The involvement of community pediatricians in the treatment of developmental-behavioral difficulties as perceived by directors of child development centers

Background Developmental-behavioral issues are among the most frequent and disabling conditions of children and adolescents seen in ambulatory settings. Guidelines of the Israeli Pediatric Association and the Israeli Society for Developmental Pediatrics specify the role of the primary-care pediatrician in screening and early identification of mild developmental behavioral conditions and define the criteria for referral to child development institutes. The aims of this study were to examine and describe how directors of these institutes perceive the role and involvement of community pediatricians in child development. Methods Qualitative interviews of the directors of 22 child development institutes from the ministry of health and the four health plans. Results According to the interviewees, there is little involvement of community pediatricians in detecting developmental delays, and it is mainly nurses and preschool teachers who detect such delays. They report that the key barriers that deter community pediatricians from greater involvement in child development diagnosis and treatment are lack of time, lack of compensation, and insufficient clinical knowledge. The interviewees would like to see community pediatricians conducting the primary medical evaluation, providing parental guidance, referring to therapists in mild cases, exercising discretion before referring children to child development institutes and providing relevant information to the institutes in the referral process. The mechanisms that they proposed for increasing the involvement of community pediatricians were expansion of pediatricians’ training, increased pediatricians’ use of teleconsultation with child development specialists and incentives for thorough performance of developmental assessments. Conclusions Due to the importance of the Issue, we strongly recommend that policymakers require child development principles, evaluation, and providing appropriate parental guidance in the curriculum of the Israeli pediatric residency program. In addition, health plans should compensate pediatricians who need to conduct longer visits for children with developmental delays. The health plans should also develop teleconsultation channels for pediatricians with child development specialists to reduce unnecessary referrals to child development institutes.

15 2020 CaRMS Residency Match Confirms Popularity of Pediatrics

Primary Subject area Medical Education Background Longitudinal data about the interest in, and competitiveness of, pediatric postgraduate training in Canada has not been reported. Objectives 1. To describe the results of the 2020 CaRMS pediatric residency match with respect to application rates, first-choice discipline choices, and succesful match rates by gender. 2. To examine the trend of these indices over the past decade. Design/Methods Data from the 2020 Canadian Residency Matching Service (CaRMS) pediatric residency match was evaluated and compared over the past decade. Residency match data from other programs was also used for some comparison reporting. Results Of a total pool of 2998 Canadian medical graduate (CMG) applicants in 2020, 305 (10.2%) applied to pediatrics, and 17 of these latter applicants (5.6%) applied solely to pediatrics. In the first iteration CaRMS match, pediatrics was the first-choice discipline for 177 CMG applicants (6.0% of all first choices). Pediatrics has been consistent as a first-choice discipline over the years: 5.9% (2017), 5.5% (2015), and 6.1% (2013). Of the 155 first-year positions offered in pediatrics this year, all were filled. Of those CMGs who matched to pediatrics in 2020, the specialty was the first-choice discipline for 128 applicants (92.8%) and the second-choice discipline for 9 applicants (6.5%). There were clear gender differences noted. Pediatrics accounted for 8.3% of female and 3.2% of male first-choice disciplines. Of the 135 females whose first-choice discipline was pediatrics, 101 matched to that first choice (74.8%). Of the 41 males whose first-choice discipline was pediatrics, 26 matched to that first choice (63.4%). Since 1995 (at CaRMS’ inception), the rates of first-choice discipline choice by gender have been quite stable (Table 1), with females consistently higher than males, while the first-choice discipline matching rate by gender have varied (Figure 1). Forty CMG applicants whose first-choice discipline was pediatrics matched to an alternate discipline choice and nine went unmatched, suggesting that pediatrics continues to be a competitive discipline. The pediatric rate of first-choice discipline matching to another alternate choice of 22.6% (40/177) is comparable to Anesthesia (22.1%; 34/154), Ophthalmology (26.7%; 20/75), and Otolaryngology (20.9%; 9/43). Conclusion Pediatrics continues to be a top specialty choice for graduates of Canadian medical schools, according to data from the 2020 CaRMS match. There are gender differences noted in the choice of pediatrics as a first-choice discipline, and in the successful match rate to pediatrics programs. The rate of successful first-choice discipline matching by gender have varied over time, with the past two years showing significantly greater matching success for females. These trends in the CaRMS pediatric data have implications on discipline recruitment and the pediatric workforce in Canada, and merit further exploration.

117 Formal Leadership Teaching in Canadian Pediatric Residency Programs

Primary Subject area Medical Education Background Effective clinical leadership is known to improve clinical outcomes, health service delivery, effective resource allocation, and patient and staff satisfaction rates. Although it is well known that leadership skills can be taught and are necessary for all physicians, there are very few described residency-level structured leadership-training curricula. Yet, pediatric residency programs' Competence-By-Design (CBD) includes 19 stage-specific, leadership-focused Milestones, spanning 10 Entrustable Professional Activities (EPAs) that will need to be assessed. Objectives The purpose of this study was to map how leadership is formally taught in Canadian pediatric residency programs and to explore how leader-specific milestones and EPA are incorporated into programs’ training. Design/Methods Program Directors from all Canadian pediatric residency programs were invited to complete an online, anonymous survey, which was developed using the AMEE Seven-Step Survey Development guidelines. The survey explored demographics, teaching structure, teaching content and methods, assessment, and participants’ perspectives. Descriptive and thematic analyses were performed. Results Ten of the 17 pediatric programs directors responded to the survey. All program directors (n=10), stated that there is a need for mandatory, formal leadership teaching and formal leadership skills assessment for pediatric residents. Yet, half of respondents (n=5) reported no formal leadership teaching and residents' leadership skills are not formally assessed in three (of 10) pediatric residency programs. Additionally, none of the programs offers stage-specific leadership teaching. Of the programs that offer formal leadership teaching, four programs’ teachings are stand-alone courses, while one program has a longitudinal leadership curriculum. Only one program offers formal teachings on leader-related CBD EPAs and/ or Milestones. Seven programs formally assess residents’ leadership skills. Of these, four programs use a formal assessment tool, while three programs do not use any assessment tool. None of the programs utilizes a validated or published leadership skills assessment tool. Thematic analyses revealed that the common barriers to introducing a formal leadership curriculum include limited available time in residents’ teaching curriculum, lack of expertise and resources to teach leadership, and difficulty in assessing leadership skills. Conclusion Although residency programs identify leadership teaching and assessment as necessary, most pediatric residency programs lack formal leadership teaching and assessment. Additionally, no such teaching is stage-specific. Understanding the current state of programs’ leadership teaching will help better prepare programs for the integration of leadership milestones/ EPAs in the curriculum.

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

Background: Resident well-being leads to better patient care practices, but a systematic approach is needed to achieve the wellness agenda. The Theory of Change was used for developing an interventional model for wellness in our study, after identifying the causes of burnout and attrition in a pediatric residency program. Methods: This was a quality improvement project where residents were asked about their main stressors in an anonymous open-ended feedback form. Workload (n=63, 37.5%) was identified as the main source of dissatisfaction. A database of 43 residents who quit in the past ten years was examined to find 40.0% of residents left after the first year of training and the main cause was marriage and/or family concerns (28.9%). Then literature was reviewed to build a wellness intervention's framework. Finally, the Theory of Change was applied focusing on restructuring the residency core, accountability and communication, and stress management. The final theory of the change model included the assumptions that the program needed restructuring because of high attrition, low first pass exam rate, and decreased patient satisfaction. The goal was to increase resident wellness and performance, while keeping patient care at the core. Results: The short-term outcomes were drop in attrition rate from an average of 8.67% to 1.75%, decrease in FCPS exam attempt from 3.3 to almost 1, and an increase in patient satisfaction. Conclusion: Using the Theory of Change, it was possible to address residents’ concerns, increase their retention and improve patient satisfaction by reconstructing the wellness program.