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Kelleher ST, Kyle WB, Penny DJ, Olsen J, Nolke L, Allen HD, McMahon CJ. Twinning International Pediatric Cardiology Fellowship Programs: A Transformative Educational Experience for Trainees with Potential for Global Adoption. Pediatr Cardiol 2024:10.1007/s00246-024-03469-x. [PMID: 38565665 DOI: 10.1007/s00246-024-03469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
Over the last decade, having endured the COVID-19 pandemic, education and training in pediatric cardiology have undergone a profound disruptive transformation. Trainees experience considerable stress achieving all the competencies required to become a competent pediatric cardiologist. Often the quality of the training experienced by trainees, the approach to patients, and potential institutional preference in management strategy is heavily influenced by the center in which they train. We developed an online live twin program of education between Texas Children's Hospital, Houston, Texas and Children's Health at Crumlin Dublin Ireland in 2019. We explored using grounded theory whether a regular scheduled shared teaching program improved fellow education and training between both centers. Trainees were surveyed to evaluate the benefits and disadvantages of such a twin program. The majority (93%) found the sessions helpful from an educational standpoint with many trainees reporting it to be a transformative experience. Three important learning themes emerged: practice variation between centers, managing uncertainty in clinical practice and cognitive overload. This pedagogical model could be replicated across multiple international pediatric cardiology units and facilitate "collaborative learning" among centers across the globe. Furthermore, this novel educational model could also be adopted by other medical specialties.
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Affiliation(s)
- Sean T Kelleher
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland
| | - William B Kyle
- Department Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Houston, Texas, 77030, USA
| | - Daniel J Penny
- Department Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Houston, Texas, 77030, USA
| | - Jillian Olsen
- Department Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Houston, Texas, 77030, USA
| | - Lars Nolke
- Department of Congenital Cardiothoracic Surgery, Children's Health Ireland, Crumlin, Dublin, 12, Ireland
| | - Hugh D Allen
- Department Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Houston, Texas, 77030, USA
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, 12, Ireland.
- UCD School of Medicine, Belfield, Dublin, 4, Ireland.
- Maastricht School of Health Professions Education, Maastricht, Netherlands.
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Kim ME, Tretter J, Wilmot I, Hahn E, Redington A, McMahon CJ. Entrustable Professional Activities and Their Relevance to Pediatric Cardiology Training. Pediatr Cardiol 2022; 44:757-768. [PMID: 36576524 PMCID: PMC9795145 DOI: 10.1007/s00246-022-03067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
Entrustable professional activities (EPAs) have become a popular framework for medical trainee assessment and a supplemental component for milestone and competency assessment. EPAs were developed to facilitate assessment of competencies and furthermore to facilitate translation into clinical practice. In this review, we explore the rationale for the introduction of EPAs, examine whether they fulfill the promise expected of them, and contemplate further developments in their application with specific reference to training in pediatric cardiology.
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Affiliation(s)
- Michael E. Kim
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Justin Tretter
- Department of Pediatric Cardiology, Pediatric Institute, Cleveland Clinic Children’s, and The Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, M-41, Cleveland, OH 44195 USA
| | - Ivan Wilmot
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Eunice Hahn
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Andrew Redington
- Department of Pediatrics, College of Medicine, Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH USA
| | - Colin J. McMahon
- Department of Paediatric Cardiology, Children’s Health Ireland at Crumlin, Crumlin, Dublin Ireland ,School of Medicine, University College Dublin, Dublin 4, Belfield, Ireland ,School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Marti-Morales M, Rohrer JE. Care coordination, family-centered care, and functional ability in children with special health care needs in the United States. Popul Health Manag 2015; 17:233-8. [PMID: 25127206 DOI: 10.1089/pop.2013.0092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to determine if there was an association between care coordination, family-centered care, and functional ability among children with special health care needs (CSHCN). Analysis of data from the 2005-2006 National Survey of CSHCN revealed that the percentages of CSHCN receiving care coordination and family-centered care were 59.3 and 66.3, respectively. Children who did not receive care coordination had a 53% higher adjusted odds (odds ratio=1.53, 95% confidence interval 1.21-1.94, P<0.001) for a limitation in functional ability compared to CSHCN who received care coordination. Family-centered care was not associated with a limitation in functional ability in CSHCN (P=0.61). CSHCN are underserved with regard to care coordination and this appears to be associated with impaired functional ability. Longitudinal studies are needed to confirm causality.
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Leichtner AM, Gillis LA, Gupta S, Heubi J, Kay M, Narkewicz MR, Rider EA, Rufo PA, Sferra TJ, Teitelbaum J. NASPGHAN guidelines for training in pediatric gastroenterology. J Pediatr Gastroenterol Nutr 2013; 56 Suppl 1:S1-8. [PMID: 23263531 DOI: 10.1097/mpg.0b013e31827a78d6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Recommendations from the Association for European Paediatric Cardiology for training in paediatric cardiac intensive care. Cardiol Young 2011; 21:480-4. [PMID: 21672292 DOI: 10.1017/s1047951111000655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The following document provides a summary of the guidelines and recommendations for paediatric cardiac intensive care training as a requirement for recognition as a European paediatric cardiologist. It is therefore primarily targeting paediatric cardiology trainees in Europe, including those doctors who might wish to become experts in cardiac intensive care. These recommendations represent a frame for consistency, will evolve, and may be adapted to specific institutional requirements. They will be complemented by a learning module to be provided by our Association in the near future.
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Wang ML, Macklin EA, Tracy E, Nadel H, Catlin EA. Updated parental viewpoints on male neonatal circumcision in the United States. Clin Pediatr (Phila) 2010; 49:130-6. [PMID: 20080519 DOI: 10.1177/0009922809346569] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Through a questionnaire, the authors sought to elicit information about initial attitudes concerning circumcision after reading a summary of the American Academy of Pediatrics (AAP) Policy Statement and, again, after reading a description of recent HIV/HPV studies. Predictors of increased support for circumcision included having a prior circumcised boy and being US born. Predictors of decreased support included being of Hispanic ethnicity and believing that the uncircumcised penis was more culturally normal. After reading the AAP statement, 86% of respondents remained favorable of elective circumcision, whereas 13% viewed it less favorably. After reading the passage about the HIV/HPV studies, the majority maintained their initial level of support. Certain characteristics were associated with an individual's desire to perform circumcision on his/her infant. Despite a slight decrease in support to perform circumcision after reading the AAP policy summary, respondents' initial attitudes toward circumcision were unchanged after subsequent review of recent HIV/HPV research.
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Affiliation(s)
- Marvin L Wang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Distorted cardiac anatomy: the congenital (R)evolution. J Am Soc Echocardiogr 2009; 22:141-4. [PMID: 19187854 DOI: 10.1016/j.echo.2008.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Anuntaseree W, Mo-Suwan L, Vasiknanonte P, Kuasirikul S, Ma-A-Lee A, Choprapawon C. Factors associated with bed sharing and sleep position in Thai neonates. Child Care Health Dev 2008; 34:482-90. [PMID: 18485024 DOI: 10.1111/j.1365-2214.2008.00832.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep in a supine position and in a bed separate from but proximate to adults is recommended, in several Western countries, to prevent Sudden Infant Death Syndrome (SIDS). Cultural differences and a lower rate of SIDS in Asian populations may affect concern with this problem and thus infant sleeping arrangements. Objective To study bed sharing and sleep position in Thai neonates and the relationship to infant and maternal characteristics. METHODS A cross-sectional survey based on interviews with parents of infants aged 21 days old, was conducted under the Prospective Cohort Study of Thai Children. RESULTS Of the total sample, 2236/3692 (60.6%) infants shared a bed with their parents. Sixty per cent of the parents placed their infants to sleep in a supine position, 32.2% on their side and 4.9% in a prone position. Bed sharing was associated with older maternal age, higher education, Muslim mother, and with work status of professional career or unemployed. Placing the infants to sleep in a prone position was associated with infant birth weight of greater than 2500 g, older maternal age, higher education, Buddhist mother, mother with professional career and middle-class household economic status. CONCLUSIONS Infant bed sharing is a common practice in the Thai culture, as in other Asian countries. The prone sleep position is less common than in Western populations. The main factor associated with both bed sharing and putting infants to sleep in the prone position was a higher maternal socioeconomic status (SES), in contrast to previous studies in some Western countries in which both practices were associated with low maternal SES. Cultural differences may play an important role in these different findings.
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Affiliation(s)
- W Anuntaseree
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
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Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA. Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatr 2007; 96:1399-403. [PMID: 17714547 DOI: 10.1111/j.1651-2227.2007.00413.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate the risk of sudden infant death in the Netherlands during bed-sharing in the first half year of life and the protective effect of breastfeeding on it. METHODS During a 10-year period between September 1996 and September 2006 nationwide, 213 cot deaths were investigated. RESULTS AND DISCUSSION Of 138 cot deaths of less than 6 months of age, 36 (26%) bed-shared. In a reference group of 1628 babies from infant welfare centres only 9.4% were bed-sharing in the night prior to the interview. After correction for smoking of one or both parents the odds ratio for cot death during bed-sharing with parents decreased with age from 9.1 (CI 4.2-19.4) at 1 month, to 4.0 (CI 2.3-6.7) at 2 months, to 1.7 (CI 0.9-3.4) at 3 months and to 1.3 (CI 1.0-1.6) at 4 through 5 months of age. The excess risk (OR > 1) associated with bed-sharing is itself not significantly influenced by the presence or absence of breastfeeding. CONCLUSION Bed-sharing is a serious risk factor for sudden infant death for all babies of less than 4 months of age. From 4 months onwards bed-sharing did not contribute significantly to the risk of cot death anymore in our study.
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Affiliation(s)
- Jan H Ruys
- Leiden University Medical Center, Reviuslaan 38, 2343 JR Oegstgeest, The Netherlands.
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Xu X, Vahratian A, Patel DA, McRee AL, Ransom SB. Emergency contraception provision: a survey of Michigan physicians from five medical specialties. J Womens Health (Larchmt) 2007; 16:489-98. [PMID: 17521252 DOI: 10.1089/jwh.2006.0196] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Despite the controversy over expanding delivery options for emergency contraceptive pills (ECP), little is known about physicians' attitudes toward over-the-counter (OTC) provision of ECP, and prior research on physicians' practices often has focused on a single specialty. This study examined the attitudes and practices regarding advance provision and OTC status of ECP among physicians in five medical specialties likely to encounter patients in need of ECP. METHODS A mail survey of a random sample of 850 Michigan physicians in family/general medicine, internal medicine, obstetrics/gynecology, pediatrics, and emergency medicine was conducted. Respondents' ECP-related attitudes and practices were assessed, and differences by physician characteristics were examined using chi-square tests and multivariable logistic regression analyses. RESULTS Two hundred seventy-one physicians responded to the survey (response rate = 32%), with 42% of them favoring OTC provision of ECP and 40% opposing it. Half of respondents never routinely initiated discussions about ECP with their sexually active, female patients, and 77% of respondents did not routinely offer advance prescriptions. After adjusting for other factors, including medical specialty, older physicians ( > or =50 years) were significantly more likely than their younger counterparts to support OTC provision of ECP (OR = 2.9, 95% CI 1.7-4.9) or offer advance prescriptions (OR = 2.5, 95% CI 1.1-5.8). Physicians with a specialty in obstetrics/gynecology were 3.5 times (95% CI 1.3-9.8) as likely as physicians in family/general medicine to offer advance prescriptions for ECP, and female physicians were 2.5 (95% CI 1.05-6.0) times as likely as male physicians to offer advance prescriptions. Graduation from a medical school within the United States and practicing in a private practice were marginally associated with a lower likelihood of supporting OTC status of ECP (OR = 0.5, 95% CI: 0.2-1.0; and OR equals; 0.6, 95% CI 0.3-1.1, respectively). CONCLUSIONS Certain physician characteristics were significantly associated with their ECP-related attitudes and practices. The majority of physicians surveyed in this study did not offer advance prescriptions for ECP, and few had initiated discussions on ECP with patients, which may pose critical barriers to patients' timely access.
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Affiliation(s)
- Xiao Xu
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Arkell S, Blair P, Henderson J, Fleming P. Is the mattress important in helping babies keep warm?--Paradoxical effects of a sleeping surface with negligible thermal resistance. Acta Paediatr 2007; 96:199-205. [PMID: 17429905 DOI: 10.1111/j.1651-2227.2007.00089.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heavy wrapping and head covering are risk factors for Sudden Infant Death Syndrome. A new mattress construction, PurFlo, has extremely low thermal resistance, and when used with an infant sleeping bag minimizes the risk of head covering. AIM To investigate the thermal balance and metabolic rate of infants sleeping on a conventional mattress or a Purflo mattress in infant sleeping bags. METHODS A longitudinal study of thermal balance of infants during day-time sleep on both mattress types in thermoneutral and cool conditions at ages 3 weeks (n = 24), 3 months (n = 22) and 5 months (n = 18). RESULTS In thermoneutral conditions axillary temperatures in quiet sleep were lower on the conventional mattress than on the PurFlo mattress (p < 0.05, Wilcoxon test). On lowering room temperature to 15-16 degrees C axillary temperatures fell, particularly in the older babies, and at each age were lower on the conventional mattress than the Purflo (differences 0.14-0.72 degrees C, p < 0.05, Wilcoxon test). CONCLUSION In both thermoneutral and cool conditions, infant temperatures were higher on the PurFlo than the conventional mattress. The more deformable surface of the PurFlo mattress may lead to more effective insulation by the sleeping bag despite a lack of mattress insulation.
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Affiliation(s)
- Sara Arkell
- Institute of Child Life and Health, University of Bristol, Bristol, UK
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Baden HP, Zimmerman JJ, Brilli RJ, Wong H, Wetzel RC, Burns JP, Nadkarni V, Checchia PA, Dalton HJ, Berger J, Pollack M, Notterman D, Green TP, Blumer J, Dean M. Intensivist-led team approach to critical care of children with heart disease. Pediatrics 2006; 117:1854-6; author reply 1856-7. [PMID: 16651353 DOI: 10.1542/peds.2006-0353] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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