Academic Pediatrics最新文献

Objective: This study aims to characterize physician objections to the provision of gender-affirming care within accredited U.S. pediatric residencies and to explore the relevance of institutional conscientious objection policies.

Methods: A cross-sectional electronic survey was distributed by the Association of Pediatric Program Directors to pediatric residency program leadership representatives from September-October 2023. Responses were compared using descriptive statistics and bivariate/multivariate analyses (P<0.05).

Results: In total, 84 of 182 (46%) pediatric residencies completed the survey. Most programs engaged in formal didactic training (n=66, 79%) and direct clinical exposure (n=57, 68%) to gender-affirming care, yet few programs (n=7, 8%) endorsed having institutional objection policies. Four programs (5%) reported trainee (n=3, 75%) or faculty (n=1, 25%) objections to gender-affirming care, none of which had formal objection policies in place. Leadership at programs with objection policies (n=7, 8%) reported increased confidence in addressing future objections, as compared to those without (p<0.01).

Conclusions: Objections to gender-affirming interventions are a rare, but plausible within pediatric residency programs, thus programs should consider anticipatory policies that balance trainee beliefs, required competency training, and safe, equitable patient care.

Background: Robust evidence has demonstrated racial and language-based inequities in clinician communication. We developed a communication coaching intervention to teach clinician educators and their learners communication skills for family-centered rounds in areas where racial inequities have been documented.

Objective: To evaluate the feasibility, acceptability, and preliminary efficacy of an equity focused communication coaching intervention.

Design/methods: We conducted a 2-arm randomized waitlist-control trial. Attending hospitalists received the coaching intervention and were given resources to teach communication skills to trainees. We taught communication skills in five domains: (1) trauma- informed care, (2) respect (3) affirmation (4) interpreter support, and (5) engaging caregivers. Clinicians completed the Feasibility of Intervention Measure (FIM) and Acceptability of Intervention Measure (AIM) as well as a brief interview post-intervention. We audio-recorded rounds with Black or Latino(a/e) caregivers pre-and post-intervention in both arms; caregivers completed a post-rounds survey. Coders unaware of arm coded communication skills. We compared coded behaviors and caregiver survey responses before and after the intervention using the Wilcoxon rank sum test and regression models.

Results: Analyses included 8 hospitalists and 43 caregivers of hospitalized children (23 in the control phase, 20 in the intervention phase). We found high clinician acceptability and feasibility ratings, with mean item scores ranging from 4.6 to 4.9 out of 5 points, respectively. In efficacy analyses, hospitalist teams used more praise (p=0.001) and partnership-building statements (p=0.006) and interrupted caregivers less (p=0.04) after receiving the intervention compared to before. Further, coders rated these encounters as having higher respect (p=0.04). Caregivers post-intervention reported greater trust (p=0.02), shared decision-making (p=0.04), and feeling that their concerns were fully elicited (p=0.04) compared to the pre-intervention encounters.

Conclusions: An equity and trauma-informed clinician communication intervention was feasible, and acceptable, and showed preliminary efficacy in changing clinician behavior as well as caregiver-reported trust and communication.

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.