Academic Pediatrics最新文献

Objective: Pediatric clinics identify and address food insecurity (FI), but processes vary nationwide. State and federal policies increasingly require FI screening in healthcare settings and as a quality metric in payment models. A better understanding of existing practices and opportunities for efficient and effective clinical integration is needed.

Methods: A multiple-choice survey was first completed with 27 clinics nationwide. Semi-structured interviews informed by the Consolidated Framework for Implementation Research were then conducted with clinics (n=25) to explore current FI practices and understand how policies and payment models could support FI processes. Descriptive analysis was used for survey results. Rapid qualitative analysis was used to identify themes.

Results: Pediatric practices were predominately in the South (44%) and in urban (70%) locations. Most used the Hunger Vital Sign to screen (89%); interventions included resource list distribution (89%), referral to federal nutrition programs (78%) and/or community-based organizations (78%). Few practices coded (37%) or billed (7%) for FI. Three overarching themes were identified: (1) FI screening, intervention, and documentation processes varied across primary care clinics; (2) Multi-level barriers hindered efforts to address FI; and (3) Policy and payment reforms are needed to support the integration of FI screening and intervention in health systems and effectively assist families experiencing FI.

Conclusions: While clinics have integrated FI screening and interventions, streamlined documentation and billing remains limited. As FI screening becomes increasingly incentivized, designing performance metrics that include healthcare provider input and address existing barriers should be a priority.

Objective: Effective communication when breaking bad news to families is crucial, yet it is often lacking. This study evaluates the efficacy of a communication teaching session via simulation to improve the quality of breaking difficult news in a pediatric resuscitation setting.

Methods: This was a prospective randomized controlled trial at the Medical University of Vienna. Participants undergoing a pediatric high-fidelity resuscitation simulation resulting in the death of a 6-year-old patient were tasked with delivering the death notice to simulation parents. These conversations were video recorded for subsequent analysis. Prior to the resuscitation scenario, the intervention group received a brief communication teaching session tailored to break bad news to pediatric relatives.

Results: This simulation included 46 medical students. The intervention group significantly outperformed the control group, with simulation parents rating participants' competence higher (P<.001) and video analysis confirming better structuring of conversations (P<.001). Participants in the intervention group used clearer language, avoiding jargon (P<.001), and even nonverbal communication skills were significantly enhanced (P<.001). Gender did not significantly influence outcomes.

Conclusions: The SimCom-Method demonstrates the feasibility and efficacy of a brief, just-in-time communication teaching session delivered immediately before a pediatric resuscitation simulation to significantly improve communication when breaking bad news. Integrating such communication teaching sessions into resuscitation curricula should be prioritized to strengthen providers' ability to support families during emotionally charged situations.

Objective: To assess the impact of preference signals (PS) and geographic signals (GS) on pediatric interview and match results in the 2023-2024 application cycle.

Methods: Residency programs provided de-identified application data (number of applicants, interview invitations, and applicants interviewed, ranked, and matched). Applicants were subdivided by degree type (MD/DO/IMG), underrepresented in medicine (URiM) status, and couples match/local student status. The proportion of applicants in each category who did/did not utilize PS/GS was compared using chi-square and Fisher's tests with OR and 95% CI reported.

Results: Ten participating programs received 11,194 applications (64.6 +/- 47.5 per available position); 10.4% included PS and 57.5% used GS. Applicants using PS had higher odds of receiving interview invitations (OR: 7.15, p < 0.001), interviewing (OR 5.41, p < 0.001), and matching (OR: 17.12, p < 0.001) than those without PS. Applicants using GS had higher odds of receiving invitations, interviewing, and matching, but this was not true across all sub-categories. PS was associated with increased odds of interviewing once invited (OR 4.82, p = 0.004), and of matching once interviewed (OR 5.80, p < 0.001). Candidates in a "matchable" rank position with PS had 8.75x higher odds of matching at a program vs. those without PS (95% CI: 5.86-13.20, p < 0.001).

Conclusions: In this cohort, applicants using PS and GS were more likely to receive interview invitations, complete an interview, and match with programs than those without PS or GS, with PS a stronger influence than GS.

Objective: Palliative care (PC) communication skills are essential to patient care, yet many pediatric fellows do not receive formal PC education. Where it exists, current training often relies on lecture and observation. Simulation-based training is an effective, experiential education tool that allows pediatric fellows to safely practice and debrief difficult conversations to improve their PC communication skills.

Methods: Pediatric fellows in hematology/oncology, critical care medicine, and neonatology completed annual or biannual half-day simulation sessions practicing PC communication skills throughout their 3-year fellowship. Each session included 3 scenes with standardized patients (SPs) followed by debriefing with PC faculty, discipline-specific physicians, and the SP. Fellows completed validated surveys evaluating their own "Self-Efficacy" and "Adequacy of their Medical Education" at the following 4 time points: baseline and the end of each fellowship year. Faculty evaluators rated each participant in 9 communication domains.

Results: Participants reported self-perceived improvements in their Self-Efficacy with PC communication (P<.001) and in the Adequacy of their PC Medical Education (P<.001) throughout the 3-year intervention. As rated by external evaluators, communication scores in all 9 domains improved throughout the intervention (P<.001). Participants found the simulation-based trainings highly realistic (95%), useful (97%), and preferable to lecture-based education (87%).

Conclusions: Simulation-based PC communication training is an effective strategy to bolster self-efficacy and skills in pediatric fellows. This method enables fellows to safely practice navigating complex clinical situations as they prepare to become attending physicians. Expanding simulation to other disciplines and pediatric training programs can enhance PC education opportunities and improve patient care.