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Rebecca Blankenburg, MD

  • Rebecca L. Blankenburg

Work and Education

Professional Education

University of Chicago, Chicago, IL, 06/30/2001

Internship

UCSF Pediatric Residency, San Francisco, CA, 06/30/2002

Residency

UCSF Pediatric Residency, San Francisco, CA, 06/30/2004

Board Certifications

Pediatric Hospital Medicine, American Board of Pediatrics

Pediatrics, American Board of Pediatrics

All Publications

Tips for developing a coaching program in medical education. Medical education online Miller-Kuhlmann, R., Sasnal, M., Gold, C. A., Nassar, A. K., Korndorffer, J. R., Van Schaik, S., Marmor, A., Williams, S., Blankenburg, R., Rassbach, C. E. 2024; 29 (1): 2289262

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.

View details for DOI 10.1080/10872981.2023.2289262

View details for PubMedID 38051864

We've Got A New One-Exploring The Resident-Fellow New Admission Interaction and Opportunities for Enhancing Motivation. Academic pediatrics Mahoney, D., Pavitt, S., Blankenburg, R. 2024

Abstract

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.The authors used modified grounded theory with experiential learning theory and self-determination theory as sensitizing concepts to conduct six focus groups and journey mapping at Stanford Children's Health from January - 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 was 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.Developing inter-trainee trust and educational buy-in are 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.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. WHAT'S NEW?: This primarily qualitative study of pediatric residents and fellows outlines what trainees need to stay engaged and motivated during the new admission interaction. It demonstrates that discreet, modifiable trainee behavior can inspire improved engagement in their fellow or resident counterpart.

View details for DOI 10.1016/j.acap.2024.01.003

View details for PubMedID 38215903

Laying the Foundation: How to Develop Rigorous Health Professions Education Scholarship. Hospital pediatrics Gilliam, C., Ramos, M., Hilgenberg, S., Rassbach, C., Blankenburg, R. 2024

View details for DOI 10.1542/hpeds.2023-007162

View details for PubMedID 38178786

Upholding Our PROMISE: Discrimination and Lack of Belonging Negatively Influence Pediatric Residents' Desire to Stay at Home Institution. Academic medicine : journal of the Association of American Medical Colleges Burns, A. M., Kester Prakash, L., Yemane, L., Blankenburg, R., Kas-Osoka, O. A., Poitevien, P., Marbin, J., Schwartz, A., Taylor Lucas, C. 2023; 98 (11S): S195-S196

View details for DOI 10.1097/ACM.0000000000005379

View details for PubMedID 37882002

Perspectives on Professional Development Among University and Community Pediatric Hospitalists. Clinical pediatrics Sun, V. K., Chappell-Campbell, L., Blankenburg, R., Sznewajs, A. 2023: 99228231203299

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.

View details for DOI 10.1177/00099228231203299

View details for PubMedID 37776239

A Specific Carbohydrate Diet Virtual Teaching Kitchen Curriculum Promotes Knowledge and Confidence in Caregivers of Pediatric Patients with Inflammatory Bowel Disease. Nutrients Rivera, N., Nguyen, K., Kalami, V., Qin, F., Mathur, M. B., Blankenburg, R., Yeh, A. M. 2023; 15 (18)

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.

View details for DOI 10.3390/nu15183999

View details for PubMedID 37764781

View details for PubMedCentralID PMC10537188

Upholding Our PROMISE: Underrepresented in Medicine Pediatric Residents' Perspectives on Interventions to Promote Belonging. Academic medicine : journal of the Association of American Medical Colleges Yemane, L., Kas-Osoka, O., Burns, A., Blankenburg, R., Prakash, L. K., Poitevien, P., Schwartz, A., Lucas, C. T., Marbin, J. 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 inclusion and 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.

View details for DOI 10.1097/ACM.0000000000005443

View details for PubMedID 37643583

Building an Anti-Racist Department through an Experiential Department-Wide Anti-Racism Curriculum. Academic pediatrics Guerin, A., Lee, J., Floyd, B., Yemane, L., Fassiotto, M., Griffith, E., Blankenburg, R., Hilgenberg, S. L., Dali, S., De Araujo, M., Jones, K., Kuo, K., Rassbach, C. E. 2023

View details for DOI 10.1016/j.acap.2023.06.001

View details for PubMedID 37422256

Introducing "View from the Academic Pediatric Association Scholars Programs"-A New and Unique Section for Academic Pediatrics ACADEMIC PEDIATRICS Myers, R. E., Blankenburg, R., Klein, M. 2023; 23 (5): 872-873
Thriving in Academic Medicine-Embracing Evolving Mentorship and Sponsorship Needs ACADEMIC PEDIATRICS Herrmann, L. E., Blankenburg, R., Klein, M., Myers, R. E. 2023; 23 (5): 884-885
Development of a Multi-site Curriculum for Inequities in Newborn Care (CINC) Informed by Pediatric Resident and Community Engagement. Academic pediatrics Punjabi, S., Blankenburg, R., Blecharczyk, E., CINC Study Team 2023

View details for DOI 10.1016/j.acap.2023.06.019

View details for PubMedID 37353193

A Visiting Rotation for Underrepresented in Medicine Pediatric Residents Is Valuable for Recruitment Into Pediatric Fellowships. Journal of graduate medical education Okorie, C. U., Kibrom, S., Rotandi, C. L., Guerin, A., Gans, H. A., Blankenburg, R. 2023; 15 (3): 397-399

View details for DOI 10.4300/JGME-D-22-00793.1

View details for PubMedID 37363674

The APPD Longitudinal Educational Assessment Research Network's First Decade. Pediatrics Schwartz, A., King, B., Mink, R., Turner, T., Abramson, E., Blankenburg, R., Degnon, L. 2023; 151 (5)

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.

View details for DOI 10.1542/peds.2022-059113

View details for PubMedID 37122062

Utilizing co-production to improve patient-centeredness and engagement in healthcare delivery: Lessons from the Patient and Family-Centered I-PASSstudies. Journal of hospital medicine O'Toole, J. K., Calaman, S., Anderson, M., Baird, J., Fegley, A., Goldstein, J., Johnson, T., Khan, A., Patel, S. J., Rosenbluth, G., Sectish, T. C., West, D. C., Landrigan, C. P., Spector, N. D., Patient and Family-Centered I-PASS Education Executive and SCORE Program Education and Training Committees 2023

View details for DOI 10.1002/jhm.13055

View details for PubMedID 36717094

Moral Injury: How It Affects Us and Tools to Combat It. MedEdPORTAL : the journal of teaching and learning resources Arquette, C., Peicher, V., Ajayi, A., Alvarez, D., Mao, A., Nguyen, T., Sawyer, A., Sears, C. M., Carragee, E. J., Floyd, B., Mahanay, B., Blankenburg, R. 2023; 19: 11357

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.

View details for DOI 10.15766/mep_2374-8265.11357

View details for PubMedID 37927405

The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation. Academic medicine : journal of the Association of American Medical Colleges Selling, S. K., Rooholamini, S. N., Grow, H. M., McPhillips, H., Hoang, K., Blankenburg, R., Rassbach, C. 2022

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 semi-structured 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.

View details for DOI 10.1097/ACM.0000000000005011

View details for PubMedID 36205486

Perspectives on Specific Carbohydrate Diet Education from Inflammatory Bowel Disease Patients and Caregivers: A Needs Assessment. JPGN reports Rivera, N., Nguyen, K., Kalami, V., Blankenburg, R., Ming Yeh, A. 2022; 3 (3): e222

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.

View details for DOI 10.1097/PG9.0000000000000222

View details for PubMedID 37168623

Developing a multi-departmental residency communication coaching program. Education for health (Abingdon, England) Nassar, A. K., Sasnal, M., Miller-Kuhlmann, R. K., Jensen, R. M., Blankenburg, R. L., Rassbach, C. E., Smith-Bentley, M., Vyas, A., Korndorffer, J. R., Gold, C. A. 2022; 35 (3): 98-104

Abstract

Local needs assessments in our institution's surgery and neurology residency programs identified barriers to effective communication, such as no shared communication framework and limited feedback on nontechnical clinical skills. Residents identified faculty-led coaching as a desired educational intervention to improve communication skills. Three university departments (Surgery, Neurology, and Pediatrics) and health-care system leaders collaborated closely to develop an innovative communication coaching initiative generalizable to other residency programs.Coaching program development involved several layers of collaboration between health-care system leaders, faculty educators, and departmental communication champions. The efforts included: (1) creating and delivering communication skills training to faculty and residents; (2) hosting frequent meetings among various stakeholders to develop program strategy, discuss opportunities and learnings, and engage other medical educators interested in coaching; (3) obtaining funding to implement the coaching initiative; (4) selecting coaches and providing salary and training support.A multi-phased mixed-methods study utilized online surveys and virtual semi-structured interviews to assess the program's quality and impact on the communication culture and the satisfaction and communication skills of residents. Quantitative and qualitative data have been integrated during data collection and analysis using embedding, building, and merging strategies.Establishing a multi-departmental coaching program may be feasible and can be adapted by other programs if similar resources and focus are present. We found that stakeholders' buy-in, financial support, protected faculty time, flexible approach, and rigorous evaluation are crucial factors in successfully implementing and sustaining such an initiative.

View details for DOI 10.4103/efh.efh_357_22

View details for PubMedID 37313890

AIMS: Increasing Diversity in Graduate Medical Education Leadership. Journal of graduate medical education Yemane, L., Omoruyi, E., Poitevien, P., Blankenburg, R. 2022; 14 (3): 340-342

View details for DOI 10.4300/JGME-D-21-01015.1

View details for PubMedID 35754647

View details for PubMedCentralID PMC9200241

Opportunities for Mitigating Bias in the Process and Priorities for Pediatric Chief Resident Selection ACADEMIC PEDIATRICS Gustafson, S., Poitevien, P., Acholonu, R., Blankenburg, R., Fromme, H. 2022; 22 (2): 319-323
The #PedsMatch21 Webinar Series: Coordinated Specialty-Level Communication During the Virtual Residency Application Cycle. Academic medicine : journal of the Association of American Medical Colleges Neelakantan, M., Heitkamp, N. M., Blankenburg, R., Frohna, J. G. 2022

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.

View details for DOI 10.1097/ACM.0000000000004623

View details for PubMedID 35139529

Vision Check: A Year in (Re)View From the APPD ACADEMIC PEDIATRICS Poitevien, P., Blankenburg, R., Pitt, M. B. 2022; 22 (1): 3-5
Finding Meaning in Medicine: Pediatric Residents' Perspectives on Humanism. Academic pediatrics Pu, H., Bachrach, L. K., Blankenburg, R. 1800

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: 32 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.

View details for DOI 10.1016/j.acap.2021.12.007

View details for PubMedID 34902564

National Pediatric Experience With Virtual Interviews: Lessons Learned and Future Recommendations PEDIATRICS Frohna, J. G., Waggoner-Fountain, L. A., Edwards, J., Fussell, J. J., Wueste, B., Gigante, J., Vinci, R. J., Heitkamp, N. M., Neelakantan, M. K., Degnon, L. E., Blankenburg, R. L., Pediat Recruitment Study Team 2021; 148 (4)

Abstract

The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community's innovations, including the use of virtual cafs to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.

View details for DOI 10.1542/peds.2021-052904

View details for Web of Science ID 000754897600050

View details for PubMedID 34330864

Physician-Scientist Training & Programming in Pediatric Residency Programs: A National Survey. The Journal of pediatrics Burns, A. M., Moore, D. J., Forster, C. S., Powell, W., Thammasitboon, S., Hostetter, M. K., Weiss, P., Boyer, D., Ward, M. A., Blankenburg, R., Heyman, M. B., Rassbach, C. E., McPhillips, H., French, A., Nguyen, S., Byrne, B. J., Parsons, D. W., Gonzalez, F., Nowalk, A. J., Ho, J., Kumar, S., Orange, J. S., Ackerman, K. G. 2021

View details for DOI 10.1016/j.jpeds.2021.07.014

View details for PubMedID 34280401

It's Not You, It's Us. Pediatrics Poitevien, P., Blankenburg, R. 2021

View details for DOI 10.1542/peds.2021-050884

View details for PubMedID 34131042

Using Speed Mentoring to Expand Scholarship Perspectives and Opportunities for Fellows. Journal of graduate medical education Guerin, A., Okamura, E., Rotandi, C. L., Halpern-Felsher, B., Blankenburg, R., Gans, H. A. 2021; 13 (3): 423-424

View details for DOI 10.4300/JGME-D-20-01284.1

View details for PubMedID 34178272

Improving Pediatric Subspecialty Recruitment Using an Interdivisional Department Session. Journal of graduate medical education Okamura, E., Rotandi, C. L., Guerin, A., Halpern-Felsher, B., Blankenburg, R., Gans, H. A. 2021; 13 (3): 424-426

View details for DOI 10.4300/JGME-D-20-01302.1

View details for PubMedID 34178273

Categorical Pediatric Residency Program Curriculum Needs: A Study of Graduating Residents and Residency Program Leadership ACADEMIC PEDIATRICS Hilgenberg, S. L., Frintner, M., Blankenburg, R. L., Haftel, H. M., Gellin, C. E. 2021; 21 (4): 589-593
In Reply to Hale et al. Academic medicine : journal of the Association of American Medical Colleges Pavitt, S., Blankenburg, R. 2021; 96 (3): 321

View details for DOI 10.1097/ACM.0000000000003872

View details for PubMedID 33661843

Addressing Goals of Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Physicians' Perspectives ACADEMIC PEDIATRICS Hoang, K., Halpern-Felsher, B., Brooks, M., Blankenburg, R. 2021; 21 (2): 24451
Perspectives from the Society for Pediatric Research: advice on sustaining science and mentoring during COVID-19. Pediatric research Forster, C. S., Nguyen, S. T., Powell, W. T., Moore, D. J., Ho, J. n., Heyman, M. B., Wenger, T. L., Gonzalez, F. n., Hostetter, M. n., Nowalk, A. n., Rassbach, C. E., Boyer, D. n., Weiss, P. n., Blankenburg, R. L., Orange, J. S., Ackerman, K. G., Burns, A. M. 2021

Abstract

The COVID-19 pandemic will leave an indelible mark on the careers of current medical trainees. Given the disruptions to medical education, economic impact on institutions, and the uncertainties around future job prospects, trainees are facing unprecedented challenges. This situation is especially concerning for futures of pediatric physician-scientist trainees, where concerns regarding maintaining the pipeline were well documented prior to the emergence of COVID-19. In this Perspectives article, we leverage the unique expertise of our workgroup to address concerns of physician-scientist trainees and to provide suggestions on how to navigate career trajectories in the post-COVID-19 era. We identified and addressed four major areas of concern: lack of in-person conferences and the associated decrease access to mentors and networking activities, decreased academic productivity, diminished job prospects, and mental health challenges. We also suggest actions for trainees, mentors and educational leaders, and institutions to help support trainees during the pandemic, with a goal of maintaining the pediatric physician-scientist pipeline.

View details for DOI 10.1038/s41390-020-01321-5

View details for PubMedID 33469179

The Impact of the COVID-19 Pandemic on Pediatric Graduate Medical Education: Lessons Learned and Pathways Forward. Academic medicine : journal of the Association of American Medical Colleges Blankenburg, R., Gonzalez Del Rey, J., Aylor, M., Frohna, J. G., McPhillips, H., Myers, R. E., Waggoner-Fountain, L. A., Degnon, L., Poitevien, P. 2021

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 graduate medical education. In addition, information was collected through Association of Pediatric Program Directors virtual cafes and conferences. Positive changes for graduate medical education 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.

View details for DOI 10.1097/ACM.0000000000004532

View details for PubMedID 34817400

Outcomes From a Novel Graduate Medical Education Leadership Program in Advancing Diversity, Equity, and Inclusion Journal of Graduate Medical Education Powell, C., Yemane, L., Brooks, M., Johnson, C., Alvarez, A., Bandstra, B., Caceres, W., Dierickx, Q., Thomas, R., Blankenburg, R. 2021; 13 (6): 774784
Do I Belong Here? Confronting Imposter Syndrome at an Individual, Peer, and Institutional Level in Health Professionals. MedEdPORTAL : the journal of teaching and learning resources Rivera, N., Feldman, E. A., Augustin, D. A., Caceres, W., Gans, H. A., Blankenburg, R. 2021; 17: 11166

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.

View details for DOI 10.15766/mep_2374-8265.11166

View details for PubMedID 34277932

Vision 2020: A Year in (Re)View From the Association of Pediatric Program Directors ACADEMIC PEDIATRICS Pitt, M. B., Poitevien, P., Blankenburg, R. 2021; 21 (1): 1618
Gender Distribution in Pediatric Hospital Medicine Leadership. Journal of hospital medicine Allan, J. M., Kim, J. L., Ralston, S. L., Black, N. M., Blankenburg, R., Shaughnessy, E. E., Fromme, H. B. 2021; 16 (1): 3133

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.

View details for DOI 10.12788/jhm.3555

View details for PubMedID 33357327

Advancing Our Understanding of Pediatric Resident Communication Skills and Disruptive Behavior and Mistreatment Strategies. Academic pediatrics Hilgenberg, S. L., Bogetz, A. L., Leibold, C., Blankenburg, R. L. 2020

View details for DOI 10.1016/j.acap.2020.10.017

View details for PubMedID 33220461

Increasing Health Care Workers' Proficiency With Using Professional Medical Interpretation: A Workshop. MedEdPORTAL : the journal of teaching and learning resources Jones, J., Rice, K., Cueto, V., Mojica, C. D., Stawitcke, M., Salem, S., Talley, E., Blankenburg, R. 2020; 16: 11017

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.

View details for DOI 10.15766/mep_2374-8265.11017

View details for PubMedID 33204841

Dismantling Racism: Association of Pediatric Program Directors' Commitment to Action ACADEMIC PEDIATRICS Blankenburg, R., Poitevien, P., del Rey, J., Aylor, M., Frohna, J., McPhillips, H., Waggoner-Fountain, L., Degnon, L. 2020; 20 (8): 105153
Shared Decision-making With Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Providers' Perspectives. Hospital pediatrics Hoang, K., Halpern-Felsher, B., Brooks, M., Blankenburg, R. 2020

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.

View details for DOI 10.1542/hpeds.2020-0075

View details for PubMedID 33037030

Categorical Pediatric Residency Program Curriculum Needs: A Study of Graduating Residents and Residency Program Leadership. Academic pediatrics Hilgenberg, S. L., Frintner, M. P., Blankenburg, R. L., Haftel, H. M., Gellin, C. E. 2020

Abstract

BACKGROUND: Pediatric residency programs must adapt their curriculum to meet evolving patient needs yet face limited resources to implement changes resulting in gaps. We performed a categorical pediatric residency program curriculum needs assessment to inform curriculum development efforts.METHODS: We analyzed data from the 2017 American Academy of Pediatrics Annual Survey of Graduating Residents and pediatric program and associate program director polls conducted at a 2019 pediatric residency program director national meeting. We used conventional content analysis to code and categorize.RESULTS: Participants included 528 (53%) graduating residents representing 88% of programs, 89 program directors, and 177 associate program directors representing at minimum 45% of programs. Participants demonstrated concordance on the top 4 needs: additional clinical experiences, career development, business of medicine, and health systems. Program leaders also identified wellness and resiliency; disparities; diversity, equity, and inclusion; and communication.DISCUSSION: This is the first categorical pediatric program general curriculum needs assessment conducted of pediatric leadership and graduating residents in over a decade. While program leadership and resident data were collected 2 years apart, we found concordance on the top 4 categories and consistency with prior national needs assessments with the exception of career development. New curriculum development efforts are underway.

View details for DOI 10.1016/j.acap.2020.09.014

View details for PubMedID 33011294

Virtual Cafes: An Innovative Way for Rapidly Disseminating Educational Best Practices and Building Community During COVID-19. Academic pediatrics Blankenburg, R., Poitevien, P., Gonzalez Del Rey, J., Degnon, L., Virtual Cafe Study Team 2020; 20 (6): 75657

View details for DOI 10.1016/j.acap.2020.05.025

View details for PubMedID 32502535

Fixing the leaky pipeline: identifying solutions for improving pediatrician-scientist training during pediatric residency. Pediatric research Burns, A. M., Ackerman, K., Thammasitboon, S., Rassbach, C., Ward, M. A., Blankenburg, R., Forster, C. S., McPhillips, H., Wenger, T., Powell, W., Heyman, M. B., Hogarty, M., Boyer, D., Hostetter, M., Weiss, P., Nguyen, S., Parsons, D. W., Moore, D. J., Byrne, B., French, A., Orange, J. S. 2020

View details for DOI 10.1038/s41390-020-0837-2

View details for PubMedID 32179872

What are the Unique Mentorship Needs of Fourth Year Medical Students Applying to Pediatrics Residency? Academic pediatrics Lester, T. R., Rassbach, C. E., Blankenburg, R. n. 2020

Abstract

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.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 semi-structured 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.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.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.

View details for DOI 10.1016/j.acap.2020.05.002

View details for PubMedID 32389758

Righting the Autonomy-Supervision Pendulum: Understanding the Impact of Independent Rounds on Medical Students, Residents, and Faculty. Academic medicine : journal of the Association of American Medical Colleges Moriarty, J. A., Vellanki, S. n., Trope, L. A., Hilgenberg, S. L., Blankenburg, R. L. 2020

Abstract

To explore trainee and faculty perspectives on an independent rounding intervention on general pediatrics wards at 2 institutions.In July 2018, the authors introduced independent rounds 1 to 2 times a week at 2 training sites. In this qualitative study, the authors conducted semi-structured focus groups with a purposive sample of junior trainees (clerkship medical students and PGY1 residents), senior trainees (PGY2 and PGY3-5 residents), and hospital medicine faculty between October 2018 and May 2019. Focus groups were audio-recorded, transcribed verbatim, and analyzed for themes using the constant comparative approach associated with grounded theory.Focus groups included 27 junior trainees, 20 senior trainees, and 18 faculty. Six themes emerged: (1) Independent rounds contributed to all trainees' development; (2) Senior residents described increased motivation to take full ownership of their patients and educational needs of the team; (3) Faculty expressed concerns about decreased opportunities for teaching and feedback, however all trainees reported unique learning from having faculty both present and absent from rounds; (4) No significant patient safety events were reported; (5) All participants identified communication and patient progression concerns; (6) A tension emerged between decreased faculty and enhanced trainee career satisfaction. Participants identified solutions to identified barriers to further improve this educational intervention.As a result of independent rounding, trainees described increased motivation to take ownership of their patients and team. Both rounding experiences contributed to their development as physicians in different ways. Further studies should explore patient and caregiver perspectives and concerns about communication and patient care progression when designing future interventions to promote resident autonomy.

View details for DOI 10.1097/ACM.0000000000003645

View details for PubMedID 32769470

What Makes the "Perfect" Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives ACADEMIC MEDICINE Pavitt, S., Bogetz, A., Blankenburg, R. 2020; 95 (1): 10410
Teaching at the Bedside: Strategies for Optimizing Education on Patient and Family Centered Rounds. Pediatric clinics of North America Ngo, T. L., Blankenburg, R., Yu, C. E. 2019; 66 (4): 88189

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.

View details for DOI 10.1016/j.pcl.2019.03.012

View details for PubMedID 31230629

The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents ACADEMIC PEDIATRICS Mahoney, D., Bogetz, A., Hirsch, A., Killmond, K., Phillips, E., Bhavaraju, V., McQueen, A., Orlov, N., Blankenburg, R., Rassbach, C. E. 2019; 19 (5): 55560
Promoting Shared Decision-Making Behaviors During Inpatient Rounds: A Multimodal Educational Intervention ACADEMIC MEDICINE Harman, S. M., Blankenburg, R., Satterfield, J. M., Monash, B., Rennke, S., Yuan, P., Sakai, D. S., Huynh, E., Chua, I., Hilton, J. F., Patient Engagement Project 2019; 94 (7): 101018
The Golden Ticket Project for peer recognition CLINICAL TEACHER Gribben, V., Bogetz, A., Bachrach, L., Blankenburg, R. 2019; 16 (3): 2038

View details for DOI 10.1111/tct.12798

View details for Web of Science ID 000468799500006

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study. BMJ (Clinical research ed.) Khan, A., Spector, N. D., Baird, J. D., Ashland, M., Starmer, A. J., Rosenbluth, G., Garcia, B. M., Litterer, K. P., Rogers, J. E., Dalal, A. K., Lipsitz, S., Yoon, C. S., Zigmont, K. R., Guiot, A., O'Toole, J. K., Patel, A., Bismilla, Z., Coffey, M., Langrish, K., Blankenburg, R. L., Destino, L. A., Everhart, J. L., Good, B. P., Kocolas, I., Srivastava, R., Calaman, S., Cray, S., Kuzma, N., Lewis, K., Thompson, E. D., Hepps, J. H., Lopreiato, J. O., Yu, C. E., Haskell, H., Kruvand, E., Micalizzi, D. A., Alvarado-Little, W., Dreyer, B. P., Yin, H. S., Subramony, A., Patel, S. J., Sectish, T. C., West, D. C., Landrigan, C. P. 2018; 363: k4764

Abstract

OBJECTIVE: To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds.DESIGN: Prospective, multicenter before and after intervention study.SETTING: Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017.PARTICIPANTS: All patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents.INTERVENTION: Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds ("family centered rounds"), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement.MAIN OUTCOME MEASURES: Medical errors (primary outcome), including harmful errors (preventable adverse events) and non-harmful errors, modeled using Poisson regression and generalized estimating equations clustered by site; family experience; and communication processes (eg, family engagement on rounds). Errors were measured via an established systematic surveillance methodology including family safety reporting.RESULTS: The overall rate of medical errors (per 1000 patient days) was unchanged (41.2 (95% confidence interval 31.2 to 54.5) pre-intervention v 35.8 (26.9 to 47.7) post-intervention, P=0.21), but harmful errors (preventable adverse events) decreased by 37.9% (20.7 (15.3 to 28.1) v 12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9) v 5.2 (3.1 to 8.8), P=0.003). Top box (eg, "excellent") ratings for six of 25 components of family reported experience improved; none worsened. Family centered rounds occurred more frequently (72.2% (53.5% to 85.4%) v 82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%) v 66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%) v 35.5% (17.0% to 59.6%), P=0.03) on rounds improved. Families expressing concerns at the start of rounds (18.2% (5.6% to 45.3%) v 37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%) v 26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change significantly.CONCLUSIONS: Although overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved after implementation of a structured communication intervention for family centered rounds coproduced by families, nurses, and physicians. Family centered care processes may improve safety and quality of care without negatively impacting teaching or duration of rounds.TRIAL REGISTRATION: ClinicalTrials.gov NCT02320175.

View details for DOI 10.1136/bmj.k4764

View details for PubMedID 30518517

THE EFFECT OF FACULTY COACHING ON RESIDENT ATTITUDES, CONFIDENCE, AND PATIENT-RATED COMMUNICATION: A MULTI-INSTITUTION STUDY. Academic pediatrics Rassbach, C. E., Bogetz, A. L., Orlov, N., McQueen, A., Bhavaraju, V., Mahoney, D., Leibold, C., Blankenburg, R. L. 2018

Abstract

OBJECTIVE: Despite a national focus on physician-patient communication, there is a paucity of literature on how patient and family feedback (PFF) can be used as a tool to help residents learn communication skills. The purpose of this study was to assess the effect of coaching on residents' attitudes towards PFF, self-confidence in communication, and patient-rated communication skills.METHODS: This was an IRB-approved, randomized-controlled trial with pediatric residents at three institutions in 2015-2016. Pre- and post-intervention, residents completed a self-assessment of their attitudes and self-confidence in communication. PFF was collected for each resident using the Communication Assessment Tool (CAT), which has been validated in other medical disciplines. Intervention group residents reviewed their baseline PFF with a faculty coach; control group residents reviewed their PFF independently.RESULTS: 114 residents completed the study, 57 in each arm. Intervention group residents were significantly more likely to ask for PFF compared with control group residents (mean change 0.36 vs. -0.11, p=.01). There were no other significant differences in resident attitudes, confidence, or patient-rated communication between groups. Both groups had increased self-confidence over time and with increasing PGY level. Patient ratings of resident communication did not differ over time or between groups.CONCLUSIONS: Residents who reviewed PFF with a faculty coach were significantly more likely to report they would ask patients for feedback than residents who reviewed PFF independently, suggesting review of feedback with a coach may enhance appreciation of patient feedback. Though self-confidence improved over time in both groups, patient ratings of resident communication skills were not significantly different over time or between groups.

View details for DOI 10.1016/j.acap.2018.10.004

View details for PubMedID 30368034

De-escalating Angry Caregivers: A Randomized Controlled Trial of a Novel Communication Curriculum for Pediatric Residents. Academic pediatrics Hilgenberg, S. L., Bogetz, A. L., Leibold, C., Gaba, D., Blankenburg, R. L. 2018

Abstract

OBJECTIVE: Medical providers struggle when communicating with angry patients and their caregivers. Pediatric residents perceive communication competencies as an important priority for learning, yet they lack confidence and desire more training in communicating with angry families. Few curricula exist to support trainees with de-escalation skill development. We developed, implemented, and evaluated the impact of a novel de-escalation curriculum on pediatric resident communication skills.METHODS: Randomized controlled trial of a 90-minute de-escalation curriculum for pediatric residents in August-September 2016. Trained standardized patient (SP) actors rated residents' communication skills following two unique encounters before and after the intervention/control session. Residents completed a retrospective pre-post communication skills self-assessment and curriculum evaluation. We used independent and paired t-tests to assess for communication improvements.RESULTS: 84 of 88 (95%) eligible residents participated (43 intervention, 41 control). Residents reported frequent encounters with angry caregivers. At baseline, interns had significantly lower mean SP-rated de-escalation skills than other residents (P=.03). Intervention residents did not improve significantly more than controls on their pre-post change in mean SP-rated de-escalation skills. Intervention residents improved significantly on their pre-post mean self-assessed de-escalation skills (P .03).CONCLUSIONS: Despite significant self-assessed improvements, residents' SP-rated de-escalation skills did not improve following a skills-based intervention. Nevertheless, our study illustrates the need for de-escalation curricula focused on strategies and peer discussion, suggests optimal timing of delivery during fall of intern year, and offers an assessment tool for exploration in future studies.

View details for DOI 10.1016/j.acap.2018.10.005

View details for PubMedID 30368036

Shared Decision-Making During Inpatient Rounds: Opportunities for Improvement in Patient Engagement and Communication JOURNAL OF HOSPITAL MEDICINE Blankenburg, R., Hilton, J. F., Yuan, P., Rennke, S., Monash, B., Harman, S. M., Sakai, D. S., Hosamani, P., Khan, A., Chua, I., Huynh, E., Shieh, L., Xie, L., Satterfield, J. M. 2018; 13 (7): 45361

View details for DOI 10.12788/jhm.2909

View details for Web of Science ID 000437294500002

An Unusual Case of Abdominal Pain and Hyponatremia in a 16-Year-Old Girl With Disordered Eating PEDIATRICS Hunter, G., Blankenburg, R., Andrews, J., Stevenson, T. 2018; 141 (1)
Reflective Practice in the Clinical Setting: A Multi-Institutional Qualitative Study of Pediatric Faculty and Residents Plant, J., Li, S. T., Blankenburg, R., Bogetz, A. L., Long, M., Butani, L. LIPPINCOTT WILLIAMS & WILKINS. 2017: S75S83

Abstract

To explore when and in what form pediatric faculty and residents practice reflection.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.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.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.

View details for PubMedID 29065027

Teaching Residents Clinical Practice Guidelines Using a Flipped Classroom Model. MedEdPORTAL : the journal of teaching and learning resources Peterson, J., Louden, D. T., Gribben, V., Blankenburg, R. 2017; 13: 10548

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.

View details for PubMedID 30800750

Families as Partners in Hospital Error and Adverse Event Surveillance. JAMA pediatrics Khan, A., Coffey, M., Litterer, K. P., Baird, J. D., Furtak, S. L., Garcia, B. M., Ashland, M. A., Calaman, S., Kuzma, N. C., O'Toole, J. K., Patel, A., Rosenbluth, G., Destino, L. A., Everhart, J. L., Good, B. P., Hepps, J. H., Dalal, A. K., Lipsitz, S. R., Yoon, C. S., Zigmont, K. R., Srivastava, R., Starmer, A. J., Sectish, T. C., Spector, N. D., West, D. C., Landrigan, C. P., Allair, B. K., Alminde, C., Alvarado-Little, W., Atsatt, M., Aylor, M. E., Bale, J. F., Balmer, D., Barton, K. T., Beck, C., Bismilla, Z., Blankenberg, R. L., Chandler, D., Choudhary, A., Christensen, E., Coghlan-McDonald, S., Cole, F. S., Corless, E., Cray, S., Da Silva, R., Dahale, D., Dreyer, B., Growdon, A. S., Gubler, L., Guiot, A., Harris, R., Haskell, H., Kocolas, I., Kruvand, E., Lane, M. M., Langrish, K., Ledford, C. J., Lewis, K., Lopreiato, J. O., Maloney, C. G., Mangan, A., Markle, P., Mendoza, F., Micalizzi, D. A., Mittal, V., Obermeyer, M., O'Donnell, K. A., Ottolini, M., Patel, S. J., Pickler, R., Rogers, J. E., Sanders, L. M., Sauder, K., Shah, S. S., Sharma, M., Simpkin, A., Subramony, A., Thompson, E. D., Trueman, L., Trujillo, T., Turmelle, M. P., Warnick, C., Welch, C., White, A. J., Wien, M. F., Winn, A. S., Wintch, S., Wolf, M., Yin, H. S., Yu, C. E. 2017

Abstract

Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection.To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports.We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; , 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient.Error and AE rates.Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P=.006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates.Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.

View details for DOI 10.1001/jamapediatrics.2016.4812

View details for PubMedID 28241211

Choose Your Own Adventure: Leading Effective Case-Based Learning Sessions Using Evidence-Based Strategies. MedEdPORTAL : the journal of teaching and learning resources Beck, J., Rooholamini, S., Wilson, L., Griego, E., McDaniel, C., Blankenburg, R. 2017; 13: 10532

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.

View details for PubMedID 30800734

The SDM 3 Circle Model: A Literature Synthesis and Adaptation for Shared Decision Making in the Hospital. Journal of hospital medicine Rennke, S. n., Yuan, P. n., Monash, B. n., Blankenburg, R. n., Chua, I. n., Harman, S. n., Sakai, D. S., Khan, A. n., Hilton, J. F., Shieh, L. n., Satterfield, J. n. 2017; 12 (12): 10018

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.

View details for PubMedID 29073314

Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships. Pediatrics Jerardi, K. E., Fisher, E. n., Rassbach, C. n., Maniscalco, J. n., Blankenburg, R. n., Chase, L. n., Shah, N. n. 2017; 140 (1)

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.

View details for DOI 10.1542/peds.2017-0698

View details for PubMedID 28600448

A Novel Pediatric Residency Coaching Program: Outcomes After One Year. Academic medicine : journal of the Association of American Medical Colleges Rassbach, C. E., Blankenburg, R. n. 2017

Abstract

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.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.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.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.

View details for DOI 10.1097/ACM.0000000000001825

View details for PubMedID 28700460

Exploring the Educational Value of Patient Feedback: A Qualitative Analysis of Pediatric Residents' Perspectives ACADEMIC PEDIATRICS Bogetz, A. L., Rassbach, C. E., Chan, T., Blankenburg, R. L. 2017; 17 (1): 4-8

View details for Web of Science ID 000391349100002

View details for PubMedID 27965014

The Discriminatory Patient and Family: Strategies to Address Discrimination Towards Trainees ACADEMIC MEDICINE Whitgob, E. E., Blankenburg, R. L., Bogetz, A. L. 2016; 91 (11): S64-S69

Abstract

Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families.A purposeful sample of pediatric faculty educational leaders was recruited from April-June 2014 at Stanford University. Using a constructivist grounded theory approach, semistructured one-on-one interviews were conducted. Participants were asked to describe how they would respond to clinical scenarios of families discriminating against trainees (involving race, gender, and religion). Interviews were audio-recorded, transcribed, and anonymized. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking. This project was IRB approved.Four themes emerged from interviews with 13 faculty: assess illness acuity, cultivate a therapeutic alliance, depersonalize the event, and ensure a safe learning environment. Participants wanted trainees to feel empowered to remove themselves from care when necessary but acknowledged that removal was not always possible or easy. Nearly all participants agreed that trainee and faculty development was needed. Suggested educational strategies included team debriefing and critical reflection.Discrimination towards trainees by patients and families is an important issue. As this type of mistreatment cannot be fully prevented, effective preparation is essential. Effective response strategies exist and can be taught to trainees to empower responses that protect learners and preserve patient care.

View details for DOI 10.1097/ACM.0000000000001357

View details for Web of Science ID 000387209500010

Enhancing Pediatric Rheumatology Education through Computer-Assisted Fellow-Taught Case Modules Peterson, R., Blankenburg, R., Cidon, M., Hsu, J. WILEY. 2016
Pediatric Resident Workload Intensity and Variability PEDIATRICS Was, A., Blankenburg, R., Park, K. T. 2016; 138 (1)

Abstract

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.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 (2) test and a Monte Carlo simulation. Linear regression was used to analyze the correlation between note-writing and order-entry workload intensity.A total of 20280 notes and 112214 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.Significant variations in workload exist among pediatric residents. This may contribute to heterogeneous educational opportunities, physician wellness, and quality of patient care.

View details for DOI 10.1542/peds.2015-4371

View details for Web of Science ID 000378853100022

View details for PubMedID 27358473

Caring for Children With Medical Complexity: Challenges and Educational Opportunities Identified by Pediatric Residents. Academic pediatrics Bogetz, J. F., Bogetz, A. L., Rassbach, C. E., Gabhart, J. M., Blankenburg, R. L. 2015; 15 (6): 621-625

Abstract

High-quality care for children with medical complexity (CMC) is in its infancy. Residents have the opportunity to view care for CMC with a fresh perspective that is informed by their work across diverse health care settings and significant time spent at the bedside. This study aimed to identify the challenges and potential solutions for complex care delivery and education from their perspectives.We conducted three 60-minute focus groups with a purposeful sample of residents and recent graduates at a US tertiary-care medical center. Data were transcribed verbatim, and themes were identified using an iterative approach and modified grounded theory.Sixteen participants identified 4 major challenges to caring for CMC: 1) lack of care coordination; 2) complex technology management; 3) patients' pervasive psychosocial needs; and 4) lack of effective health care provider training. Participants identified 3 solutions: 1) greater integration of primary care providers; 2) attention to psychosocial needs through shared decision making; and 3) integration of longitudinal patient relationships into provider training. We found that residents who experienced longitudinal relationships with CMC felt more efficacious and better equipped to handle challenges of caring for CMC as a result of their broader understanding of patients' priorities and of their role as providers.Residents recognize important challenges and offer thoughtful solutions to caring for CMC. Although multiple solutions exist, formal integration of longitudinal patient experiences into residency training may better prepare residents to understand patient priorities and identify when their own attitudinal changes can guide them into more efficacious roles as providers.

View details for DOI 10.1016/j.acap.2015.08.004

View details for PubMedID 26409304

Outcomes of a Randomized Controlled Educational Intervention to Train Pediatric Residents on Caring for Children With Special Health Care Needs CLINICAL PEDIATRICS Bogetz, J. F., Gabhart, J. M., Rassbach, C. E., Sanders, L. M., Mendoza, F. S., Bergman, D. A., Blankenburg, R. L. 2015; 54 (7): 659-666

Abstract

Objective. To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). Methods. Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. Results. Response rates were 65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. Conclusion. SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease.

View details for DOI 10.1177/0009922814564050

View details for PubMedID 25561698

Questioning as a teaching tool. Pediatrics Long, M., Blankenburg, R., Butani, L. 2015; 135 (3): 406-408

Abstract

The Dreyfus and Bloom frameworks can help the great clinical teacher craft questions that are learner-centric and appropriately challenging.Employing strategies to ask the right questions in the right way can further add to the effectiveness of using questions as a valuable teaching,learning, and assessment tool.

View details for DOI 10.1542/peds.2014-3285

View details for PubMedID 25647682

Continuing education needs of pediatricians across diverse specialties caring for children with medical complexity. Clinical pediatrics Bogetz, J. F., Bogetz, A. L., Gabhart, J. M., Bergman, D. A., Blankenburg, R. L., Rassbach, C. E. 2015; 54 (3): 222-227

Abstract

Objective. Care for children with medical complexity (CMC) relies on pediatricians who often are ill equipped, but striving to provide high quality care. We performed a needs assessment of pediatricians across diverse subspecialties at a tertiary academic US children's hospital about their continuing education needs regarding the care of CMC. Methods. Eighteen pediatricians from diverse subspecialties were asked to complete an online anonymous open-ended survey. Data were analyzed using modified grounded theory. Results. The response rate was 89% (n = 16). Of participants, 31.2% (n = 5) were general pediatricians, 18.7% (n = 3) were hospitalists, and 50% (n = 8) were pediatric subspecialists. Pediatricians recognized the need for skills in care coordination, giving bad news, working in interprofessional teams, and setting goals of care with patients. Conclusions. Practicing pediatricians need skills to improve care for CMC. Strategically incorporating basic palliative care education may fill an important training need across diverse pediatric specialties.

View details for DOI 10.1177/0009922814564049

View details for PubMedID 25561699

Changes in Medical Errors after Implementation of a Handoff Program NEW ENGLAND JOURNAL OF MEDICINE Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., NOBLE, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., Bismilla, Z., Coffey, M., Mahant, S., Blankenburg, R. L., Destino, L. A., EVERHART, J. L., Patel, S. J., Bale, J. F., Spackman, J. B., Stevenson, A. T., Calaman, S., Cole, F. S., Balmer, D. F., Hepps, J. H., Lopreiato, J. O., Yu, C. E., Sectish, T. C., Landrigan, C. P. 2014; 371 (19): 1803-1812

Abstract

Miscommunications are a leading cause of serious medical errors. Data from multicenter studies assessing programs designed to improve handoff of information about patient care are lacking.We conducted a prospective intervention study of a resident handoff-improvement program in nine hospitals, measuring rates of medical errors, preventable adverse events, and miscommunications, as well as resident workflow. The intervention included a mnemonic to standardize oral and written handoffs, handoff and communication training, a faculty development and observation program, and a sustainability campaign. Error rates were measured through active surveillance. Handoffs were assessed by means of evaluation of printed handoff documents and audio recordings. Workflow was assessed through time-motion observations. The primary outcome had two components: medical errors and preventable adverse events.In 10,740 patient admissions, the medical-error rate decreased by 23% from the preintervention period to the postintervention period (24.5 vs. 18.8 per 100 admissions, P<0.001), and the rate of preventable adverse events decreased by 30% (4.7 vs. 3.3 events per 100 admissions, P<0.001). The rate of nonpreventable adverse events did not change significantly (3.0 and 2.8 events per 100 admissions, P=0.79). Site-level analyses showed significant error reductions at six of nine sites. Across sites, significant increases were observed in the inclusion of all prespecified key elements in written documents and oral communication during handoff (nine written and five oral elements; P<0.001 for all 14 comparisons). There were no significant changes from the preintervention period to the postintervention period in the duration of oral handoffs (2.4 and 2.5 minutes per patient, respectively; P=0.55) or in resident workflow, including patient-family contact and computer time.Implementation of the handoff program was associated with reductions in medical errors and in preventable adverse events and with improvements in communication, without a negative effect on workflow. (Funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and others.).

View details for DOI 10.1056/NEJMsa1405556

View details for Web of Science ID 000344170300009

Challenges and Potential Solutions to Educating Learners About Pediatric Complex Care ACADEMIC PEDIATRICS Bogetz, J. F., Bogetz, A. L., Bergman, D., Turner, T., Blankenburg, R., Ballantine, A. 2014; 14 (6): 603-609

Abstract

To identify existing challenges and potential strategies for providing complex care training to future pediatricians from a national group of educators.Data were collected from pediatric educators involved in complex care at the Pediatric Educational Excellence Across the Continuum national meeting. Participants completed an anonymous 15-item survey adapted from the Association of American Medical Colleges (AAMC) Best Practices for Better Care initiative and participated in a focus group to understand the challenges and potential solutions to pediatric complex care education. Data were analyzed using grounded theory.Of the 15 participants, 9 (60%) were in educational leadership positions. All participants provided care to children with medical complexity (CMC), although 80% (n = 12) reported no formal training. Thematic analysis revealed learners' challenges in 2 domains: 1) a lack of ownership for the patient because of decreased continuity, decision-making authority, and autonomy, as a result of the multitude of care providers and parents' distrust; and 2) a sense of being overwhelmed as a result of lack of preparedness and disruptions in work flow. Participants suggested 3 mitigating strategies: being candid about the difficulties of complex care, discussing the social mandate to care for CMC, and cultivating humility among learners.Residency education must prepare pediatricians to care for all children, regardless of disease. Training in complex care involves redefining the physician's role so that they are better equipped to participate in collaboration, empathy and advocacy with CMC. This study is the first to identify specific challenges and offer potential solutions to help establish training guidelines.

View details for Web of Science ID 000344966800013

The prevalence of social and behavioral topics and related educational opportunities during attending rounds. Academic medicine Satterfield, J. M., Bereknyei, S., Hilton, J. F., Bogetz, A. L., Blankenburg, R., Buckelew, S. M., Chen, H. C., Monash, B., Ramos, J. S., Rennke, S., Braddock, C. H. 2014; 89 (11): 1548-1557

Abstract

To quantify the prevalence of social and behavioral sciences (SBS) topics during patient care and to rate team response to these topics once introduced.This cross-sectional study used five independent raters to observe 80 inpatient ward teams on internal medicine and pediatric services during attending rounds at two academic hospitals over a five-month period. Patient-level primary outcomes-prevalence of SBS topic discussions and rate of positive responses to discussions-were captured using an observational tool and summarized at the team level using hierarchical models. Teams were scored on patient- and learner-centered behaviors.Observations were made of 80 attendings, 83 residents, 75 interns, 78 medical students, and 113 allied health providers. Teams saw a median of 8.0 patients per round (collectively, 622 patients), and 97.1% had at least one SBS topic arise (mean = 5.3 topics per patient). Common topics were pain (62%), nutrition (53%), social support (52%), and resources (39%). After adjusting for team characteristics, the number of discussion topics raised varied significantly among the four services and was associated with greater patient-centeredness. When topics were raised, 38% of teams' responses were positive. Services varied with respect to learner- and patient-centeredness, with most services above average for learner-centered, and below average for patient-centered behaviors.Of 30 SBS topics tracked, some were addressed commonly and others rarely. Multivariable analyses suggest that medium-sized teams can address SBS concerns by increasing time per patient and consistently adopting patient-centered behaviors.

View details for DOI 10.1097/ACM.0000000000000483

View details for PubMedID 25250747

Stimulating Reflective Practice Among Your Learners PEDIATRICS Butani, L., Blankenburg, R., Long, M. 2013; 131 (2): 204-206

View details for DOI 10.1542/peds.2012-3106

View details for Web of Science ID 000314355100044

View details for PubMedID 23339227