Death and the Pediatric House Officer Revisited

PEDIATRICS ◽  
1984 ◽  
Vol 73 (5) ◽  
pp. 676-681 ◽  
Author(s):  
William H. Sack ◽  
Gregory Fritz ◽  
Penelope Garrison Krener ◽  
Lewis Sprunger

Thirty-six third-year pediatric residents at four Western university training programs were interviewed individually and retrospectively about the magnitude of their clinical experience in managing the treatment of chronically ill and dying children, as well as the psychosocial educational curriculum of their training program as it pertained to these experiences. The residents managed an average of 35 dying children during their first 2½ years of pediatric residency. They imparted the news of a potentially fatal disease to an average of 33 families during this same time span. There was a disparity between the magnitude of the clinical experience and the time and emphasis on these issues in the residency curriculum. The implications of these findings for an improved educational curriculum in the psychosocial care of dying children are discussed.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 51-51
Author(s):  
Puja J. Umaretiya ◽  
Arielle Spellun ◽  
Angela Marie Feraco

51 Background: Cancer remains the leading cause of childhood death beyond infancy. Though growing subspecialty palliative care provides expertise in caring for dying children, all pediatricians encounter dying patients and should feel adequately prepared to participate in their care. Clinicians who feel insufficiently trained in communication or end-of-life care are more likely to distance themselves from seriously ill patients and report higher levels of distress and burnout. Pediatric residents are often responsible for the frontline care of dying children in the hospital and yet, most pediatric residencies lack a formal end-of-life curriculum. Here, we aim to understand the experience of pediatric residents caring for dying patients. Methods: A thirty-four item survey instrument was administered to residents in a large pediatric residency program at a tertiary care center at Rising Junior Orientation and Rising Senior Orientation in spring 2018. All residents present completed the survey. Results: Seventy-six residents completed surveys including 46 rising juniors and 30 rising seniors. Only 19 residents (25%) reported receiving any training in caring for dying children; most of which was by noon/morning conferences or informal teaching. Nearly all (70/74; 95%) residents felt that their training in caring for dying children was not sufficient. A majority of residents reported minimal to no comfort with discussion of goals of care (73%) or resuscitation status (69%), managing pain (76%), anxiety (79%), and dyspnea (80%) at the end-of-life, performing a death exam (81%), and reaching out to families after the death of a child (85%). A majority of residents anticipate continuing to care for dying children after residency (50/76; 66%). Conclusions: Pediatric residents are uncomfortable with caring for dying patients and receive minimal training, suggesting that end-of-life care is a large gap in the pediatric residency training experience.


Author(s):  
Kathleen McNeil ◽  
Mohsin Rashid

Background: Focused objectives provide effective learning. Pediatric residents in Canada follow objectives set by the Royal College of Physicians and Surgeons of Canada (RCPSC) with the goal of becoming competent general pediatricians. During the gastroenterology rotation, it remains unclear as to what clinical problems listed in the aforementioned objectives are crucial to understand as part of general pediatric practice. The purpose of this study was to identify the gastroenterological conditions of most importance to incorporate into a focused curriculum for pediatric residents. Methods: All pediatricians across four Canadian Atlantic provinces were surveyed by a mailed questionnaire. Questions included demographics and ranking of the 14 clinical problems currently listed in the RCPSC objectives along with six more generated after input was gained from pediatric gastroenterologists. Results: Of the 234 pediatricians surveyed, 132 (56%) responded, 48% of whom were general pediatricians. Celiac disease, gastroesophageal reflux, and obesity (currently not on the RCPSC list) were identified as important/very important conditions to understand by 94.4%, 96.1%, and 96.0% of respondents, respectively. There were no significant differences in rankings between general pediatricians and subspecialists. Most (75.6%) recommended  that a rotation in gastroenterology be mandatory during pediatric residency. Conclusions: A survey of Canadian pediatricians provided an overview of the importance of different diseases to use in developing a  gastroenterology curriculum for core pediatric residency training. Such information is crucial as it can identify gaps in RCPSC learning objectives. Ongoing input from practicing general pediatricians can help keep medical schooling curricula updated.


Author(s):  
Amy C. Trowbridge ◽  
Lindsay Gibbon ◽  
Laura Buck ◽  
Lauren Schmidt ◽  
Ruth Engelberg ◽  
...  

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_3) ◽  
pp. 984-988
Author(s):  
Joel J. Alpert ◽  
Suzette M. Levenson ◽  
Cindy J. Osman ◽  
Sabin James

Objective. Many organizations make efforts to identify future pediatric leaders, often focusing on chief residents (CRs). Identifying future leaders is an issue of great importance not only to the ultimate success of the organization but also to the profession. Because little is known regarding whether completing a CR predicts future leadership in medicine, we sought to determine if former pediatric CRs when compared with pediatric residents who were not CRs reported more often that they were leaders in their profession. Design/Methods. Twenty-four pediatric training programs stratified by resident size (<18, 18–36, and >36) and geography (East, South, Midwest, and West) were selected randomly from the Graduate Medical Education Directory(American Medical Association, Chicago, IL). Program directors were contacted by mail and telephone and asked to provide their housestaff rosters from 1965–1985. The resulting resident sample was surveyed by questionnaire in 1995. Results. Fifteen of 17 program directors (88%) who possessed the requested data provided 1965–1985 rosters yielding a sample of 963 residents. Fifty-five percent of the resident sample (533) responded. Fifty-eight of the respondents had not completed a pediatric residency, leaving a survey sample of 475. Thirty-four percent (163) were CRs. The sample had a mean age of 47, 67% were male and 87% married. Fellowships were completed by 51%. More former CRs compared with non-CRs (75% vs 64%), more former fellows than non-fellows (75% vs 60%) and more males than females (74% vs 55%) reported they were professional leaders. These associations persisted in a logistic regression that controlled for CR status, gender, marital status, and fellowship status as leadership predictors. Former CRs, former fellows, and men were, respectively, 1.8, 2.3, and 2.3 times more likely to report professional leadership. Conclusions. Pediatric residents who were former CRs and/or fellows, and males were more likely to report professional leadership. Although men were more likely to report professional leadership, with more women entering pediatrics the reported gender differences will likely disappear over time.


PEDIATRICS ◽  
1952 ◽  
Vol 10 (3) ◽  
pp. 373-375

POSTGRADUATE COURSE IN PEDIATRIC ENDOCRINOLOGY AND METABOLISM A Pediatric Postgraduate Endocrinology and Metabolism course will be held at the Burnham Memorial Hospital for Children, Massachusetts General Hospital, Boston, under the direction of Dr. Nathan B. Talbot and associates, Oct. 6 through Oct. 11, 1952, daily from 9:00 am, to 4:30 p.m. For further details, write Courses for Graduates, Harvard Medical School, 25 Shattuck St., Boston. ANNOUNCEMENT OF PEDIATRIC RESIDENCY FELLOWSHIPS Through the generosity of Mr. D. Mead Johnson and Mead Johnson and Company, the American Academy of Pediatrics is pleased to announce that 8 fellowships for pediatric residents will be available for a period of one year, beginning Jan. 1, 1953.


PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 477-480
Author(s):  
Howard Dubowitz

Child maltreatment has become an increasingly important concern for pediatricians. The purpose of this study was to assess, via mailed questionnaires, the training and resources of pediatric residents in the area of child maltreatment. Responses were received from 72% of all US programs. The median amount of training was eight hours during the first and third years of training and seven hours during the second year; approximately half of this was clinical supervision in the care of maltreated children. Eighty-one percent of programs had an interdisciplinary team for suspected cases of child maltreatment. Only 17 of 167 programs reported a separate budget for their team. Although two thirds of programs were rated as adequate or better, 79% of respondents wanted to strengthen their teaching efforts. There appears to be a limited commitment by residency programs to enhance the competency of pediatricians in the area of child maltreatment. There is a need for improved training and resources.


2009 ◽  
Vol 9 (4) ◽  
pp. e10
Author(s):  
Allen R. Friedland ◽  
Tom A. Melgar ◽  
David A. Kaelber ◽  
William L. Cull ◽  
John K. Chamberlain ◽  
...  

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1448
Author(s):  
Peter Cartledge ◽  
Christian Umuhoza ◽  
Natalie McCall

Background: The University of Rwanda is the only African residency to have implemented the pediatric International In-Training Examination (I-ITE) as a tool to monitor resident knowledge acquisition. The objective of this study was to better understand the acceptance and relevance of this exam to residents from this setting and their perceptions regarding this assessment tool. Methods: This is a mixed-methods study describing candidate feedback. Immediately on completing the I-ITE residents provided feedback by filling in an electronic questionnaire comprised of four closed Likert questions and an open text box for free-text feedback. Participants were pediatric residents from the University of Rwanda, the only university in Rwanda with a pediatric residency program. Quantitative analysis of the Likert questions was undertaken descriptively using SPSS. Free-text feedback was coded and analysed. No specific guiding theory was used during the qualitative analysis, with coding and analysis undertaken by two researchers. Results: Eighty-four residents completed a total of 213 I-ITE sittings during the five exam cycles undertaken during the study period. Quantitative and qualitative feedback was given by residents during 206 and 160 sittings, giving a response rate of 97% and 75%, respectively. Five themes emerged from the qualitative analysis; 1) undertaking the I-ITE was a positive experience; 2) exam content; 3) formative nature of the assessment; 4) challenges to completing the exam; 5) practicalities to undertaking the exam. Conclusion: Qualitative feedback demonstrates that the I-ITE, a standardized, and independent exam, produced by the American Board of Pediatrics, was valued and well accepted by Rwanda pediatric residents. Its formative nature and the breadth and quality of the questions were reported to positively contribute to the residents' formative development.


Author(s):  
Rachel Boykan ◽  
Robert M. Jacobson

Objective: The research sought to identify the general use of medical librarians in pediatric residency training, to define the role of medical librarians in teaching evidence-based medicine (EBM) to pediatric residents, and to describe strategies and curricula for teaching EBM used in pediatric residency training programs.Methods: We sent a 13-question web-based survey through the Association of Pediatric Program Directors to 200 pediatric residency program directors between August and December 2015.Results: A total of 91 (46%) pediatric residency program directors responded. Most (76%) programs had formal EBM curricula, and more than 75% of curricula addressed question formation, searching, assessment of validity, generalizability, quantitative importance, statistical significance, and applicability. The venues for teaching EBM that program directors perceived to be most effective included journal clubs (84%), conferences (44%), and morning report (36%). While 80% of programs utilized medical librarians, most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic not necessarily EBM (58%). Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. The use of a librarian was not associated with having an EBM curriculum but was significantly associated with the size of the program. Smaller programs were more likely to utilize librarians (100%) than were medium (71%) or large programs (75%).Conclusions: While most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians’ expertise in teaching EBM is underutilized. Programs should work to better integrate librarians’ expertise, both in the didactic and clinical teaching of EBM.


PEDIATRICS ◽  
1990 ◽  
Vol 85 (6) ◽  
pp. 1109-1111
Author(s):  
DANIEL D. CHAPMAN ◽  
JOAN E. HODGMAN ◽  
ROBERT L. JOHNSON ◽  
NANCY M. MATLIN

In this issue, Honigfeld et al1 discuss manpower strategies adopted by nine hospitals that either discontinued or significantly reduced their pediatric residency programs. Several of the hospitals surveyed had a significant pediatric inpatient population and two thirds had a Neonatal Intensive Care Unit. The loss of resident positions represented a major manpower crisis for these institutions. The 16 hospitals that originally met the study guidelines in 1986 to 1987 represent only a small fraction of the existing 234 accredited training programs.


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