Lost in translation: a national cross-sectional study on medical interpreter use by pediatric residents

BACKGROUND

Lack of communication in a family's preferred language is inequitable and results in inferior care. Pediatric residents provide care to many families with non-English or French language preferences (NEFLP). There is no data available about how Canadian pediatric residents use interpreters, making it difficult to develop targeted interventions to improve patient experience.

OBJECTIVES

Our purpose was to assess translation services in pediatric training centers and evaluate resident perception of their clinical skills when working with NEFLP patients and families. This survey represents the first collection of data from Canadian pediatric residents about interpreter services.

METHODS

Eligible participants included all pediatric residents enrolled in an accredited Canadian pediatric training program. An anonymous survey was developed in REDCap© and distributed via email to all pediatric residents across Canada. Descriptive statistics were performed in STATA v15.1.

RESULTS

122 residents responded. Interpreter services were widely available but underused in a variety of clinical situations. Most (85%) residents felt they provided better care to patients who shared their primary language (English or French), compared with families who preferred other languages-even when an interpreter was present. This finding was consistent across four self-assessed clinical skills.

CONCLUSIONS

Residents are more confident in their clinical and communication skills when working with families who share their primary language. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Pediatric training programs should develop curriculum content that targets safe and effective interpreter use while reviewing non-spoken aspects of cultural awareness and safety.

A retrospective study investigating requests for self-citation during open peer review in a general medicine journal

Introduction

Peer review is a volunteer process for improving the quality of publications by providing objective feedback to authors, but also presents an opportunity for reviewers to seek personal reward by requesting self-citations. Open peer review may reduce the prevalence of self-citation requests and encourage author rebuttal over accession. This study aimed to investigate the prevalence of self-citation requests and their inclusion in manuscripts in a journal with open peer review.

Methods

Requests for additional references to be included during peer review for articles published between 1 January 2017 and 31 December 2018 in BMC Medicine were evaluated. Data extracted included total number of self-citations requested, self-citations that were included in the final published manuscript and manuscripts that included at least one self-citation, and compared with corresponding data on independent citations.

Results

In total, 932 peer review reports from 373 manuscripts were analysed. At least one additional citation was requested in 25.9% (n = 241) of reports. Self-citation requests were included in 44.4% of reports requesting additional citations (11.5% of all reports). Requests for self-citation were significantly more likely than independent citations to be incorporated in the published manuscript (65.1% vs 52.1%; chi-square p = 0.003). At the manuscript level, when requested, self-citations were incorporated in 76.6% of manuscripts (n = 72; 19.3% of all manuscripts) compared with 68.5% of manuscripts with independent citation requests (n = 102; 27.3% of manuscripts). A significant interaction was observed between the presence of self-citation requests and the likelihood of any citation request being incorporated (100% incorporation in manuscripts with self-citation requests alone versus 62.7–72.2% with any independent citation request; Fisher’s exact test p<0.0005).

Conclusions

Requests for self-citations during the peer review process are common. The transparency of open peer review may have the unexpected effect of encouraging authors to incorporate self-citation requests by disclosing peer reviewer identity.

(MED) RESIDENT SATISFACTION IN CANADIAN PEDIATRIC RESIDENT CONTINUITY CLINICS

BACKGROUND

Resident continuity clinics (RCCs) provide an opportunity for residents to gain experience with longitudinal care in an outpatient setting. RCCs have become a part of almost all recognized residency training programs across specialties in North America. However, the structure, function, and effectiveness of RCCs vary widely.

OBJECTIVES

To determine resident perspective on the structure and function of paediatric RCCs and investigate which factors were associated with resident satisfaction with paediatric RCCs.

DESIGN/METHODS

A qualitative survey of Canadian paediatric resident trainees was conducted to assess their RCC experience. The survey was administered through the REDCap© database and distributed through the Canadian Pediatric Program Directors Consortium in June-July 2016.

RESULTS

There were 127 respondents. Approximately 40% participated in RCCs. The majority of respondents were likely to recommend RCCs to other programs. The most common structure reported was a monthly half-day clinic overseen by an academic paediatrician. Referrals were mainly from inpatient wards, emergency department or family physicians. The majority of residents were satisfied with their experience (n=33, 71.7%). Participants in resident-run RCCs had more positive views compared to participants in staff-run RCCs (all U≥25.0, p≤0.009). Contributing factors to a positive RCC experience included patient-resident continuity, being viewed as the main care provider, and learning to make independent management decisions.

CONCLUSION

Almost all respondents felt that RCCs should be part of paediatric residency training. Further research is needed to determine the optimal structure for paediatric RCCs. Understanding our current training environment is an important precursor for informing program leadership and national policymakers who wish to improve ambulatory care training

Face and neck swelling in a 16-year-old boy

Scleredema adultorum is a rare condition characterised by progressive collagen and mucin deposition in the skin. While the aetiology has not been clearly delineated, the condition is often associated with common infections. The current report describes a previously healthy 16-year-old boy who presented with 3 weeks of progressive neck swelling and skin induration. He had evidence of both active streptococcal and Ebstein-Barr virus (EBV) infections. Skin biopsy confirmed the diagnosis of scleredema. The patient was treated for his streptococcal infection, but otherwise managed conservatively. Clear improvement in the signs and symptoms was seen at a 3-month follow-up appointment. Scleredema can be a complication of streptococcal infection but to our knowledge has not been reported in association with EBV. It should be considered in the differential diagnosis of any patient presenting with cutaneous/subcutaneous induration and swelling of the face and/or neck.