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Crenshaw ML, Piazza BR, Otsuka NY, Schwend RM, Alexander N, Hennrikus W. Musculoskeletal Education: An Assessment of the Value of the American Academy of Pediatrics Musculoskeletal Boot Camp Course in Improving Clinical Confidence of Pediatricians Managing Common Musculoskeletal Conditions. Clin Pediatr (Phila) 2021; 60:241-246. [PMID: 33771043 DOI: 10.1177/00099228211002983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2016, the American Academy of Pediatrics Section on Orthopaedics established an annual Musculoskeletal (MSK) Boot Camp course to fill the gaps in MSK knowledge, performance, and outcomes for pediatricians and primary care doctors. A standardized one-day curriculum of key MSK topics was developed including short lectures, hands-on workshops, debates, live webinars, and Q&A sessions. A survey was created to evaluate attendee confidence related to diagnosing 20 common MSK conditions in children and adolescents at the beginning and end of the course. Confidence in diagnosing the conditions was gauged using a 6-point Likert-type scale. A two-sample t test was used to compare overall confidence score pre- and post-seminar. In addition, each subtopic was analyzed. The average pre-seminar confidence score was 3.92 versus 4.86 post-seminar. All categories demonstrated a statistically increased confidence score post-seminar (P < .0001). Live MSK continuing education for pediatricians is effective in improving confidence in clinical practice.
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Affiliation(s)
- Megan L Crenshaw
- Department of Orthopaedics, Penn State Milton Hershey Medical Center, Hershey, PA, USA
| | - Brian R Piazza
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Norman Y Otsuka
- Department of Orthopaedics, Southern Illinois University, Springfield, IL, USA
| | | | - Niccole Alexander
- Division of Hospital and Surgical Subspecialties, American Academy of Pediatrics, Itasca, IL, USA
| | - William Hennrikus
- Department of Orthopaedics, Penn State Milton Hershey Medical Center, Hershey, PA, USA
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Koelink E, Boutis K. Paediatrician office follow-up of common minor fractures. Paediatr Child Health 2014; 19:407-12. [PMID: 25382996 DOI: 10.1093/pch/19.8.407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence suggests that minor paediatric fractures can be followed by primary care paediatricians (PCPs). OBJECTIVES To determine PCP opinions, knowledge and perceived barriers to managing minor paediatric fractures in the office. METHODS An online survey was sent between June and September 2013 to all paediatricians who subscribed to the American Academy of Pediatrics PROS-Net Listerv and to those who were registered with the Scott's Canadian Medical Directory as paediatricians who treated children in a primary care capacity. The primary outcome was the proportion of PCPs who agreed with PCP follow-up of minor paediatric fractures. Secondary outcomes included PCP's perceived barriers to office follow-up. RESULTS A total of 1752 surveys were sent; 1235 were eligible and 459 (37.2%) responded to the survey. Overall, 296 (69.5% [95% CI 65.2% to 74.0%]) PCPs agreed that minor paediatric fractures could be followed in a PCP office. The most frequently reported barriers were lack of materials to replace immobilization (58.1%), PCP knowledge deficits (44.8%) and a perceived parental preference for an orthopedic surgeon (38.6%). Finally, 58.8% of respondents believed that further education was necessary if PCPs assumed responsibility for follow-up of midshaft clavicle fractures, while 66.5% and 77.1% (P<0.0001) believed this was necessary for distal radius buckle and fibular fractures, respectively. CONCLUSIONS More than two-thirds of responding PCPs in Canada and the United States agreed that minor common paediatric fractures can be followed-up by paediatricians. However, PCPs reported some barriers to this management strategy, including a desire for more education on this topic.
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Affiliation(s)
- Eric Koelink
- Division of Emergency Medicine, Department of Pediatrics, McMaster University Medical Centre and McMaster University, Hamilton
| | - Kathy Boutis
- Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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Rosenberg AA, Kamin C, Glicken AD, Jones MD. Training gaps for pediatric residents planning a career in primary care: a qualitative and quantitative study. J Grad Med Educ 2011; 3:309-14. [PMID: 22942954 PMCID: PMC3179204 DOI: 10.4300/jgme-d-10-00151.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/14/2011] [Accepted: 04/06/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. OBJECTIVES To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. METHODS Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003-2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from "not at all well prepared" to "extremely well prepared" for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders. RESULTS Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence. CONCLUSIONS Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.
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Affiliation(s)
- Adam A Rosenberg
- Corresponding author: Adam A. Rosenberg, MD, The Children's Hospital, Box B158, 13123 East 16th Avenue, Aurora, CO 80045, 720.777.5332,
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Leslie LK. What can data tell us about the quality and relevance of current pediatric residency education? Pediatrics 2009; 123 Suppl 1:S50-5. [PMID: 19088246 DOI: 10.1542/peds.2008-1578l] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Residency Review and Redesign (R(3)P) Project relied on both qualitative and quantitative data in developing its recommendations regarding residency education. This article reviews quantitative data in the published literature of import to the R(3)P Project as well as findings by Freed and colleagues published in this supplement to Pediatrics. Primary questions of interest to the R(3)P Project included: What factors drive decision-making regarding residency selection? Do current training programs have the flexibility to meet the needs of residents, no matter what their career choice with pediatrics? What areas need greater focus within residency training? Should the length of training remain at 36 months? Based on the available data, the R(3)P Project concluded that more diversity needs to be fostered with training programs. By promoting innovative and diverse approaches to improving pediatric residency education, members of the R(3)P Project hope to enhance learning, encourage multiple career paths within the broad field of pediatrics, and, ultimately, improve patient and family outcomes.
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Affiliation(s)
- Laurel K Leslie
- Department of Medicine, Tufts Medical Center, 800 Washington St, 345, Boston, MA 02111, USA.
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Thompson G, Purcell L. Sports medicine training in Canadian paediatric residency programs: Are we doing enough? Paediatr Child Health 2008; 12:295-9. [PMID: 19030373 DOI: 10.1093/pch/12.4.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2006] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess sports medicine teaching in Canadian paediatric residency programs and recent paediatric graduates' comfort level with sports medicine. DESIGN AND METHODS Recent paediatric graduates were surveyed about the amount of sports medicine training they had received during residency, as well as their comfort level in diagnosing and managing common sports medicine problems. Paediatric residency program directors were surveyed about the sports medicine content in their programs. RESULTS Survey response rates for recent graduates and program directors were 52.6% and 81.3%, respectively. Of the recent graduates who responded, 84.7% had 5 h or less of formal sports medicine teaching during residency and 94.9% had no formal clinical rotation in sports medicine. The vast majority of respondents (84.2%) were less than comfortable with their musculoskeletal anatomy knowledge; only 15.8% were comfortable. There were no significant differences between general paediatricians and subspecialists in their reported comfort level with diagnosis (P=0.938) and management (P=0.967) of sports injuries. No program provided more than 5 h of formal teaching in sports medicine, and only one program has a core sports medicine rotation. None of the responding program directors felt that new paediatricians are even somewhat prepared to provide adequate medical care for athletes, and 61.5% felt that a curriculum in sports medicine was necessary. CONCLUSIONS Canadian paediatric residents had limited exposure to sports medicine, and many recent graduates were uncomfortable with their skills in sports medicine. Canadian paediatric residency programs should include a curriculum in sports medicine to adequately prepare future paediatricians to care for young athletes.
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Affiliation(s)
- Graham Thompson
- Division of Emergency Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta
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Shipley LJ, Stelzner SM, Zenni EA, Hargunani D, O'Keefe J, Miller C, Alverson B, Swigonski N. Teaching community pediatrics to pediatric residents: strategic approaches and successful models for education in community health and child advocacy. Pediatrics 2005; 115:1150-7. [PMID: 15821300 DOI: 10.1542/peds.2004-2825j] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To improve child health at a community level, pediatricians require knowledge and skills that have not been traditionally included in residency training. Recent policy statements from the American Academy of Pediatrics and requirements from Accreditation Council for Graduate Medical Education Residency Review committees emphasizing the importance of community pediatrics training have provided additional incentive for pediatric residency programs to actively explore methods of teaching the principles and promoting the practice of community pediatrics to resident trainees. With a growing number of diverse educational models in various stages of practice or development, common themes and approaches to promote successful teaching of community health and child advocacy can be described. This article defines strategies for 2 critical elements of community pediatrics training, engaging residents and building strong community partnerships, then highlights a number of educational models that illustrate key curricular components and methods. Published results from evaluations of some programs suggest that community pediatrics training of this caliber will cultivate a cadre of pediatricians (academic and community based, generalists and subspecialists, researchers and practitioners) who understand child health in the context of community and have the leadership and collaborative skills to improve the health of children in their communities.
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Affiliation(s)
- Laura Jean Shipley
- Department of Pediatrics, University of Rochester, Rochester, New York, USA.
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Abstract
INTRODUCTION Sports are the leading injury-related cause for pediatric primary care visits. Pediatric residency education guidelines suggest incorporating sports medicine (SM) education into curricula; however, research is lacking regarding effective teaching methods. OBJECTIVE To assess reported US pediatric residency SM curricula, teaching methods, and resident evaluation of SM education. DESIGN/METHODS Chief residents (CRs) and third-year residents (PL3s) from 100 randomly selected US Accreditation Council for Graduate Medical Education-accredited residency programs, stratified by size and geographic location, received surveys regarding programs' SM curriculum and teaching methods and individuals' methods for learning SM. RESULTS Response rates were 63% and 39% for CRs and PL3s, respectively. According to CRs, 34% of programs had no one in charge of their SM curriculum. Lecture (77%) was the primary method used for teaching SM. Hands-on teaching (37%) was used less frequently. CRs stated that 29% of programs did not include musculoskeletal examination teaching in their curriculums; 24% did not include formal teaching of concussion management, and 29% did not include reasons for medical disqualification. PL3s rated teaching of joint examinations and the preparticipation physical as the most poorly taught components of the physical examination. PL3s rated hands-on teaching and patient experience as the best methods for improving SM education. CRs reported that only 36% of programs have discussed incorporating more SM into their curriculum. CONCLUSIONS SM education is deficient in US pediatric residency programs. Standardized curricula should be developed with a focus on hands-on training as a means for teaching SM to pediatric residents.
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Reeder BM, Lyne ED, Patel DR, Cucos DR. Referral patterns to a pediatric orthopedic clinic: implications for education and practice. Pediatrics 2004; 113:e163-7. [PMID: 14993571 DOI: 10.1542/peds.113.3.e163] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Musculoskeletal medicine is becoming an increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently published voluntary guidelines to establish diagnoses that should be referred to a pediatric specialist rather than a general specialist (pediatric orthopedic surgery vs general orthopedic surgery). Given the crisis in pediatric orthopedic surgery manpower and resources, we believe that these guidelines are useful in defining appropriate referrals. The purpose of this study was to compare diagnoses that primary care pediatric providers believe commonly need referral to the AAP Guidelines for Referral to Pediatric Specialists recommendations for referral to pediatric orthopedic specialists. METHODS A chart review of successive new referrals (n = 286) to the pediatric orthopedic clinic during a 12-month period was conducted. The following information was collected: 1) diagnosis from referring provider, 2) diagnosis and treatment plan by the pediatric orthopedic surgeon, 3) type of referring provider (eg, pediatrician, family practitioner, resident physician, physician assistant), and 4) patient age. The referring diagnosis, final orthopedic diagnosis, and treatment plan for each patient was compared against the AAP Guidelines for Referral to Pediatric Specialists. The terms "appropriate" and "inappropriate" were used to differentiate those diagnoses that matched versus those that did not match the AAP Guidelines, respectively. RESULTS This analysis shows that a significant percentage (64.7%) of definitive diagnoses of referred cases were not consistent with the new AAP recommended guidelines for referral to pediatric orthopedic surgeons. In addition, a 23.8% (68 of 286) false-positive rate of referring diagnoses is noted. Cases that required no treatment or follow-up to monitor demonstrated a 32.8% (60 of 183) [(40 no treatment + 20 monitor inappropriate)/(116 no treatment + 67 monitor total)] false-positive rate. CONCLUSIONS Inappropriate referrals create a large use of pediatric orthopedic resources, which delays care of other, more appropriate patients. A large proportion of referrals indicated either a lack of basic textbook knowledge or lack of examination skills and appropriate diagnostic tools as demonstrated by a high number of definitive diagnosis indicating normal variants.
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Affiliation(s)
- Brian M Reeder
- Department of Pediatrics, Michigan State University-Kalamazoo Center for Medical Studies, Kalamazoo, Michigan 49008, USA
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Sweeney CL, Davidson M, Melgar T, Patel D, Cucos D. The current status of sports medicine training in United States internal medicine residency programmes. Br J Sports Med 2003; 37:219-25. [PMID: 12782546 PMCID: PMC1724652 DOI: 10.1136/bjsm.37.3.219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the general status of sports medicine training in internal medicine residency programmes in the United States. METHODS A cross sectional survey of the programme directors and chief residents of each of the 407 accredited internal medicine programmes listed in the 1999-2000 Graduate Medical Education Directory. RESULTS The questionnaire was returned by 231 of 404 (57%) programme directors and 233 of 404 (58%) chief residents. A chief and director of the same programme (paired responses) replied from 144 of 404 (36%) programmes surveyed. A formal sports medicine curriculum was reported by 22.1% of programme directors. Programmes with a formal curriculum were 2.9 times more likely to offer any of the sports medicine educational experiences (p<0.0001; Cochran-Mantel-Haenszel). Programmes with block rotations were more likely to include all of the educational experiences surveyed than those without (p<0.002 for each; chi(2) test). A total of 162 programmes included sports medicine as part of other rotations. Most programmes only included sports medicine as part of other rotations: 44.6% (103/231) of all programmes and 63.6% (103/162) of programmes with sports medicine as part of other rotations. Some 29.9% (69/231) of directors reported having an elective, and 3.9% (9/231) reported a required rotation. Almost a quarter (21.7%; 50/231) of directors reported that their residents received no clinical experience in sports medicine. CONCLUSIONS Little attention is given to the subject of sports medicine when internal medicine residency curricula are developed in the United States. Thus only a small percentage of American internal medicine residency programmes provide significant training in sports medicine.
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Affiliation(s)
- C L Sweeney
- Michigan State University, Kalamazoo Center for Medical Studies, USA.
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Walton DM, Edwards MC. Nationwide survey of pediatric residency training in newborn medicine: preparation for primary care practice. Pediatrics 2002; 110:1081-7. [PMID: 12456903 DOI: 10.1542/peds.110.6.1081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Pediatric residency training programs need regular revision, but there is little evidence to support changes. The recent reduction in time spent in the newborn nursery may negatively affect the care of infants in pediatric practice. This survey was undertaken to assess the preparation of recent graduates of training programs with respect to newborn care in their current practice. METHODS A nationwide survey was sent to 1997 pediatric residency graduates in May 1999. The American Medical Association Masterfile was used to identify pediatricians who met the criteria. The survey included questions about preparation and confidence in topics obtained from the Residency Review Committee guidelines for the newborn nursery. There were questions about duration of nursery experience, learning barriers, teaching preferences, current nursery responsibility, and practice location along with other information about the respondents. RESULTS After 2 mailings, 801 surveys were received. Practice distribution was comparable to those who took the pediatric boards for the first time in 1997, and response was nationwide. Overall, 45% attend deliveries and 71% care for sick newborns. Respondents with only 1 month of normal newborn nursery felt this was insufficient preparation. Bedside teaching by faculty members was rated most highly. The most commonly rated areas of poor preparation were prenatal visits, perinatal infections, and management of breastfeeding issues. CONCLUSIONS The current structure of nursery training in many residency programs may be insufficient preparation for primary care practice. Results of this and future surveys of recent graduates provide evidence to direct changes in residency training.
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Affiliation(s)
- Dawn M Walton
- Children's National Medical Center, Washington, DC, USA.
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