Ann E. Burke

Individualized Learning Plans: Basics and Beyond

From the Department of Pediatrics, University of California, Davis, Sacramento, Calif (Dr Li); and Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke) Dr Burke is the president of the Association of Pediatric Program Directors. Address correspondence to Su-Ting T. Li, MD, MPH, 2516 Stockton Blvd, Sacramento, California 95817. (e-mail: su-ting.li@ucdmc.ucdavis. edu).

Domain of Competence: Practice-Based Learning and Improvement

From the Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Department of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minn (Dr Benson); Association of American Medical Colleges, Washington, DC (Dr Englander); Competency-Based Assessment, The American Board of Pediatrics, Chapel Hill, NC (Dr Carraccio); and Department of Pediatrics, Childrens Hospital of Philadelphia, Philadelphia, Pa (Dr Hicks) The views expressed in this report are those of the authors and do not necessarily represent those of the Accreditation Council for Graduate Medical Education, the American Board of Pediatrics, the Association of Pediatric Program Directors, or the Academic Pediatric Association. The authors declare that they have no conflict of interest. Publication of this article was supported by the American Board of Pediatrics Foundation and the Association of Pediatric Program Directors. Address correspondence to Ann E. Burke, MD, Wright State University Boonshoft School of Medicine, One Children’s Plaza, Dayton Children’s Hospital, Department of Pediatrics, Dayton, OH 45404 (e-mail: ann.burke@wright.edu).

The pediatrics milestones: a continuous quality improvement project is launched-now the hard work begins!

From the Association of American Medical Colleges, Washington, DC (Dr Englander); Department of Pediatrics, Dayton Children’s Medical Center and the Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Winthrop University Hospital, Winthrop, NY (Dr Guralnick); Departments of Pediatrics and Internal Medicine, University of Minnesota Amplatz Children’s Hospital and the University of Minnesota School of Medicine, Minneapolis, MN (Dr Benson); Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Hicks and Ludwig); Department of Pediatrics, Boston Children’s Hospital/Boston Medical Center and Boston University School of Medicine, Boston, Mass (Dr Schumacher); Dartmouth Institute for Health Policy and Clinical Practice Center for Leadership and Improvement, Hanover, NH (Ms Johnson); and American Board of Pediatrics, Chapel Hill, NC (Dr Carraccio) Address correspondence to Robert Englander, MD, MPH, Association of American Medical Colleges, 2450 N Street NW, Washington, DC 20037 (e-mail: renglander@aamc.org).

In pursuit of meaningful use of learning goals in residency: A qualitative study of pediatric residents

Purpose Medical education aims to equip physicians for lifelong learning, an objective supported by the conceptual framework of self-regulated learning (SRL). Learning goals have been used to develop SRL skills in learners across the medical education continuum. This study’s purpose was to elicit residents’ perspectives on learning goal use and to develop explanations suggesting how aspects of the learning environment may facilitate or hinder the meaningful use of learning goals in residency. Method Resident focus groups and program director interviews were conducted in 2012–2013, audio-recorded, and transcribed. Programs were selected to maximize diversity of size, geographic location, type of program, and current use of learning goals. Data were analyzed using the constant comparative method associated with grounded theory. Further analysis compared themes frequently occurring together to strengthen the understanding of relationships between the themes. Through iterative discussions, investigators built a grounded theory. Results Ninety-five third-year residents and 12 program directors at 12 pediatric residency programs participated. The analysis identified 21 subthemes grouped into 5 themes: program support, faculty roles, goal characteristics and purposes, resident attributes, and accountability and goal follow-through. Review of relationships between the themes revealed a pyramid of support with program support as the foundation that facilitates the layers above it, leading to goal follow-through. Conclusions Program support facilitates each step of the SRL process that leads to meaningful use of learning goals in residency. A strong foundation of program support should include attention to aspects of the implicit curriculum as well as the explicit curriculum.

Pediatric Residents’ Perspectives on Reducing Work Hours and Lengthening Residency: A National Survey

OBJECTIVE: In 2011, the Accreditation Council on Graduate Medical Education increased restrictions on resident duty-hours. Additional changes have been considered, including greater work-hours restrictions and lengthening residency. Program directors tend to oppose further restrictions; however, residents’ views are unclear. We sought to determine whether residents support these proposals, and if so why. METHODS: We surveyed US pediatric residents from a probability sample of 58 residency programs. We used multivariate logistic regression to determine predictors of support for (1) a 56-hour workweek and (2) the addition of 1 year to residency to achieve a 56-hour week. RESULTS: Fifty-seven percent of sampled residents participated (n = 1469). Forty-one percent of respondents supported a 56-hour week, with 28% neutral and 31% opposed. Twenty-three percent of all residents would be willing to lengthen training to reduce hours. The primary predictors of support for a 56-hour week were beliefs that it would improve education (odds ratio [OR] 8.6, P < .001) and quality of life (OR 8.7, P < .001); those who believed patient care would suffer were less likely to support it (OR 0.10, P < .001). Believing in benefits to education without decrement to patient care also predicted support for a 56-hour-week/4-year program. CONCLUSIONS: Pediatric residents who support further reductions in work-hours believe reductions have positive effects on patient care, education, and quality of life. Most would not lengthen training to reduce hours, but a minority prefers this schedule. If evidence mounts showing that reducing work-hours benefits education and patient care, pediatric residents’ support for the additional year may grow.

Resident work duty hour requirements: medical educators' perspectives.

From the Association of Pediatric Program Directors (Drs Burke, Rushton, Guralnick, Hicks); Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio (Dr Burke); Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind (Dr Rushton); Winthrop University Hospital, Mineola, NY (Dr Guralnick); and The Children’s Hospital of Philadelphia, Department of Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, Pa (Dr Hicks) Address correspondence to Ann E. Burke, MD, Dayton Children’s Medical Center, Medical Education Department, One Children’s Plaza, Dayton, Ohio 45419 (e-mail: Ann.burke@wright.edu).

Federation of Pediatric Organizations Task Force on Women in Pediatrics: Considerations for Part-Time Training and Employment for Research-Intensive Fellows and Faculty

Recognizing the significant issues and opportunities confronting the pediatric workforce, the Federation of Pediatric Organizations (FOPO) in 2007 appointed the second FOPO Task Force on Women in Pediatrics. The task force selected 4 issues on which to focus its attention in the subsequent 2 years: 1) routinely provide the option to train and work part-time at specific career stages; 2) allow flexibility in the career paths of physician/scientists; 3) draw more women into leadership positions; and 4) address child care issues. At the 2008 Pediatric Academic Societies Meeting, the task force hosted a symposium focusing on the provision of flexibility in the career paths of physician/scientists. This commentary summarizes the portions of the symposium that focused on current funding regulations at the National Institutes of Health (NIH) about part-time and protected research time and changes being considered and experiments conducted in 2 leading institutions that have permitted physician/ scientists to work part time. OVERVIEW Although the percent of women in medicine quadrupled in the last 30 years, women represent only 14% of tenured faculty and 12% of full professors 1 and approximately 10% of pediatric department chairs. 2 This is not a “pipeline issue,” because women represent 50% of matriculating medical students, 70% of pediatricians in training, and 50% of all practicing pediatricians. 3-5 Rather, it may be that academic institutions require women faculty to adjust to organizational structures, policies, and procedures that were established at a time when most faculty were men whose spouses had primary commitment to the household. 2 Institutional requirements for physician scientists have remained particularly rigid. In most universities, the physician scientist path is a tenure track position with the traditional restrictions and requirements to attain tenure, including a restricted time frame, explicit requirements for obtaining grant funding and producing publications, prohibitions against parttime appointments, and an inflexible tenure clock. 6,7 These requirements may not be realistic for women faculty because of their multiple roles, such as childbearing and rearing, forcing parents to choose between needs of their families and the de

The AAP resilience in the face of grief and loss curriculum

A career in pediatrics can bring great joy and satisfaction. It can also be challenging and lead some providers to manifest burnout and depression. A curriculum designed to help pediatric health providers acquire resilience and adaptive skills may be a key element in transforming times of anxiety and grief into rewarding professional experiences. The need for this curriculum was identified by the American Academy of Pediatrics Section on Medical Students, Residents and Fellowship Trainees. A working group of educators developed this curriculum to address the professional attitudes, knowledge, and skills essential to thrive despite the many stressors inevitable in clinical care. Fourteen modules incorporating adult learning theory were developed. The first 2 sections of the curriculum address the knowledge and skills to approach disclosure of life-altering diagnoses, and the second 2 sections focus on the provider’s responses to difficult patient care experiences and their needs to develop strategies to maintain their own well-being. This curriculum addresses the intellectual and emotional characteristics patient care medical professionals need to provide high-quality, compassionate care while also addressing active and intentional ways to maintain personal wellness and resilience.

Practical Suggestions for the Creation and Use of Meaningful Learning Goals in Graduate Medical Education.

From the Department of Pediatrics, Nationwide Children’s Hospital, Ohio State University School of Medicine, Columbus, Ohio (Drs Reed and Mahan); Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo (Drs Lockspeiser, Hanson, and Rosenberg); Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children’s Hospital, Dayton, Ohio (Dr Burke); Department of Pediatrics, Children’s Hospital at Dartmouth, Geisel School of Medicine at Dartmouth, Hanover, NH (Dr Gifford); Department of Pediatrics, Riley Hospital for Children and IU School of Medicine, Indianapolis, Ind (Dr McKenna); and Department of Pediatrics, University of California Davis School of Medicine, Sacramento, Calif (Dr Li) The authors declare that they have no conflict of interest. Address correspondence to Suzanne Reed, MD, Division of Hematology/Oncology/BMT, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205 (e-mail: suzanne.reed@nationwidechildrens.org).

Competent for Unsupervised Practice: Use of Pediatric Residency Training Milestones to Assess Readiness.

Purpose To describe clinical skills progression during pediatric residency using the distribution of pediatric milestone assessments by subcompetency and year of training and to determine reasonable milestone expectations at time of graduation. Method Multi-institutional cohort study of the milestones reported to the Accreditation Council for Graduate Medical Education for all 21 pediatric subcompetencies. Most subcompetencies were measured using five milestone levels (1 = novice, 2 = advanced beginner, 3 = competent, 4 = proficient, 5 = master); 3 subcompetencies had only four levels defined. Results Milestone assessments for 2,030 pediatric residents in 47 programs during academic year 2013–2014 were obtained. There was significant variation in end-of-year milestone ratings for residents within each level of training, which decreased as training level increased. Most (78.9%; 434/550) graduating third-year pediatric residents received a milestone rating of ≥ 3 in all 21 subcompetencies; fewer (21.1%; 116/550) received a rating of ≥ 4 in all subcompetencies. Across all training levels, professionalism and interpersonal communication skills were rated highest; quality improvement was rated lowest. Conclusions Trainees entered residency with a wide range of skills. As they advanced, skill variability within a training level decreased. Most graduating pediatric residents were still advancing on the milestone continuum toward proficiency and mastery, and an expectation of milestone ratings ≥ 4 in all categories upon graduation is unrealistic; milestone ratings ≥ 3 upon graduation may be more realistic. Understanding current pediatric residents’ and graduates’ skills can help to identify key areas that should be specifically targeted during training.