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Miller-Kuhlmann R, Sasnal M, Gold CA, Nassar AK, Korndorffer JR, Van Schaik S, Marmor A, Williams S, Blankenburg R, Rassbach CE. Tips for developing a coaching program in medical education. Med Educ Online 2024; 29:2289262. [PMID: 38051864 PMCID: PMC10783821 DOI: 10.1080/10872981.2023.2289262] [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] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.
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Affiliation(s)
| | - Marzena Sasnal
- Center for Research on Education Outcomes, Stanford University, Palo Alto, USA
| | - Carl A. Gold
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, USA
| | | | | | - Sandrijn Van Schaik
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Andrea Marmor
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Sarah Williams
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
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Hoang K, Mollie Grow H, Rooholamini SN, McPhillips H, Selling SK, Rassbach CE, Blankenburg R. Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study. Acad Pediatr 2024:S1876-2859(24)00155-4. [PMID: 38729301 DOI: 10.1016/j.acap.2024.04.012] [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: 05/09/2023] [Revised: 03/27/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates. METHODS In July to November 2020, we conducted an IRB-approved qualitative study with semi-structured interviews of residency graduates from two pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness. RESULTS We interviewed 34 residency graduates from two institutions and identified four themes on how coaches influenced residency graduates' PIF by 1) a presence of a trusting relationship, 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback, 3) integrating clinical skill, career interests, and work-life integration, and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency. CONCLUSIONS Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training. WHAT'S NEW This study is the first to explore how clinical coaching can be used to develop and enhance residents' professional identity formation both during and after residency and provides strategies coaches and residents can use to facilitate PIF.
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Affiliation(s)
- Kim Hoang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
| | - H Mollie Grow
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Sahar N Rooholamini
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Heather McPhillips
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Stevens PE, Rassbach CE, Qin F, Kuo KW. Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020-2021. Pediatr Crit Care Med 2024; 25:396-406. [PMID: 38088772 DOI: 10.1097/pcc.0000000000003429] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To understand the perspectives of pediatric fellows training in critical care subspecialties about providing spiritual care. DESIGN Cross-sectional survey of United States National Residency Matching Program pediatric fellows training in critical care specialties. SETTING Online survey open from April to May 2021. SUBJECTS A total of 720 fellows (165 cardiology, 259 critical care, and 296 neonatology) were contacted, with a response rate of 245 of 720 (34%). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We assessed fellows' survey responses about spiritual care in neonatal and pediatric critical care units. Categorical data were compared using chi-square test or Fisher exact tests. The Wilcoxon rank-sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Free-text responses were independently coded by two research investigators. A total of 203 of 245 (83%) responding fellows had never received training about spiritual care and 176 of 245 (72%) indicated that they would be likely to incorporate spiritual care into their practice if they received training. Prior training was associated with increased familiarity with a framework for taking a spiritual history ( p < 0.001) and increased knowledge of spiritual practices that could influence medical care ( p = 0.03). Prior training was also associated with increased self-reported frequency of taking a spiritual history ( p < 0.001) and comfort in referring families to spiritual care resources ( p = 0.02). Lack of time and training were the most reported barriers to providing spiritual care. CONCLUSIONS Providing spiritual care for families is important in critical care settings. In 2020-2021, in the United States, 245 pediatric critical care fellows responded to a survey about spiritual care in their practice and reported that they lacked training in this subject. An opportunity exists to implement spiritual care curricula into pediatric fellowship training.
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Affiliation(s)
- Paige E Stevens
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, CA
| | - Caroline E Rassbach
- Department of Pediatrics, Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA
| | - FeiFei Qin
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Kevin W Kuo
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
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Gold CA, Jensen R, Sasnal M, Day HS, Miller-Kuhlmann RK, Blankenburg RL, Rassbach CE, Morris AM, Korndorffer JR, Nassar AK. Impact of a coaching program on resident perceptions of communication confidence and feedback quality. BMC Med Educ 2024; 24:435. [PMID: 38649901 PMCID: PMC11036561 DOI: 10.1186/s12909-024-05383-5] [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: 06/02/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND While communication is an essential skill for providing effective medical care, it is infrequently taught or directly assessed, limiting targeted feedback and behavior change. We sought to evaluate the impact of a multi-departmental longitudinal residency communication coaching program. We hypothesized that program implementation would result in improved confidence in residents' communication skills and higher-quality faculty feedback. METHODS The program was implemented over a 3-year period (2019-2022) for surgery and neurology residents at a single institution. Trained faculty coaches met with assigned residents for coaching sessions. Each session included an observed clinical encounter, self-reflection, feedback, and goal setting. Eligible residents completed baseline and follow-up surveys regarding their perceptions of feedback and communication. Quantitative responses were analyzed using paired t-tests; qualitative responses were analyzed using content analysis. RESULTS The baseline and follow-up survey response rates were 90.0% (126/140) and 50.5% (46/91), respectively. In a paired analysis of 40 respondents, residents reported greater confidence in their ability to communicate with patients (inpatient: 3.7 vs. 4.3, p < 0.001; outpatient: 3.5 vs. 4.2, p < 0.001), self-reflect (3.3 vs. 4.3, p < 0.001), and set goals (3.6 vs. 4.3, p < 0.001), as measured on a 5-point scale. Residents also reported greater usefulness of faculty feedback (3.3 vs. 4.2, p = 0.001). The content analysis revealed helpful elements of the program, challenges, and opportunities for improvement. Receiving mentorship, among others, was indicated as a core program strength, whereas solving session coordination and scheduling issues, as well as lowering the coach-resident ratio, were suggested as some of the improvement areas. CONCLUSIONS These findings suggest that direct observation of communication in clinical encounters by trained faculty coaches can facilitate long-term trainee growth across multiple core competencies. Future studies should evaluate the impact on patient outcomes and workplace-based assessments.
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Affiliation(s)
- Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Jensen
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3639, Stanford, CA, 94305, USA
| | - Marzena Sasnal
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, CA, USA
| | - Heather S Day
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, CA, USA
| | - Rebecca K Miller-Kuhlmann
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Arden M Morris
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, CA, USA
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3639, Stanford, CA, 94305, USA
| | - Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3639, Stanford, CA, 94305, USA.
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Madduri GB, Torwekar EL, Demirel S, Durham M, Hauff KI, Kaul R, Nichols T, Ravid NL, Shaner MA, Rassbach CE. CRISP: An Inpatient Pediatric Curriculum for Family Medicine Residents Using Clinical Reasoning and Illness Scripts. MedEdPORTAL 2024; 20:11393. [PMID: 38524942 PMCID: PMC10957791 DOI: 10.15766/mep_2374-8265.11393] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/04/2024] [Indexed: 03/26/2024]
Abstract
Introduction Clinical reasoning enables safe patient care and is an important competency in medical education but can be challenging to teach. Illness scripts facilitate clinical reasoning but have not been used to create pediatric curricula. Methods We created CRISP (Clinical Reasoning with Illness Scripts in Pediatrics), a curriculum comprising four 1-hour learning sessions that deliberately incorporated clinical reasoning concepts and illness scripts to organize how four common chief complaints were taught to family medicine residents on inpatient pediatric rotations. We performed a multisite curriculum evaluation project over 6 months with family medicine residents at four institutions to assess whether the use of clinical reasoning concepts to structure CRISP was feasible and acceptable for learners and instructors and whether the use of illness scripts increased knowledge of four common pediatric chief complaints. Results For all learning sessions, family medicine residents and pediatric hospitalists agreed that CRISP's format was preferable to traditional didactic lectures. Pre-/posttest scores showed statistically significant increases in family medicine resident knowledge (respiratory distress [n = 42]: pretest, 72%, posttest, 92%; abdominal pain [n = 44]: pretest, 82%, posttest, 96%; acute febrile limp [n = 44]: pretest, 68%, posttest, 81%; well-appearing febrile infant [n = 42]: pretest, 58%, posttest, 73%; ps < .05). Discussion By using clinical reasoning concepts and illness script comparison to structure a pediatric curriculum, CRISP represents a novel instructional approach that can be used by pediatric hospitalists to increase family medicine resident knowledge about diagnoses associated with common pediatric chief complaints.
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Affiliation(s)
- Gayatri B. Madduri
- Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Family Medicine Inpatient Pediatrics Rotation Director, John Muir Medical Center
| | - Elizabeth L. Torwekar
- GME Director of Pediatric Education and Pediatric Hospitalist, Department of Pediatrics, Randall Children's Hospital, Legacy Health
| | - Shaban Demirel
- Vice President of Research, Legacy Research Institute, and Director of Clinical Research, Legacy Health
| | - Megan Durham
- Clinical Instructor, Department of Pediatrics, Randall Children's Hospital, Legacy Health
| | - Kimberlee I. Hauff
- Associate Professor, Department of Family Medicine, University of Washington; Family Medicine Inpatient Pediatrics Rotation Director, Swedish Medical Center
| | - Rajat Kaul
- Associate Professor, Division of Hospital Medicine, Department of Pediatrics, Ebeid Children's Hospital; Pediatric Clerkship Director, University of Toledo College of Medicine and Life Sciences
| | - Tristan Nichols
- Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Family Medicine Inpatient Pediatrics Rotation Director, John Muir Medical Center
| | - Noga L. Ravid
- Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Chair, Department of Pediatrics, John Muir Medical Center
| | - Mason A. Shaner
- Third-Year Medical Student, University of Michigan Medical School
| | - Caroline E. Rassbach
- Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, and Program Director, Pediatrics Residency and Pediatrics-Anesthesiology Residency, Stanford University School of Medicine
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Thomson JE, Rassbach CE, Shah N, Walker J, Wilson K, Shah SS, Jerardi K. Development of Scholarship Core Competencies for Pediatric Hospital Medicine Fellowship Programs. Hosp Pediatr 2024; 14:e66-e74. [PMID: 38073321 DOI: 10.1542/hpeds.2023-007360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/02/2024]
Abstract
The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.
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Affiliation(s)
- Joanna E Thomson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Caroline E Rassbach
- Division of Hospital Medicine, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
| | - Neha Shah
- Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia
- Department of Pediatrics, the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jacqueline Walker
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Karen Wilson
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
- UR Medicine Golisano Children's Hospital, Rochester, New York
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen Jerardi
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Guerin A, Lee J, Floyd B, Yemane L, Fassiotto M, Griffith E, Blankenburg R, Hilgenberg SL, Dali S, De Araujo M, Jones K, Kuo K, Rassbach CE. Building an Antiracist Department Through an Experiential Department-Wide Antiracism Curriculum. Acad Pediatr 2023; 23:1505-1506. [PMID: 37422256 DOI: 10.1016/j.acap.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Allison Guerin
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - July Lee
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Baraka Floyd
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Lahia Yemane
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Magali Fassiotto
- Office of Faculty Development & Diversity (M Fassiotto), Stanford School of Medicine, Stanford, Calif.
| | - Emmett Griffith
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Rebecca Blankenburg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Sarah L Hilgenberg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Salma Dali
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Monique De Araujo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kamaal Jones
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kevin Kuo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Caroline E Rassbach
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
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Sebok-Syer SS, Lingard L, Panza M, Van Hooren TA, Rassbach CE. Supportive and collaborative interdependence: Distinguishing residents' contributions within health care teams. Med Educ 2023; 57:921-931. [PMID: 36822577 DOI: 10.1111/medu.15064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Individual assessments disregard team contributions, while team assessments disregard an individual's contributions. Interdependence has been put forth as a conceptual bridge between our educational traditions of assessing individual performance and our imminent challenge of assessing team-based performance without losing sight of the individual. The purpose of this study was to develop a more refined conceptualisation of interdependence to inform the creation of measures that can assess the interdependence of residents within health care teams. METHODS Following a constructivist grounded theory approach, we conducted 49 semi-structured interviews with various members of health care teams (e.g. physicians, nurses, pharmacists, social workers and patients) across two different clinical specialties-Emergency Medicine and Paediatrics-at two separate sites. Data collection and analysis occurred iteratively. Constant comparative inductive analysis was used, and coding consisted of three stages: initial, focused and theoretical. RESULTS We asked participants to reflect upon interdependence and describe how it exists in their clinical setting. All participants acknowledged the existence of interdependence, but they did not view it as part of a linear spectrum where interdependence becomes independence. Our analysis refined the conceptualisation of interdependence to include two types: supportive and collaborative. Supportive interdependence occurs within health care teams when one member demonstrates insufficient expertise to perform within their scope of practice. Collaborative interdependence, on the other hand, was not triggered by lack of experience/expertise within an individual's scope of practice, but rather recognition that patient care requires contributions from other team members. CONCLUSION In order to assess a team's collective performance without losing sight of the individual, we need to capture interdependent performances and characterise the nature of such interdependence. Moving away from a linear trajectory where independence is seen as the end goal can also help support efforts to measure an individual's competence as an interdependent member of a health care team.
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Affiliation(s)
| | - Lorelei Lingard
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michael Panza
- Centre for Education Research and Innovation, Western University, London, Ontario, Canada
| | - Tamara A Van Hooren
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Nguyen C, Xie J, Brandford E, Wang T, Rassbach CE. Benefits and challenges of combined pediatrics-anesthesiology residency programs: A qualitative study. Paediatr Anaesth 2023; 33:800-807. [PMID: 37435637 DOI: 10.1111/pan.14727] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The combined pediatrics-anesthesiology residency program was created in 2011 for trainees interested in careers within both specialties. Prior studies have cited challenges of combined training, but none have systematically identified benefits. AIMS Our objective was to describe the perceived educational and professional benefits and challenges of combined pediatrics-anesthesiology residency programs. METHODS In this qualitative study using a phenomenological approach, all graduates of combined pediatrics-anesthesiology residency programs from 2016 to 2021, program directors, associate program directors, and faculty mentors were invited to participate in surveys and interviews. Study members conducted interviews using a semi-structured interview guide. Each transcript was coded inductively by two authors and themes were developed using thematic analysis through the lens of self-determination theory. RESULTS 43 of 62 graduates and faculty responded to our survey (69% response rate), and 14 graduates and five faculty were interviewed. Survey and interview data represented seven programs, including five currently accredited combined programs. Themes emerged regarding benefits of training: it 1) fosters residents' clinical expertise in managing critically ill and medically complex children; 2) provides residents with exceptional knowledge and skills in communicating between medical and perioperative services; and 3) affords unique academic and career opportunities. Other themes emerged regarding the challenges of long duration of training and transitions between pediatrics and anesthesiology rotations. CONCLUSIONS This is the first study to describe the perceived educational and professional benefits of combined pediatrics-anesthesiology residency programs. Combined training affords exceptional clinical competence and autonomy in the management of pediatric patients and the ability to skillfully navigate hospital systems, and leads to robust academic and career opportunities. However, the duration of training and challenging transitions may threaten residents' sense of relatedness to colleagues and peers, and their self-perceived competence and autonomy. These results can inform mentoring and recruitment of residents to combined pediatrics-anesthesiology programs and career opportunities for graduates.
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Affiliation(s)
- Clarice Nguyen
- Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA
| | - James Xie
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Elena Brandford
- Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Tammy Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
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Goyal T, Bereknyei Merrell S, Weimer-Elder B, Kline M, Rassbach CE, Gold CA. A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills. J Palliat Med 2023; 26:1180-1187. [PMID: 36952327 DOI: 10.1089/jpm.2022.0371] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.
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Affiliation(s)
- Tarini Goyal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Barbette Weimer-Elder
- Physician Partnership Program, Patient Experience, Stanford Health Care, Stanford, California, USA
| | - Merisa Kline
- Physician Partnership Program, Patient Experience, Stanford Health Care, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Carl A Gold
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
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11
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Hoang K, Rassbach CE. Leadership & professional development: Coaching to develop clinicians, teachers, and leaders. J Hosp Med 2023. [PMID: 37301729 DOI: 10.1002/jhm.13150] [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: 01/23/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Kim Hoang
- Division of Hospital Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
| | - Caroline E Rassbach
- Division of Hospital Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
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12
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Aziz S, Barber J, Singh A, Alayari A, Rassbach CE. Resident and nurse perspectives on the use of secure text messaging systems. J Hosp Med 2022; 17:880-887. [PMID: 36036216 DOI: 10.1002/jhm.12953] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND As hospitals shift away from pagers and towards secure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors. OBJECTIVE This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital. DESIGN This was a qualitative study with focus groups. SETTING AND PARTICIPANTS Participants were pediatric residents and nurses at Lucile Packard Children's Hospital. INTERVENTION Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached. MAIN OUTCOME AND MEASURES Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being. RESULTS Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume. CONCLUSION Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.
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Affiliation(s)
- Sara Aziz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Barber
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amit Singh
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Clinical Informatics, Stanford Children's Health, Palo Alto, California, USA
| | - Amethyst Alayari
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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13
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Nassar AK, Sasnal M, Miller-Kuhlmann RK, Jensen RM, Blankenburg RL, Rassbach CE, Smith-Bentley M, Vyas A, Korndorffer JR, Gold CA. Developing a multi-departmental residency communication coaching program. Educ Health (Abingdon) 2022; 35:98-104. [PMID: 37313890 DOI: 10.4103/efh.efh_357_22] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Local needs assessments in our institution's surgery and neurology residency programs identified barriers to effective communication, such as no shared communication framework and limited feedback on nontechnical clinical skills. Residents identified faculty-led coaching as a desired educational intervention to improve communication skills. Three university departments (Surgery, Neurology, and Pediatrics) and health-care system leaders collaborated closely to develop an innovative communication coaching initiative generalizable to other residency programs. Innovation Coaching program development involved several layers of collaboration between health-care system leaders, faculty educators, and departmental communication champions. The efforts included: (1) creating and delivering communication skills training to faculty and residents; (2) hosting frequent meetings among various stakeholders to develop program strategy, discuss opportunities and learnings, and engage other medical educators interested in coaching; (3) obtaining funding to implement the coaching initiative; (4) selecting coaches and providing salary and training support. Evaluation A multi-phased mixed-methods study utilized online surveys and virtual semi-structured interviews to assess the program's quality and impact on the communication culture and the satisfaction and communication skills of residents. Quantitative and qualitative data have been integrated during data collection and analysis using embedding, building, and merging strategies. Discussion and Implications Establishing a multi-departmental coaching program may be feasible and can be adapted by other programs if similar resources and focus are present. We found that stakeholders' buy-in, financial support, protected faculty time, flexible approach, and rigorous evaluation are crucial factors in successfully implementing and sustaining such an initiative.
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Affiliation(s)
- Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Marzena Sasnal
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca K Miller-Kuhlmann
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel M Jensen
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca L Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Alpa Vyas
- Stanford Health Care, Stanford, California, USA
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Carl A Gold
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
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14
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Niehaus AD, Rassbach CE, Stevenson DA. A survey of program directors for combined pediatrics and medical genetics and genomics residency programs: Perspectives when evaluating applicants. Am J Med Genet A 2022; 188:2315-2324. [PMID: 35633299 DOI: 10.1002/ajmg.a.62846] [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] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/06/2022]
Abstract
While combined pediatrics and medical genetics and genomics residency programs are growing in number and applicants, there are still workforce shortages within the medical genetics field. Medical students would benefit from additional information on the training pathways and insight into the application process itself. Program Directors of combined pediatrics and medical genetics and genomics residency programs were surveyed to characterize factors that influence interview selection and rank list decisions, application logistics, recruitment, and training pathways. When evaluating applicants, representatives from both pediatrics and medical genetics are involved in the screening process. Additionally, both groups value prior research experience, but do not have a clear preference for a particular subcategory or domain of research. Most program directors think that all currently-available training pathways can provide optimal training. Further action is needed to provide medical students with the knowledge to make more informed decisions about their career and medical school advisors with objective data to counsel students. There was support among program directors to initiate consideration of creating a pathway for medical students to match directly into a medical genetics and genomics residency.
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Affiliation(s)
- Annie D Niehaus
- Division of Medical Genetics, Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
| | - David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, Stanford School of Medicine, Stanford, California, USA
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15
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Selling SK, Kirkey D, Goyal T, Singh A, Gold CA, Hilgenberg SL, Weimer-Elder B, Kuo KW, Rassbach CE. Impact of a relationship-centered care communication curriculum on pediatric residents' practice, perspectives, and opportunities to Develop expertise. Patient Educ Couns 2022; 105:1290-1297. [PMID: 34538683 DOI: 10.1016/j.pec.2021.08.014] [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] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To investigate the impacts of a Relationship-Centered Care (RCC) communication curriculum with coaching on pediatric residents 1) self-reported use of RCC strategies and perspectives, and 2) opportunities to develop adaptive expertise. METHODS Residents (n = 77) completed a 4 h RCC training and shared resultant RCC goals with Coaches (n = 15). Data included resident surveys and reflections immediately post-training, and resident and coach surveys 6-months later. Reported use of RCC strategies were compared over time with paired t-tests. Qualitative data were analyzed using open coding guided by sensitizing principles from the RCC framework and adaptive expertise. RESULTS Pediatric residents reported significant increases (p < 0.001) in use of 4/9 RCC strategies after 6 months: eliciting all concerns, chunking information, checking for understanding, and teach-back. Resident reflections highlighted shifts in perspective around RCC. Training combined with coaching provided opportunities for residents to develop adaptive expertise through adapting and innovating across settings and contexts. CONCLUSION Residents had significant increases in reported use of key RCC strategies after a training combined with coaching and demonstrated opportunities to develop adaptive expertise. PRACTICE IMPLICATIONS Residency programs should include RCC training with an emphasis on the new and challenging strategies and provide opportunities to practice and receive coaching.
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Affiliation(s)
| | - Danielle Kirkey
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Tarini Goyal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Amit Singh
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Sarah L Hilgenberg
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA.
| | | | - Kevin Wu Kuo
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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16
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Gold JM, Yemane L, Keppler H, Balasubramanian V, Rassbach CE. Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents. Acad Pediatr 2022; 22:698-704. [PMID: 35158087 DOI: 10.1016/j.acap.2022.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gender disparities in academic medicine continue to be pervasive. Written evaluations of residents may provide insight into perceptions of residents by faculty, which may influence letters of recommendation for positions beyond residency and reinforce perceived stereotype threat experienced by trainees. OBJECTIVE To examine language used in faculty evaluations of pediatrics residents to determine if there are differences in language used with respect to gender of resident. DESIGN/METHODS All faculty evaluations of residents in 3 consecutive intern classes from 2016 to 2018 were collected and redacted for name and gender identifiers. We performed a qualitative analysis of written comments in 2 mandatory free text sections. The study team initially coded text collectively, generating a code book, then individually to apply the coding scheme. Next, evaluations were unblinded to gender. Code applications were aggregated by resident, and frequencies of code application by resident were compared by standardized mean differences to detect imbalances between genders. RESULTS A total of 448 evaluations were analyzed: 88 evaluations of 17 male residents, and 360 evaluations of 70 female residents. Codes more frequently applied to women included "enthusiasm," and "caring," while codes more frequently applied to men included "intelligence," and "prepared." A conceptual model was created to reflect potential impacts of these differences using a lens of social role theory. CONCLUSIONS We identified differences in the way male and female residents are evaluated by faculty, which may have negative downstream effects on female residents, who may experience negative self-perception, differential development of clinical skills, and divergent career opportunities as a result.
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Affiliation(s)
- Jessica M Gold
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif.
| | - Lahia Yemane
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif
| | - Hannah Keppler
- Department of Pediatrics (H Keppler), Albert Einstein College of Medicine, Bronx, NY
| | | | - Caroline E Rassbach
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif
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17
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Dasgupta MN, Kirkey DC, Weatherly JA, Kuo KW, Rassbach CE. Using Self-Determination Theory to Drive an Evidence-Based Medicine Curriculum for Pediatric Residents: A Mixed Methods Study. Acad Pediatr 2022; 22:486-494. [PMID: 34929387 DOI: 10.1016/j.acap.2021.12.018] [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: 01/21/2021] [Revised: 08/24/2021] [Accepted: 12/13/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The ability to incorporate evidence-based medicine (EBM) into clinical practice is an Accreditation Council for Graduate Medical Education competency, yet many pediatric residents have limited knowledge in this area. The objective of this study is to describe the effect of an EBM curriculum on resident attitudes and clinical use of EBM. METHODS We implemented a longitudinal EBM curriculum to review key literature and guidelines and teach EBM principles. In this Institutional Review Board-exempt mixed methods study, we surveyed residents, fellows, and faculty about resident use of EBM at baseline, 6 months, and 12 months after the beginning of the intervention. We conducted point prevalence surveys of faculty about residents' EBM use on rounds. Residents participated in focus groups, which were audio-recorded, transcribed, and coded using conventional content analysis to develop themes. RESULTS Residents (N = 61 pre- and 70 post-curriculum) reported an increased appreciation for the importance of EBM and comfort generating a search question. Faculty reported that residents cited EBM on rounds, with an average of 2.4 citations/week. Cited evidence reinforced faculty's plans 79% of the time, taught faculty something new 57% of the time, and changed management 21% of the time. Focus groups with 22 trainees yielded 4 themes: 1) increased competence in understanding methodology and evidence quality; 2) greater autonomy in application of EBM; 3) a call for relatedness from faculty role models and a culture that promotes EBM; and 4) several barriers to successful use of EBM. CONCLUSIONS After implementation of a longitudinal EBM curriculum, trainees described increased use of EBM in clinical practice.
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Affiliation(s)
- Minnie N Dasgupta
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Danielle C Kirkey
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Jake A Weatherly
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
| | - Kevin W Kuo
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
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18
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Burns AM, Moore DJ, Forster CS, Powell W, Thammasitboon S, Hostetter MK, Weiss P, Boyer D, Ward MA, Blankenburg R, Heyman MB, Rassbach CE, McPhillips H, French A, Nguyen S, Byrne BJ, Parsons DW, Gonzalez F, Nowalk AJ, Ho J, Kumar S, Orange JS, Ackerman KG. Physician-Scientist Training and Programming in Pediatric Residency Programs: A National Survey. J Pediatr 2022; 241:5-9.e3. [PMID: 34280401 DOI: 10.1016/j.jpeds.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Audrea M Burns
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
| | - Daniel J Moore
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Ian Burr Division of Pediatric Endocrinology and Diabetes, Nashville, TN
| | - Catherine S Forster
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Weston Powell
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Satid Thammasitboon
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | | | - Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Debra Boyer
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mark A Ward
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA
| | - Melvin B Heyman
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA
| | - Heather McPhillips
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Anthony French
- Department of Pediatrics, Washington University Medical Center, St. Louis Children's Hospital, St Louis, MO
| | - Suong Nguyen
- Department of Pediatrics, Washington University Medical Center, St. Louis Children's Hospital, St Louis, MO
| | - Bobbi J Byrne
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN
| | - Donald Williams Parsons
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Fernando Gonzalez
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA
| | - Andrew J Nowalk
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jacqueline Ho
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Shelley Kumar
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jordan S Orange
- Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Vagelos College of Physicians and Surgeons, New York, NY
| | - Kate G Ackerman
- Department of Pediatrics, University of Rochester/UR Medicine Golisano Children's Hospital, Rochester, NY
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Abstract
OBJECTIVES Pediatric hospital medicine (PHM) fellowships have rapidly developed to meet established needs. The purpose of this research was to describe the research and career outcomes of PHM fellowship graduates. We hypothesized that graduates would report significant research and academic productivity. METHODS This was an institutional review board-approved, cross-sectional survey of PHM fellowship graduates in 2018. The 88-item survey was modified from an existing survey, developed by experts to address study objectives and pilot tested, and it included quantitative and qualitative items to assess characteristics of fellowship training and research and career outcomes. RESULTS A total of 63% of PHM fellowship graduates (143 of 228) completed the survey (graduation dates, 2000-2018). In total, 89% graduated from dedicated PHM fellowship programs, with 59% completing a 2-year fellowship and 78% now practicing primarily at a university or children's hospital. Fellows conducted research in clinical research (53%), quality improvement (41%), health services (24%), and medical education (19%). A total of 77% of graduates continued to do research after graduation, with 63% publishing and 25% obtaining grant funding. Graduates of 2- and 3-year fellowships and those with a master's degree were significantly more productive. Graduates now hold important roles in academic and health systems leadership. Graduates are highly satisfied with their decision to do PHM fellowship and identified 5 themes regarding how fellowship impacted their career outcomes. CONCLUSIONS In this study, we document robust research activity and leadership positions among PHM fellowship graduates and can serve as a benchmark for metrics that PHM educational leaders can use to assess outcomes and improve training regarding research and career development.
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Affiliation(s)
- Caroline E Rassbach
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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20
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Nguyen B, Barber A, Rassbach CE. Resident Clinical Experience During the Pandemic: What Has It Cost Us and What Have We Gained? Hosp Pediatr 2021; 11:e120-e122. [PMID: 33863815 DOI: 10.1542/hpeds.2021-005970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Bradford Nguyen
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Aisha Barber
- Department of Pediatrics, Children's National Hospital and School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Caroline E Rassbach
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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21
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Lester TR, Rassbach CE, Blankenburg R. What Are the Unique Mentorship Needs of Fourth-Year Medical Students Applying to Pediatrics Residency? Acad Pediatr 2020; 20:1206-1212. [PMID: 32389758 DOI: 10.1016/j.acap.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/24/2020] [Accepted: 05/03/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The qualities of good medical school mentors have been well described. However, there is little written about the mentoring needs of medical students applying to pediatrics residency. METHODS In order to characterize pediatrics interns' perspectives on the mentorship needs of fourth-year medical students applying to residency, the authors conducted an IRB-approved, qualitative-modified grounded-theory study using a brief survey and semistructured focus groups of pediatric interns in January and February 2018. Two investigators independently coded the focus group transcripts and reconciled codes to develop categories and themes using constant comparison, which were then reviewed by the third author for validation. To further ensure trustworthiness of analysis, participants were asked to comment on the themes' accuracy. RESULTS Eighteen pediatrics interns participated, representing 15 medical schools. Four major themes emerged: 1) effective mentors guide medical students to self-reflect and find their own answers about what is important to them in a residency program; 2) multiple mentors are helpful during the residency application process; 3) several key components of advising are often missing during the residency application process; 4) students find it difficult to be honest with their mentors if there is a perceived conflict of interest. CONCLUSIONS Medical students applying for pediatrics residency have specific mentorship needs and cite opportunities to improve this area of mentorship. Several key recommendations include utilizing multiple mentors and providing emotional support during the residency application process. In addition, near-peer mentorship is important for medical students applying to residency and should be facilitated by medical schools.
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Affiliation(s)
- Talia R Lester
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
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22
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Burns AM, Ackerman KG, Thammasitboon S, Rassbach CE, Ward MA, Blankenburg RL, Forster CS, McPhillips HA, Wenger TL, Powell WT, Heyman MB, Hogarty MD, Boyer D, Hostetter M, Weiss P, Nguyen ST, Parsons DW, Moore DJ, Byrne BJ, French AR, Orange JS. Fixing the leaky pipeline: identifying solutions for improving pediatrician-scientist training during pediatric residency. Pediatr Res 2020; 88:163-167. [PMID: 32179872 DOI: 10.1038/s41390-020-0837-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Audrea M Burns
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Kate G Ackerman
- Department of Pediatrics, University of Rochester/UR Medicine Golisano Children's Hospital, Rochester, NY, USA
| | - Satid Thammasitboon
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA, USA
| | - Mark A Ward
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rebecca L Blankenburg
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA, USA
| | - Catherine S Forster
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences/Children's National Medical Center, Washington, DC, USA
| | - Heather A McPhillips
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Tara L Wenger
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Weston T Powell
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Melvin B Heyman
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA, USA
| | - Michael D Hogarty
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Debra Boyer
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Margaret Hostetter
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Suong T Nguyen
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Donald Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Daniel J Moore
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Nashville, TN, USA
| | - Bobbi J Byrne
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anthony R French
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jordan S Orange
- Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, New York City, NY, USA
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Mahoney D, Bogetz A, Hirsch A, Killmond K, Phillips E, Bhavaraju V, McQueen A, Orlov N, Blankenburg R, Rassbach CE. The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents. Acad Pediatr 2019; 19:555-560. [PMID: 30576788 DOI: 10.1016/j.acap.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/22/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education calls for residency programs to incorporate multisource feedback, which may include patient feedback, into resident competency assessments. Program directors face numerous challenges in gathering this feedback. This study assesses the feasibility and acceptability of patient feedback collection in the inpatient and outpatient setting at 3 institutions. METHODS Patient feedback was collected using a modified version of the Communication Assessment Tool (CAT). Trained research assistants administered the CAT to eligible patients and families in pediatric ward, intensive care, and outpatient settings from July to October 2015. Completion rates and reasons for non-completion were recorded. Patient satisfaction with the CAT was assessed on a 5-point Likert scale. RESULTS The CAT was completed by 860/1413 (61%) patients. Completion rates in the pediatric ward and intensive care settings were 45% and 38%, respectively, compared to 91% in the outpatient setting. In inpatient settings, survey non-completion was typically due to participant unavailability; this was rarely a reason in the outpatient setting. A total of 93.4% of patients were satisfied or very satisfied with using the CAT. It was found that 6.36 hours of research assistant time would be required to gather a valid quantity of patient feedback for a single resident in the outpatient setting, compared to 10.14 hours in the inpatient setting. CONCLUSIONS Although collecting feedback using our standardized protocol is acceptable to patients, obtaining sufficient feedback requires overcoming several barriers and a sizable time commitment. Feedback collection in the outpatient setting may be higher yield than in the inpatient setting due to greater patient/family availability. Future work should focus on innovative methods to gather patient feedback in the inpatient setting to provide program directors with a holistic view of their residents' communication skills.
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Affiliation(s)
- David Mahoney
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif.
| | - Alyssa Bogetz
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
| | - Amanda Hirsch
- Department of Pediatrics, Pritzker School of Medicine (A Hirsch)
| | - Katherine Killmond
- University of California, Irvine, School of Medicine (K Killmond), Irvine
| | - Elisa Phillips
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
| | - Vasudha Bhavaraju
- Department of Pediatrics (V Bhavaraju), Phoenix Children's Hospital/Maricopa Medical Center, University of Arizona College of Medicine, Phoenix
| | - Alisa McQueen
- Department of Pediatrics, Comer Children's Hospital (A McQueen and N Orlov), The University of Chicago, Chicago, Ill
| | - Nicola Orlov
- Department of Pediatrics, Comer Children's Hospital (A McQueen and N Orlov), The University of Chicago, Chicago, Ill
| | - Rebecca Blankenburg
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
| | - Caroline E Rassbach
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
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Abstract
PROBLEM The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement. APPROACH The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback. OUTCOMES Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before. NEXT STEPS Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.
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Affiliation(s)
- Caroline E Rassbach
- C.E. Rassbach is clinical associate professor, associate residency program director, and coaching director, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9221-1643. R. Blankenburg is clinical associate professor, associate chair for education, and residency program director, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-1938-6113
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Bogetz JF, Bogetz AL, Rassbach CE, Gabhart JM, Blankenburg RL. Caring for Children With Medical Complexity: Challenges and Educational Opportunities Identified by Pediatric Residents. Acad Pediatr 2015; 15:621-5. [PMID: 26409304 DOI: 10.1016/j.acap.2015.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/11/2014] [Revised: 07/25/2015] [Accepted: 08/13/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE High-quality care for children with medical complexity (CMC) is in its infancy. Residents have the opportunity to view care for CMC with a fresh perspective that is informed by their work across diverse health care settings and significant time spent at the bedside. This study aimed to identify the challenges and potential solutions for complex care delivery and education from their perspectives. METHODS We conducted three 60-minute focus groups with a purposeful sample of residents and recent graduates at a US tertiary-care medical center. Data were transcribed verbatim, and themes were identified using an iterative approach and modified grounded theory. RESULTS Sixteen participants identified 4 major challenges to caring for CMC: 1) lack of care coordination; 2) complex technology management; 3) patients' pervasive psychosocial needs; and 4) lack of effective health care provider training. Participants identified 3 solutions: 1) greater integration of primary care providers; 2) attention to psychosocial needs through shared decision making; and 3) integration of longitudinal patient relationships into provider training. We found that residents who experienced longitudinal relationships with CMC felt more efficacious and better equipped to handle challenges of caring for CMC as a result of their broader understanding of patients' priorities and of their role as providers. CONCLUSIONS Residents recognize important challenges and offer thoughtful solutions to caring for CMC. Although multiple solutions exist, formal integration of longitudinal patient experiences into residency training may better prepare residents to understand patient priorities and identify when their own attitudinal changes can guide them into more efficacious roles as providers.
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Affiliation(s)
- Jori F Bogetz
- Division of Hospital Medicine, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, Calif; Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
| | - Alyssa L Bogetz
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Caroline E Rassbach
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | | | - Rebecca L Blankenburg
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
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Bogetz JF, Rassbach CE, Bereknyei S, Mendoza FS, Sanders LM, Braddock CH. Training health care professionals for 21st-century practice: a systematic review of educational interventions on chronic care. Acad Med 2015; 90:1561-1572. [PMID: 26039140 DOI: 10.1097/acm.0000000000000773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care. METHOD A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner's chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller's classification of clinical competence was used to assess the quality of learner achievements for each educational intervention. RESULTS A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner's CCM and showed high-level learner competence according to Miller's classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives. CONCLUSIONS The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.
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Affiliation(s)
- Jori F Bogetz
- J.F. Bogetz is postdoctoral fellow and clinical instructor, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.E. Rassbach is associate residency program director, pediatric hospitalist, and clinical assistant professor, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. S. Bereknyei is a research scholar, Stanford Center for Medical Education Research and Innovation (SCeMERI), Stanford University School of Medicine, Palo Alto, California. F.S. Mendoza is professor of pediatrics and chief, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. L.M. Sanders is associate professor of pediatrics, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.H. Braddock III is professor of medicine and vice dean for education, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California
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Bogetz JF, Gabhart JM, Rassbach CE, Sanders LM, Mendoza FS, Bergman DA, Blankenburg RL. Outcomes of a randomized controlled educational intervention to train pediatric residents on caring for children with special health care needs. Clin Pediatr (Phila) 2015; 54:659-66. [PMID: 25561698 DOI: 10.1177/0009922814564050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). METHODS Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. RESULTS Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. CONCLUSION SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease.
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Affiliation(s)
- Jori F Bogetz
- Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, CA. USA
| | - Julia M Gabhart
- Lucile Packard Children's Hospital, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Caroline E Rassbach
- Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, CA. USA
| | - Lee M Sanders
- Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, CA. USA
| | - Fernando S Mendoza
- Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, CA. USA
| | - David A Bergman
- Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, CA. USA
| | - Rebecca L Blankenburg
- Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, CA. USA
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Bogetz JF, Bogetz AL, Gabhart JM, Bergman DA, Blankenburg RL, Rassbach CE. Continuing education needs of pediatricians across diverse specialties caring for children with medical complexity. Clin Pediatr (Phila) 2015; 54:222-7. [PMID: 25561699 DOI: 10.1177/0009922814564049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Care for children with medical complexity (CMC) relies on pediatricians who often are ill equipped, but striving to provide high quality care. We performed a needs assessment of pediatricians across diverse subspecialties at a tertiary academic US children's hospital about their continuing education needs regarding the care of CMC. METHODS Eighteen pediatricians from diverse subspecialties were asked to complete an online anonymous open-ended survey. Data were analyzed using modified grounded theory. RESULTS The response rate was 89% (n = 16). Of participants, 31.2% (n = 5) were general pediatricians, 18.7% (n = 3) were hospitalists, and 50% (n = 8) were pediatric subspecialists. Pediatricians recognized the need for skills in care coordination, giving bad news, working in interprofessional teams, and setting goals of care with patients. CONCLUSIONS Practicing pediatricians need skills to improve care for CMC. Strategically incorporating basic palliative care education may fill an important training need across diverse pediatric specialties.
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Affiliation(s)
- Jori F Bogetz
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alyssa L Bogetz
- Stanford Center for Medical Education Research and Innovation (SCeMERI), Stanford University School of Medicine, Palo Alto, CA, USA
| | - Julia M Gabhart
- Lucile Packard Children's Hospital, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - David A Bergman
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rebecca L Blankenburg
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Caroline E Rassbach
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
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