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Miller-Kuhlmann R, Sasnal M, Gold CA, Nassar AK, Korndorffer JR, Van Schaik S, Marmor A, Williams S, Blankenburg R, Rassbach CE. Tips for developing a coaching program in medical education. Med Educ Online 2024; 29:2289262. [PMID: 38051864 PMCID: PMC10783821 DOI: 10.1080/10872981.2023.2289262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.
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Affiliation(s)
| | - Marzena Sasnal
- Center for Research on Education Outcomes, Stanford University, Palo Alto, USA
| | - Carl A. Gold
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, USA
| | | | | | - Sandrijn Van Schaik
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Andrea Marmor
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Sarah Williams
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
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Mahoney D, Pavitt S, Blankenburg R. We've Got a New One-Exploring the Resident-Fellow New Admission Interaction and Opportunities for Enhancing Motivation. Acad Pediatr 2024; 24:692-699. [PMID: 38215903 DOI: 10.1016/j.acap.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/12/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To characterize the phases of a new admission interaction between collaborating pediatric residents and fellows; to explore trainee perspectives on motivating and demotivating qualities of that interaction; and to identify behaviors that lead to an optimal new admission interaction. METHODS The authors used modified grounded theory with experiential learning theory and self-determination theory as sensitizing concepts to conduct 6 focus groups and journey mapping at Stanford Children's Health from January to March 2021. The sessions were audio-recorded and transcribed verbatim. Two authors independently coded the transcripts and developed categories and themes using constant comparison, while a third author reviewed these findings. The qualitative data were triangulated with surveys and journey mapping data and conceptualized into a model of trainee motivation during the new admission interaction. They outlined an optimal new admission interaction using behaviors consistently described by participants as motivating. RESULTS Developing inter-trainee trust and educational buy-in is essential for both residents and fellows to feel intrinsically motivated and engaged during a new admission. Residents need to feel autonomous, competent, and related to the team in order to develop trust and buy-in. Fellows require assurance of patient safety to develop trust and a sense of self-efficacy in fostering resident growth to develop buy-in. Lack of trust or buy-in from either party leads to a cycle of trainee disengagement. CONCLUSIONS Trainee motivation and engagement with patient care can be impacted by discreet, modifiable behavior by their fellow or resident counterpart, which may help improve the quality of care delivered.
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Affiliation(s)
- David Mahoney
- Department of Pediatrics (D Mahoney), Stanford University School of Medicine, Palo Alto, Calif.
| | - Sara Pavitt
- Department of Neurology and by courtesy Department of Pediatrics (S Pavitt), Dell Medical School, Austin, Tex.
| | - Rebecca Blankenburg
- Department of Pediatrics (R Blankenburg), Stanford University School of Medicine, Palo Alto, Calif.
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Gilliam C, Ramos M, Hilgenberg S, Rassbach C, Blankenburg R. Laying the Foundation: How to Develop Rigorous Health Professions Education Scholarship. Hosp Pediatr 2024; 14:e132-e137. [PMID: 38178786 DOI: 10.1542/hpeds.2023-007162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
| | - Margarita Ramos
- Pediatric Hospital Medicine, Children's National Medical Center, Washington, DC
| | - Sarah Hilgenberg
- Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Caroline Rassbach
- Pediatrics, Stanford University School of Medicine, Stanford, California
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4
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Yemane L, Kas-Osoka O, Burns A, Blankenburg R, Prakash LK, Poitevien P, Schwartz A, Lucas CT, Marbin J. Upholding Our PROMISE: Underrepresented in Medicine Pediatric Residents' Perspectives on Interventions to Promote Belonging. Acad Med 2023; 98:1434-1442. [PMID: 37643583 DOI: 10.1097/acm.0000000000005443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE Underrepresented in medicine (UIM) residents experience challenges during training that threaten their sense of belonging in medicine; therefore, residency programs should intentionally implement interventions to promote belonging. This study explored UIM pediatric residents' perspectives on current residency program measures designed to achieve this goal. METHOD The authors conducted a secondary qualitative analysis as part of a national cross-sectional study, PROmoting Med-ed Insight into Supportive Environments (PROMISE), which explored pediatric residents' experiences and perspectives during training in relation to their self-identities. A 23-item web-based survey was distributed through the Association of Pediatric Program Directors Longitudinal Educational Research Assessment Network from October 2020 to January 2021. Participants provided free-text responses to the question "What are current measures that promote a sense of belonging for the UIM community in your training program?" The authors used conventional content analysis to code and identify themes in responses from UIM participants. RESULTS Of the 1,748 residents invited to participate, 931 (53%) residents from 29 programs completed the survey, with 167 (18%) identifying as UIM. Of the 167 UIM residents, 74 (44%) residents from 22 programs responded to the free-text question. The authors coded more than 140 unique free-text responses and identified 7 major themes: (1) critical mass of UIM residents; (2) focused recruitment of UIM residents; (3) social support, including opportunities to build community among UIM residents; (4) mentorship; (5) caring and responsive leadership; (6) education on health disparities, diversity, equity, inclusion, and antiracism; and (7) opportunities to serve, including giving back to the local community and near-peer mentorship of UIM premedical and medical students. CONCLUSIONS This is the first national study to describe UIM pediatric residents' perspectives on interventions that promote a sense of belonging. Programs should consider implementing these interventions to foster inclusion and belonging among UIM trainees.
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Arquette C, Peicher V, Ajayi A, Alvarez D, Mao A, Nguyen T, Sawyer A, Sears CM, Carragee EJ, Floyd B, Mahanay B, Blankenburg R. Moral Injury: How It Affects Us and Tools to Combat It. MedEdPORTAL 2023; 19:11357. [PMID: 37927405 PMCID: PMC10622333 DOI: 10.15766/mep_2374-8265.11357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/03/2023] [Indexed: 11/07/2023]
Abstract
Introduction Moral injury comprises feelings of guilt, despair, shame, and/or helplessness from having one's morals transgressed. Those underrepresented in health care are more likely to experience moral injury arising from micro- and macroaggressions. This workshop was designed for interprofessional health care providers ranging from students to program leadership to raise awareness about moral injury and provide tools to combat it. Methods This 75-minute interactive workshop explored moral injury through a health care lens. It included components of lecture, case-based learning, small-group discussion, and individual reflection. Participants completed anonymous postworkshop evaluations, providing data on satisfaction and intention to change practice. We used descriptive statistics to analyze the quantitative data and applied content analysis to the qualitative data. Results The workshop was presented at two local academic conferences. Data were collected from 34 out of 60 participants, for a response rate of 57%. Ninety-seven percent of participants felt the workshop helped them define and identify moral injury and was a valuable use of their time, as well as indicating they would apply the information learned in their daily life. One hundred percent would recommend the workshop to a friend or colleague. Almost half felt they could implement strategies to address moral injury after participating in the workshop. Discussion This workshop proved to be a valuable tool to define and discuss moral injury. The materials can be adapted to a broad audience.
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Affiliation(s)
- Connor Arquette
- Fourth-Year Resident, Department of Plastic Surgery, Stanford University School of Medicine
| | - Valerie Peicher
- Postdoctoral Fellow, Department of Pediatrics, Stanford University School of Medicine
| | - Antonette Ajayi
- Fellow, Department of Pediatrics, Stanford University School of Medicine
| | - Dora Alvarez
- Third-Year Resident, Department of Pediatrics, Stanford University School of Medicine
| | - Alice Mao
- Fellow, Department of Medicine, Stanford University School of Medicine
| | - Tram Nguyen
- Fellow, Department of Medicine, Stanford University School of Medicine
| | - Anthony Sawyer
- Fourth-Year Resident, Department of Anesthesia, Stanford University School of Medicine
| | - Connie Martin Sears
- Fourth-Year Resident, Department of Ophthalmology, Stanford University School of Medicine
| | - Eugene J. Carragee
- Professor, Department of Orthopedic Surgery, Stanford University School of Medicine
| | - Baraka Floyd
- Assistant Professor, Department of Pediatrics, Stanford University School of Medicine
| | - Bernadett Mahanay
- Fellowship Programs Manager, Department of Anesthesia, Stanford University School of Medicine
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Guerin A, Lee J, Floyd B, Yemane L, Fassiotto M, Griffith E, Blankenburg R, Hilgenberg SL, Dali S, De Araujo M, Jones K, Kuo K, Rassbach CE. Building an Antiracist Department Through an Experiential Department-Wide Antiracism Curriculum. Acad Pediatr 2023; 23:1505-1506. [PMID: 37422256 DOI: 10.1016/j.acap.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Allison Guerin
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - July Lee
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Baraka Floyd
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Lahia Yemane
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Magali Fassiotto
- Office of Faculty Development & Diversity (M Fassiotto), Stanford School of Medicine, Stanford, Calif.
| | - Emmett Griffith
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Rebecca Blankenburg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Sarah L Hilgenberg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Salma Dali
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Monique De Araujo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kamaal Jones
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kevin Kuo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Caroline E Rassbach
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
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7
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Burns AM, Kester Prakash L, Yemane L, Blankenburg R, Kas-Osoka OA, Poitevien P, Marbin J, Schwartz A, Taylor Lucas C. Upholding Our PROMISE: Discrimination and Lack of Belonging Negatively Influence Pediatric Residents' Desire to Stay at Home Institution. Acad Med 2023; 98:S195-S196. [PMID: 37983441 DOI: 10.1097/acm.0000000000005379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Audrea M Burns
- Author affiliations: A.M. Burns, Baylor College of Medicine; L. Kester Prakash, University of California Davis School of Medicine; L. Yemane, R. Blankenburg, Stanford School of Medicine; P. Poitevien, Warren Alpert Medical School of Medicine at Brown University; O.A. Kas-Osoka, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas; J. Marbin, University of California Berkeley-University of California San Francisco Joint Medical Program; A. Schwartz, University of Illinois at Chicago; C. Taylor Lucas, University of California Irvine School of Medicine/CHOC
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8
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Punjabi S, Blankenburg R, Blecharczyk E. Development of a Multi-site Curriculum for Inequities in Newborn Care (CINC) Informed by Pediatric Resident and Community Engagement. Acad Pediatr 2023; 23:1516-1519. [PMID: 37353193 DOI: 10.1016/j.acap.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Shamita Punjabi
- Department of Pediatrics, Stanford Medicine Children's Health-Lucile Packard Children's Hospital, Palo Alto, CA.
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford Medicine Children's Health-Lucile Packard Children's Hospital, Palo Alto, CA.
| | - Elizabeth Blecharczyk
- Department of Pediatrics, Stanford Medicine Children's Health-Lucile Packard Children's Hospital, Palo Alto, CA.
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9
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Sun VK, Chappell-Campbell L, Blankenburg R, Sznewajs A. Perspectives on Professional Development Among University and Community Pediatric Hospitalists. Clin Pediatr (Phila) 2023:99228231203299. [PMID: 37776239 DOI: 10.1177/00099228231203299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Multiple professional societies have emphasized the importance of professional development for physicians. This qualitative study aimed to explore pediatric hospitalists' perceptions of professional development needs and to refine a framework for professional development in pediatric hospital medicine (PHM). We conducted four focus groups in April to May 2019 with 19 pediatric hospitalists at six clinical sites within a single institution. Participants identified key components of professional development including skill development, personal growth, career satisfaction, and individualization. Hospitalists agreed upon 8 domains of professional development: clinical excellence, advocacy, global health, health care administration, informatics, medical education, quality improvement, and research. They also identified missing the mentorship necessary to change their passions into career advancement, highlighted barriers and facilitators, and noted that an alignment in personally meaningful projects to what is meaningful to the institution was in everyone's best interests. Faculty programs should build infrastructure to aid pediatric hospitalists in achieving their career goals.
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Affiliation(s)
- Vivien K Sun
- Division of Pediatric Hospital Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Laura Chappell-Campbell
- Division of Pediatric Hospital Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Rebecca Blankenburg
- Division of Pediatric Hospital Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Aimee Sznewajs
- Department of Pediatric Hospital Medicine, Children's Minnesota, Minneapolis, MN, USA
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Rivera N, Nguyen K, Kalami V, Qin F, Mathur MB, Blankenburg R, Yeh AM. A Specific Carbohydrate Diet Virtual Teaching Kitchen Curriculum Promotes Knowledge and Confidence in Caregivers of Pediatric Patients with Inflammatory Bowel Disease. Nutrients 2023; 15:3999. [PMID: 37764781 PMCID: PMC10537188 DOI: 10.3390/nu15183999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Diet-based approaches such as the Specific Carbohydrate Diet (SCD) have proposed health benefits for patients with Inflammatory Bowel Disease (IBD). Despite its potential effectiveness, patients and caregivers identified barriers towards implementing the SCD, and a majority expressed interest in formal education surrounding the SCD. This study aimed to determine the impact of a virtual teaching kitchen curriculum on caregivers' knowledge and perspectives on implementing the SCD. Inclusion criteria included pediatric patients with IBD aged 3-21 years and their caregivers. Participants should have fewer than 12 months of experience with the SCD or have no experience with the SCD but with an interest in learning it. Twenty-three caregivers took part in a 90-min virtual teaching kitchen curriculum and completed pre- and post-session surveys. Caregivers had statistically significant increases in total curriculum scores (p < 0.0001) as well as increases in all curricular elements post-curriculum teaching. Caregivers indicated that they plan to apply the newly acquired recipes and cooking concepts and appreciated the encouragement and support they received during the course. Curricular strengths identified included the innovative multimodal curriculum structure and professional and community support. IBD centers can use this pilot study to create or expand SCD and other nutritional curricula for the IBD community.
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Affiliation(s)
- Nancy Rivera
- Division of Pediatric Hospital Medicine, The Permanente Medical Group, Santa Clara, CA 95051, USA
| | - Kaylie Nguyen
- Stanford Children’s Health, Lucile Packard Children’s Hospital, Palo Alto, CA 94304, USA; (K.N.); (V.K.)
| | - Venus Kalami
- Stanford Children’s Health, Lucile Packard Children’s Hospital, Palo Alto, CA 94304, USA; (K.N.); (V.K.)
| | - Feifei Qin
- Quantitative Sciences Unit, Stanford University, Palo Alto, CA 94304, USA;
| | - Maya B. Mathur
- Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA;
| | - Rebecca Blankenburg
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA 94304, USA;
| | - Ann Ming Yeh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA 94304, USA;
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11
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Myers RE, Blankenburg R, Klein M. Introducing “View from the Academic Pediatric Association Scholars Programs”—A New and Unique Section for Academic Pediatrics. Acad Pediatr 2023; 23:872-873. [PMID: 36858247 DOI: 10.1016/j.acap.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Ross E Myers
- Department of Pediatrics (RE Myers), Case Western Reserve University School of Medicine and Rainbow Babies and Children...s Hospital, Cleveland, OH.
| | - Rebecca Blankenburg
- Department of Pediatrics (R Blankenburg), Stanford School of Medicine, Palo Alto, CA
| | - Melissa Klein
- Department of Pediatrics (M Klein), University of Cincinnati College of Medicine, Division of General and Community Pediatrics, Cincinnati Children...s Hospital Medical Center, Cincinnati, OH
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12
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Herrmann LE, Blankenburg R, Klein M, Myers RE. Thriving in Academic Medicine..÷Embracing Evolving Mentorship and Sponsorship Needs. Acad Pediatr 2023; 23:884-885. [PMID: 36842750 DOI: 10.1016/j.acap.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Affiliation(s)
- Lisa E Herrmann
- Department of Pediatrics (LE Herrmann, M Klein), University of Cincinnati College of Medicine, Cincinnati, OH; Division of Hospital Medicine (LE Herrmann), Cincinnati Children...s Hospital Medical Center, Cincinnati, OH.
| | - Rebecca Blankenburg
- Department of Pediatrics (R Blankenburg), Stanford School of Medicine, Palo Alto, CA
| | - Melissa Klein
- Department of Pediatrics (LE Herrmann, M Klein), University of Cincinnati College of Medicine, Cincinnati, OH; Division of General Pediatrics (M Klein), Cincinnati Children...s Hospital Medical Center, Cincinnati, OH
| | - Ross E Myers
- Department of Pediatrics (RE Myers), Case Western Reserve University School of Medicine and Rainbow Babies and Children...s Hospital, Cleveland, OH
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13
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Okorie CUA, Kibrom S, Rotandi CL, Guerin A, Gans HA, Blankenburg R. A Visiting Rotation for Underrepresented in Medicine Pediatric Residents Is Valuable for Recruitment Into Pediatric Fellowships. J Grad Med Educ 2023; 15:397-399. [PMID: 37363674 PMCID: PMC10286915 DOI: 10.4300/jgme-d-22-00793.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Caroline U. A. Okorie
- Clinical Associate Professor of Pediatrics, Director, PRESS Program, and Associate Program Director, Pediatric Residency Program, Stanford University School of Medicine
| | - Sara Kibrom
- Clinical Assistant Professor of Pediatrics, Associate Director, PRESS Program, Stanford University School of Medicine
| | - Charlene L. Rotandi
- Department Fellowship Manager, Department of Pediatrics, Stanford University School of Medicine
| | - Allison Guerin
- Senior Director of Education and Diversity, Equity, Inclusion & Justice, Department of Pediatrics, Stanford University School of Medicine
| | - Hayley A. Gans
- Clinical Professor, Pediatric Infectious Diseases, Director, Fellowship Education, Department of Pediatrics, Stanford University School of Medicine
| | - Rebecca Blankenburg
- Clinical Professor of Pediatrics, Assistant Dean of Graduate Medical Education, Associate Chair of Education in Pediatrics, and Director, Coaching Program at Stanford, Department of Pediatrics, Stanford University School of Medicine
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14
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Schwartz A, King B, Mink R, Turner T, Abramson E, Blankenburg R, Degnon L. The APPD Longitudinal Educational Assessment Research Network's First Decade. Pediatrics 2023; 151:191115. [PMID: 37122062 DOI: 10.1542/peds.2022-059113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 05/02/2023] Open
Abstract
ABSTRACT In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. We report on evaluation of the network after 10 years of operation by reviewing program context, input, processes, and products to measure its progress in performing educational research that advances training of future pediatricians. Historical changes in medical education shaped the initial development of the network. APPD LEARN now includes 74% (148 of 201) of US Pediatric residency programs and has recently incorporated a network of Pediatric subspecialty fellowship programs. At the time of this evaluation, APPD LEARN had approved 19 member-initiated studies and 14 interorganizational studies, resulting in 23 peer-reviewed publications, numerous presentations, and 7 archived sharable data sets. Most publications focused on how and when interventions work rather than whether they work, had high scores for reporting rigor, and included organizational and objective performance outcomes. Member program representatives had positive perceptions of APPD LEARN's success, with most highly valuing participation in research that impacts training, access to expertise, and the ability to make authorship contributions for presentations and publication. Areas for development and improvement identified in the evaluation include adopting a formal research prioritization process, infrastructure changes to support educational research that includes patient data, and expanding educational outreach within and outside the network. APPD LEARN and similar networks contribute to high-rigor research in pediatric education that can lead to improvements in training and thereby the health care of children.
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Affiliation(s)
- Alan Schwartz
- Departments of Medical Education and Pediatrics,University of Illinois at Chicago, Chicago, Illinois
- Association of Pediatric Program Directors, McLean, Virginia
| | - Beth King
- Association of Pediatric Program Directors, McLean, Virginia
| | - Richard Mink
- Association of Pediatric Program Directors, McLean, Virginia
- Harbor-UCLA Medical Center, Torrance, California
| | - Teri Turner
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Erika Abramson
- Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | | | - Laura Degnon
- Association of Pediatric Program Directors, McLean, Virginia
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Selling SK, Rooholamini SN, Grow HM, McPhillips H, Hoang K, Blankenburg R, Rassbach C. The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation. Acad Med 2023; 98:376-383. [PMID: 36205486 DOI: 10.1097/acm.0000000000005011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Coaching programs have been implemented in medical education to improve skill development and feedback for trainees. As more faculty take on coaching roles, it is critical to understand how being a coach affects faculty as well as trainees. This study examined the effects of coaching residents on faculty members' relationships, learning, and professional identity formation (PIF), as they move through intersecting communities across landscapes of practice. METHOD From July 2020 to January 2021, the authors conducted a mixed-methods study of current and former coaches at 2 institutions with longitudinal pediatric resident coaching programs. They used a concurrent triangulation design in which qualitative and quantitative data were collected simultaneously and integrated during data analysis. A survey explored the impact of coaching on faculty members' learning, relationships, and PIF, and semistructured interviews further examined coaches' experiences. The interview transcripts were analyzed inductively guided by the sensitizing principles of PIF and landscapes of practice. RESULTS Of 43 eligible coaches, 32 (74%) completed the survey, and 18 completed interviews. Four themes emerged from the interviews. (1) Coaches' relationships supported belonging in multiple communities. (2) Coaching enabled multidimensional learning. (3) Relationships served as mechanisms of learning for coaches. (4) Coaches' relationships and learning catalyzed PIF. Furthermore, there was a significant difference in the effects of coaching on career growth by faculty rank ( P = .02). Coaches' strengthened PIF increased a sense of purpose, meaning, and professional fulfillment, and inspired new career directions. Survey data further supported these findings. CONCLUSIONS Being a coach deepened faculty members' professional identities through their varied relationships, multidimensional learning, and sense of belonging in intersecting communities. This study introduces a framework to understand the factors mediating coaches' PIF and highlights how investing in coaching leads to important benefits for coaches.
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Affiliation(s)
- Sarah Kate Selling
- S.K. Selling is a medical student, Stanford University School of Medicine, Stanford, California
| | - Sahar N Rooholamini
- S.N. Rooholamini is assistant professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - H Mollie Grow
- H.M. Grow is associate professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Heather McPhillips
- H. McPhillips is professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kim Hoang
- K. Hoang is clinical assistant professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rebecca Blankenburg
- R. Blankenburg is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Caroline Rassbach
- C. Rassbach is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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16
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Rivera N, Nguyen K, Kalami V, Blankenburg R, Ming Yeh A. Perspectives on Specific Carbohydrate Diet Education from Inflammatory Bowel Disease Patients and Caregivers: A Needs Assessment. JPGN Rep 2022; 3:e222. [PMID: 37168623 PMCID: PMC10158462 DOI: 10.1097/pg9.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/18/2022] [Indexed: 05/13/2023]
Abstract
The specific carbohydrate diet (SCD) has potential health benefits for inflammatory bowel disease (IBD); however, adherence is challenging. Through an online needs assessment survey, this study explored the perspectives of patients and caregivers using the SCD to manage IBD to determine barriers, knowledge gaps, and desired areas for further learning about the SCD. Inclusion criteria included patients with IBD or their caregivers who had experience with the SCD. Of the 208 participants, 87% of participants were female with a mean age of 46 years. Fifty-seven percent had never received SCD training before starting the diet. Participants favored more education on several topics within the SCD and identified one-on-one sessions as the preferred learning modality. Barriers identified were initial steep learning curve, time commitment, and a desire for more support from healthcare professionals. This needs assessment survey highlights the gaps in educational priorities for patients on the SCD.
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Affiliation(s)
- Nancy Rivera
- From the Division of Pediatric Hospital Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA
| | - Kaylie Nguyen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford Children’s Health, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Venus Kalami
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford Children’s Health, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Rebecca Blankenburg
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Ann Ming Yeh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
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17
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Neelakantan M, Heitkamp NM, Blankenburg R, Frohna JG. The #PedsMatch21 Webinar Series: Coordinated Specialty-Level Communication During the Virtual Residency Application Cycle. Acad Med 2022; 97:1012-1016. [PMID: 35139529 DOI: 10.1097/acm.0000000000004623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PROBLEM The landscape of pediatric medical education changed significantly in the wake of the COVID-19 pandemic. Fourth-year medical students applying to pediatric residency programs were particularly affected by alterations to traditional away rotations, the inability to conduct in-person visits, and resulting changes in ways of communicating with residency programs. Applicants were concerned about the virtual component of the application cycle and worried as to how to manage the COVID-19-related changes. Program leaders also faced apprehension at how to close communication gaps and effectively use virtual tools to reach applicants. APPROACH Founders of the Twitter-based @FuturePedsRes (FPR) organization recognized these concerns and developed a webinar series during the 2020-2021 academic year to create opportunities for programs and applicants to communicate. Leaders of the Association of Pediatric Program Directors and the Council on Medical Student Education in Pediatrics joined as sponsors and co-hosts. The #PedsMatch21 webinar series consisted of 9 total webinars: 2 overviews, 5 regional, 1 for osteopathic students, and 1 for international medical graduates. OUTCOMES A total of 138 pediatric residency programs across the country participated in the #PedsMatch21 webinar series. Each webinar brought in a mean of 431 attendees, from the United States and several other countries. Follow-up surveys immediately after each webinar and again at the end of the interview season demonstrated that the webinars decreased applicants' anxiety, provided helpful information on the virtual season, and increased their awareness of programs. NEXT STEPS The #PedsMatch21 webinar series demonstrated utility in addressing applicants' concerns and allowing applicants access to a greater number of programs. Webinar-based strategies should be considered across all medical specialties as a useful method of providing accessible forums for programs and applicants.
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Affiliation(s)
- Mekala Neelakantan
- M. Neelakantan is a pediatric intern, University of Michigan, Ann Arbor, Michigan. At the time this project was conducted, she was a fourth-year medical student, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Nicholas M Heitkamp
- N.M. Heitkamp is a pediatric intern, Eastern Virginia Medical School, Norfolk, Virginia. At the time this project was conducted, he was a fourth-year medical student, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rebecca Blankenburg
- R. Blankenburg is president, Association of Pediatric Program Directors, and clinical professor, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
| | - John G Frohna
- J.G. Frohna is professor (CHS), Departments of Pediatrics and Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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18
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Yemane L, Omoruyi E, Poitevien P, Blankenburg R. AIMS: Increasing Diversity in Graduate Medical Education Leadership. J Grad Med Educ 2022; 14:340-342. [PMID: 35754647 PMCID: PMC9200241 DOI: 10.4300/jgme-d-21-01015.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lahia Yemane
- Clinical Associate Professor, Stanford University School of Medicine, Director, Association of Pediatric Program Directors (APPD) AIMS Program
| | - Emma Omoruyi
- Associate Professor, The University of Texas Health Science Center at Houston McGovern Medical School, Chair, APPD UIM in Peds GME Learning Community
| | - Patricia Poitevien
- Clinical Assistant Professor, Warren Alpert Medical School of Brown University, President-Elect, APPD
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19
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Pu H, Bachrach LK, Blankenburg R. Finding Meaning in Medicine: Pediatric Residents' Perspectives on Humanism. Acad Pediatr 2022; 22:680-688. [PMID: 34902564 DOI: 10.1016/j.acap.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/23/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To explore pediatric residents' perspectives on humanism and how residency impacts humanism formation. METHODS We conducted a qualitative study with pediatric resident focus groups at Stanford. Transcripts were analyzed by two investigators using grounded theory. Subsequent literature review led us to adapt Cruess et al. 2015's professional identity formation framework to describe development of a humanism identity in residency. Member check was done to verify themes and the adapted framework. RESULTS Thirty two pediatric residents participated. Five themes emerged: 1) Empathy, compassion, and respect are foundational elements of humanism. 2) Each resident had a unique view of humanism derived from personal values. 3) Residents felt that the terms excellence and resilience (Gold Foundation IECARES model) did not fit with their own definitions. 4) Residents felt that humanism is a central part of their practice and training. 5) The demands, structure, and culture of residency were often in conflict with promoting humanism in residents. Based on residents' perspectives, we modified the professional identity formation and socialization conceptual framework proposed by Cruess et al. 2015 to reflect humanism identity formation during pediatrics residency. The new framework emphasizes the increased power of the healthcare system and unconscious acquisition on humanism formation in residency as compared to medical school. CONCLUSIONS Residents believe that humanism is a core part of practicing medicine and should be reinforced during residency training. Cruess' professional identity and socialization framework is a tool for a better understanding of the complexity of humanism development in residency.
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Affiliation(s)
- Helen Pu
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
| | - Laura K Bachrach
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
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20
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Blankenburg R, Gonzalez del Rey J, Aylor M, Frohna JG, McPhillips H, Myers RE, Waggoner-Fountain LA, Degnon L, Poitevien P. The Impact of the COVID-19 Pandemic on Pediatric Graduate Medical Education: Lessons Learned and Pathways Forward. Acad Med 2022; 97:S35-S39. [PMID: 34817400 PMCID: PMC8855778 DOI: 10.1097/acm.0000000000004532] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article, the authors describe the impact of the COVID-19 pandemic on pediatric graduate medical education (GME), including the impact on clinical experiences for trainees, teaching methods used, trainee wellness, GME leader wellness and support, and the traditional interview process. A thorough literature review was done to identify impacts of the COVID-19 pandemic on pediatric GME. In addition, information was collected through Association of Pediatric Program Directors virtual cafes and conferences. Positive changes for GME from the COVID-19 pandemic included: the rapid transition to telehealth; asynchronous learning allowing for increased cross-program collaboration; innovative online teaching modalities; increased flexibility and decreased cost of online recruitment; and shared innovations across pediatric GME. Challenging aspects of the COVID-19 pandemic included: decreased learning about common childhood illnesses, such as bronchiolitis, acute otitis media, and influenza; decreased patient volumes and patient complexity in clinics and inpatient wards, leading to less practice developing efficiency, time management, and triaging skills; and an increased burden on trainees, including moral distress and decreased support from one another and other social supports. The COVID-19 pandemic has highlighted important opportunities in U.S. educational systems. As medical educators move forward, it will be important to learn from these while mitigating the negative impacts.
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Affiliation(s)
- Rebecca Blankenburg
- R. Blankenburg is president, Association of Pediatric Program Directors, and associate chair of education and clinical professor, Stanford University School of Medicine, Palo Alto, California
| | - Javier Gonzalez del Rey
- J. Gonzalez del Rey is past president, Association of Pediatric Program Directors, and associate chair for education and professor, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Megan Aylor
- M. Aylor is secretary-treasurer, Association of Pediatric Program Directors, director, Pediatrics Residency Program, and associate professor, Oregon Health & Science University, Portland, Oregon
| | - John G. Frohna
- J.G. Frohna is a past member-at-large, Association of Pediatric Program Directors Board, vice chair of education and director, Pediatrics Residency Program, and professor, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Heather McPhillips
- H. McPhillips is a member-at-large, Association of Pediatric Program Directors Board, director, Pediatrics Residency Program, and professor, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Ross E. Myers
- R.E. Myers is a member-at-large, Association of Pediatric Program Directors Board, associate director, Pediatrics Residency Program, and associate professor, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - Linda A. Waggoner-Fountain
- L.A. Waggoner-Fountain is a member-at-large, Association of Pediatric Program Directors Board, associate director, Pediatrics Residency Program, and professor, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Laura Degnon
- L. Degnon is executive director, Association of Pediatric Program Directors, McLean, Virginia
| | - Patricia Poitevien
- P. Poitevien is president-elect, Association of Pediatric Program Directors, director, Residency Program, and assistant professor, Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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21
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Gustafson S, Poitevien P, Acholonu R, Blankenburg R, Fromme HB. Opportunities for Mitigating Bias in the Process and Priorities for Pediatric Chief Resident Selection. Acad Pediatr 2022; 22:319-323. [PMID: 34902563 DOI: 10.1016/j.acap.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/11/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To describe the current processes and priorities for pediatric chief resident (CR) selection, to characterize pediatric CR demographics in the past 5 years nationally, and to identify opportunities for addressing bias in the process of pediatric CR selection. METHODS We used a cross-sectional study design with an anonymous national survey of pediatric program directors (PDs) through a web-based platform in January 2020. RESULTS A total of 92 of 200 (46%) of PDs responded. About 16% of CR are underrepresented in medicine (UIM) by race/ethnicity. The influential factors most commonly cited in selection were nominations from faculty (84%) and peers (77%), followed by fit with other co-chiefs (68%). Only 17% reported having a specific method to mitigate bias in CR selection, most commonly involving multiple stakeholders in the process. CONCLUSIONS Current CR selection relies on processes with the potential to introduce bias. Programs have opportunities to address bias in the CR selection process by reevaluating methods vulnerable to bias, including peer/faculty nominations, fit with peers, ITE scores, and assessments through the use of more objective selection tools.
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Affiliation(s)
- Sarah Gustafson
- David Geffen School of Medicine at UCLA, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center (S Gustafson), Torrance, Calif.
| | - Patricia Poitevien
- Warren Alpert Medical School at Brown University (P Poitevien), Providence, RI
| | - Rhonda Acholonu
- Montefiore Medical Center/Albert Einstein College of Medicine (R Acholonu), Bronx, NY
| | - Rebecca Blankenburg
- Lucile Packard Children's Hospital, Stanford School of Medicine (R Blankenburg), Palo Alto, Calif
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22
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Burns AM, Moore DJ, Forster CS, Powell W, Thammasitboon S, Hostetter MK, Weiss P, Boyer D, Ward MA, Blankenburg R, Heyman MB, Rassbach CE, McPhillips H, French A, Nguyen S, Byrne BJ, Parsons DW, Gonzalez F, Nowalk AJ, Ho J, Kumar S, Orange JS, Ackerman KG. Physician-Scientist Training and Programming in Pediatric Residency Programs: A National Survey. J Pediatr 2022; 241:5-9.e3. [PMID: 34280401 DOI: 10.1016/j.jpeds.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Audrea M Burns
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
| | - Daniel J Moore
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Ian Burr Division of Pediatric Endocrinology and Diabetes, Nashville, TN
| | - Catherine S Forster
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Weston Powell
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Satid Thammasitboon
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | | | - Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Debra Boyer
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mark A Ward
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA
| | - Melvin B Heyman
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA
| | - Heather McPhillips
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Anthony French
- Department of Pediatrics, Washington University Medical Center, St. Louis Children's Hospital, St Louis, MO
| | - Suong Nguyen
- Department of Pediatrics, Washington University Medical Center, St. Louis Children's Hospital, St Louis, MO
| | - Bobbi J Byrne
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN
| | - Donald Williams Parsons
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Fernando Gonzalez
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA
| | - Andrew J Nowalk
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jacqueline Ho
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Shelley Kumar
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jordan S Orange
- Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Vagelos College of Physicians and Surgeons, New York, NY
| | - Kate G Ackerman
- Department of Pediatrics, University of Rochester/UR Medicine Golisano Children's Hospital, Rochester, NY
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23
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Powell C, Yemane L, Brooks M, Johnson C, Alvarez A, Bandstra B, Caceres W, Dierickx Q, Thomas R, Blankenburg R. Outcomes From a Novel Graduate Medical Education Leadership Program in Advancing Diversity, Equity, and Inclusion. J Grad Med Educ 2021; 13:774-784. [PMID: 35070089 PMCID: PMC8672828 DOI: 10.4300/jgme-d-21-00235.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/17/2021] [Accepted: 08/20/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Academic medicine needs more diverse leadership from racial/ethnic minorities, women, people with disabilities, and LGBTQIA+ physicians. Longitudinal structural support programs that bring together underrepresented in medicine (UiM) and non-UiM trainees are one approach to build leadership and scholarship capacity in diversity, equity, and inclusion (DEI). OBJECTIVE To describe the creation, satisfaction with, and feasibility of a Leadership Education in Advancing Diversity (LEAD) Program and evaluate scholars' changes in self-efficacy, intended and actual behavior change, and outputs in leadership and DEI scholarship. METHODS In 2017, we created the LEAD Program, a 10-month longitudinal, single institution program that provides residents and fellows ("scholars") across graduate medical education (GME) with leadership training and mentorship in creating DEI-focused scholarship. In the first 3 cohorts (2017-2020), we assessed scholars' self-efficacy, actual and planned behavior change, and program satisfaction using IRB-approved, de-identified retrospective pre-/post-surveys. We measured scholarship as the number of workshops presented and publications developed by the LEAD scholars. We used descriptive statistics and paired 2-tailed t tests to analyze the data. RESULTS Seventy-five trainees completed LEAD; 99% (74 of 75) completed the retrospective pre-/post-surveys. There was statistically significant improvement in scholars' self-efficacy for all learning objectives. All trainees thought LEAD should continue. LEAD scholars have created workshops and presented at local, regional, and national conferences, as well published their findings. Scholars identified the greatest benefits as mentorship, developing friendships with UiM and ally peers outside of their subspecialty, and confidence in public speaking. CONCLUSIONS LEAD is an innovative, feasible GME-wide model to improve resident and fellow self-efficacy and behaviors in DEI scholarship and leadership.
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Affiliation(s)
- Carmin Powell
- All authors are with the Stanford School of Medicine
- Carmin Powell, MD, is Clinical Assistant Professor, Department of Pediatrics
| | - Lahia Yemane
- All authors are with the Stanford School of Medicine
- Lahia Yemane, MD, is Clinical Associate Professor, Department of Pediatrics
| | - Michelle Brooks
- All authors are with the Stanford School of Medicine
- Michelle Brooks, C-TAGME, is Residency Coordinator, Department of Pediatrics
| | - Carrie Johnson
- All authors are with the Stanford School of Medicine
- Carrie Johnson, MBA, is Residency Education Manager, Department of Pediatrics
| | - Al'ai Alvarez
- All authors are with the Stanford School of Medicine
- Al'ai Alvarez, MD, is Clinical Assistant Professor, Department of Emergency Medicine
| | - Belinda Bandstra
- All authors are with the Stanford School of Medicine
- Belinda Bandstra, MD, is Clinical Associate Professor, Department of Psychiatry
| | - Wendy Caceres
- All authors are with the Stanford School of Medicine
- Wendy Caceres, MD, is Clinical Assistant Professor, Department of Medicine
| | - Quynh Dierickx
- All authors are with the Stanford School of Medicine
- Quynh Dierickx, MD, is Clinical Assistant Professor, Department of Anesthesia
| | - Reena Thomas
- All authors are with the Stanford School of Medicine
- Reena Thomas, MD, PhD, is Clinical Associate Professor, Department of Neurology
| | - Rebecca Blankenburg
- All authors are with the Stanford School of Medicine
- Rebecca Blankenburg, MD, MPH, is Clinical Professor, Department of Pediatrics
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Affiliation(s)
- Patricia Poitevien
- Hasbro Children's Hospital, and Division of Hospitalist Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rebecca Blankenburg
- Stanford Children's Hospital and Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
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25
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Guerin A, Okamura E, Rotandi CL, Halpern-Felsher B, Blankenburg R, Gans HA. Using Speed Mentoring to Expand Scholarship Perspectives and Opportunities for Fellows. J Grad Med Educ 2021; 13:423-424. [PMID: 34178272 PMCID: PMC8207922 DOI: 10.4300/jgme-d-20-01284.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Allison Guerin
- Director of Education Administration, Department of Pediatrics, Stanford School of Medicine
| | - Erica Okamura
- Department Fellowship Coordinator, Department of Pediatrics, Stanford School of Medicine
| | - Charlene L. Rotandi
- Department Fellowship Manager, Department of Pediatrics, Stanford School of Medicine
| | - Bonnie Halpern-Felsher
- Director of Fellowship Scholarship and Professor, Department of Pediatrics, Stanford School of Medicine
| | - Rebecca Blankenburg
- Associate Chair of Education and Clinical Professor, Department of Pediatrics, Stanford School of Medicine
| | - Hayley A. Gans
- Director of Fellowship Education and Clinical Professor, Department of Pediatrics, Stanford School of Medicine
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26
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Okamura E, Rotandi CL, Guerin A, Halpern-Felsher B, Blankenburg R, Gans HA. Improving Pediatric Subspecialty Recruitment Using an Interdivisional Department Session. J Grad Med Educ 2021; 13:424-426. [PMID: 34178273 PMCID: PMC8207912 DOI: 10.4300/jgme-d-20-01302.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Erica Okamura
- Department Fellowship Coordinator, Department of Pediatrics, Stanford School of Medicine
| | - Charlene L. Rotandi
- Department Fellowship Manager, Department of Pediatrics, Stanford School of Medicine
| | - Allison Guerin
- Director of Education Administration, Department of Pediatrics, Stanford School of Medicine
| | - Bonnie Halpern-Felsher
- Director of Fellowship Scholarship and Professor, Department of Pediatrics, Stanford School of Medicine
| | - Rebecca Blankenburg
- Associate Chair of Education and Clinical Professor, Department of Pediatrics, Stanford School of Medicine
| | - Hayley A. Gans
- Director of Fellowship Education and Clinical Professor, Department of Pediatrics, Stanford School of Medicine
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27
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Pavitt S, Blankenburg R. In Reply to Hale et al. Acad Med 2021; 96:321. [PMID: 33661843 DOI: 10.1097/acm.0000000000003872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Sara Pavitt
- Pediatric headache fellow, University of California, San Francisco, San Francisco, California; ; ORCID: https://orcid.org/0000-0002-6822-3118
| | - Rebecca Blankenburg
- Clinical professor and associate chair of education, Stanford School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-1938-6113
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Allan JM, Kim JL, Ralston SL, Black NMP, Blankenburg R, Shaughnessy EE, Fromme HB. Gender Distribution in Pediatric Hospital Medicine Leadership. J Hosp Med 2021; 16:31-33. [PMID: 33357327 DOI: 10.12788/jhm.3555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022]
Abstract
Pediatric Hospital Medicine (PHM), a field early in its development and with a robust pipeline of women, is in a unique position to lead the way in gender equity. We describe the proportion of women in divisional and fellowship leadership positions at university-based PHM programs (n = 142). When compared with the PHM field at large, women appear to be underrepresented as PHM division/program leaders (70% vs 55%; P< .001) but not as fellowship directors (70% vs 66%; P > .05). Women appear proportionally represented in associate/assistant leadership roles when compared with the distribution of the PHM field at large. Tracking these trends overtime is essential to advancing the field.
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Affiliation(s)
- Jessica M Allan
- Pediatric Hospital Medicine, Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, California
| | - Juliann L Kim
- Pediatric Hospital Medicine, Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, California
| | - Shawn L Ralston
- Department of Pediatrics, Johns Hopkins University College of Medicine, Baltimore, Maryland
| | - Nicole M Paradise Black
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Rebecca Blankenburg
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Erin E Shaughnessy
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Alabama-Birmingham, Birmingham, Alabama
| | - H Barrett Fromme
- Department of Pediatrics, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Rivera N, Feldman EA, Augustin DA, Caceres W, Gans HA, Blankenburg R. Do I Belong Here? Confronting Imposter Syndrome at an Individual, Peer, and Institutional Level in Health Professionals. MedEdPORTAL 2021; 17:11166. [PMID: 34277932 PMCID: PMC8257750 DOI: 10.15766/mep_2374-8265.11166] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/04/2021] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Imposter syndrome (IS) is a feeling of being an intellectual fraud and is common among health professionals, particularly those underrepresented in medicine. IS is accompanied by burnout, self-doubt, and beliefs of decreased success. This workshop aims to discuss the impact of IS and develop strategies to confront IS at the individual, peer, and institutional levels. METHODS During the 75-minute interactive workshop, participants listened to didactics and engaged in individual reflection, small-group case discussion, and large-group instruction. Workshop participants and facilitators included medical students, residents, fellows, faculty, staff, and program leadership. Anonymous postworkshop evaluations exploring participants' satisfaction and intentions to change their behavior were collected. Descriptive statistics were used to analyze the quantitative data, and content analysis was used to analyze participants' intentions to change their behavior. RESULTS The workshop was presented at three local academic conferences and accepted at one national conference. Data were collected from 92 participants. Ninety-two percent of participants felt the workshop met its objectives, and 90% felt the workshop was a valuable use of their time. Furthermore, 90% of participants stated they would apply information learned at the workshop in the future. The participants indicated an intent to change behavior on individual, peer, and institutional levels, while recognizing that barriers exist at all those levels. DISCUSSION This workshop proved to be an effective means to discuss strategies on how to address IS at the individual, peer, and institutional levels. The materials can be adapted for relevance to various audiences.
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Affiliation(s)
- Nancy Rivera
- Resident, Department of Pediatrics, Stanford School of Medicine
- Corresponding Author:
| | - Elana A. Feldman
- Clinical Assistant Professor, Department of Pediatrics, University of Washington School of Medicine
| | | | - Wendy Caceres
- Clinical Assistant Professor, Department of Medicine, Stanford School of Medicine
| | - Hayley A. Gans
- Clinical Professor, Department of Pediatrics, Stanford School of Medicine
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Affiliation(s)
- Michael B Pitt
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota School of Medicine & Masonic Children's Hospital (MB Pitt), Minneapolis, Minn.
| | - Patricia Poitevien
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Warren Alpert Medical School at Brown University & Hasbro Children's Hospital (P Poitevien), Providence, RI
| | - Rebecca Blankenburg
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine & Lucile Packard Children's Hospital (R Blankenburg), Palo Alto, Calif
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Jones J, Rice K, Cueto V, Mojica CDV, Stawitcke M, Salem S, Talley E, Blankenburg R. Increasing Health Care Workers' Proficiency With Using Professional Medical Interpretation: A Workshop. MedEdPORTAL 2020; 16:11017. [PMID: 33204841 PMCID: PMC7666837 DOI: 10.15766/mep_2374-8265.11017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Families with limited English proficiency are at risk for poor outcomes and medical errors due to barriers in communication. The use of professional medical interpretation has been linked to improved access to care, improved patient satisfaction, and better outcomes. However, medical interpretation remains underutilized, and the literature lacks guidelines for training health care workers in its use. This workshop aims to teach the skills needed to access and appropriately use professional medical interpretation. METHODS Our team included two residents, two fellows, two faculty members, and two fellowship coordinators. This 90-minute workshop targeted at health care workers included a warm-up activity, role-play with three different types of interpretation, and large-group discussion. Anonymous evaluations were collected at the end of the workshop. RESULTS The workshop was presented at six academic conferences (three local, one regional, and two national). Postworkshop evaluations were collected from 53 participants from multiple health care backgrounds (including medical students, residents, and physicians). The majority of participants reported that the workshop met learning objectives (98%), represented a valuable use of time (98%), and included useful handouts (92%). In addition, 90% of participants reported that the information shared in the workshop would be applied to their medical practice. Themes that emerged from postworkshop evaluations included participants' intentions to change their practice, to augment training for other providers, and to pursue institutional change. DISCUSSION This workshop fills an important gap in medical education and provides a comprehensive orientation to interpretation resources and best practices.
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Affiliation(s)
- Jessica Jones
- Clinical Instructor, Department of Pediatrics, Stanford School of Medicine
| | - Kerrilynn Rice
- Pediatric Hospitalist, Department of Pediatrics, Valley Children's Hospital
| | - Victor Cueto
- Assistant Professor, Department of Medicine, Rutgers New Jersey Medical School
| | | | - Meghan Stawitcke
- Coordinator, Department of Pediatrics, Stanford School of Medicine
| | - Sara Salem
- Senior Coordinator, Department of Pediatrics, Stanford School of Medicine
| | - Elizabeth Talley
- Clinical Associate Professor, Department of Pediatrics, Stanford School of Medicine
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Lester TR, Rassbach CE, Blankenburg R. What Are the Unique Mentorship Needs of Fourth-Year Medical Students Applying to Pediatrics Residency? Acad Pediatr 2020; 20:1206-1212. [PMID: 32389758 DOI: 10.1016/j.acap.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/24/2020] [Accepted: 05/03/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The qualities of good medical school mentors have been well described. However, there is little written about the mentoring needs of medical students applying to pediatrics residency. METHODS In order to characterize pediatrics interns' perspectives on the mentorship needs of fourth-year medical students applying to residency, the authors conducted an IRB-approved, qualitative-modified grounded-theory study using a brief survey and semistructured focus groups of pediatric interns in January and February 2018. Two investigators independently coded the focus group transcripts and reconciled codes to develop categories and themes using constant comparison, which were then reviewed by the third author for validation. To further ensure trustworthiness of analysis, participants were asked to comment on the themes' accuracy. RESULTS Eighteen pediatrics interns participated, representing 15 medical schools. Four major themes emerged: 1) effective mentors guide medical students to self-reflect and find their own answers about what is important to them in a residency program; 2) multiple mentors are helpful during the residency application process; 3) several key components of advising are often missing during the residency application process; 4) students find it difficult to be honest with their mentors if there is a perceived conflict of interest. CONCLUSIONS Medical students applying for pediatrics residency have specific mentorship needs and cite opportunities to improve this area of mentorship. Several key recommendations include utilizing multiple mentors and providing emotional support during the residency application process. In addition, near-peer mentorship is important for medical students applying to residency and should be facilitated by medical schools.
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Affiliation(s)
- Talia R Lester
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
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Hoang K, Halpern-Felsher B, Brooks M, Blankenburg R. Shared Decision-making With Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Providers' Perspectives. Hosp Pediatr 2020; 10:977-985. [PMID: 33037030 DOI: 10.1542/hpeds.2020-0075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Shared decision-making (SDM) is the pinnacle of patient-centered care and has been shown to improve health outcomes, especially for children with chronic medical conditions. However, parents perceive suboptimal involvement during hospitalization. The objective was to explore the perspectives of parents of hospitalized children and their hospital providers on facilitators and barriers to SDM in the hospital and identify strategies to increase SDM. METHODS A qualitative study was conducted by using semistructured interviews with parents of hospitalized children with and without complex chronic conditions and their pediatric hospital medicine faculty. Parents and faculty were matched and individually interviewed on the same day. Two investigators iteratively coded transcripts and identified themes using modified grounded theory, with an additional author reviewing themes. RESULTS Twenty-seven parents and 16 faculty participated in the interviews. Four themes emerged: (1) parents and providers value different components of SDM; (2) providers assume SDM is easier with parents of children with medical complexity; (3) factors related to providers, parents, patients, and family-centered rounds were identified as barriers to SDM; and (4) parents and providers identified strategies to facilitate SDM in the hospital. CONCLUSIONS There is a discrepancy between parents' and providers' understanding of SDM, with parents most valuing their providers' ability to actively listen and explain the medical issue and options with them. There are many barriers that exist that make it difficult for both parties to participate. Several strategies related to family-centered rounds have been identified that can be implemented into clinical practice to mitigate these barriers.
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Affiliation(s)
- Kim Hoang
- Divisions of Pediatric Hospital Medicine and
| | | | - Michelle Brooks
- Pediatrics Residency Program, Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, California
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Blankenburg R, Poitevien P, Gonzalez Del Rey J, Degnon L. Virtual Cafes: An Innovative Way for Rapidly Disseminating Educational Best Practices and Building Community During COVID-19. Acad Pediatr 2020; 20:756-757. [PMID: 32502535 PMCID: PMC7265843 DOI: 10.1016/j.acap.2020.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Rebecca Blankenburg
- Department of Pediatrics, Stanford School of Medicine (R Blankenburg), Palo Alto, Calif.
| | - Patricia Poitevien
- Department of Pediatrics, Hasbro Children's Hospital, Brown University (P Poitevien), Providence, RI
| | - Javier Gonzalez Del Rey
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (J Gonzalez del Rey), Cincinnati, Ohio
| | - Laura Degnon
- Association of Pediatric Program Directors (L Degnon), McLean, Va
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Pavitt S, Bogetz A, Blankenburg R. What Makes the "Perfect" Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives. Acad Med 2020; 95:104-110. [PMID: 31299036 DOI: 10.1097/acm.0000000000002867] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To characterize the methods of inpatient consult communication, given new communication modalities; to explore residents' and fellows' perspectives on the ideal consult and how this consult could affect their teaching, learning, and patient safety; and to identify barriers to and strategies for optimizing consultations. METHOD Using qualitative grounded theory, the authors conducted semistructured focus groups with pediatric residents and fellows at Lucile Packard Children's Hospital at Stanford University from October 2016 to September 2017, using questions developed by expert consensus to address study objectives. Sessions were audiorecorded and transcribed verbatim. Two authors independently coded the transcripts and reconciled codes to develop categories and themes using constant comparison. The third author validated the codes, categories, and themes. To ensure trustworthiness, participants edited the themes for accuracy. RESULTS Twenty-seven residents and 16 fellows participated in 7 focus groups (3 with residents, 4 with fellows). Four themes emerged: (1) Many forms of communication are successfully used for initial inpatient consult recommendations (in person, phone, text messages, notes in electronic medical records); (2) residents and fellows prefer in-person communication for consults, believing it leads to improved teaching, learning, and patient safety; (3) multiple strategies can optimize consults regardless of communication modality; and (4) how residents frame the initial consult affects the interaction and can increase fellow engagement, which leads to more fellow teaching, residents' improved understanding, and better patient care. CONCLUSIONS Residents and fellows believe that structured initial consults conducted in person improve teaching, learning, and patient care. Several strategies exist to optimize this process.
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Affiliation(s)
- Sara Pavitt
- S. Pavitt is a child neurology resident, Department of Neurology, Stanford School of Medicine, Palo Alto, California. A. Bogetz is associate program director of the pediatric residency program, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California. R. Blankenburg is program director and associate chair of education, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
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Blankenburg R, Poitevien P, Gonzalez del Rey J, Aylor M, Frohna J, McPhillips H, Waggoner-Fountain L, Degnon L. Dismantling Racism: Association of Pediatric Program Directors' Commitment to Action. Acad Pediatr 2020; 20:1051-1053. [PMID: 32861803 PMCID: PMC7450251 DOI: 10.1016/j.acap.2020.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Rebecca Blankenburg
- Department of Pediatrics, Stanford School of Medicine (R Blankenburg), Palo Alto, Calif.
| | - Patricia Poitevien
- Department of Pediatrics, Hasbro Children's Hospital, Brown University (P Poitevien), Providence, RI
| | - Javier Gonzalez del Rey
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (J Gonzalez del Rey), Cincinnati, Ohio
| | - Megan Aylor
- Department of Pediatrics, Oregon Health & Science University (M Aylor), Portland, Ore
| | - John Frohna
- Department of Pediatrics, University of Wisconsin (J Frohna), Madison, Wis
| | - Heather McPhillips
- Department of Pediatrics, Seattle Children's Hospital, University of Washington (H McPhillips), Seattle, Wash
| | | | - Laura Degnon
- Association of Pediatric Program Directors (L Degnon), McLean, Va
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Abstract
Resident and attending concern about the potential for decreased teaching has been cited as one of the drawbacks to the adoption of family-centered rounds (FCR). Despite these concerns, FCR can enhance clinical education through direct exposure to multiple patients by all team members, as well as by allowing faculty to teach, model, observe, and assess learners' clinical skills more effectively than in nonbedside settings. This article provides many strategies and approaches to bedside teaching designed to enhance education and communication among care team members as well as patients and their families.
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Affiliation(s)
- Thuy L Ngo
- Pediatric Emergency Medicine, Johns Hopkins School of Medicine, 1800 Orleans Street, G-1509, Baltimore, MD 21287, USA.
| | - Rebecca Blankenburg
- Pediatric Hospital Medicine, Stanford School of Medicine, 725 Welch Road, MC 5906, Palo Alto, CA 94304, USA
| | - Clifton E Yu
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
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Mahoney D, Bogetz A, Hirsch A, Killmond K, Phillips E, Bhavaraju V, McQueen A, Orlov N, Blankenburg R, Rassbach CE. The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents. Acad Pediatr 2019; 19:555-560. [PMID: 30576788 DOI: 10.1016/j.acap.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Accreditation Council for Graduate Medical Education calls for residency programs to incorporate multisource feedback, which may include patient feedback, into resident competency assessments. Program directors face numerous challenges in gathering this feedback. This study assesses the feasibility and acceptability of patient feedback collection in the inpatient and outpatient setting at 3 institutions. METHODS Patient feedback was collected using a modified version of the Communication Assessment Tool (CAT). Trained research assistants administered the CAT to eligible patients and families in pediatric ward, intensive care, and outpatient settings from July to October 2015. Completion rates and reasons for non-completion were recorded. Patient satisfaction with the CAT was assessed on a 5-point Likert scale. RESULTS The CAT was completed by 860/1413 (61%) patients. Completion rates in the pediatric ward and intensive care settings were 45% and 38%, respectively, compared to 91% in the outpatient setting. In inpatient settings, survey non-completion was typically due to participant unavailability; this was rarely a reason in the outpatient setting. A total of 93.4% of patients were satisfied or very satisfied with using the CAT. It was found that 6.36 hours of research assistant time would be required to gather a valid quantity of patient feedback for a single resident in the outpatient setting, compared to 10.14 hours in the inpatient setting. CONCLUSIONS Although collecting feedback using our standardized protocol is acceptable to patients, obtaining sufficient feedback requires overcoming several barriers and a sizable time commitment. Feedback collection in the outpatient setting may be higher yield than in the inpatient setting due to greater patient/family availability. Future work should focus on innovative methods to gather patient feedback in the inpatient setting to provide program directors with a holistic view of their residents' communication skills.
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Affiliation(s)
- David Mahoney
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif.
| | - Alyssa Bogetz
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
| | - Amanda Hirsch
- Department of Pediatrics, Pritzker School of Medicine (A Hirsch)
| | - Katherine Killmond
- University of California, Irvine, School of Medicine (K Killmond), Irvine
| | - Elisa Phillips
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
| | - Vasudha Bhavaraju
- Department of Pediatrics (V Bhavaraju), Phoenix Children's Hospital/Maricopa Medical Center, University of Arizona College of Medicine, Phoenix
| | - Alisa McQueen
- Department of Pediatrics, Comer Children's Hospital (A McQueen and N Orlov), The University of Chicago, Chicago, Ill
| | - Nicola Orlov
- Department of Pediatrics, Comer Children's Hospital (A McQueen and N Orlov), The University of Chicago, Chicago, Ill
| | - Rebecca Blankenburg
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
| | - Caroline E Rassbach
- Department of Pediatrics (D Mahoney, A Bogetz, E Phillips, R Blankenburg, and CE Rassbach), Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine (D Mahoney), Palo Alto, Calif
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Harman SM, Blankenburg R, Satterfield JM, Monash B, Rennke S, Yuan P, Sakai DS, Huynh E, Chua I, Hilton JF. Promoting Shared Decision-Making Behaviors During Inpatient Rounds: A Multimodal Educational Intervention. Acad Med 2019; 94:1010-1018. [PMID: 30893066 PMCID: PMC6594883 DOI: 10.1097/acm.0000000000002715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To estimate the effectiveness of a multimodal educational intervention to increase use of shared decision-making (SDM) behaviors by inpatient pediatric and internal medicine hospitalists and trainees at teaching hospitals at Stanford University and the University of California, San Francisco. METHOD The 8-week Patient Engagement Project Study intervention, delivered at four services between November 2014 and January 2015, included workshops, campaign messaging, report cards, and coaching. For 12-week pre- and postintervention periods, clinician peers used the nine-point Rochester Participatory Decision-Making Scale (RPAD) to evaluate rounding teams' SDM behaviors with patients during ward rounds. Eligible teams included a hospitalist and at least one trainee (resident, intern, medical student), in addition to nonphysicians. Random-effects models were used to estimate intervention effects based on RPAD scores that sum points on nine SDM behaviors per patient encounter. RESULTS In total, 527 patient encounters were scored during 175 rounds led by 49 hospitalists. Patient and team characteristics were similar across pre- and postintervention periods. Improvement was observed on all nine SDM behaviors. Adjusted for the hierarchical study design and covariates, the mean RPAD score improvement was 1.68 points (95% CI, 1.33-2.03; P < .001; Cohen d = 0.82), with intervention effects ranging from 0.7 to 2.5 points per service. Improvements were associated with longer patient encounters and a higher percentage of trainees per team. CONCLUSIONS The intervention increased behaviors supporting SDM during ward rounds on four independent services. The findings recommend use of clinician-focused interventions to promote SDM adoption in the inpatient setting.
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Affiliation(s)
- Stephanie M Harman
- S.M. Harman is clinical associate professor, Department of Medicine, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-1356-9314. R. Blankenburg is clinical associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-1938-6113. J.M. Satterfield is professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-2765-3701. B. Monash is associate professor, Departments of Medicine and Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California. S. Rennke is professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-2004-8496. P. Yuan is research assistant, Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8472-0739. D.S. Sakai is clinical associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-2345-9856. E. Huynh is an MBA student, University of California, Berkeley, Haas School of Business, Berkeley, California. I. Chua is assistant professor, Department of Pediatrics, Children's National Medical Center, Washington, D.C., and clinical instructor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California. J.F. Hilton is professor, Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2452-4274
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Blankenburg R, Hilton JF, Yuan P, Rennke S, Monash B, Harman SM, Sakai DS, Hosamani P, Khan A, Chua I, Huynh E, Shieh L, Xie L. Shared Decision-Making During Inpatient Rounds: Opportunities for Improvement in Patient Engagement and Communication. J Hosp Med 2018; 13:453-461. [PMID: 29401211 PMCID: PMC6392000 DOI: 10.12788/jhm.2909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Shared decision-making (SDM) improves patient engagement and may improve outpatient health outcomes. Little is known about inpatient SDM. OBJECTIVE To assess overall quality, provider behaviors, and contextual predictors of SDM during inpatient rounds on medicine and pediatrics hospitalist services. DESIGN A 12-week, cross-sectional, single-blinded observational study of team SDM behaviors during rounds, followed by semistructured patient interviews. SETTING Two large quaternary care academic medical centers. PARTICIPANTS Thirty-five inpatient teams (18 medicine, 17 pediatrics) and 254 unique patient encounters (117 medicine, 137 pediatrics). INTERVENTION Observational study. MEASUREMENTS We used a 9-item Rochester Participatory Decision-Making Scale (RPAD) measured team-level SDM behaviors. Same-day interviews using a modified RPAD assessed patient perceptions of SDM. RESULTS Characteristics associated with increased SDM in the multivariate analysis included the following: service, patient gender, timing of rounds during patient's hospital stay, and amount of time rounding per patient (P < .05). The most frequently observed behaviors across all services included explaining the clinical issue and matching medical language to the patient's level of understanding. The least frequently observed behaviors included checking understanding of the patient's point of view, examining barriers to follow-through, and asking if the patient has any questions. Patients and guardians had substantially higher ratings for SDM quality compared to peer observers (7.2 vs 4.4 out of 9). CONCLUSIONS Important opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.
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Affiliation(s)
- Rebecca Blankenburg
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA.
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Patrick Yuan
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Stephanie Rennke
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brad Monash
- Division of Hospital Medicine, Department of Medicine, and Division of Hospital Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Stephanie M Harman
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Debbie S Sakai
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - Poonam Hosamani
- Division of Hospital Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Adeena Khan
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ian Chua
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
| | - Eric Huynh
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Lisa Shieh
- Division of Hospital Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Lijia Xie
- Medicine Residency Program, Department of Medicine, Stanford School of Medicine, USA
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Abstract
BACKGROUND A supportive working environment can be protective against burnout in residency training. To help foster a positive culture, we developed the 'Golden Ticket Project' (GTP) and evaluated it as a tool for peer appreciation. METHODS In October 2013-July 2014, all paediatric residents (n = 83) at a paediatric residency programme were invited to participate in the GTP. Through an electronic form, residents could award a co-resident with a 'Golden Ticket' for any behaviour that they were grateful for. Two authors manually coded and analysed the tickets using content analysis to identify recurring themes. We also distributed an anonymous survey to all residents to assess their attitudes toward the GTP. RESULTS The majority (61%) of residents either gave or received 'Golden Tickets' (51/83). Reasons for receiving tickets fell into five categories: (i) teamwork; (ii) positive attitude; (iii) patient care; (iv) resident-resident support; and (v) supervisory skills. Across all three classes, teamwork was recognised most frequently, noted in 43% of all tickets. The recognition of other behaviours varied by class. Fifty-five percent (46/83) of residents completed the programme evaluation survey. Seventy-six percent (35/46) of respondents wanted the programme to continue; of those, 49% (17/35) 'agreed' or 'strongly agreed' that they were 'more aware of acts of kindness in the residency program because of the GTP'. A supportive working environment can be protective against burnout in residency training DISCUSSION: The GTP is a feasible and valued peer-support initiative for residents. The GTP characterised behaviours and attitudes that residents were grateful for in their peers. These behaviours could inform the development of wellness interventions for residents that focus on building supportive working environments.
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Affiliation(s)
- Valerie Gribben
- Department of Pediatrics, University of California San Francisco, California, USA
| | - Alyssa Bogetz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Laura Bachrach
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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Abstract
PROBLEM The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement. APPROACH The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback. OUTCOMES Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before. NEXT STEPS Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.
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Affiliation(s)
- Caroline E Rassbach
- C.E. Rassbach is clinical associate professor, associate residency program director, and coaching director, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9221-1643. R. Blankenburg is clinical associate professor, associate chair for education, and residency program director, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-1938-6113
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Hunter G, Blankenburg R, Andrews J, Stevenson T. An Unusual Case of Abdominal Pain and Hyponatremia in a 16-Year-Old Girl With Disordered Eating. Pediatrics 2018; 141:peds.2017-0291. [PMID: 29208727 DOI: 10.1542/peds.2017-0291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/24/2022] Open
Abstract
A previously healthy 16-year-old girl presented to the emergency department with 1 week of severe, diffuse abdominal pain and constipation, as well as several episodes of nonbloody, nonbilious emesis. Her symptoms began several days after she decreased her caloric intake in an attempt to lose weight. She had been drinking 48 to 60 oz of water per day for several days before admission in an attempt to ameliorate her constipation. She also admits to drinking alcohol the night before her pain began. She had visited several other emergency departments before her presentation to our hospital, and she had been sent home on a bowel regimen without amelioration of her symptoms. On arrival to our emergency department, she described severe diffuse abdominal pain. Her abdomen was tender to palpation throughout but soft with no rebound tenderness or peritoneal signs. The remainder of her physical examination yielded normal results. She was found to have hyponatremia with a sodium level of 122 and no neurologic sequelae. Abdominal radiograph showed moderate constipation but her abdominal pain continued even after bowel cleanout. The home, education, activities, drugs, sex, suicide, and safety assessment revealed several stressors, including a recent suicide in the family and a history of disordered eating and anxiety. Here, we present her case, diagnostic evaluation, ultimate diagnosis, and complications.
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Affiliation(s)
| | | | - Jennifer Andrews
- Departments of Pediatrics and.,Pathology, Stanford University School of Medicine, Stanford, California
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Tchou MJ, Walz A, Burgener E, Schroeder A, Blankenburg R. Teaching High-Value Care in Pediatrics: A National Survey of Current Practices and Guide for Future Curriculum Development. Acad Pediatr 2017. [PMID: 29270265 DOI: 10.1016/j.acap.2015.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Health care expenditures in the United States are increasing at an unsustainable pace. There have been calls to incorporate education on resource stewardship into medical training, yet the perceived need for and current use of high-value care (HVC) curricula in pediatrics residency programs is unknown. Objective We described the current national landscape of HVC curricula in pediatrics residencies, including characterization of current programs, barriers to the practice of HVC, and clarification of preferred curricula types. Methods Using a cross-sectional study design, we conducted a national, anonymous, web-based survey of pediatrics residency program directors and pediatrics chief residents in fall 2014. Results We received responses from 85 of 199 (43%) pediatrics program directors and 74 of 199 (37%) pediatrics chief residents. Only 10% (8 of 80) of program directors and 12% (8 of 65) of chief residents reported having a formal curriculum on HVC. Respondents identified the largest barriers to HVC as a lack of cost transparency (program directors) and attending physicians having the final say in treatment decisions (chief residents). The majority of respondents (83%, 121 of 146) agreed their program needs a HVC curriculum, and 90% (131 of 145) reported they would use a curriculum if it was available. Respondents significantly preferred a case-based conference discussion format over other approaches. Conclusions Most pediatrics residency programs responding to a survey lacked formal HVC curricula. There is a desire nationally for HVC education in pediatrics, particularly in a case-based discussion format.
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Rennke S, Yuan P, Monash B, Blankenburg R, Chua I, Harman S, Sakai DS, Khan A, Hilton JF, Shieh L, Satterfield J. The SDM 3 Circle Model: A Literature Synthesis and Adaptation for Shared Decision Making in the Hospital. J Hosp Med 2017; 12:1001-1008. [PMID: 29073314 PMCID: PMC5709161 DOI: 10.12788/jhm.2865] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patient engagement through shared decision-making (SDM) is increasingly seen as a key component for patient safety, patient satisfaction, and quality of care. Current SDM models do not adequately account for medical and environmental contexts, which may influence medical decisions in the hospital. We identified leading SDM models and reviews to inductively construct a novel SDM model appropriate for the inpatient setting. A team of medicine and pediatric hospitalists reviewed the literature to integrate core SDM concepts and processes and iteratively constructed a synthesized draft model. We then solicited broad SDM expert feedback on the draft model for validation and further refinement. The SDM 3 Circle Model identifies 3 core categories of variables that dynamically interact within an "environmental frame." The resulting Venn diagram includes overlapping circles for (1) patient/family, (2) provider/team, and (3) medical context. The environmental frame includes all external, contextual factors that may influence any of the 3 circles. Existing multistep SDM process models were then rearticulated and contextualized to illustrate how a shared decision might be made. The SDM 3 Circle Model accounts for important environmental and contextual characteristics that vary across settings. The visual emphasis generated by each "circle" and by the environmental frame direct attention to often overlooked interactive forces and has the potential to more precisely define, promote, and improve SDM. This model provides a framework to develop interventions to improve quality and patient safety through SDM and patient engagement for hospitalists.
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Affiliation(s)
- Stephanie Rennke
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Patrick Yuan
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brad Monash
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca Blankenburg
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Ian Chua
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center, George Washington School of Medicine, Washington, DC, USA
| | - Stephanie Harman
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Debbie S Sakai
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Adeena Khan
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Lisa Shieh
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Jason Satterfield
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
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Plant J, Li STT, Blankenburg R, Bogetz AL, Long M, Butani L. Reflective Practice in the Clinical Setting: A Multi-Institutional Qualitative Study of Pediatric Faculty and Residents. Acad Med 2017; 92:S75-S83. [PMID: 29065027 DOI: 10.1097/acm.0000000000001910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To explore when and in what form pediatric faculty and residents practice reflection. METHOD From February to June 2015, the authors conducted focus groups of pediatric faculty and residents at the University of California, Davis; Stanford University; and the University of California, San Francisco, until thematic saturation occurred. Transcripts were analyzed based on Mezirow's and Schon's models of reflection, using the constant comparative method associated with grounded theory. Two investigators independently coded transcripts and reconciled codes to develop themes. All investigators reviewed the codes and developed a final list of themes through consensus. Through iterative discussions, investigators developed a conceptual model of reflection in the clinical setting. RESULTS Seventeen faculty and 20 residents from three institutions participated in six focus groups. Five themes emerged: triggers of reflection, intrinsic factors, extrinsic factors, timing, and outcome of reflection. Various triggers led to reflection; whether a specific trigger led to reflection depended on intrinsic and extrinsic factors. When reflection occurred, it happened in action or on action. Under optimal conditions, this reflection was goal and action directed and became critical reflection. In other instances, this process resulted in unproductive rumination or acted as an emotional release or supportive therapy. CONCLUSIONS Participants reflected in clinical settings, but did not always explicitly identify it as reflection or reflect in growth-promoting ways. Strategies to enhance critical reflection include developing knowledge and skills in reflection, providing performance data to inform reflection, creating time and space for safe reflection, and providing mentorship to guide the process.
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Affiliation(s)
- Jennifer Plant
- J. Plant is associate professor, Department of Pediatrics, University of California, Davis, Sacramento, California. S.T. Li is associate professor, Department of Pediatrics, University of California, Davis, Sacramento, California. R. Blankenburg is associate professor, Department of Pediatrics, Stanford University, Palo Alto, California. A.L. Bogetz is associate program director and education program developer, Department of Pediatrics, Stanford University, Palo Alto, California. M. Long is associate professor, Department of Pediatrics, University of California, San Francisco, San Francisco, California. L. Butani is professor, Department of Pediatrics, University of California, Davis, Sacramento, California
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Jerardi KE, Fisher E, Rassbach C, Maniscalco J, Blankenburg R, Chase L, Shah N. Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships. Pediatrics 2017; 140:peds.2017-0698. [PMID: 28600448 DOI: 10.1542/peds.2017-0698] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/24/2022] Open
Abstract
Pediatric Hospital Medicine (PHM) is an emerging field in pediatrics and one that has experienced immense growth and maturation in a short period of time. Evolution and rapid expansion of the field invigorated the goal of standardizing PHM fellowship curricula, which naturally aligned with the field's evolving pursuit of a defined identity and consideration of certification options. The national group of PHM fellowship program directors sought to establish curricular standards that would more accurately reflect the competencies needed to practice pediatric hospital medicine and meet future board certification needs. In this manuscript, we describe the method by which we reached consensus on a 2-year curricular framework for PHM fellowship programs, detail the current model for this framework, and provide examples of how this curricular framework may be applied to meet the needs of a variety of fellows and fellowship programs. The 2-year PHM fellowship curricular framework was developed over a number of years through an iterative process and with the input of PHM fellowship program directors (PDs), PHM fellowship graduates, PHM leaders, pediatric hospitalists practicing in a variety of clinical settings, and other educators outside the field. We have developed a curricular framework for PHM Fellowships that consists of 8 education units (defined as 4 weeks each) in 3 areas: clinical care, systems and scholarship, and individualized curriculum.
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Affiliation(s)
- Karen E Jerardi
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio;
| | - Erin Fisher
- Department of Pediatrics, University of California San Diego, San Diego, California
| | - Caroline Rassbach
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Jennifer Maniscalco
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | | | - Lindsay Chase
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Neha Shah
- Department of Pediatrics, Children's National Medical Center, Washington, DC
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Peterson J, Louden DT, Gribben V, Blankenburg R. Teaching Residents Clinical Practice Guidelines Using a Flipped Classroom Model. MedEdPORTAL 2017; 13:10548. [PMID: 30800750 PMCID: PMC6342164 DOI: 10.15766/mep_2374-8265.10548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/20/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Prior studies have demonstrated poor guideline compliance by pediatricians, and there is no published curriculum on how to teach clinical guidelines. Furthermore, in a national survey of pediatric residency training programs conducted in 2015, only two had a formal curriculum for teaching clinical guidelines. This module provides a framework for teaching residents clinical guidelines through a modified flipped classroom approach. Associated materials include a guide for faculty facilitators, sample slides and worksheet, and pictures of the classroom setup. METHODS In this module, the guidelines for acute otitis media (AOM), obstructive sleep apnea syndrome (OSAS), and attention deficit-hyperactivity disorder (ADHD) are taught in three sessions and evaluated with a pre-/posttest assessing knowledge, attitudes, self-efficacy, and satisfaction. Each guideline is delivered in a 30-minute session, with five learners per group. Faculty training requires approximately 30 minutes of preparation. The intervention groups (n = 9 for OSAS, 10 each for AOM and ADHD) received three weekly, half-hour flipped classroom lessons. The control group (n = 19) had no formal guideline education. RESULTS Pre-/posttests showed a statistically significant improvement in knowledge and attitudes in the group of interns who received this educational intervention over the control group. The learners rated the sessions as highly effective. DISCUSSION This module provides an efficient and effective way of utilizing a modified flipped classroom approach to teach learners the correct use of clinical guidelines, a skill residents must master to provide evidence-based care. This curriculum has been successfully incorporated into our pediatric residency program.
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Affiliation(s)
- Jaime Peterson
- Postdoctoral Fellow, Stanford University School of Medicine
- Clinical Instructor in General Pediatrics, Stanford University School of Medicine
| | - Drew Taylor Louden
- Postdoctoral Fellow in Pediatric Emergency Medicine, Seattle Children's Hospital
| | - Valerie Gribben
- Clinical Instructor in Pediatrics, Division of Hospitalist Medicine, Washington University in St. Louis School of Medicine
| | - Rebecca Blankenburg
- Clinical Associate Professor, Stanford University School of Medicine
- Pediatric Residency Program Director, Stanford University School of Medicine
- Associate Chair of Education, Stanford University School of Medicine
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Beck J, Rooholamini S, Wilson L, Griego E, McDaniel C, Blankenburg R. Choose Your Own Adventure: Leading Effective Case-Based Learning Sessions Using Evidence-Based Strategies. MedEdPORTAL 2017; 13:10532. [PMID: 30800734 PMCID: PMC6342156 DOI: 10.15766/mep_2374-8265.10532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/22/2016] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Learning how to lead engaging teaching sessions is critical for faculty development and for optimizing teaching opportunities. We developed an interactive workshop to provide an evidence-based framework for designing and facilitating case-based discussions. METHODS This workshop was designed as a 150-minute large-group session, though a 90-minute session is possible. Six to 10 students per facilitated group is optimal. Faculty training requires approximately 30 minutes prior to the session. Associated materials include guidelines to prepare faculty facilitators and participants for the large-group discussion and small-group practice sessions with role-plays. Also included are two prompting cases, a template for designing a large- or small-group session, a form to guide constructive feedback in the role-plays, and an evaluation form. RESULTS This workshop was accepted for presentation at two national conferences in 2016: the Pediatric Academic Societies Meeting (PAS) and the Pediatric Hospital Medicine Conference (PHM). Average responses to "Workshop was a valuable use of my time" were 4.93 out of 5 (PAS) and 4.45 out of 5 (PHM). Average responses to "I learned information I can apply at my home institution" were 4.93 out of 5 (PAS) and 4.80 out of 5 (PHM). DISCUSSION This large- and small-group teaching module has been incorporated into multiple pediatric residency programs and rated as highly effective by learners. Learning how to develop engaging, objective-focused group teaching sessions is an essential skill that residents, chief residents, fellows, and faculty must master to make the most of teaching opportunities.
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Affiliation(s)
- Jimmy Beck
- Assistant Professor of Pediatrics, University of Washington School of Medicine
| | - Sahar Rooholamini
- Acting Assistant Professor of Pediatrics, University of Washington School of Medicine
| | - Lauren Wilson
- Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine
| | - Elena Griego
- Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine
| | - Corrie McDaniel
- Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine
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Abstract
BACKGROUND Research on resident workloads has focused primarily on the quantity of hours worked, rather than the content of those hours or the variability among residents. We hypothesize that there are statistically significant variations in resident workloads and better understanding of workload intensity could improve resident education. METHODS The Stanford Children's Health research database was queried for all electronic notes and orders written by pediatric residents from June 2012 to March 2014. The dataset was narrowed to ensure an accurate comparison among residents. A survey was used to determine residents' self-perceived workload intensity. Variability of total notes written and orders entered was analyzed by χ(2) test and a Monte Carlo simulation. Linear regression was used to analyze the correlation between note-writing and order-entry workload intensity. RESULTS A total of 20 280 notes and 112 214 orders were written by 26 pediatric interns during 6 core rotations between June 2012 and June 2013. Both order-entry and note-writing workload intensity showed highly significant (P < .001) variability among residents. "High workload" residents, defined as the top quartile of total workload intensity, wrote 91% more orders and 19% more notes than "low workload" residents in the bottom quartile. Statistically significant correlation was observed between note-writing and order-entry workload intensity (R(2) = 0.22; P = .02). There was no significant correlation between residents' self-perceived workload intensity and their objective workload. CONCLUSIONS Significant variations in workload exist among pediatric residents. This may contribute to heterogeneous educational opportunities, physician wellness, and quality of patient care.
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Affiliation(s)
| | | | - K T Park
- Department of Pediatrics, and Gastroenterology, Stanford University School of Medicine, Palo Alto, California
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