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PediagogyTM: A Novel, Resident-Based Educational Podcast. PediagogyTM: 一种新颖的、基于居民的教育播客。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-16 DOI: 10.1016/j.acap.2024.08.002
Lidia Park, Tammy Yau, Lena van der List, Su-Ting T Li
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引用次数: 0
Unveiling Gender Bias: An Update on Faculty Teaching Evaluations in Academic Medicine. 揭开性别偏见的面纱:学术医学界教师教学评价的最新情况。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-12 DOI: 10.1016/j.acap.2024.08.007
Sarah Webber, Jessica C Babal, Ann H Allen, Laura P Chen, Kirstin A M Nackers, Brittany J Allen, Deanna Jewell, Madeline Q Kieren, Michelle M Kelly
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引用次数: 0
A Randomized Trial of Virtual Reality Training to Improve Firearm Safety Counseling Skills. 提高枪支安全咨询技能的虚拟现实培训随机试验。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-10 DOI: 10.1016/j.acap.2024.08.005
Michelle March, Matthew Zackoff, Jacob Fleck, Andrea Meisman, Kristen Humphrey, Melinda C MacDougall, Shelley Ehrlich, Cornelia Griggs, Chana Sacks, Peter Masiakos, Melissa Klein, Francis Real

Objective: To evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention.

Methods: We conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback. All residents completed audio-recorded standardized patient (SP) encounters before and after the training as well as a retrospective pre-post survey. Two reviewers, blinded to the allocation arm, used a standardized assessment tool to generate performance scores. Outcomes of interest included the difference between groups in SP performance scores and self-reported confidence.

Results: From March to July 2023, 62% of eligible pediatric residents (n = 47/76) completed the allocated study tasks (intervention 19, control 28). In both groups, SP performance scores and self-reported confidence improved. Compared to the control group, the intervention group demonstrated improvement in sharing information on secure storage devices (P = 0.009) and increased confidence in providing information on secure storage (P = 0.002).

Conclusions: Compared with didactic training alone, a VR intervention using deliberate practice improved residents' skills and confidence related to firearm safety counseling.

目的评估新型虚拟现实(VR)干预措施--"住院医师家庭枪支安全教育与咨询"(REACH)的效果:我们在美国中西部一家学术性初级保健中心的儿科住院医师中开展了一项单中心随机对照试验,比较了 "REACH 枪械安全 "与说教式培训(干预)和单独说教式培训(对照)的效果。在干预组中,参与者与虚拟人物一起练习枪械安全咨询,并获得即时反馈。所有住院医师都在培训前后完成了标准化患者(SP)会诊录音以及事后回顾调查。两名评审人员在分配组盲的情况下,使用标准化的评估工具对学员的表现进行评分。研究结果包括各组间的 SP 表现评分差异和自我信心报告:从 2023 年 3 月到 7 月,62% 符合条件的儿科住院医师(n=47/76)完成了分配的研究任务(干预组 19 人,对照组 28 人)。干预组和对照组的SP表现得分和自我信心均有所提高。与对照组相比,干预组在共享安全存储设备信息方面有所改善(p=0.009),在提供安全存储信息方面的信心有所增强(p=0.002):与单纯的说教式培训相比,采用刻意练习的 VR 干预提高了住院医生在枪支安全咨询方面的技能和信心。
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引用次数: 0
Sexual identity is associated with adverse childhood experiences (ACEs) in US early adolescents. 美国早期青少年的性别认同与童年不良经历(ACEs)有关。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-10 DOI: 10.1016/j.acap.2024.07.022
Julia H Raney, Shayna Weinstein, Alexander Testa, Kyle T Ganson, Zain Memon, David V Glidden, Fiona C Baker, Claire D Brindis, Jason M Nagata

Objective: To determine disparities in adverse childhood experiences (ACEs) by sexual identity in a national cohort of early adolescents.

Methods: We analyzed cross-sectional data from year 2 of the Adolescent Brain Cognitive Development Study (N=10,934, 2018-2020, ages 10-14 years). Disparities in ACE score across lesbian, gay, or bisexual (LGB), not sure, and heterosexual adolescents were assessed using multinomial logistic regression analyses. Logistic regressions estimated the associations between sexual identity and each individual ACE. Analyses were adjusted for potential confounders.

Results: In adjusted models, LGB adolescents had higher risk of experiencing 2, 3, or ≥4 ACEs (Relative Risk Ratios [RRR] =1.57, 95% CI 1.01-2.42), 3 (RR=1.78, 95% CI 1.100-2.88), or ≥4 ACEs (RRR=3.20, 95% CI 1.92-5.32), and not sure adolescents had a higher risk of having ≥4 ACEs (RRR=2.17, 95% CI 1.22-3.87), compared to heterosexual adolescents. LGB and not sure adolescents had higher risks of reporting emotional abuse ("yes" OR =4.21, 95% CI 1.84-9.61; "maybe" OR=6.20, 95% CI 2.91-13.19) and parent mental illness ("yes" OR=1.95, 95% CI 1.48-2.57; "maybe" OR=1.63, 95% CI 1.21-2.18) compared to heterosexual adolescents.

Conclusions: LGB adolescents and those questioning their sexual identity were at greater risk of having higher ACE scores, with LGB adolescents experiencing the highest risk of experiencing ACEs. LGB adolescents also had higher odds of reporting emotional and parent mental illness. Recognizing this heightened risk of ACEs in early adolescence is critical for designing clinic and school-based interventions.

目的确定全国早期青少年队列中不同性别身份的儿童不良经历(ACE)的差异:我们分析了青少年大脑认知发展研究第二年的横截面数据(N=10934,2018-2020 年,10-14 岁)。我们使用多项式逻辑回归分析评估了女同性恋、男同性恋或双性恋(LGB)青少年、不确定青少年和异性恋青少年之间 ACE 分数的差异。逻辑回归估算了性身份与每个个体 ACE 之间的关联。分析对潜在的混杂因素进行了调整:在调整后的模型中,LGB 青少年经历 2、3 或≥4 个 ACE 的风险较高(相对风险比 [RRR] =1.57,95% CI 1.01-2.42),经历 3 个 ACE 的风险较高(RR=1.78,95% CI 1.100-2.88),经历≥4 个 ACE 的风险较高(相对风险比 [RRR] =1.57,95% CI 1.01-2.42)。与异性恋青少年相比,男女同性恋、双性恋和变性青少年以及不确定青少年发生≥4次ACE的风险更高(RRR=2.17,95% CI 1.22-3.87)。与异性恋青少年相比,男女同性恋、双性恋和变性青少年以及不确定青少年报告情感虐待("是 "OR=4.21,95% CI 1.84-9.61;"可能 "OR=6.20,95% CI 2.91-13.19)和父母患有精神疾病("是 "OR=1.95,95% CI 1.48-2.57;"可能 "OR=1.63,95% CI 1.21-2.18)的风险更高:结论:男女同性恋、双性恋和变性青少年以及那些对自己的性身份有疑问的青少年有更高的 ACE 评分风险,其中男女同性恋、双性恋和变性青少年经历 ACE 的风险最高。此外,LGB 青少年报告患有情绪病和父母精神疾病的几率也更高。认识到青春期早期发生 ACE 的高风险对于设计诊所和学校的干预措施至关重要。
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引用次数: 0
Longitudinal Improvement in Public Speaking Skills Through Participation in a Resident Public Speaking Curriculum. 通过参加居民公共演讲课程纵向提高公共演讲技能。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-07 DOI: 10.1016/j.acap.2024.08.004
Tyler J Benning, Jacob R Greenmyer, Richmond M Castillo, James L Homme, David J Hall, Jason H Homme

Objective: To promote public speaking skills, a pediatrics residency program developed a longitudinal public speaking curriculum grounded in deliberate practice and reflective practice.

Methods: Residents delivered annual presentations and received formal feedback. Audience evaluation forms from 2005-2017 were included for analysis. The form used 5-point scales (5= best) for specific presentation elements (clarity, eye contact/body language, pace, succinct text, minimally distracting delivery, clear conclusion, appropriate learning objectives, achieving learning objectives, and answering questions) and for overall quality. Longitudinal changes in scores were analyzed with paired t tests.

Results: Overall, 5,771 evaluations of 276 presentations given by 97 residents were analyzed. Between post-graduate year (PGY)-1 and PGY-3 presentations, mean overall rating increased from 4.38 to 4.59 (P<.001, d=0.51). The median percentage of 5-point scores increased from 50.0% (IQR, 24.3%-65.4%) to 72.5% (IQR, 53.3%-81.2%). Eight of 9 specific elements showed significant increases (median effect size 0.55). Residents whose initial presentations ranked in the bottom quartile had larger improvements than residents initially ranked in the top quartile.

Conclusions: After pediatric residents participated in a public speaking curriculum with targeted objectives, formal feedback, and repeated practice, their public speaking skills improved. Public speaking curricula can and should be adopted more broadly in graduate medical education.

目的为了提高公共演讲技能,儿科住院医师培训项目开发了一套以刻意练习和反思练习为基础的纵向公共演讲课程:方法:住院医师进行年度演讲并获得正式反馈。2005-2017年的听众评估表被纳入分析范围。该表格针对具体的演讲要素(清晰度、眼神交流/肢体语言、节奏、简洁的文字、尽量不分散注意力的表达、清晰的结论、适当的学习目标、实现学习目标和回答问题)和整体质量采用了 5 分制(5 分=最佳)。得分的纵向变化通过配对 t 检验进行分析:结果:共分析了 97 名住院医师对 276 场演讲进行的 5771 次评价。在研究生 1 年级(PGY)和研究生 3 年级(PGY-3)的演讲中,平均总评分从 4.38 分上升到 4.59 分(PConclusions:儿科住院医师参加了具有针对性目标、正式反馈和反复练习的公开演讲课程后,他们的公开演讲技能得到了提高。公开演讲课程可以而且应该在医学研究生教育中更广泛地采用。
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引用次数: 0
Underrepresented in Medicine Trainees' Sense of Belonging and Professional Identity Formation after Participation in the Leadership Education in Advancing Diversity Program. 参加 "促进多元化领导力教育 "项目后,医学界少数派受训人员的归属感和职业认同感的形成》(Underrepresented in Medicine Trainees' Sense of Belonging and Professional Identity Formation after Participation in the Leadership Education in Advancing Diversity Program)。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-06 DOI: 10.1016/j.acap.2024.08.003
Lahia Yemane, Carmin Powell, Jeffrey Edwards, Takudzwa Shumba, Al'ai Alvarez, Belinda Bandstra, Michelle Brooks, Cati Brown-Johnson, Wendy Caceres, Tamara Dunn, Carrie Johnson, Felipe D Perez, Travis Reece-Nguyen, Reena P Thomas, Amelia C Watkins, Rebecca Blankenburg

Background: There are persistent structural barriers that threaten inclusion and retention of underrepresented in medicine (UIM) residents and fellows (trainees) as future faculty in academic medicine. We developed the Leadership Education in Advancing Diversity (LEAD) Program at a single, academic institution, to address these barriers through a 10-month longitudinal curriculum across GME for trainees to develop leadership and scholarship skills in DEI.

Objective: Explore how participation in LEAD impacted UIM trainees' sense of belonging and professional identity formation in academic medicine; as well as perceptions about pursuing a career in academic medicine and future leadership roles.

Methods: IRB-approved qualitative study in August 2020-August 2021 with individual, semi-structured interviews of UIM LEAD graduates from the first 4 cohorts (2017-2021). Data were analyzed by two authors using modified grounded theory.

Results: 14 UIM trainees were interviewed; seven themes emerged. Critical aspects of the program: (1) Creation of a community of shared DEI values (2) Mentorship (3) Role of allies. Results of the program: (4) Deepened appreciation of personal and professional identity as UIM (5) Fostered belonging in academic medicine (6) Appreciation of different careers in academic medicine and how to integrate DEI interests (7) Inspired trainees to pursue leadership roles.

Conclusions: LEAD can serve as a model for other institutions that seek to support UIM trainees' sense of belonging, professional identity formation, and perceptions about pursuing careers in academic medicine and future leadership roles.

背景:持续存在的结构性障碍威胁着医学领域代表性不足的住院医师和研究员(受训人员)作为未来学术医学教员的融入和保留。我们在一家学术机构制定了 "促进多样性领导力教育(LEAD)计划",通过为期 10 个月的纵向课程来解决这些障碍:探索参与 LEAD 如何影响 UIM 学员在学术医学中的归属感和职业认同感的形成,以及对学术医学职业生涯和未来领导角色的看法:2020年8月至2021年8月,对UIM LEAD前四届(2017-2021年)毕业生进行了个人半结构式访谈。两位作者采用修正的基础理论对数据进行了分析:结果:14 名 UIM 学员接受了访谈;出现了七个主题。项目的关键方面:(1)创建一个具有共同 DEI 价值观的社区(2)导师制(3)盟友的作用。该计划的成果:(4)加深了对作为 UIM 的个人和职业身份的认识(5)培养了对学术医学的归属感(6)了解了学术医学中的不同职业以及如何整合 DEI 兴趣(7)激励了学员追求领导角色:LEAD可以作为其他机构的典范,帮助大学医学院的学员建立归属感、职业认同感,以及对从事学术医学职业和未来领导角色的看法。
{"title":"Underrepresented in Medicine Trainees' Sense of Belonging and Professional Identity Formation after Participation in the Leadership Education in Advancing Diversity Program.","authors":"Lahia Yemane, Carmin Powell, Jeffrey Edwards, Takudzwa Shumba, Al'ai Alvarez, Belinda Bandstra, Michelle Brooks, Cati Brown-Johnson, Wendy Caceres, Tamara Dunn, Carrie Johnson, Felipe D Perez, Travis Reece-Nguyen, Reena P Thomas, Amelia C Watkins, Rebecca Blankenburg","doi":"10.1016/j.acap.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.acap.2024.08.003","url":null,"abstract":"<p><strong>Background: </strong>There are persistent structural barriers that threaten inclusion and retention of underrepresented in medicine (UIM) residents and fellows (trainees) as future faculty in academic medicine. We developed the Leadership Education in Advancing Diversity (LEAD) Program at a single, academic institution, to address these barriers through a 10-month longitudinal curriculum across GME for trainees to develop leadership and scholarship skills in DEI.</p><p><strong>Objective: </strong>Explore how participation in LEAD impacted UIM trainees' sense of belonging and professional identity formation in academic medicine; as well as perceptions about pursuing a career in academic medicine and future leadership roles.</p><p><strong>Methods: </strong>IRB-approved qualitative study in August 2020-August 2021 with individual, semi-structured interviews of UIM LEAD graduates from the first 4 cohorts (2017-2021). Data were analyzed by two authors using modified grounded theory.</p><p><strong>Results: </strong>14 UIM trainees were interviewed; seven themes emerged. Critical aspects of the program: (1) Creation of a community of shared DEI values (2) Mentorship (3) Role of allies. Results of the program: (4) Deepened appreciation of personal and professional identity as UIM (5) Fostered belonging in academic medicine (6) Appreciation of different careers in academic medicine and how to integrate DEI interests (7) Inspired trainees to pursue leadership roles.</p><p><strong>Conclusions: </strong>LEAD can serve as a model for other institutions that seek to support UIM trainees' sense of belonging, professional identity formation, and perceptions about pursuing careers in academic medicine and future leadership roles.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hospitalization Patterns for Rural-Residing Children from 2002 to 2017. 2002 至 2017 年农村儿童住院模式。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-05 DOI: 10.1016/j.acap.2024.07.021
Corrie E McDaniel, Matt Hall, Jay G Berry

Objective: The closure of inpatient pediatric units within general hospitals has contributed to the regionalization of pediatric care. For children in rural areas, the distance traveled for hospitalization impacts the quality of care for children, the impact upon families, and the preparedness for disaster planning within rural communities. We assessed trends in location of hospitalization over time for rural-residing children.

Methods: Using the Healthcare Cost and Utilization Project's State Inpatient Databases, we studied 256,947 hospitalizations for rural-residing children 0-17 years of age within eight states (CO, FL, KY, NC, NJ, NY, OR, WA) from 2002-2017. Level of rurality was defined by Rural-Urban Commuting Area Codes: micropolitan, small rural, and isolated rural. Birth, psychiatric, and surgical hospitalizations were excluded. Trends in number of hospitalizations by hospital location, interfacility transfer (IFT), and whether the hospital location was the same level of rurality as the patient's home residence were assessed with the Cochran-Armitage trend test.

Results: From 2002 to 2017, hospitalizations for rural-residing children decreased by 52.7% (56,168 to 26,548) and IFTs increased from 6.7% to 26.5% (p<.001). The proportion of total hospitalizations within metropolitan areas for rural-residing children increased from 32.2% to 72.8% (p<.001). Local-area agreement between the patient's residence and hospital utilized decreased from 53.6% to 21.5% (p<.001).

Conclusions: Although overall hospitalizations for rural-residing children decreased, IFTs increased, and the proportion hospitalized in metropolitan areas increased. The impact of this shift in inpatient health services on efficiency and quality of care for rural-residing children needs further exploration.

目的:综合医院儿科住院部的关闭促进了儿科护理的区域化。对于农村地区的儿童来说,住院治疗的距离会影响到儿童医疗服务的质量、对家庭的影响以及农村社区灾害规划的准备情况。我们评估了农村儿童住院地点的变化趋势:利用医疗成本与利用项目的州住院患者数据库,我们对 2002-2017 年间八个州(科罗拉多州、佛罗里达州、肯塔基州、北卡罗来纳州、新泽西州、纽约州、俄勒冈州和华盛顿州)256947 名居住在农村的 0-17 岁儿童的住院情况进行了研究。乡村化程度由乡村-城市通勤区代码定义:大都市、小乡村和偏远乡村。出生、精神和手术住院不包括在内。通过科克伦-阿米蒂奇趋势检验法评估了按医院所在地、医院间转院(IFT)以及医院所在地是否与患者家庭居住地属于同一乡村等级划分的住院人数趋势:结果:从2002年到2017年,居住在农村的儿童住院人数减少了52.7%(从56168人减少到26548人),IFT从6.7%增加到26.5%(p结论:虽然居住在农村的儿童总体住院人数减少了,但IFT却增加了:虽然居住在农村地区的儿童的总体住院人数减少了,但综合住院治疗人数却增加了,而且在大城市地区住院的比例也增加了。住院医疗服务的这种转变对农村儿童医疗服务效率和质量的影响需要进一步探讨。
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引用次数: 0
Postpartum Depression Screening in Pediatric Primary Care Clinics and Infant Receipt of Preventive or Acute Care. 儿科初级保健诊所的产后抑郁症筛查与婴儿接受预防性或急性护理的关系。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-05 DOI: 10.1016/j.acap.2024.08.001
Danielle P Tyson, Leah Vance Utset, Rose Y Hardy, Mattina A Davenport, Kierra S Barnett, Deena J Chisolm, Laura J Chavez

Objective: To evaluate the association between postpartum depression (PPD) screening results in pediatric primary care and subsequent infant preventive and acute care utilization.

Methods: This was a retrospective cohort analysis of 5,341 infants born in 2021 whose mothers were screened for PPD at a well-child visit during the first 6 months. Logistic regression was used to examine that association between a positive PPD screen and 1) adherence to the 12-month well-child visit, and 2) any acute care visits (urgent care or emergency department visits) from 6-15 months. The association between PPD screen and number of acute care visits was examined with negative binomial logistic regression.

Results: The incidence of positive PPD screens was 15.6% in the first 6 months. There was no significant difference in 12-month well-child visit adherence based on PPD screening (adjusted odds ratio (aOR): 0.91; 95% confidence interval (CI): 0.77 to 1.06; p-value: 0.206). The odds of having any acute care visit were higher among infants whose mothers screened positive for PPD (aOR: 1.2; 95% CI: 1.0 to 1.3; p-value: 0.009). There was a significant difference in the incidence rate of acute care visits based on PPD screening results (incidence rate ratio: 1.1; 95% CI: 1.0 to 1.2; p-value: 0.005).

Conclusions: Screening positive for PPD was associated with subsequent acute care utilization but not 12-month preventive care. Primary care providers may need to proactively follow-up after acute care visits to ensure both infant health and maternal needs are met, connecting mothers to resources as needed.

目的评估儿科初级保健中产后抑郁症(PPD)筛查结果与随后婴儿预防和急症护理使用之间的关联:这是一项回顾性队列分析,研究对象是 2021 年出生的 5341 名婴儿,这些婴儿的母亲在头 6 个月的儿童健康检查中接受了 PPD 筛查。采用逻辑回归法研究了 PPD 筛查阳性与 1) 12 个月儿童健康检查的坚持率,以及 2) 6-15 个月期间任何急诊就诊(紧急护理或急诊就诊)之间的关联。PPD 筛查与急诊就诊次数之间的关系采用负二项逻辑回归法进行检验:结果:PPD筛查阳性率在前6个月为15.6%。根据 PPD 筛查结果,12 个月的儿童保健就诊率没有明显差异(调整后的几率比 (aOR):0.91;95% 置信区间 (CI):0.77 至 1.06;P 值:0.206)。母亲 PPD 筛查呈阳性的婴儿接受任何急症护理的几率更高(aOR:1.2;95% CI:1.0 至 1.3;p 值:0.009)。根据 PPD 筛查结果,急诊就诊率存在明显差异(发病率比:1.1;95% CI:1.0 至 1.2;P 值:0.005):结论:PPD筛查结果呈阳性与随后的急症护理使用率有关,但与12个月的预防性护理无关。初级医疗服务提供者可能需要在急诊就诊后主动跟进,以确保婴儿健康和孕产妇需求得到满足,并根据需要将母亲与资源联系起来。
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引用次数: 0
A National Survey to Assess LGBTQ+ Curricular Needs in Pediatrics Residency Programs. 评估儿科住院医师项目中 LGBTQ+ 课程需求的全国调查。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-02 DOI: 10.1016/j.acap.2024.07.016
Lauren T Roth, Pamela Carpenter, Alan Schwartz, Brian Lurie

Objective: Despite incremental increases in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) health education, there are no uniform training requirements in graduate medical education and the extent to which pediatrics residency programs incorporate LGBTQ+ curricula remains unknown. We aimed to assess the current state of LGBTQ+ health education in pediatrics residency programs.

Methods: We surveyed all 202 Accreditation Council for Graduate Medical Education (ACGME)-accredited categorical pediatrics program directors (PDs) in the United States. PDs were contacted via the Association for Pediatrics Program Directors (APPD) listserv with a link to an anonymous electronic survey.

Results: We had a 53.4% response rate (107/202) with representation from all regions, sizes, and settings. Only 7.5% of programs have robust LGBTQ+ curricula, but many (71%) offer some sessions. About half (54.2%) believe their residents are not at all or somewhat prepared to care for LGBTQ+ patients after training. Many PDs are not at all or somewhat confident their residents learn about gender affirming care (49.5%) or are aware of community resources for LGBTQ+ youth (54.2%). In 91% of programs, 0-25% of faculty educate trainees about LGBTQ+ health. The majority (74.8%) of PDs are very or moderately likely to implement a standardized LGBTQ+ health curriculum. The most prominent barriers were inadequate time (55.1%) and lack of faculty training (51.4%).

Conclusion: Many pediatrics programs have implemented some LGBTQ+ health education; however, PDs lack confidence in residents' abilities to independently care for LGBTQ+ youth after training. An accessible and standardized curriculum is not only needed but desired by programs.

目的:尽管女同性恋者、男同性恋者、双性恋者、跨性别者、同性恋者/质疑者(LGBTQ+)健康教育在逐步增加,但医学研究生教育中并没有统一的培训要求,儿科住院医师培训项目在多大程度上纳入了 LGBTQ+ 课程仍是未知数。我们旨在评估儿科住院医师培训项目中LGBTQ+健康教育的现状:我们调查了美国所有202个经毕业医学教育认证委员会(ACGME)认证的分类儿科项目主任(PDs)。我们通过儿科项目主任协会(APPD)的邮件列表与儿科项目主任取得联系,并提供了匿名电子调查的链接:我们的回复率为 53.4%(107/202),来自所有地区、规模和环境。仅有 7.5% 的项目开设了丰富的 LGBTQ+ 课程,但许多项目(71%)开设了一些课程。约有一半(54.2%)的住院医师认为,他们在接受培训后完全没有或在一定程度上没有做好护理 LGBTQ+ 患者的准备。许多 PD 对他们的住院医师是否了解性别平权护理(49.5%)或是否了解 LGBTQ+ 青少年的社区资源(54.2%)没有信心。在 91% 的项目中,0-25% 的教师会对学员进行 LGBTQ+ 健康教育。大多数项目主任(74.8%)非常有可能或比较有可能实施标准化的 LGBTQ+ 健康课程。最突出的障碍是时间不足(55.1%)和缺乏师资培训(51.4%):结论:许多儿科项目已经实施了一些LGBTQ+健康教育;然而,儿科医师对住院医师在培训后独立护理LGBTQ+青少年的能力缺乏信心。儿科项目不仅需要,而且希望有一个易于使用的标准化课程。
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引用次数: 0
Piloting Home Produce Delivery to Improve Food Security, Budget, and Diet in Families with Children: A Mixed-Methods Study. 试行家庭农产品配送以改善有子女家庭的食品安全、预算和饮食:混合方法研究。
IF 3 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-02 DOI: 10.1016/j.acap.2024.07.017
Laura M Plencner, J Nalubega Ross, Matthew Hall, Emily A Hurley, Jean L Raphael, Evelyn Donis De Miranda, Jeffrey D Colvin

Background: Few children in food insecure (FI) households meet dietary recommendations for fruit and vegetables ("produce"). Barriers include affordability, accessibility, and desirability. Home produce delivery may reduce FI, increase produce consumption, and decrease budget tradeoffs.

Objective: Evaluate the acceptability and potential impact of delivering produce through home visiting programs on FI, diet, and budget tradeoffs.

Methods: In this prospective pre/post mixed methods study, 51 parents engaged in home visiting programs were enrolled. Participants completed pre- and post-program surveys on FI (18-item Food Security Scale), produce consumption, and budget tradeoffs. Pre- and post-surveys were compared using McNemar's test and weighted kappas. Interview guides were based on Social Cognitive Theory and a previously published framework. Interviews were conducted in English or Spanish; thematic analysis was completed.

Results: Twenty-nine (56.9%) participants completed both surveys. Most were female (96.3%) and Hispanic (79.3%) (Table 1). Food security improved in the post-period, with more participants reporting high food security (pre: 6.9%, post: 31.0%) and fewer reporting very low food security (pre: 20.7%, post: 6.9%, p<0.01) (Table 2). Budgetary tradeoffs decreased in the post-program period (pre: 71.4%, post: 48.1%, p=0.03). Fifteen participants were interviewed. Themes included 1) saved money, 2) increased fruit and vegetable consumption, and 3) interest in future participation.

Conclusion: This pilot study found that an intervention for delivery of produce through home visiting programs was acceptable to participants and resulted in potential improvements in FI and household budgets. This supports future studies to further explore the impact of this novel intervention.

What's new: In this prospective mixed-methods pilot, home delivered produce was acceptable and feasible with potentially improved food security and household budgets; evidence of potential change in produce consumption was mixed. Changes in budget tradeoffs is a novel outcome in food programs.

背景:食物无保障(FI)家庭中很少有儿童能达到水果和蔬菜("农产品")的膳食建议。其中的障碍包括经济承受能力、可及性和可取性。送农产品到家可以减少食物无保障家庭,增加农产品消费,减少预算权衡:评估通过家访计划提供农产品对家庭收入、饮食和预算权衡的可接受性和潜在影响:在这项前瞻性的前后混合方法研究中,有 51 名参与家访项目的家长报名参加。参加者在项目前后完成了有关 FI(18 项粮食安全量表)、农产品消费和预算权衡的调查。使用 McNemar 检验和加权卡方对前后调查进行比较。访谈指南以社会认知理论和之前发布的框架为基础。访谈以英语或西班牙语进行,并完成了主题分析:29名参与者(56.9%)完成了两项调查。大多数参与者为女性(96.3%)和西班牙裔(79.3%)(表 1)。调查后,食品安全状况有所改善,报告食品安全状况良好的参与者人数增加(调查前:6.9%,调查后:31.0%),报告食品安全状况极差的参与者人数减少(调查前:20.7%,调查后:6.9%,p<0.05):6.9%,p 结论:这项试点研究发现,通过家访计划提供农产品的干预措施可以为参与者所接受,并有可能改善食物安全指数和家庭预算。新内容:在这项前瞻性的混合方法试点研究中,家庭配送农产品是可以接受和可行的,并有可能改善食品安全和家庭预算;农产品消费的潜在变化证据不一。预算权衡的变化是食品计划的一项新成果。
{"title":"Piloting Home Produce Delivery to Improve Food Security, Budget, and Diet in Families with Children: A Mixed-Methods Study.","authors":"Laura M Plencner, J Nalubega Ross, Matthew Hall, Emily A Hurley, Jean L Raphael, Evelyn Donis De Miranda, Jeffrey D Colvin","doi":"10.1016/j.acap.2024.07.017","DOIUrl":"https://doi.org/10.1016/j.acap.2024.07.017","url":null,"abstract":"<p><strong>Background: </strong>Few children in food insecure (FI) households meet dietary recommendations for fruit and vegetables (\"produce\"). Barriers include affordability, accessibility, and desirability. Home produce delivery may reduce FI, increase produce consumption, and decrease budget tradeoffs.</p><p><strong>Objective: </strong>Evaluate the acceptability and potential impact of delivering produce through home visiting programs on FI, diet, and budget tradeoffs.</p><p><strong>Methods: </strong>In this prospective pre/post mixed methods study, 51 parents engaged in home visiting programs were enrolled. Participants completed pre- and post-program surveys on FI (18-item Food Security Scale), produce consumption, and budget tradeoffs. Pre- and post-surveys were compared using McNemar's test and weighted kappas. Interview guides were based on Social Cognitive Theory and a previously published framework. Interviews were conducted in English or Spanish; thematic analysis was completed.</p><p><strong>Results: </strong>Twenty-nine (56.9%) participants completed both surveys. Most were female (96.3%) and Hispanic (79.3%) (Table 1). Food security improved in the post-period, with more participants reporting high food security (pre: 6.9%, post: 31.0%) and fewer reporting very low food security (pre: 20.7%, post: 6.9%, p<0.01) (Table 2). Budgetary tradeoffs decreased in the post-program period (pre: 71.4%, post: 48.1%, p=0.03). Fifteen participants were interviewed. Themes included 1) saved money, 2) increased fruit and vegetable consumption, and 3) interest in future participation.</p><p><strong>Conclusion: </strong>This pilot study found that an intervention for delivery of produce through home visiting programs was acceptable to participants and resulted in potential improvements in FI and household budgets. This supports future studies to further explore the impact of this novel intervention.</p><p><strong>What's new: </strong>In this prospective mixed-methods pilot, home delivered produce was acceptable and feasible with potentially improved food security and household budgets; evidence of potential change in produce consumption was mixed. Changes in budget tradeoffs is a novel outcome in food programs.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Academic Pediatrics
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