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.

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.

National Survey of Combined Pediatrics-Anesthesiology Residents and Graduates: Factors Contributing to Changing Career Aspirations Over Time.

Background: The Dual Pathway for Certification in Pediatrics and Anesthesiology was created in 2011 to develop leaders in caring for children with complex medical and surgical conditions. While existing dual-trained practitioners report continued practice in both pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM), recent surveys of dual pathway trainees have shown that only one-quarter still currently plan to pursue training in PCCM, a change from their initial plans to complete training in both PA and PCCM. The aim of this study was to further characterize the motivations driving shifts in career trajectory during training as well as factors affecting the combined training experience.

Participation in a Resident-as-Teacher Rotation: Motivations of and Impacts on Faculty Coaches.

Purpose: Coaching in medical education is increasingly used for trainee development for a variety of skills, including improving trainee teaching skills through resident-as-teacher programs. Faculty who serve as coaches commit significant effort to the coaching role, often without protected time or support. Little is known about faculty motivations to participate in coaching programs or how the coaching experience affects the faculty.

Training in Adolescent Substance and Opioid Misuse in Pediatric Residency Programs.

This study describes pediatric residency program training in adolescent substance use and opioid misuse, correlates training to local overdose rates, and identifies gaps in training.

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.

Effect of a Novel Mindfulness Curriculum on Burnout During Pediatric Internship: A Cluster Randomized Clinical Trial.

Importance: Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges.

Objective: To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout.

Design, Setting, And Participants: This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region.

The Use of Parenting Electives in Pediatric Residency.

Background: Financial considerations and the desire to not prolong training often influence residents' parental leave length. Some residencies offer parenting electives. These primarily self-directed electives can extend parental time at home, support transition back to work, and allow residents to remain in training and be paid during these transitions.

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.

Women's Experiences of the Effect of Financial Strain on Parenting and Mental Health.

Objective: To develop a conceptual theory to describe how financial strain affects women with young children to inform clinical care and research.

Design: Qualitative, grounded theory.

Setting: Participants were recruited from the waiting area of a pediatric clinic and an office of the Special Supplemental Nutrition Program for Women, Infants, and Children embedded within the largest safety-net academic medical center in New England.

MINdI: Mindfulness Instruction for New Interns.

Introduction: Trainee burnout has reached epidemic proportions and is increasing among physicians compared to non-health care professionals. Burnout is associated with depression and lower empathy, poor patient adherence to medical plans, and early physician retirement. Mindfulness is the quality of being nonjudgmental and present and has been shown to decrease physician burnout.

TEACH and repeat: Deliberate practice for teaching.

Background: Deliberate practice facilitates skill mastery. We aimed to create a novel resident-as-teacher rotation, leveraging a deliberate practice framework with repeated practice in real-life teaching settings, with feedback from dedicated faculty member coaches.

Methods: A resident-as-teacher rotation was designed for 35 Postgraduate Year-2 (PGY2) paediatric residents.

Defining the Essential Components of a Teaching Service.

Objectives: A large portion of residency education occurs in inpatient teaching services without widely accepted consensus regarding the essential components that constitute a teaching service. We sought to generate consensus around this topic, with the goal of developing criteria programs that can be used when creating, redesigning, or evaluating teaching services.

Methods: A list of potential components of teaching services was developed from a literature search, interviews, and focus groups.

Application Factors Associated With Clinical Performance During Pediatric Internship.

Objective: Our goal was to identify aspects of residency applications predictive of subsequent performance during pediatric internship.

Methods: We conducted a retrospective cohort study of graduates of US medical schools who began pediatric internship in a large pediatric residency program in the summers of 2013 to 2017. The primary outcome was the weighted average of subjects' Accreditation Council for Graduate Medical Education pediatric Milestone scores at the end of pediatric internship.

Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees.

Introduction: The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences.

Using the Modified Delphi Method to Develop a Tool to Assess Pediatric Residents Supervising on Inpatient Rounds.

Background: Consensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking.

Objective: Use modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, nonspecialty teaching rounds and pilot the checklist.

Design/methods: One hundred and forty-one initial candidate behaviors were identified through literature review and narrowed by local stakeholders.

Keystone: Exploring Pediatric Residents' Experiences in a Longitudinal Integrated Block.

Problem: Residency training in many specialties has traditionally been divided into short, discrete, single-specialty rotations. Although providing the learner with in-depth exposure to a specific discipline, educators have challenged this rotational model, citing problems with patient and team continuity and maladaptive coping. Longitudinal integrated clerkships, adopted by many medical schools, offer an alternative model and have demonstrated improved outcomes for students related to patient-centeredness, advocacy, and integration with teams.