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Wilpers A, Goldblatt Hyatt E, Bahtiyar MO, Hu Y, Leon-Martinez D, Chervenak FA, McCoyd JLM. "We All Want to Be Able to Tell You Something Hopeful": Clinicians' Experiences Providing Maternal-Fetal Surgery Counseling. Fetal Diagn Ther 2023; 50:353-367. [PMID: 37315537 DOI: 10.1159/000531535] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Prenatal counseling about maternal-fetal surgery can be traumatic and confusing for pregnant people. It can also be technically and emotionally complex for clinicians. As maternal-fetal surgery rapidly advances and becomes more common, more evidence is needed to inform counseling practices. The objective of this study was to develop a deeper understanding of the methods clinicians currently use to train for and provide counseling, as well as their needs and recommendations for future education and training. METHODS We used interpretive description methods and interviewed interprofessional clinicians who regularly counsel pregnant people about maternal-fetal surgery. RESULTS We conducted 20 interviews with participants from 17 different sites who were maternal-fetal medicine specialists (30%), pediatric surgeons (30%), nurses (15%), social workers (10%), a genetic counselor (5%), a neonatologist (5%), and a pediatric subspecialist (5%). Most were female (70%), non-Hispanic white (90%), and practiced in the Midwest (50%). We identified four overarching themes: (1) contextualizing maternal-fetal surgery counseling; (2) establishing shared understanding; (3) supporting decision-making; and (4) training for maternal-fetal surgery counseling. Within these themes, we identified key practice differences among professions, specialties, institutions, and regions. CONCLUSION Participants are committed to practicing informative and supportive counseling to empower pregnant people to make autonomous decisions about maternal-fetal surgery. Nevertheless, our findings indicate a dearth of evidence-based communication practices and guidance. Participants identified significant systemic limitations affecting pregnant people's decision-making options related to maternal-fetal surgery.
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Affiliation(s)
- Abigail Wilpers
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- National Clinician Scholars Program, Yale School of Medicine and Yale School of Nursing, New Haven, Connecticut, USA
- Fetal Care Center, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut, USA
| | - Erica Goldblatt Hyatt
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Mert Ozan Bahtiyar
- Fetal Care Center, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut, USA
| | - Yunzhe Hu
- Barnard College, New York, New York, USA
| | - Daisy Leon-Martinez
- Fetal Care Center, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, Connecticut, USA
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital, Hempstead, New York, USA
| | - Judith L M McCoyd
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Froeliger A, Harper L, Tunon de Lara S, Lavrand F, Loot M, Lefevre Y, Sentilhes L, Coatleven F, Dobremez É. Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital. J Perinat Med 2022; 50:419-426. [PMID: 35026885 DOI: 10.1515/jpm-2021-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe our experience with prenatal counselling for surgical anomalies in a large volume center. The secondary aim is to suggest a list of prenatal abnormalities warranting counselling by a pediatric surgeon. METHODS We reviewed all prenatal counselling consultations performed by the pediatric surgery team between January 1st, 2015 and December 31st, 2016. RESULTS A total of 169 patients or couples had a prenatal consultation with a pediatric surgeon. Prenatal work-up included a fetal MRI in 26% of cases, mainly for digestive and thoracic pathologies (56.1% of cases). Consultation with the pediatric surgeon led mainly to recommendations concerning the place of delivery. Induction for reasons related to the fetal anomaly occurred in 22.2% of cases. Most children were surgically treated within the first year of life (63.5%). Correlation between predicted prognosis and actual status at four years of life was 96.9%. Correlation between prenatal and postnatal diagnosis was 87.4%. CONCLUSIONS Prenatal counselling by a pediatric surgeon allows couples to obtain clear information on the pathology of their unborn child, giving them greater autonomy in their decision to continue the pregnancy.
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Affiliation(s)
- Alizée Froeliger
- Department of Gynecology and Obstetrics, Bordeaux University Hospital, Bordeaux, France
| | - Luke Harper
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Sara Tunon de Lara
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Lavrand
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Maya Loot
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Yan Lefevre
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Gynecology and Obstetrics, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Coatleven
- Department of Gynecology and Obstetrics, Bordeaux University Hospital, Bordeaux, France
| | - Éric Dobremez
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
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Lopyan NM, Perrone EE, Gadepalli SK, Raval MV, Tsao K, Rich BS. Current status of subspecialization in pediatric surgery: A focus on fetal surgery. J Pediatr Surg 2022; 57:610-615. [PMID: 34134857 DOI: 10.1016/j.jpedsurg.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Fetal surgery is a growing field within pediatric surgery. We sought to understand practice patterns of pediatric surgeons who subspecialize in fetal surgery. METHODS A survey was sent to all active non-trainee surgeons within the American Pediatric Surgical Association. Respondents were stratified based on self-reported fetal affiliations. RESULTS Of 1015 surveys, we received 405 responses (40%). Fetal surgery practices were described by 77 self-designated fetal center members. Centers provide prenatal consultation (99%), diagnostic imaging (84%), care/delivery coordination (83%), and/or fetal surgery/procedures (52%). The majority (56%) of fetal programs are directed by surgery and maternal fetal medicine. Pediatric surgeons are represented on the fetal team in 96% of centers. Prenatal consultations are primarily seen by any pediatric surgeon in the group (53%), with the pediatric surgeon on call operating on/caring for the baby postnatally in the majority (64%), regardless of who performed the prenatal consultation. Only 29% of fetal center members performed a fetal operation in the last year. Yearly fetal case numbers vary widely per procedure, with the most common being complex twin procedures and needle-based sclerotherapy. CONCLUSIONS Fetal centers vary by services offered, team composition, and interventions performed, with few surgeons performing a wide range of fetal surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Natalie M Lopyan
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
| | - Erin E Perrone
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA; The North American Fetal Therapy Network (NAFTNet), USA
| | - Samir K Gadepalli
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Mehul V Raval
- Department of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kuojen Tsao
- Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA; The North American Fetal Therapy Network (NAFTNet), USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
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Wilpers A, Bahtiyar MO, Stitelman D, Batten J, Calix RX, Chase V, Yung N, Maassel N, Novick G. The parental journey of fetal care: a systematic review and metasynthesis. Am J Obstet Gynecol MFM 2021; 3:100320. [PMID: 33493706 DOI: 10.1016/j.ajogmf.2021.100320] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to synthesize the qualitative literature on parental experiences of fetal care to reflect events that happened across the continuum of care and to better understand parents' positive and negative experiences with care delivery. DATA SOURCES Eligible studies published until June 2020 were retrieved from MEDLINE, Embase, Cochrane Central Register of Controlled Trials, EBSCO CINAHL, Web of Science, and ProQuest. STUDY ELIGIBILITY CRITERIA Studies must have been: (1) published in English in a peer-reviewed journal or in ProQuest, (2) available in full text, (3) contained a qualitative component, and (4) focused on expectant parents' experiences of tertiary, coordinated, multidisciplinary prenatal diagnosis and care related to a fetal anomaly. STUDY APPRAISAL AND SYNTHESIS METHODS Researchers used the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. A metastudy and an interpretive description approach was taken to synthesize the events that happened across the continuum of care and the themes associated with a positive care experience. RESULTS The metasynthesis included 13 studies and 217 patients from 11 different multidisciplinary fetal diagnosis and intervention practices across North America and Europe. We identified key events that influenced parental experience of fetal care across the continuum. The themes associated with a positive care experience are parents (1) gaining understanding and feeling understood, (2) realizing agency and control, and (3) finding hope and meaning. We identified aspects of healthcare delivery that served as barriers or facilitators to these positive experiences. CONCLUSION Understanding the commonalities of the parental experience of fetal care across diverse settings creates a foundation for improving care and better meeting the needs of parents undergoing a painful and life-defining event. Although health outcomes are not always positive, a positive experience of care is possible and can assist parents to cope with their grief, manage their expectations, and engage in their care. The findings of this study illustrate the ways in which healthcare delivery can facilitate or obstruct a positive care experience.
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Affiliation(s)
- Abigail Wilpers
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten).
| | - Mert Ozan Bahtiyar
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - David Stitelman
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Janene Batten
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Roberto X Calix
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Victoria Chase
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Nicholas Yung
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Nathan Maassel
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
| | - Gina Novick
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Wilpers, Bahtiyar, Stitelman, Calix, and Chase); Division of Pediatric Surgery, Department of Surgery (Drs Stitelman, Yung, and Maassel), Yale School of Medicine, New Haven, CT; Yale New Haven Hospital, New Haven, CT (Drs Wilpers, Bahtiyar, Stitelman, Calix, Chase, Yung, and Maassel); Yale School of Nursing, Yale University, Orange, CT (Drs Wilpers, Bahtiyar, and Novick); Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT (Ms Batten)
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Who moved my fellow: changes to Accreditation Council for Graduate Medical Education fellowships in pediatric surgery and what may be yet to come. Curr Opin Pediatr 2019; 31:409-413. [PMID: 31090584 DOI: 10.1097/mop.0000000000000762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Over the past 15 years, the Accreditation Council for Graduate Medical Education (ACGME) has significantly altered the regulatory framework governing fellowship training in pediatric surgery. The daily experiences of pediatric surgical trainees have been impacted by these changes, but training program directors and faculty have not developed a consistent approach to managing this shift. This review highlights the changes, which have occurred, analyzes the current state of fellowship training, and proposes potential strategies for management. RECENT FINDINGS The implementation of work hour restrictions, increased supervision requirements, the milestone evaluation program and most recently, enforcement of required critical care experience, have caused significant changes in the curriculum. Pediatric surgical trainees record more total cases, and more minimally invasive surgical (MIS) cases, in particular, than ever before. A subset of this increase may result from trainees performing cases previously assigned to general surgery residents. Teaching cases performed by fellows have decreased. Although the relationship between these shifts in training experience and the didactic curriculum is not clear, we also note that the Pediatric Surgery Certifying Examination failure rate has increased, approaching 20% in recent years. SUMMARY It is unclear whether the changes in Pediatric Surgery training programs have been effective, or (conversely) have led to unintended consequences. Paradigm shifts in our training model may be required to address the changes in surgical education and skill acquisition, so that well tolerated, competent and skillful pediatric surgeons continue to enter the workforce.
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Breaud J, Talon I, Fourcade L, Podevin G, Rod J, Audry G, Dohin B, Lecompte JF, Bensaid R, Rampal V, Azzie G. The National Pediatric Surgery Simulation Program in France: A tool to develop resident training in pediatric surgery. J Pediatr Surg 2019; 54:582-586. [PMID: 30318311 DOI: 10.1016/j.jpedsurg.2018.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE To implement resident curriculum in France based on theoretical teaching and bed side training, the national council known as the "Collège Hospitalier et Universitaire de Chirurgie Pédiatrique" examined the relevance and feasibility of systematically introducing simulation program in the pediatric surgery resident training. MATERIAL AND METHODS A national simulation training program was developed and took place in a 2-day session organized in 7 simulation centers in France. The program included technical (laparoscopic/suturing technique on low-fidelity models) and nontechnical (6 scenarios for standardized consultation, and a team work scenario based on errors prevention in the operative room) skills. Evaluation of the program (Likert scale from 1 (bad) to 5 (excellent) and notation on 20 points) concerned trainees and trainers. RESULTS 40 residents (95% of all pediatric surgery French residents) attended with a ratio of trainees/trainer of ½. The training objectives earned a score of 4.46/5. The pedagogical value of the seminar scored 4.7/5, teaching quality 17.95/20, and the overall seminar score was 17.35/20. CONCLUSION This program, unique nationally, was assessed very favorably by the participating residents and by the involved trainers. To our knowledge, it represents the first mandatory national simulation training program included within a surgical training model. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jean Breaud
- Medical Simulation Center, Cote d'Azur University, Faculté de Médecine de Nice, 28 avenue de Valombrose, 06000, Nice, France; Pediatric Surgery Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, 57 avenue de la californie, 06200, Nice, France.
| | - Isabelle Talon
- Pediatric Surgery Department CHU de Strasbourg, Hopital de Hautepierre, 1 avenue Moliere, 67200, Strasbourg, France
| | - Laurent Fourcade
- Pediatric Surgery Department, CHU de Limoges, Hopital de la Mère et de l'Enfant, 8 avenue Dominique Larrey, 87000, Limoges, France
| | - Guillaume Podevin
- Pediatric Surgery Department, CHU d'Angers, 4 rue Larrey, 49933, Angers cedex 9, France
| | - Julien Rod
- Pediatric Surgery Department, CHU de Caen, Avenue de la Côte de Nacre, CS, 30001, 14033 Caen Cedex 9, France
| | - Georges Audry
- Pediatric Surgery Department, Hopital Armand Trousseau, APHP, 26 avenue du Dr Arnold Netter,75012, Paris, France
| | - Bruno Dohin
- Pediatric Surgery Department, CHU de Saint Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez
| | - Jean-Francois Lecompte
- Pediatric Surgery Department, Hopitaux Pédiatriques de Nice CHU-Lenval, 57 avenue de la californie, 06200, Nice, France
| | - Ronny Bensaid
- Pediatric Surgery Department, Hopitaux Pédiatriques de Nice CHU-Lenval, 57 avenue de la californie, 06200, Nice, France
| | - Virginie Rampal
- Pediatric Surgery Department, Hopitaux Pédiatriques de Nice CHU-Lenval, 57 avenue de la californie, 06200, Nice, France
| | - Georges Azzie
- Pediatric Surgery Department, Sick Children Hospital, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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Berman L, Jackson J, Miller K, Kowalski R, Kolm P, Luks FI. Expert surgical consensus for prenatal counseling using the Delphi method. J Pediatr Surg 2018; 53:1592-1599. [PMID: 29274787 DOI: 10.1016/j.jpedsurg.2017.11.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/27/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric surgeons frequently offer prenatal consultation for congenital pulmonary airway malformation (CPAM) and congenital diaphragmatic hernia (CDH); however, there is no evidence-based consensus to guide prenatal decision making and counseling for these conditions. Eliciting feedback from experts is integral to defining best practice regarding prenatal counseling and intervention. METHODS A Delphi consensus process was undertaken using a panel of pediatric surgeons identified as experts in fetal therapy to address current limitations. Areas of discrepancy in the literature on CPAM and CDH were identified and used to generate a list of content and intervention questions. Experts were invited to participate in an online Delphi survey. Items that did not reach first-round consensus were broken down into additional questions, and consensus was achieved in the second round. RESULTS Fifty-four surgeons (69%) responded to at least one of the two survey rounds. During round one, consensus was reached on 54 of 89 survey questions (61%), and 45 new questions were developed. During round two, consensus was reached on 53 of 60 survey questions (88%). CONCLUSIONS We determined expert consensus to establish guidelines regarding perinatal management of CPAM and CDH. Our results can help educate pediatric surgeons participating in perinatal care of these patients. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Loren Berman
- Sidney Kimmel Medical College of Thomas Jefferson University, 1025 Walnut St. #100, Philadelphia, PA 19107, USA; Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA.
| | - Jordan Jackson
- University of California San Francisco-East Bay, 1411 East 31st St., QIC 22134, Oakland, CA 94602, USA.
| | - Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health 3007 Tilden St NW, Washington, DC 20008, USA.
| | - Rebecca Kowalski
- Value Institute at Christiana Care Health System and Christiana Care Emergency Department, 4755 Ogletown-Stanton Rd., Newark, DE 19718, USA.
| | - Paul Kolm
- Value Institute at Christiana Care Health System and Christiana Care Emergency Department, 4755 Ogletown-Stanton Rd., Newark, DE 19718, USA.
| | - Francois I Luks
- Alpert Medical School of Brown University, Box G-A1, Providence, RI 02912, USA; Hasbro Children's Hospital, 593 Eddy St., Providence, RI 02903, USA.
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Danziger P, Laventhal N. Prenatal consultation: perspectives on training, relevance, and utilization among pediatric subspecialty program directors. J Perinatol 2018; 38:989-996. [PMID: 29740188 DOI: 10.1038/s41372-018-0121-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/20/2018] [Accepted: 03/01/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize the experience and training of house officers in prenatal consultation, and to assess program directors' perceptions regarding adequacy of training, and relevance and utilization of prenatal consultation in their field. STUDY DESIGN An online survey was distributed to program directors of all ACGME-accredited programs in the United States in relevant pediatric subspecialties. RESULTS Ninety-five percent (142/150) of respondents agreed that prenatal consultation from their field can impact decision-making, yet 46% (69/149) believe their prenatal consult services are underutilized. The majority (56%, 86/152) reported no formal curriculum related to prenatal consultation in their program. Nine percent (14/150) rated their trainees as not adequately trained to perform competent prenatal consultation upon graduation; 35% (52/150) rated trainees as only "somewhat" competent. CONCLUSION Our study, the first of its kind, reveals widespread lack of formal training curricula, which may explain the finding that many graduating trainees are perceived as inadequately prepared to perform competent prenatal consultation.
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Affiliation(s)
- Phoebe Danziger
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, USA.
| | - Naomi Laventhal
- Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor, USA.,Division of Neonatal-Perinatal Medicine, Ann Arbor, USA.,Center for Bioethics and Social Sciences in Medicine, Ann Arbor, USA
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Petroze RT, Castle SL, Radulescu A, Grant C, Van Arendonk K, Neff LP. An appeal from fellows. J Pediatr Surg 2018; 53:1259-1260. [PMID: 29618411 DOI: 10.1016/j.jpedsurg.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Robin T Petroze
- Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | | | - Andrei Radulescu
- Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL.
| | - Christa Grant
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
| | | | - Lucas P Neff
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA.
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