; 148:peds.2021-050196. [PMID: 34667096 DOI: 10.1542/peds.2021-050196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Entrustable Professional Activities (EPAs) were developed to assess pediatric fellows. We previously showed that fellowship program directors (FPDs) may graduate fellows who still require supervision. How this compares with their expectations for entrustment of practicing subspecialists is unknown. METHODS We surveyed US FPDs in 14 pediatric subspecialties through the Subspecialty Pediatrics Investigator Network between April and August 2017. For each of 7 common pediatric subspecialty EPAs, we compared the minimum level of supervision that FPDs required for graduation with the level they expected of subspecialists for safe and effective practice using the Friedman rank sum test and paired t test. We compared differences between subspecialties using linear regression. RESULTS We collected data from 660 FPDs (response rate 82%). For all EPAs, FPDs did not require fellows to reach the level of entrustment for graduation that they expected of subspecialists to practice (P < .001). FPDs expected the least amount of supervision for the EPAs consultation and handovers. Mean differences between supervision levels for graduation and practice were smaller for clinical EPAs (consultation, handovers, lead a team) when compared with nonclinical EPAs (quality improvement, management, lead the profession and scholarship; P = .001) and were similar across nearly all subspecialties. CONCLUSIONS Fellowship graduates may need continued development of clinical and nonclinical skills in their early practice period, underscoring a need for continued assessment and mentoring. Graduation readiness must be based on clear requirements, with alignment of FPD expectations and regulatory standards, to ensure quality care for patients.
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Affiliation(s)
- Pnina G Weiss
- Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Bruce E Herman
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Tandy Aye
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Jill J Fussell
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer Kesselheim
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - John D Mahan
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kathleen A McGann
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Angela Myers
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Diane E J Stafford
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | | | - Megan L Curran
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | | | - Pamela High
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Deborah C Hsu
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sarah Pitts
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Cary Sauer
- Department of Pediatrics, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.,The Lundquist Institute for Biomedical Innovation, Harbor-University of California, Los Angeles Medical Center, Torrance, California
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8
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Miller KA, Keeney T, Fialkowski A, Srinivasan S, Singh TA, Kesselheim J, Farrell S, Cooper C, Royce CS. Leveraging Podcasts to Introduce Medical Students to the Broader Community of Health Care Professionals. MedEdPORTAL 2021; 17:11191. [PMID: 34754938 PMCID: PMC8542682 DOI: 10.15766/mep_2374-8265.11191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Safe, patient-centered, and cost-effective care requires effective collaboration within interprofessional teams. Education programs for health care professionals are often siloed, providing students with limited interprofessional education (IPE) opportunities to learn from, with, and about other professions. Podcasts offer a novel approach to facilitate IPE, allowing for asynchronous conversations with interprofessional colleagues. METHODS We developed four podcasts with various health care professionals for 135 preclinical medical students preparing to transition into clinical rotations. The podcasts were coupled with an hour-long interactive session with the podcast interviewees conducted via videoconference. The curriculum explored the distinct education paths, roles, and responsibilities of various health care disciplines. Strategies for communicating effectively with and learning from interprofessional team members were emphasized. RESULTS There were 197 unique downloads of the podcasts, and 95 students attended the interactive session. Most students reported that the podcasts and follow-up live session enhanced their learning (100% and 98% of students who completed the postcurriculum survey, respectively). Responses to the postcurriculum survey revealed students learned strategies for engaging in productive interprofessional conversations, the importance of leveraging the distinct roles and responsibilities of diverse health professionals, the value of learning from other health professionals, and the use of respectful language. DISCUSSION This IPE curriculum built around podcasts enhances medical student learning and represents an innovative approach to improving access to IPE in a virtual learning environment. This modality can be adapted to meet the needs of a wide spectrum of learners and can be coupled with in-person learning.
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Affiliation(s)
| | | | | | | | - Tara A. Singh
- Instructor, Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
| | | | - Susan Farrell
- Associate Professor, Emergency Medicine, Harvard Medical School
| | | | - Celeste S. Royce
- Assistant Professor, Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
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9
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Turner DA, Schwartz A, Carraccio C, Herman B, Weiss P, Baffa JM, Chess P, Curran M, Dammann C, High P, Hsu D, Pitts S, Sauer C, Aye T, Fussell J, Kesselheim J, Mahan J, McGann K, Myers A, Mink R. Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation. Acad Med 2021; 96:S22-S28. [PMID: 34183598 DOI: 10.1097/acm.0000000000004091] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate. METHOD In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level. RESULTS The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001). CONCLUSIONS Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.
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Affiliation(s)
- David A Turner
- D.A. Turner is vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina, and consulting professor, Duke University Medical Center, Durham, North Carolina. At the time this work was completed, he was associate professor, Duke University Medical Center, Durham, North Carolina
| | - Alan Schwartz
- A. Schwartz is the Michael Reese Endowed Professor of Medical Education, interim head, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Carol Carraccio
- C. Carraccio was vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina at the time this work was completed
| | - Bruce Herman
- B. Herman is professor and vice chair of education, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Pnina Weiss
- P. Weiss is vice chair of education and associate professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Jeanne M Baffa
- J.M. Baffa is emeritus associate professor of pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Patricia Chess
- P. Chess is professor, University of Rochester Medical Center, Rochester, New York
| | - Megan Curran
- M. Curran is associate professor, Department of Pediatrics, University of Colorado-Denver, Denver, Colorado
| | - Christiane Dammann
- C. Damman is professor, Department of Pediatrics, Tufts Children's Hospital, Boston, Massachusetts
| | - Pamela High
- P. High is professor, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Deborah Hsu
- D. Hsu is professor, Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Sarah Pitts
- S. Pitts is assistant professor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cary Sauer
- C. Sauer is associate professor, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Tandy Aye
- T. Aye is associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jill Fussell
- J. Fussell is professor, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer Kesselheim
- J. Kesselheim is associate professor, Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - John Mahan
- J. Mahan is professor, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kathleen McGann
- K. McGann is vice chair of education and professor, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Angie Myers
- A. Myers is professor of pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Richard Mink
- R. Mink is professor of pediatrics, The David Geffen School of Medicine at University of California Los Angeles (UCLA) and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
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10
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Dzara K, Heller A, Kesselheim J. The COVID-19 Online Learning Transition and the Plus/Delta Debriefing Model. J Contin Educ Health Prof 2021; 41:91-93. [PMID: 33929354 DOI: 10.1097/ceh.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As a result of the COVID-19 pandemic, the Harvard Medical School Master of Medical Sciences in Medical Education program implemented the Plus/Delta debriefing model to collect real-time learner feedback and facilitate continuous quality improvement within our assessment and program evaluation module, which rapidly transitioned online. The model is grounded in quality improvement methodology and encourages bidirectional rather than top-down feedback. Learners identified specifically what went well with each module session (Plus) and how to improve for the next time (Delta). After each session, narrative responses were reviewed, aggregated into meaningful categories, and implemented when possible. Implemented improvements focused on increasing session interactivity and enhancing communication. Learners pointed to the uniqueness of the model and applauded efforts to embed them in the cocreation process. Asking learners to debrief their experience-especially during a module which is iteratively redesigned week-by-week-can offer a realistic view of what is working and what needs further refinement. As we continue to navigate the COVID-19 pandemic, rapid, continuous educational quality improvement deserves renewed emphasis. Implementing the Plus/Delta debriefing model into longitudinal online teaching sessions is a translatable, easily replicable, and free method of receiving immediate and valuable learner feedback.
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Affiliation(s)
- Kristina Dzara
- Dr. Dzara: Assistant Professor of Pediatrics and Faculty, Master of Medical Sciences in Medical Education Program, Departments of Pediatrics and Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital and the Brigham Education Institute, Brigham and Women's Hospital, Boston, MA; Ms. Heller: Associate Director, Master of Medical Sciences in Medical Education Program, Harvard Medical School, Bostton, MA; and Dr. Kesselheim: Associate Professor of Pediatrics, and Director, Master of Medical Sciences in Medical Education Program, Department of Pediatric Hematology/Oncology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
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11
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Kesselheim J, Baker JN, Kersun L, Lee-Miller C, Moerdler S, Snaman JM, Warwick A, Weng S, Zhang Z. Humanism and professionalism training for pediatric hematology-oncology fellows: Results of a multicenter randomized trial. Pediatr Blood Cancer 2020; 67:e28308. [PMID: 32729211 DOI: 10.1002/pbc.28308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Although humanism and professionalism are central tenets to the practice of medicine, few formal curricula exist for medical trainees. Following a national needs assessment among pediatric hematology-oncology (PHO) fellows, we created a novel curriculum entitled "Humanism and Professionalism for Pediatric Hematology-Oncology" (HP-PHO). In this study, we measure outcomes of this curricular intervention. METHOD We cluster-randomized 20 PHO fellowship programs to deliver usual training in humanism and professionalism (UT) or the novel curriculum (intervention) during the 2016-2017 academic year. The primary outcome measure was the Pediatric Hematology-Oncology Self-Assessment in Humanism (PHOSAH). Secondary measures included the Maslach Burnout Inventory, Patient-Provider Orientation Scale, Empowerment at Work Scale, and a 5-point satisfaction scale. Participating fellows completed pre- and posttests at the beginning and end of the academic year, respectively, and we calculated change scores for each study instrument. RESULTS Cluster randomization yielded 59 intervention and 41 UT fellows. The nine intervention sites administered 33 of 36 modules. Change scores on the PHOSAH were not significantly different between the UT and intervention arms. However, fellows on the intervention arm gave significantly higher ratings on several items within the satisfaction scale related to physician burnout, physician depression, balancing professional duties and personal life, and humanism overall. CONCLUSIONS Exposure to the HP-PHO curriculum did not alter fellows' self-assessed humanism and professionalism skills. However, intervention fellows expressed significantly higher levels of satisfaction in their humanism training, indicating the curriculum's potential for positive impact on the fellows' perceived learning environment.
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Affiliation(s)
- Jennifer Kesselheim
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Justin N Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie Kersun
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cathy Lee-Miller
- Department of Oncology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Scott Moerdler
- Department of Pediatrics, The Children's Hospital at Montefiore, New York City, New York
| | - Jennifer M Snaman
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Ann Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shicheng Weng
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Zilu Zhang
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
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Moerdler S, Li Y, Weng S, Kesselheim J. Burnout in pediatric hematology oncology fellows: Results of a cross-sectional survey. Pediatr Blood Cancer 2020; 67:e28274. [PMID: 32277803 DOI: 10.1002/pbc.28274] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/07/2022]
Abstract
Burnout is a significant problem in the medical community, including among pediatric hematology/oncology (PHO) faculty. However, the prevalence of burnout, its associated risk factors, and outcomes within PHO fellows are unknown. We present the results of a cross-sectional study of PHO fellows from 21 training programs. A total of 45/115 fellows (39.1%) met criteria for high level of burnout. Fellows who met criteria for high burnout also demonstrated poor outcomes including decreased empowerment, increased doctor-centered care, decreased self-assessed humanism, and decreased satisfaction with training. Further longitudinal investigation is needed to better understand burnout and the causative factors affecting PHO fellows.
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Affiliation(s)
- Scott Moerdler
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Yunhui Li
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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Madsen M, Takemi M, Kesselheim J, Tashiro S, Siebner H. Focal TACS of the primary motor hand area at individual mu and beta rhythm – effects on cortical excitability. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Affiliation(s)
- Kristina Dzara
- instructor of pediatrics director, MMSc Medical Education Program, and assistant professor of pediatrics, Harvard Medical School
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15
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Mink R, Schwartz A, Carraccio C, High P, Dammann C, McGann KA, Kesselheim J, Herman B, Baffa G, Herman B, Turner DA, Fussell J, High P, Hsu D, Stafford D, Aye T, Sauer C, Kesselheim J, Myers A, McGann K, Dammann C, Chess P, Mahan J, Weiss P, Curran M, Schwartz A, Carraccio C, Herman B, Mink R, Havalad V, Pinheiro J, Alderman E, Fuloria M, McCabe ME, Mehta J, Rivas Y, Rosenberg M, Doughty C, Hergenroeder A, Kale A, Lee-Kim Y, Rama JA, Steuber P, Voigt B, Hardy K, Johnston S, Boyer D, Mauras C, Schonwald A, Sharma T, Barron C, Dennehy P, Jacobs ES, Welch J, Kumar D, Mason K, Roizen N, Rose JA, Bokor B, Chapman JI, Frank L, Sami I, Schuette J, Lutes RE, Savelli S, Amirnovin R, Harb R, Kato R, Marzan K, Monzavi R, Vanderbilt D, Doughty L, McAneney C, Rice W, Widdice L, Erenberg F, Gonzalez BE, Adkins D, Green D, Narayan A, Rehder K, Clingenpeel J, Starling S, Karpen HE, Rouster-Stevens K, Bhatia J, Fuqua J, Anders J, Trent M, Ramanathan R, Nicolau Y, Dozor AJ, Kinane TB, Stanley T, Rao AN, Bone M, Camarda L, Heffner V, Kim O, Nocton J, Rabbitt AL, Tower R, Amaya M, Jaroscak J, Kiger J, Macias M, Titus O, Awonuga M, Vogt K, Warwick A, Coury D, Hall M, Letson M, Rose M, Glickstein J, Lusman S, Roskind C, Soren K, Katz J, Siqueira L, Atlas M, Blaufox A, Gottleib B, Meryash D, Vuguin P, Weinstein T, Armsby L, Madison L, Scottoline B, Shereck E, Henry M, Teaford PA, Long S, Varlotta L, Zubrow A, Barlow C, Feldman H, Ganz H, Grimm P, Lee T, Weiner LB, Molle-Rios Z, Slamon N, Guillen U, Miller K, Federman M, Cron R, Hoover W, Simpson T, Winkler M, Harik N, Ross A, Al-Ibrahim O, Carnevale FP, Waz W, Bany-Mohammed F, Kim JH, Printz B, Brook M, Hermiston M, Lawson E, van Schaik S, McQueen A, Booth KVP, Tesher M, Barker J, Friedman S, Mohon R, Sirotnak A, Brancato J, Sayej WN, Maraqa N, Haller M, Stryjewski B, Brophy P, Rahhal R, Reinking B, Volk P, Bryant K, Currie M, Potter K, Falck A, Weiner J, Carney MM, Felt B, Barnes A, Bendel CM, Binstadt B, Carlson K, Garrison C, Moffatt M, Rosen J, Sharma J, Tieves KS, Hsu H, Kugler J, Simonsen K, Fastle RK, Dannaway D, Krishnan S, McGuinn L, Lowe M, Witchel SF, Matheo L, Abell R, Caserta M, Nazarian E, Yussman S, Thomas AD, Hains DS, Talati AJ, Adderson E, Kellogg N, Vasquez M, Allen C, Brion LP, Green M, Journeycake J, Yen K, Quigley R, Blaschke A, Bratton SL, Yost CC, Etheridge SP, Laskey T, Pohl J, Soprano J, Fairchild K, Norwood V, Johnston TA, Klein E, Kronman M, Nanda K, Smith L, Allen D, Frohna JG, Patel N, Estrada C, Fleming GM, Gillam-Krakauer M, Moore P, El Khoury JC, Helderman J, Barretto G, Levasseur K, Johnston L. Creating the Subspecialty Pediatrics Investigator Network. J Pediatr 2018; 192:3-4.e2. [PMID: 29246355 DOI: 10.1016/j.jpeds.2017.09.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Mink
- Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance, CA
| | | | | | - Pamela High
- W Alpert Medical School of Brown University, Providence, RI
| | | | | | | | - Bruce Herman
- University of Utah/Primary Children's Hospital, Salt Lake City, UT
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Attai DJ, Anderson PF, Fisch MJ, Graham DL, Katz MS, Kesselheim J, Markham MJ, Pennell NA, Sedrak MS, Thompson MA, Utengen A, Dizon DS. Risks and benefits of Twitter use by hematologists/oncologists in the era of digital medicine. Semin Hematol 2017; 54:198-204. [PMID: 29153081 DOI: 10.1053/j.seminhematol.2017.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 12/25/2022]
Abstract
Twitter use by physicians, including those in the hematology-oncology field, is increasing. This microblogging platform provides a means to communicate and collaborate on a global scale. For the oncology professional, an active Twitter presence provides opportunities for continuing medical education, patient engagement and education, personal branding, and reputation management. However, because Twitter is an open, public forum, potential risks such as patient privacy violations, personal information disclosures, professionalism lapses, and time management need to be considered and managed. The authors have summarized the benefits and risks of Twitter use by the hematology-oncology physician. In addition, strategies to maximize benefit and minimize risk are discussed, and resources for additional learning are provided.
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Affiliation(s)
- Deanna J Attai
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
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Greenzang K, Kesselheim J. The Importance of Fostering Ownership During Medical Training: Working 9-5 Isn't the Only Issue. Am J Bioeth 2016; 16:17-18. [PMID: 27471930 DOI: 10.1080/15265161.2016.1197339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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File W, Bylund CL, Kesselheim J, Leonard D, Leavey P. Do pediatric hematology/oncology (PHO) fellows receive communication training? Pediatr Blood Cancer 2014; 61:502-6. [PMID: 24039096 PMCID: PMC5561546 DOI: 10.1002/pbc.24742] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/26/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE The Accreditation Council for Graduate Medical Education (ACGME) has established communication as a core competency for physicians in training. However, data suggest that most pediatric residents perceive inadequate training in the delivery of bad news and the majority of former trainees in pediatric oncology received no formal training in the delivery of bad news during fellowship. The study examines communication training in ACGME accredited US pediatric hematology-oncology (PHO) fellowship programs. METHODS An online survey was distributed to 315 PHO fellows in training via the American Society of Pediatric Hematology/Oncology (ASPHO) fellow email registry. Each fellow received an initial request to participate and 2 reminders, while participation was encouraged through a random incentive drawing. RESULTS One hundred and ten fellows (35%) responded. Eighty percent of respondents perceived communication training to be important to fellow education, however only 32% reported receiving communication training (other than direct observation). The most common reported teaching method of fellowship communication training was formal lecture (42%). Twenty-three percent of respondents reported neither communication training nor frequent feedback on their communication skills from faculty observation. This same group was the least satisfied with their programs' approach to teaching communication (P < 0.001). CONCLUSIONS There is limited communication training in PHO fellowships despite ACGME requirements and fellows' interest in this training. Didactic learning remains the most frequently described training method, yet educational theory identifies the limitation of didactic lectures alone. Communication training employing novel teaching methods and emphasizing communication challenges identified by fellows should be developed and evaluated.
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Affiliation(s)
- Wilson File
- Division of Pediatric Hematology-Oncology, Children’s Medical Center Dallas, The University of Texas Southwestern, Dallas, Texas
| | - Carma L. Bylund
- Department of Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, New york
| | - Jennifer Kesselheim
- Dana Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts
| | - David Leonard
- Division of Pediatric Hematology-Oncology, Children’s Medical Center Dallas, The University of Texas Southwestern, Dallas, Texas
| | - Patrick Leavey
- Division of Pediatric Hematology-Oncology, Children’s Medical Center Dallas, The University of Texas Southwestern, Dallas, Texas,Correspondence to: Patrick Leavey, The University of Texas Southwestern Medical Center, Division of Pediatric Hematology-Oncology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063.
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O'Connell AE, Lee JP, Yee C, Kesselheim J, Dioun A. Successful desensitization to brentuximab vedotin after anaphylaxis. Clin Lymphoma Myeloma Leuk 2013; 14:e73-5. [PMID: 24373790 DOI: 10.1016/j.clml.2013.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/24/2013] [Accepted: 11/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Amy E O'Connell
- Department of Allergy/Immunology, Boston Children's Hospital, Boston, MA.
| | - Joyce P Lee
- Department of Pharmacy, Boston Children's Hospital, Boston, MA
| | - Christina Yee
- Department of Allergy/Immunology, Boston Children's Hospital, Boston, MA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Center for Cancer and Blood Disorders, Boston, MA
| | - Anahita Dioun
- Department of Allergy/Immunology, Boston Children's Hospital, Boston, MA
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Lennon K, Pretel R, Kesselheim J, te Heesen S, Kukuruzinska MA. Proliferation-dependent differential regulation of the dolichol pathway genes in Saccharomyces cerevisiae. Glycobiology 1995; 5:633-42. [PMID: 8563151 DOI: 10.1093/glycob/5.6.633] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The dolichol pathway serves in the synthesis of the dolichol-linked oligosaccharide precursor for protein N-glycosylation. Recently, we reported that mRNAs of genes that function at the early steps in the dolichol pathway in yeast, ALG7, ALG1 and ALG2, were co-ordinately induced following growth stimulation of G0-arrested cells in a manner similar to that of the transcripts of the early growth response genes (Kukuruzinska, M.A. and Lennon, K. Glycobiology, 4, 437-443, 1994). To determine whether the entire dolichol pathway was co-ordinately regulated with growth, we examined the expression of genes functioning late in the pathway, including two genes encoding oligosaccharyltransferase subunits, at two critical control points in the G1 phase of cell cycle: G0/G1 and START. We show that early in G1, at the G0/G1 transition point, the late ALG genes and the two oligosaccharyltransferase-encoding genes examined were regulated co-ordinately with the early ALG genes: they were downregulated upon exit from the mitotic cell cycle into G0, and they were induced following growth stimulation in the absence of de novo protein synthesis. All the dolichol pathway genes produced transcripts with short half-lives that were rapidly stabilized in the presence of cycloheximide. In contrast, cell division arrest late in G1, at START, was accompanied by a selective downregulation of only the first dolichol pathway gene, ALG7, and not of the genes functioning later in the pathway. These results indicate that, depending on their position in G1, cells either co-ordinately or differentially regulate the dolichol pathway genes.
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Affiliation(s)
- K Lennon
- Department of Oral Biology, Boston University Medical Center, MA, USA
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