Ellen K. Hamburger

Medical schools in sub-Saharan Africa.

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.

Feasibility of a virtual learning collaborative to implement an obesity QI project in 29 pediatric practices

BACKGROUND Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children. OBJECTIVE To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process. DESIGN Prospective cohort. PARTICIPANTS Pediatric practices that were part of the Childrens National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits. INTERVENTION s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance. MAIN OUTCOME MEASURE s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients. RESULTS Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal. CONCLUSION A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.

The Referral and Consultation Entrustable Professional Activity: Defining the Components in Order to Develop a Curriculum for Pediatric Residents

From the Department of Pediatrics, George Washington University, Children’s National Health System, Office of Medical Education, Washington, DC (Dr Hamburger, Dr Agrawal, Dr Boogaard, Dr Weisz, and Dr Ottolini); Departments of Pediatrics (Dr Lane and Dr Hanson), and Family Medicine (Dr Hanson), University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colo The authors declare that they have no conflict of interest. Address correspondence to Ellen K. Hamburger, MD, Department of Pediatrics, George Washington University, Children’s National Medical System, Office of Medical Education, 111 Michigan Ave NW, Washington, DC 20037 (e-mail: ehamburg@childrensnational.org).

Tools for Learning About the Referral and Consultation Process for Pediatric Residents

Management of referral and consultation is an entrustable professional activity for pediatric residents; however, few tools exist to teach these skills. We designed and implemented tools to prompt discussion, feedback, and reflection about the process of referral, notably including the familys perspective.