1
|
Dyess NF, Carr CB, Mavis SC, Caruso CG, Izatt S, French H, Dadiz R, Bonachea EM, Gray MM. Implicit Bias and Health Disparities Education in the Neonatal Intensive Care Unit. Am J Perinatol 2024. [PMID: 38190976 DOI: 10.1055/a-2240-1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE This study aimed to characterize implicit bias (IB) and health disparities (HD) education in neonatal-perinatal medicine (NPM), including current educational opportunities, resources, and barriers. STUDY DESIGN A national web-based survey was sent to NPM fellows, neonatologists, and frontline providers after iterative review by education experts from the National Neonatology Curriculum Committee. Quantitative data were analyzed with chi-square and Fisher's exact tests. Qualitative data were evaluated using thematic analysis. RESULTS Of the 452 NPM survey respondents, most desired additional IB (76%) and HD (83%) education. A greater proportion of neonatologists than fellows received IB (83 vs. 57%) and HD (87 vs. 74%) education. Only 41% of neonatologists reported that their institution requires IB training. A greater proportion of fellows than neonatologists expressed dissatisfaction with the current approaches for IB (51 vs. 25%, p < 0.001) and HD (43 vs. 25%, p = 0.015) education. The leading drivers of dissatisfaction included insufficient time spent on the topics, lack of specificity to NPM, inadequate curricular scope or depth, and lack of local educator expertise. A minority of faculty who were tasked to educate others have received specific educator training on IB (21%) and HD (16%). Thematic analysis of survey free-text responses identified three main themes on the facilitators and barriers to successful IB and HD education: individual, environmental, and curricular design variables. CONCLUSION NPM trainees and neonatologists desire tailored, active, and expert-guided IB and HD education. Identified barriers are important to address in developing an effective IB/HD curriculum for the NPM community. KEY POINTS · There is a gap between the current delivery of IB/HD education and the needs of the NPM community.. · NPM trainees and neonatologists desire tailored, active, and expert-guided IB and HD education.. · A successful curriculum should be widely accessible, NPM-specific, and include facilitator training..
Collapse
Affiliation(s)
| | - Cara Beth Carr
- Division of Neonatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie C Mavis
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Catherine G Caruso
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Susan Izatt
- Division of Neonatology, Department of Pediatrics, Duke University, Durham, North Carolina
| | - Heather French
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Elizabeth M Bonachea
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
2
|
Forman K, Bruno CJ, Izatt S, Fuloria M, Adams A, Kim M, Zuber J, Cano N, LaTuga MS. Building Relationships: Advanced Practice Providers and Fellows in Neonatal-Perinatal Medicine. Am J Perinatol 2023. [PMID: 37541311 DOI: 10.1055/s-0043-1771503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Advanced practice providers (APPs) are a critical component of health care teams, especially in the neonatal intensive care unit. At times, APPs and neonatal-perinatal medicine (NPM) fellows may experience tension in their professional relationship. They may perceive the other's performance and abilities differently. We hypothesized that satisfaction with the APP-NPM fellow interprofessional relationship would be associated with higher perception of APP competence by NPM fellows. STUDY DESIGN We surveyed 274 medical providers: NPM fellows (24.8%), NPM program directors (24.5%), and APPs (50.7%). APPs were defined as neonatal nurse practitioners, pediatric nurse practitioners, physician assistants, or neonatal hospitalists. We obtained demographic data, information about sources of conflict in the APP-NPM fellow relationship, level of satisfaction with the relationship, and targeted interventions for improvement. NPM fellow perception of APP competence as well as APP self-assessed competence were elicited. Statistical analyses were performed with chi-square tests and Fisher's exact tests. RESULTS Overall, APPs and NPM fellows were generally satisfied with their relationship. All groups reported APP competence as equivalent to a third-year NPM fellow. NPM fellow perception of APP competence increased with year of fellow training. Higher perceived APP competence by NPM fellows correlated with higher relationship satisfaction scores. Difficulties with teamwork, communication and respect were associated with lower satisfaction within the APP-NPM fellow relationship. CONCLUSION The professional working dynamic between these two groups is viewed positively by all. Satisfaction with the APP-NPM fellow relationship correlated with higher perception of APP competence by NPM fellows. Targeted interventions that increase NPM fellow perception of APP competence and ameliorate the difficulties encountered in the APP-NPM fellow relationship may improve this interprofessional relationship. KEY POINTS · Advanced practice providers and NPM fellows may have similar responsibilities leading to challenges.. · NPM fellows with higher perceived competence of APPs had higher satisfaction with their relationship.. · Training APPs to teach, creating interprofessional education, and routine debrief sessions may help..
Collapse
Affiliation(s)
- Katie Forman
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Christie J Bruno
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Susan Izatt
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Mamta Fuloria
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron Adams
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jennifer Zuber
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nefertiti Cano
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Mariam S LaTuga
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
3
|
Gray MM, Dadiz R, Izatt S, Gillam-Krakauer M, Carbajal MM, Johnston LC, Payne A, Vasquez MM, Bonachea EM, Karpen H, Falck AJ, Chess PR, Huber M, French H. Comparison of knowledge acquisition and retention following traditional didactic vs. flipped classroom education utilizing a standardized national curriculum: a randomized controlled trial. J Perinatol 2022; 42:1512-1518. [PMID: 35660790 DOI: 10.1038/s41372-022-01423-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 01/25/2022] [Revised: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Measure the effectiveness of and preference for a standardized, national curriculum utilizing flipped classrooms (FC) in neonatal-perinatal medicine (NPM) fellowships. STUDY DESIGN Multicentered equivalence, cluster randomized controlled trial of NPM fellowship programs randomized to receive standardized physiology education as in-class lectures (traditional didactic, TD arm) or as pre-class online videos followed by in-class discussions (FC arm). Four multiple-choice question quizzes and three surveys were administered to measure knowledge acquisition, retention, and educational preferences. RESULTS 530 fellows from 61 NPM fellowships participated. Quiz performance was comparable between groups at all time points (p = NS, TD vs FC at 4 time points). Post intervention, more fellows in both groups preferred group discussions (pre/post FC 42% vs. 58%, P = 0.002; pre/post TD 43% vs. 60%, P = < 0.001). FC fellows were more likely to rate classroom effectiveness positively (FC/TD, 70% vs. 36%, P < 0.001). CONCLUSIONS FCs promote knowledge acquisition and retention equivalent to TD and FC modalities are preferred by fellows.
Collapse
Affiliation(s)
- Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way, Seattle, WA, 98105, USA
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 651, Rochester, 14642, Rochester, NY, USA
| | - Susan Izatt
- Department of Pediatrics, Duke University, DUMC Box 102509, Durham, NC, 27710, USA
| | - Maria Gillam-Krakauer
- Department of Pediatrics, Vanderbilt University Medical Center, 11112 Doctor's Office Tower, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Melissa M Carbajal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, W6104, Houston, TX, 77030, USA
| | - Lindsay C Johnston
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Allison Payne
- Department of Pediatrics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, RBC Suite 3100, Mailstop 6010, Cleveland, OH, 44106, USA
| | - Margarita M Vasquez
- Department of Pediatrics, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MSC 7812, San Antonio, TX, 78229, USA
| | - Elizabeth M Bonachea
- Department of Pediatrics, Ohio State University, 700 Children's Drive, FB 6th floor Neonatology, Columbus, OH, 43205, USA
| | - Heidi Karpen
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, 2105 Uppergate Drive NE, Rm 324, Atlanta, GA, 30033, USA
| | - Alison J Falck
- Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca 8th floor, Baltimore, MD, 21201, USA
| | - Patricia R Chess
- Departments of Pediatrics and Biomedical Engineering, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 651, Rochester, NY, 14642, USA
| | - Matthew Huber
- Division of Neonatology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Heather French
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| |
Collapse
|
4
|
Mavis SC, Caruso CG, Carr CB, Dyess NF, French H, Dadiz R, Vasquez M, Johnston L, Gillam-Krakauer M, Chess P, Izatt S, Payne AH, Carbajal MM, Bonachea EM, Gray MM. Consensus on an implicit bias and health disparities curriculum in neonatal medicine: a Delphi study. J Perinatol 2022; 42:1519-1526. [PMID: 36203083 DOI: 10.1038/s41372-022-01530-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite longstanding and recurrent calls for effective implicit bias (IB) education in health professions education as one mechanism to reduce ongoing racism and health disparities, such curricula for neonatal-perinatal medicine (NPM) are limited. We aim to determine the key curricular elements for educating NPM fellows, advanced practice providers, and attending physicians in the critical topics of IB and health disparities. STUDY DESIGN A modified Delphi study was performed with content experts in IB and health disparities who had educational relationships to those working and training in the neonatal intensive care unit. RESULT Three Delphi rounds were conducted from May to November 2021. Experts reached consensus on a variety of items for inclusion in the curriculum, including educational goals, learning objectives, teaching strategies, and educator principles. CONCLUSION Essential curricular components of an IB and health disparities curriculum for neonatal medicine were defined using rigorous consensus building methodology.
Collapse
Affiliation(s)
- Stephanie C Mavis
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Catherine G Caruso
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Cara Beth Carr
- Division of Neonatology, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Nicolle F Dyess
- Division of Neonatal Medicine, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Heather French
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Margarita Vasquez
- Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lindsay Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Gillam-Krakauer
- Mildred T. Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patricia Chess
- Department of Pediatrics and Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Susan Izatt
- Division of Neonatology, Duke University Medical Center, Durham, NC, USA
| | - Allison H Payne
- Division of Neonatology, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Melissa M Carbajal
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Elizabeth M Bonachea
- Section of Neonatology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
5
|
Johnston LC, Falck AJ, Vasquez MM, Dadiz R, French H, Izatt S, Bonachea E, Karpen HE, Carbajal MM, Payne A, Gillam-Krakauer M, Gray MM. Flipping the Teachers: Impact of a Standardized Physiology Curriculum on Neonatology Medical Educators. Am J Perinatol 2022. [PMID: 36041469 DOI: 10.1055/a-1933-4893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Academic physicians must teach elements in an Accreditation Council for Graduate Medical Education (ACGME)-mandated curriculum while balancing career development and clinical workload. Exploring educator perceptions on the learning environment and comparing two instructional methods (traditional didactics [TD] vs. flipped classroom [FC]) in one pediatric subspecialty may elucidate current challenges, barriers, and strategies to optimize learning and educator satisfaction. STUDY DESIGN A randomized trial comparing effectiveness and learner preference for FC versus TD physiology teaching was conducted in ACGME-accredited neonatal-perinatal medicine (NPM) fellowship programs in 2018 to 2019. Educator preferences were elicited through online surveys pre- and postintervention. Free-text comments were provided for questions exploring strengths, challenges, and opportunities in fellowship education. Statistical analysis included comparisons of demographics and pre-post-intervention educator responses between groups. Thematic analysis of text responses was conducted to identify common subthemes. RESULTS From 61 participating programs, 114 FC educators and 130 TD educators completed surveys. At baseline, all educators experienced professional satisfaction from teaching fellows, but noted challenges with time available to create and/or deliver educational content, limited content expertise amongst faculty, colleagues' limited enthusiasm toward educating fellows, and lack of perceived value of education by institutions given limited protected time or credit toward promotion. Postintervention, educators in both groups noted a preference to teach physiology using FC due to interactivity, learner enthusiasm, and learner-centeredness. FC educators had a 17% increase in preference to teach using FC (p = 0.001). Challenges with FC included ensuring adequate trainee preparation, protecting educational time, and providing educators with opportunities to develop facilitation skills. CONCLUSION Overall, NPM educators in a trial evaluating a standardized, peer-reviewed curriculum report professional satisfaction from teaching, but described logistical challenges with developing/delivering content. Educators preferred instruction using FC, but identified challenges with learner preparedness and ensuring adequate educator time and skill. Future efforts should be dedicated to addressing these barriers. KEY POINTS · Many challenges exist for educators teaching neonatal-perinatal medicine fellows, including time, support, and recognition.. · Many educators preferred using flipped classroom methodology with a standardized curriculum due to interactivity and learner-centeredness.. · Benefits of a standardized, peer-reviewed curriculum include reduced preparation time, adaptability of content, and learning environment enhancement..
Collapse
Affiliation(s)
- Lindsay C Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Alison J Falck
- Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, California
| | - Margarita M Vasquez
- Department of Pediatrics, University of Texas Health San Antonio, San Antonio, Texas
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Heather French
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Izatt
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Elizabeth Bonachea
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, NY
| | - Heidi E Karpen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Allison Payne
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Maria Gillam-Krakauer
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
6
|
Gillam-Krakauer M, Sharma J, Myers P, Bonachea EM, Cicalese E, Lawrence K, Bauserman M, Good M, Schwarz B, Payne A, Carbajal M, Angert R, Trzaski J, Johnston L, Chess P, Dadiz R, Enciso J, Falck A, Frost M, Gray M, Izatt S, Kane S, Kiefer A, Leeman KT, Malik SK, Nair J, O’Reilly D, Sawyer T, Smith MC, Stanley K, Vasquez M, Wambach JA, Wraight CL, Bonachea EM. Part 6: Essentials of Neonatal-Perinatal Medicine fellowship: program administration. J Perinatol 2022; 42:976-981. [PMID: 35082429 PMCID: PMC8790011 DOI: 10.1038/s41372-022-01314-8] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/20/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
A successful Neonatal-Perinatal Medicine fellowship (NPM-F) program requires presence and insight of national and institutional supervisory organizations as well as effective program-specific leaders: program director (PD), associate program director (APD), program coordinator (PC), and core faculty. It is becoming more common for PDs and APDs to have advanced training in medical education and conduct medical education research. While NPM-F program leaders benefit from a strong national NPM educator community, they face challenges of increased regulatory burden and unclear national guidelines with variable local interpretation for protected time. National and local organizations can support program leaders and promote their academic success while reducing burnout and turnover by providing leadership training, academic mentoring, and adequate protected time for research and program-specific tasks.
Collapse
Affiliation(s)
- Maria Gillam-Krakauer
- Mildred T Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Jotishna Sharma
- grid.239559.10000 0004 0415 5050Children’s Mercy Hospital, Kansas City, MO USA
| | - Patrick Myers
- grid.413808.60000 0004 0388 2248Ann and Robert Lurie Children’s Hospital, Chicago, IL USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Gray MM, Dadiz R, Izatt S, Gillam-Krakauer M, Carbajal MM, Falck AJ, Bonachea EM, Johnston LC, Karpen H, Vasquez MM, Chess PR, French H. Value, Strengths, and Challenges of e-Learning Modules Paired with the Flipped Classroom for Graduate Medical Education: A Survey from the National Neonatology Curriculum. Am J Perinatol 2021; 38:e187-e192. [PMID: 32276279 DOI: 10.1055/s-0040-1709145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aimed to determine the value, strengths, and challenges of implementing an e-learning based flipped classroom (FC) educational modality as part of the standardized physiology National Neonatology Curriculum (NNC), created for neonatal-perinatal medicine (NPM) fellow learners and faculty educators. STUDY DESIGN This is a cross-sectional study of NPM fellows and faculty educators who utilized at least one of the e-learning based NNC FC respiratory physiology programs between May and September 2018. Participants were surveyed anonymously regarding their experiences participating in the NNC, including measures of preparation time. A combination of descriptive statistics and proportion comparisons were used for data analysis. RESULTS Among 172 respondents, the majority of fellow and faculty respondents reported positive attitudes toward the educational content and case discussions, and the majority supported national standardization of NPM physiology education (92%). Fellows reported greater preclass preparation for their FC compared with previous didactic lectures (30-60 vs. 0-15 minutes, p < 0.01). Faculty facilitators reported less preparation time before facilitating a FC compared with the time required for creating a new didactic lecture (median: 60 vs. 240 minutes, p < 0.01). Both fellows and faculty respondents preferred the FC approach to traditional didactics, with fellows showing a greater degree of preference than faculty (68 vs. 52%, respectively, p = 0.04). CONCLUSION Fellows and faculty educators supported the FC learning, reporting peer-to-peer learning, and the establishment of a learning community which promotes adult learning and critical thinking skills. A national physiology curriculum creates equitable and engaging educational experiences for all NPM fellows while reducing individual program burden of content creation. Our findings further supported the development of an NNC using a flipped classroom modality.
Collapse
Affiliation(s)
- Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Susan Izatt
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Maria Gillam-Krakauer
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa M Carbajal
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Alison J Falck
- Department of Pediatrics, University of Maryland, Baltimore, Maryland
| | | | - Lindsay C Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Heidi Karpen
- Department of Pediatrics, Emory Children's Pediatric Institute, Atlanta, Georgia
| | - Margarita M Vasquez
- Department of Pediatrics, University of Texas Health San Antonio, San Antonio, Texas
| | - Patricia R Chess
- Division of Pediatrics and Biomedical Engineering, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Heather French
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
8
|
Affiliation(s)
- G. Abrahams
- Toronto Western Hospital Toronto. Ontario MST2S8
| | - R. Mathews
- Toronto Western Hospital Toronto. Ontario MST2S8
| | - M. Zlotnik
- Toronto Western Hospital Toronto. Ontario MST2S8
| | - S. Izatt
- Toronto Western Hospital Toronto. Ontario MST2S8
| | | |
Collapse
|
9
|
Affiliation(s)
- Susan Izatt
- Professor of Pediatrics, Division of Neonatology, Duke University Medical Center
| |
Collapse
|
10
|
French H, Gray M, Gillam-Krakauer M, Bonachea EM, Carbajal M, Payne A, Vasquez MM, Rubinos L, Falck A, Izatt S, Dadiz R. Flipping the classroom: a national pilot curriculum for physiology in neonatal-perinatal medicine. J Perinatol 2018; 38:1420-1427. [PMID: 30087455 DOI: 10.1038/s41372-018-0185-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Received: 02/01/2018] [Revised: 06/13/2018] [Accepted: 06/29/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore interest, feasibility, perceived effectiveness, and acceptability of a standardized, national physiology curriculum for neonatal-perinatal medicine (NPM) fellows using online videos for knowledge acquisition paired with flipped classrooms (FCs) for knowledge application. STUDY DESIGN Two educational programs pairing online videos with FCs were developed and peer-reviewed. These programs were piloted at five institutions. Fellows completed surveys, and fellows and educators participated in focus groups after their FC experiences. RESULTS Thirty-five fellows responded to the survey. Forty-one fellows and six educators participated in focus groups. Fellows and educators preferred online videos paired with FCs over didactic teaching and perceived them to be effective for knowledge acquisition and application. CONCLUSION Fellows and educators preferred FC learning over traditional didactics and reported that FCs facilitated creation of a learning community, fostering active learning. The favorable response toward this pilot project and the feasibility of its use supports further development of a standardized NPM physiology curriculum for fellowship training.
Collapse
Affiliation(s)
- Heather French
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Megan Gray
- Division of Neonatology, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Melissa Carbajal
- Division of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Allison Payne
- Division of Neonatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Margarita M Vasquez
- Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Laura Rubinos
- Division of Neonatology, University of Texas Southwestern, Dallas, TX, USA
| | - Alison Falck
- Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susan Izatt
- Division of Neonatology, Duke University Medical Center, Durham, NC, USA
| | - Rita Dadiz
- Division of Neonatology, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
11
|
Khandelwal M, Bailey S, Izatt S, Chu M, Vas S, Bargman J, Oreopoulos D. Structural Changes in Silicon Rubber Peritoneal Dialysis Catheters in Patients using Mupirocin at the Exit Site. Int J Artif Organs 2018; 26:913-7. [PMID: 14636007 DOI: 10.1177/039139880302601007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Structural damage to polyurethane PD (peritoneal dialysis) catheters in patients using mupirocin ointment is widely appreciated, but damage to silicon rubber PD catheters is less well described. Ten catheters (6.6%) out of 152 were found to have structural alterations such as opacification, ballooning, thinning, and rupture. The duration of PD in these 10 patients ranged from 23 months to 80 months (mean duration 51.1 months). The frequency of mupirocin application varied from daily (2 cases) to 2-3 times per week (7 cases). In eight catheters opacification occurred at the exit site whereas one catheter showed opacification midway between the exit site and the titanium adaptor. One catheter showed opacification, ballooning, and thinning at the exit site ruptured in the form of two slit-like openings. In conclusion, various structural changes such as opacification, ballooning or thinning were seen in 6.6% of silicon rubber PD catheters in patients using mupirocin at the exit site. Although the mechanism remains elusive, mupirocin or the antiseptic solution alone or in combination may be contributory. We believe that this is an under-reported complication and encourage other health care givers to incorporate a search for such changes during clinic visits.
Collapse
Affiliation(s)
- M Khandelwal
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | |
Collapse
|
12
|
DeMeo SD, Izatt S, Goldberg RN. A newborn with an anorectal malformation. J Pediatr 2013; 163:1220-1. [PMID: 23809047 DOI: 10.1016/j.jpeds.2013.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/20/2013] [Accepted: 05/10/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen D DeMeo
- Division of Neonatology, Duke University Hospital, Durham, North Carolina
| | | | | |
Collapse
|
13
|
Tapiawala SN, Penner TC, Bargman JM, Izatt S, Oreopoulos DG. Pericatheter leak with air bubbles in the effluent of a patient on chronic peritoneal dialysis without peritonitis: your diagnosis? Perit Dial Int 2008; 28:312-313. [PMID: 18474926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
|
14
|
Wang T, Izatt S, Dalglish C, Bargman J, Jassal S, Vas S, Oreopoulos D. Peritoneal dialysis in a nursing home: limited survival expectations. Clin Nephrol 2003; 60:373-4. [PMID: 14640246 DOI: 10.5414/cnp60373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
15
|
Szabo T, Siccion Z, Izatt S, Vas SI, Bargman J, Oreopoulos DG. Outcome of Pseudomonas aeruginosa exit-site and tunnel infections: a single center's experience. Adv Perit Dial 2000; 15:209-12. [PMID: 10682104] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
We reviewed the course and outcome of all Pseudomonas aeruginosa (PA) exit-site and tunnel infections (ESI/TI) that occurred at our home peritoneal dialysis (PD) unit over a 3-year period (July 1995 to June 1998). We documented PA ESI/TI in 19 out of a total of 467 patients. Of the 19 patients, 12 having local redness and tenderness but no discharge were treated conservatively with increased frequency of dressing with or without hydrogen peroxide locally. Of the 12 cases receiving local care, 7 resolved without recurrence over 14.4 months follow-up, while the remaining 5 developed persistent ESI/TI with discharge and required treatment with antibiotics. Seven more patients who initially presented with purulent discharge also received systemic antibiotics. Only 1 of the 12 patients with PA ESI/TI treated with antibiotics resolved; the remaining 11 patients developed PA peritonitis over a 1-month to 7-month period after the initial PA ESI/TI. In 2 of these 11 patients, simultaneous PD catheter removal and replacement was attempted for the treatment of PA ESI/TI, but these patients also developed PA peritonitis 1-3 weeks after the procedure. Of the 11 patients with PA peritonitis associated with PA ESI/TI, 1 died, 6 were transferred to permanent hemodialysis, and just 4 continued PD after PD catheter replacement. Though not frequent, PA ESI/TI is still a serious complication of home PD at our unit, resulting in ESI/TI-related PA peritonitis and catheter loss in 58% of cases. Local treatment of mild PA ESI/TI (redness and induration) seems to be effective. On the other hand, patients with purulent discharge are likely to develop peritonitis and technique failure despite antibiotic therapy. Early catheter replacement can be considered in these cases.
Collapse
Affiliation(s)
- T Szabo
- Toronto Hospital, Western Division, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
16
|
Izatt S. Y2K and the peritoneal dialysis patient. Perit Dial Int 1999; 19:515-6. [PMID: 10641770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
|
17
|
Balaskas EV, Izatt S, Chu M, Oreopoulos DG. Tidal volume peritoneal dialysis versus intermittent peritoneal dialysis. Adv Perit Dial 1993; 9:105-109. [PMID: 8105900] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In a 12-week crossover study we assessed the effect of tidal volume peritoneal dialysis (TVPD) on serum chemistry, patient well-being, appetite and sleep, blood pressure, and body weight period and compared it with the effect of intermittent peritoneal dialysis (IPD) on these same parameters over a similar period. We used similar volumes of dialysis solutions per exchange and session, and the exchanges were of the same duration in each session. There were 12 patients (6 males, 6 females) with a mean age of 76 years (range 61-88 years), and mean duration of peritoneal dialysis 49 months (range 20-148 months). Five patients started with TVPD and switched to IPD after 3 months; the remaining 7 patients started with IPD and switched to TVPD for the next 3 months. No differences were seen between TVPD and IPD in any of the measured parameters: body weight, appetite, sleep, and well-being by self-assessment, number of transfusions, and complications related to peritoneal dialysis. There were two episodes of peritonitis during the TVPD period and none during the IPD period. Our data indicate that TVPD and IPD are equally effective when applied over similar durations and with similar volumes of dialysis solutions in each session. The improved results with TVPD that others have reported probably can be explained by the use of higher volumes of dialysate.
Collapse
Affiliation(s)
- E V Balaskas
- Division of Nephrology, Toronto Hospital, Ontario, Canada
| | | | | | | |
Collapse
|
18
|
Abraham G, Blake PG, Mathews RE, Bargman JM, Izatt S, Oreopoulos DG. Genital swelling as a surgical complication of continuous ambulatory peritoneal dialysis. Int J Gynaecol Obstet 1991. [DOI: 10.1016/0020-7292(91)90281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
19
|
Abraham G, Blake PG, Mathews RE, Bargman JM, Izatt S, Oreopoulos DG. Genital swelling as a surgical complication of continuous ambulatory peritoneal dialysis. Surg Gynecol Obstet 1990; 170:306-8. [PMID: 2321120] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Genital edema was seen as a complication of continuous ambulatory peritoneal dialysis (CAPD) in 18 patients, who accounted for 4 per cent of all patients on CAPD. In the majority of patients, the swelling developed suddenly and painlessly in the scrotum, penis or labia majora. Some of the patients noticed ultrafiltration failure. In the majority of these patients, this was a result of fluid leakage through the patent processus vaginalis. In one female patient, fluid leaked through the implantation site of the catheter. A computed tomographic scan using contrast media is a useful diagnostic tool in identifying the side of the defect in patients with generalized scrotal or penile edema. Surgical repair of the hernia and the hole in the processus vaginalis or hernia sac prevented recurrence. A trial of temporary discontinuation of CAPD or intermittent peritoneal dialysis using small volumes of dialysis fluid prevented recurrence while reinstituting CAPD in patients with normal findings from contrast studies. Intermittent peritoneal dialysis using low volumes of dialysis fluid with stepwise increase prevented recurrence while reinstituting CAPD two to three weeks after surgical repair.
Collapse
Affiliation(s)
- G Abraham
- Department of Medicine and Surgery, Toronto Western Hospital, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
20
|
Robson M, Oreopoulos DG, Izatt S, Ogilvie R, Rapoport A, deVeber GA. Influence of exchange volume and dialysate flow rate on solute clearance in peritoneal dialysis. Kidney Int 1978; 14:486-90. [PMID: 108449 DOI: 10.1038/ki.1978.153] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To find the ideal dialysate flow rate and exchange volume for use in long-term peritoneal dialysis, 10 patients were studied over a period of 1.5 yr. Exchange volumes of 1 or 2 liters and dialysate flow rates of 1, 2, 3, 4, and 6 liters/hr were tested. Dextrose concentration remained constant at 1.5 g/100 ml. Peritoneal clearances for BUN, creatinine, and uric acid were calculated at 2, 5, 10, 15, and 20 hr during dialysis making a total of 120 clearances for each patient. All patients used a reverse osmosis automatic machine. The clearance of all three solutes tended to be higher with exchange volumes of 2 liters than they did with 1 liter; this trend was significant for BUN (P less than 0.025) and uric acid (P less than 0.025) but not for creatinine. There was a significant rise in clearance with increasing flow rates per hour for all solutes as shown in the following table. (Formula: see text), Since patients could not tolerate a flow rate of 6 liters/hr, we conclude that flow rate of 4 liters/hr with a 2-liter exchange will give maximum efficiency.
Collapse
|
21
|
Karanicolas S, Oreopoulos DG, Izatt S, Shimizu A, Manning RF, Sepp H, de Veber GA, Darby T. Epidemic of aseptic peritonitis caused by endotoxin during chronic peritoneal dialysis. N Engl J Med 1977; 296:1336-7. [PMID: 859532 DOI: 10.1056/nejm197706092962309] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
22
|
Oreopoulos DG, Izatt S, Zellerman G, Karanicolas S, Mathews RE. A prospective study of the effectiveness of three permanent peritoneal catheters. Proc Clin Dial Transplant Forum 1976; 6:96-100. [PMID: 1029897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
23
|
|
24
|
|