Associations Between Residency Program Size and Readiness for Unsupervised Practice in Pediatrics.

Objective: This study sought to determine differences in program reported entrustable professional activity (EPA) entrustment-supervision levels based on residency program size.

Methods: At the end of the 2021-22, 2022-23, and 2023-24 academic years, entrustment-supervision levels for the 17 General Pediatrics EPAs were determined by clinical competency committees for graduating pediatric residents at 48 pediatrics residency programs. Programs were categorized as small, medium, large, and very large.

Novice Experts: Exploring Fellows' Perspectives on the Transition from Residency to Fellowship.

Introduction: Advanced training experiences are required in certain countries for subspecialization. In the United States, a decline in Milestones and in levels of supervision for Entrustable Professional Activities for incoming subspecialty fellows has been described and attributed to changes in context that fellows experience. We aimed to explore this transition to advanced training, and specifically to describe which contextual factors are salient to fellows at the residency to fellowship transition and the supports available for a smooth transition to fellowship.

An Untold Story: The Feelings of Pediatric Residents Early in the COVID-19 Pandemic and What They Can Teach Us Today.

Objective: To understand the feelings of pediatrics residents early in the COVID-19 pandemic and to offer insights still relevant today.

Methods: We performed a thematic analysis exploring resident feelings early in the pandemic using free-text responses on a national survey distributed between May and June 2020. We analyzed responses from the following multi-part free text question embedded in the larger survey, "Which of the following feelings have you experienced in your role as a pediatric resident during the COVID-19 pandemic" with response prompts including relief, guilt, pride, sadness, worry, fear, and other.

A realist evaluation of prospective entrustment decisions in paediatric residency clinical competency committees.

Purpose: Making entrustment decisions (granting more responsibility, advancement and graduation) are important actions in medical training that pose risks to trainees and patients if not done well. A previous realist synthesis of the existing literature revealed that clinical competency committees (CCCs) do not typically make deliberate entrustment decisions, instead defaulting to the promotion and graduation of trainees in the absence of red flags. This study sought further understanding of these areas through empirical data.

The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments.

Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning.

Lost in the pandemic: COVID-19's impact on health professions educators.

Background: Minimal research has explored the pandemic's impact on health professions educators (HPEs). Given that health professions educator academies provide centralised support and professional development to HPEs through communities of practice and promoting education at their institutions, it is important to examine how academies met HPEs' needs during the pandemic. This study investigates the COVID-19 pandemic's effects on HPEs and examines how academies supported HPEs' educational roles during the pandemic.

A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees.

Introduction: The real-world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why?

Methods: Realist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes.

Peer evaluations in an anonymous and open system: Intern reactions and evaluation analysis.

Purpose: Feedback and evaluation from peers is fundamental to trainees' professional development but may be uncomfortable to provide non-anonymously. We aimed to understand resident perception of anonymous and open written evaluation systems and to analyze evaluations in each of these systems.

Materials And Method: We compared two years of intern peer evaluations at a large United States-based pediatric residency program - the 2018-2019 and 2019-2020 years during which intern peer evaluations were anonymous and open, respectively.

Race, Ethnicity, and Ancestry in Clinical Pathways: A Framework for Evaluation.

Clinical algorithms, or "pathways," promote the delivery of medical care that is consistent and equitable. Race, ethnicity, and/or ancestry terms are sometimes included in these types of guidelines, but it is unclear if this is appropriate for clinical decision-making. At our institution, we developed and applied a structured framework to determine whether race, ethnicity, or ancestry terms identified in our clinical pathways library should be retained, modified, or removed.

Beyond the Workshop: Results From a Longitudinal, Interprofessional Teaching Certificate Program.

Objectives: While most hospital-based, healthcare professionals are expected to teach and supervise, few receive training in education. We designed, implemented, and evaluated an interprofessional, hospital-based teaching certificate program based on experiential learning and reflective practice for healthcare professionals with little or no formal training in education.

Methods: Participants attended educational seminars; incorporated new concepts, skills, and behaviors in their teaching; and submitted written reflections.

A Unique Lens: Understanding What Nurses Are Best Positioned to Assess About Residents.

Background: Resident feedback is generally elicited from attending physicians, although nurses can also provide feedback on distinct domains. Physicians may be hesitant to accept feedback from nurses if they perceive that nurses are being asked about areas outside their expertise. Understanding specific resident behaviors that nurses are best suited to assess is critical to successful implementation of feedback from nurses to residents.

COVID-19 Pandemic Impact on Pediatricians Entering the Pediatric Workforce.

Objective: Determine extent of impact of coronavirus disease 2019 (COVID-19) pandemic on career choice and employment of pediatricians entering pediatric workforce.

Methods: A national, cross-sectional electronic survey of pediatricians registering for the 2021 American Board of Pediatrics initial general certifying examination on the impact of the COVID-19 pandemic on 3 aspects of career (career choice, employment search, employment offers) was performed. Data were analyzed using descriptive statistics and multivariate logistic regression to determine factors associated with the pandemic's impact on career.

Learner Handoffs Within Clinical Rotations: From the Resident Perspective.

Purpose: Competency-based medical education relies on repeated longitudinal assessments of learners. Frequent attending physician transitions within clinical rotations present a significant barrier to the educational continuity required in competency-based medical education. Learner handoffs (LHs), or the transfer of information regarding learners on a team among faculty supervisors, is a potential solution.

Bridge Builders: A Qualitative Study of Fellows' Successful Supervision of Residents.

Purpose: Clinical fellows, those training to become subspecialists in a program certified by the Accreditation Council for Graduate Medical Education, supervise residents on inpatient subspecialty rotations. Unlike for supervising residents or for faculty, there is a paucity of literature describing fellows' supervision of residents. The aim of this study was to understand residents' and fellows' perception of successful supervision of residents by fellows on inpatient subspecialty rotations to inform the development of curricula to support fellows as supervisors.

Making prospective entrustment decisions: Knowing limits, seeking help and defaulting.

Introduction: Many studies focused on entrustment have not considered prospective entrustment decisions, where clinical competency and entrustment committees determine how much supervision trainees will require in the future for tasks occurring in not completely known contexts. The authors sought to explore factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education (UME).

Methods: The authors conducted a constructivist grounded theory study with 23 faculty participants from GME and UME clinical competency and entrustment committees in the United States between October 2020 and March 2021.

An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities.

Racism and discrimination are the root of many pediatric health inequities and are well described in the literature. Despite the pervasiveness of pediatric health inequities, we have failed to adequately educate and prepare general pediatricians and pediatric subspecialists to address them. Deficiencies within education across the entire continuum and in our health care systems as a whole contribute to health inequities in unacceptable ways.

Changes Made to Orders Placed by Overnight Admitting Residents on Teaching Rounds the Next Day.

Objectives: Increased focus on health care quality and safety has generally led to additional resident supervision by attending physicians. At our children's hospital, residents place orders overnight that are not explicitly reviewed by attending physicians until morning rounds. We aimed to categorize the types of orders that are added or discontinued on morning rounds the morning after admission to a resident team and to understand the rationale for these order additions and discontinuations.

Pediatric Resident Perspectives on the Impact of COVID-19 on Training.

Objectives: At the onset of the coronavirus disease 2019 pandemic, disruptions to pediatric care and training were immediate and significant. We sought to understand the impact of the pandemic on residency training from the perspective of pediatric residents.

Methods: We conducted a cross-sectional survey of categorical pediatric residents at US training programs at the end of the 2019-2020 academic year.

Interns' perspectives on impacts of the COVID-19 pandemic on the medical school to residency transition.

Background: The COVID-19 pandemic resulted in disruptions to medical school training and the transition to residency for new post-graduate year 1 resident-physicians (PGY1s). Therefore, the aim of this study was to understand the perspectives of United States PGY1s regarding the impact of the pandemic on these experiences. Our secondary aims were to understand how desire to practice medicine was impacted by the pandemic and whether PGY1s felt that they were able to meaningfully contribute to the COVID-19 response as students.

Pediatric Trainees as Parents: Perspectives on Parenthood From Pediatric Resident Parents.

Objectives: Prior work across medical and surgical specialties shows that parenthood during residency training is associated with challenges including limited parental leave, lack of accommodations for breastfeeding, and concerns about career impact. Less is known about the experience of parenthood during pediatric residency training. The objective of this study was to identify themes related to the experience of parenthood during pediatric residency.

Pediatric Trainees as Parents: Perspectives From a Pandemic.

Objectives: Resident parents are at the intersection of converging challenges during the coronavirus disease 2019 (COVID-19) pandemic, and their perspective has yet to be explored. This qualitative study aimed to identify themes related to the experience of pediatric resident parents during the COVID-19 pandemic.

Methods: We performed semistructured interviews with pediatric residents who were also parents.

Pediatric Intern Clinical Exposure During the COVID-19 Pandemic.

Background And Objectives: Pediatric health care encounters declined during the coronavirus disease 2019 (COVID-19) pandemic, and pediatric residency programs have adapted trainee schedules to meet the needs of this changing clinical environment. We sought to evaluate the impact of the pandemic on pediatric interns' clinical exposure.

Methods: In this retrospective cohort study, we quantified patient exposure among pediatric interns from a single large pediatric residency program at a freestanding children's hospital.