Academic Pediatrics最新文献

Objective: Effective leadership enhances clinical team performance through collaboration, resource management and communication. Currently, most resident physicians learn leadership skills through informal apprenticeship.

Methods: This observational study quantifies the leadership and communication skills (LCS) demonstrated by pediatric residents leading interdisciplinary teams in simulated life-threatening events at a single institution using retrospective video review. Using a checklist of LCS, three authors each scored the occurrence of 12 LCS skills within the first 5 minutes of response, plus binary outcomes related to appropriate diagnosis, team formation, appropriate interventions, and a shared mental model. Intraclass correlation coefficients assessed interrater reliability. Wilcoxon rank-sum and Fisher's exact tests compared LCS scores to scenario types and outcomes.

Results: Thirty-one residents led interprofessional teams in 16 cardiogenic shock and 15 status epilepticus scenarios. Average ICCs were 0.68-0.96. Total scores for the 12 LCS skills ranged from 7-26 (median 15, IQR 11-19). Residents performed most LCS skills less than half of the time, scoring highest in reassessment, soliciting team input, and refraining from active participation. Only 13% of residents declared themselves team leader at any point, and core skills of resource management, anticipation and seeking help were infrequently demonstrated. Overall, team leader behaviors resulted in 15(48%) appropriate diagnoses, 18(58%) team formations, 16(52%) appropriate interventions, and 8(26%) shared mental models.

Conclusions: Pediatric residents inconsistently demonstrate LCS, regardless of familiarity with the simulated scenario, highlighting that these skills may not be effectively learned through traditional curricula. Our findings underscore the need for a targeted leadership curriculum.

Objectives: Studies of birthweight and academic achievement have focused on low or very low birthweight thresholds or continuous birthweight and early childhood academic outcomes. This study examines the relationship between birthweight and children's academic achievement across the entire birthweight distribution and throughout childhood and adolescence.

Methods: Birth certificates for children born in Iowa in 1989-2010 are linked to standardized school math and reading tests through 2017-2018. Birthweight is examined in 100-gram ranges. Outcomes are math and reading scores over grades 2 through 11. Differences in achievement by birthweight are estimated in a regression controlling for child, maternal, and school/testing covariates, pooling grades and separately for elementary, middle, and high school.

Results: The sample is nearly 75% of the birth population and includes over 592,000 unique children and 3.9 million child-grade observations. Academic achievement generally improves with higher birthweight but in smaller increments. Gaps in standard deviations (SDs) of math (reading) scores are 0.55-0.75 (0.28-0.53) SDs at 501-1000 grams, 0.34-0.44 (0.18-0.29) SDs at 1001-1800 grams, and 0.15-0.27 (0.11-0.19) SDs at 1801-2700 grams compared to the median/mean birthweight range of 3401-3500 grams. Math gaps at lower birthweights are overall larger than reading. Gaps are persistent over school years but appear to narrow by high school.

Conclusions: There are meaningful academic achievement gaps below median/mean birthweight that persist throughout childhood and adolescence. It is important to consider detailed birthweight data rather than pre-established thresholds for informing medical and learning interventions and to bolster these interventions to address developmental and learning gaps.

Purpose: Theory and research suggest that being arrested, incarcerated in a juvenile facility, or incarcerated in an adult facility before 18 could be associated with higher levels of functional limitations during adulthood when compared to non-criminal legal system (CLS) involved individuals. This pathway may exist due to limited healthcare access during early adulthood. We hypothesized that: CLS involvement before 18 could be associated with higher levels of functional limitations directly and indirectly through health care access.

Methods: The data come from the National Longitudinal Survey of Youth 1997. CLS involvement was measured as no contact, arrested, arrested and incarcerated in a juvenile facility, and arrested and incarcerated in an adult facility before 18. Functional limitations are limitations in functioning from physical/mental impairments. Health care access captured health insurance enrollment and doctor care usage. We examined the direct and indirect effects of CLS involvement before 18 on functional limitations using Structural Equation Modeling.

Results: Of the analytical sample (N=8961), 14%, 2%, and 1% reported being arrested, incarcerated in a juvenile facility, or incarcerated in an adult facility before 18 (respectively). Individuals arrested/incarcerated in juvenile facilities had lower health care access than non-CLS-involved individuals. Individuals arrested/incarcerated in an adult facility before 18 had higher functional limitations than non-CLS involved individuals. Higher health care access was associated with higher functional limitations.

Major conclusions: Being arrested/incarcerated in a juvenile facility had indirect effects on functional limitations during adulthood. Being arrested/incarcerated in an adult facility before 18 had direct effects on functional limitations during adulthood.

Background: Understanding whether political policies influence residents' training and career decision-making is critical to address pediatric workforce concerns.

Methods: We surveyed pediatrics residents on factors influencing residency application/ranking decisions (interns only) and future practice plans (all). Respondents reporting "state political policies" as an influence identified which specific topics affected them, the degree and direction of influence, and reasons for this influence. Responses were analyzed using standard descriptive statistics and compared by respondent demographics; open-ended responses were analyzed for common themes.

Results: 652 residents from 18 US programs received surveys; 215 (33.0%) responded. Of 66 interns, 35 (53.0%) reported that state political policies influenced their application/ranking decisions. Most were somewhat/much less likely to apply/rank programs in states restricting abortion (n = 24, 68.6%); reproductive healthcare (n = 23, 65.7%), or gender-affirming care (n = 22, 62.9%). Many respondents (81%) indicated at least one political policy would influence future practice decisions; most were less likely to practice in states restricting reproductive health (n = 134, 76.6%), abortion (n = 129, 73.7%), gender-affirming care (n = 118, 67.4%), and LGBTQIA+ rights (n = 118, 67.4%). Common reasons included access to care and physician autonomy. Residents who self-identified as more progressive (OR 0.11, 95% CI 0.02-0.49) or planned to start families within 3-5 years (OR 0.25, 95% CI 0.06-0.89) were less likely to plan future practice in states with restrictive policies.

Conclusions: State political policies significantly impact pediatrics residents' decision-making around residency applications and ranking, as well as future practice decisions.

Objective: Rapid integration of artificial intelligence (AI) into healthcare is transforming the physician role, necessitating curricular reform. However, perspectives of AI healthcare industry experts are rarely considered. This study explored their views on the evolving physician role and AI-related adaptations to undergraduate medical education.

Methods: Participants were recruited via purposive and snowball sampling for a cross-sectional qualitative study using an online survey and live interviews. Participants compared AI and physician skills and shared perspectives on proposed AI-related learning objectives. Data was collected from August - September 2024 and underwent inductive thematic analysis until reaching sufficiency.

Results: Thirteen AI healthcare industry experts participated. Three themes reflected shifting perceptions of the physician role and one focused on adaptations to medical education. Experts anticipated AI tools will augment rather than replace physicians and physician roles will shift away from administrative tasks toward human-centered aspects of care. Participants highlighted that medical students must be able to understand, appraise, and interpret AI tools while retaining sufficient skills to operate in the absence of AI.

Conclusions: Three insights emerged: AI technologies will augment rather than replace physicians; educators should adapt curricula to prioritize humanistic competencies over administrative tasks; and integration of AI healthcare industry expert perspectives is valuable for comprehensive curriculum development.

Objective: Pediatric hospitalists commonly care for children with symptoms unable to be attributed to a unifying diagnosis. Although pediatric hospitalists prioritize patient- and family-centered care, very little is known about the communication of uncertainty on family-centered rounds. This study explores caregivers' perceptions of conversations regarding diagnostic uncertainty during family-centered rounds on a pediatric hospital medicine service.

Methods: This qualitative study was conducted at a single, freestanding, 700 bed, quaternary care children's hospital. We conducted 15 semi-structured interviews with a purposive sample of caregivers of children admitted with an uncertain diagnosis. Interviews explored caregivers' experiences throughout the diagnostic process and perceptions of conversations with the healthcare team on family-centered rounds. Interviews were recorded, transcribed verbatim, and deidentified. Three researchers independently coded transcripts using an inductive, thematic analysis approach.

Results: Data analysis yielded seven themes: the importance of inherent individual caregiver contextual factors, the presence of caregiver expectations, general team communication skills, interprofessional team dynamics, the value of a plan and symptom management, time as a barrier and facilitator, and development of a therapeutic alliance. Caregiver experiences and perceptions were mapped along a diagnostic model to demonstrate opportunities for improvement when medical providers are faced with diagnostic uncertainty.

Conclusion: Understanding caregivers' experiences and perceptions of conversations regarding diagnostic uncertainty can assist medical providers in managing, communicating, and overcoming uncertainty. Results suggest uncertainty is complex and multilayered, however, uncertainty about a diagnosis can be overcome by providing symptom management and certainty in the plan and follow-up.

Objective: No assessment instrument with validity evidence exists to assess resident competence in communicating medical ambiguity. Here, validity evidence was collected for STATUS (Scalable Tolerating Ambiguity/Uncertainty Tool Utilizing Simulation).

Methods: Using avatar patients and two simulated cases, investigators created a guidebook and trained ten faculty in STATUS use. Pediatric residents completed two video-recorded simulated cases. Residents self-assessed tolerance for communicating medical ambiguity. Two faculty reviewed each video, assessing participants for communicating medical ambiguity. Validity evidence collected included: content, response process, internal structure, and relationship to other variables. Generalizability theory analysis was conducted to understand the assessment tools' reliability.

Results: Of 89 eligible residents, forty-three (48.3%) had sessions recorded. Eighty-six videos were analyzed. Faculty rater training increased inter-rater reliability by 0.34 units. The Φ-coefficient was 0.72 for the resident self-assessment tool and 0.26 for the faculty rater assessment tool. The decision study found that with 11 faculty raters and 11 scenarios, the Φ-coefficient would be 0.70. Resident self-assessment negatively associated faculty rater assessment with a Spearman correlation of -0.21 overall, indicating a possible weak correlation.

Conclusion: Results provide sufficient reliability to measure resident self-assessment of tolerance for communicating medical ambiguity. More scenarios would likely result in higher reliability for faculty assessment.

Objective: Early Head Start (EHS) supports early relational health (ERH) among low-income parent-child dyads through center-based and home-visiting services. Children born preterm and/or with functional impairments may benefit from these services due to unique developmental needs. We aimed to: 1) Describe child, family, and program characteristics among children born preterm or with functional impairment enrolled in EHS; 2) Investigate associations between prematurity and functional impairment and ERH outcomes; 3) Explore whether EHS programming modifies these associations.

Study design: We used data from the 2018 EHS Family and Child Experiences Study. We calculated descriptive characteristics of children stratified by prematurity and functional impairment. We used regression to study associations between these conditions and ERH while accounting for child and family characteristics and investigated interactions between these conditions and EHS program characteristics.

Results: Our sample included 2,084 children (10% preterm, 9% with ≥1 functional impairment). Compared to full term children, preterm children had lower social emotional competence (B -1.07, SE 0.40). Compared to those without, children with ≥1 functional impairment had lower parent-child relationship closeness (B -1.79, SE 0.69) and child social emotional competence (B -1.81, SE 0.52), and higher parent-child relationship conflict (B 1.76, SE 0.65) and child social emotional problem behaviors (B 2.31, SE 0.93). Communication/language skills were lower among preterm children receiving center-based compared to home-based EHS services (B -3.65, SE 1.76).

Conclusions: Medical/developmental conditions affect ERH among low-income dyads. Future studies should examine whether community-based services like EHS adequately support ERH among this population.