Ernest Frugé

Decision Making in Pediatric Oncology: Who Should Take the Lead? The Decisional Priority in Pediatric Oncology Model

Decision making in pediatric oncology can look different to the ethicist and the clinician. Popular ethical theories argue that clinicians should not make decisions for patients, but rather provide information so that patients can make their own decisions. However, this theory does not always reflect clinical reality. We present a new model of decision making that reconciles this apparent discrepancy. We first distinguish decisional priority from decisional authority. The person (parent, child, or clinician) who first identifies a preferred choice exercises decisional priority. In contrast, decisional authority is a nondelegable parental right and duty, in which a mature child may join. This distinction enables us to analyze decisional priority without diminishing parental authority. This model analyzes decisions according to two continuous underlying characteristics. One dominant characteristic is the likelihood of cure. Because cure, when possible, is the ultimate goal, the clinician is in a better position to assume decisional priority when a child probably can be cured. The second characteristic is whether there is more than one reasonable treatment option. The interaction of these two complex continual results in distinctive types of decisional situations. This model explains why clinicians sometimes justifiably assume decisional priority when there is one best medical choice. It also suggests that clinicians should particularly encourage parents (and children, when appropriate) to assume decisional priority when there are two or more clinically reasonable choices. In this circumstance, the family, with its deeper understanding of the childs nature and preferences, is better positioned to take the lead.

When best intentions aren't enough: helping medical students develop strategies for managing bias about patients.

Introduction/AimsImplicit bias can impact physician–patient interactions, alter treatment recommendations, and perpetuate health disparities. Medical educators need methods for raising student awareness about the impact of bias on medical care.SettingSeventy-two third-year medical student volunteers participated in facilitated small group discussions about bias.Program DescriptionWe tested an educational intervention to promote group-based reflection among medical students about implicit bias.Program EvaluationWe assessed how the reflective discussion influenced students’ identification of strategies for identifying and managing their potential biases regarding patients. 67% of the students (n = 48) identified alternate strategies at post-session. A chi-square analysis demonstrated that the distribution of these strategies changed significantly from pre-session to post-session

A Comparison of the WISC and WISC-R in a Juvenile Delinquent Population.

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Increasing Diversity in Pediatric Hematology/Oncology

, including reductions in the use of internal feedback and humanism and corresponding increases in the use of reflection, debriefing and other strategies.DiscussionGroup-based reflection sessions, with a provocative trigger to foster engagement, may be effective educational tools for fostering shifts in student reflection about bias in encounters and willingness to discuss potential biases with colleagues, with implications for reducing health disparities.

Defining and managing career challenges for mid-career and senior stage pediatric hematologist/oncologists†

Hope is important to patients, yet physicians are sometimes unsure how to promote hope in the face of life‐threatening illness.

Predictors of Suboptimal Follow-up in Pediatric Cancer Survivors.

WISC and WISC-R subtest and IQ scores were compared in two samples of juveniles referred to a large metropolitan juvenile probation department (Ns = 180 and 185, respectively). The samples were equated for age, sex, race, and grade level. Significant differences were found on six of the 10 subtests. There were also significant differences between WISC and WISC-R scores on the Verbal, Performance, and Full Scale scores. In each case the WISC-R score was lower than the WISC score with the exception of the Arithmetic subtest. We conclude from these data that juvenile delinquents score significantly lower on the WISC-R than on the WISC. Psychologists using the WISC-R where the WISC had been previously used should educate their referral sources and other users of scores from the WISC-R to the differences in the test scores between the WISC and WISC-R.

Problem-Solving Strategies in Dementia Patient-Caregiver Dyads

Pediatric hematologist/oncologists lead in a variety of roles and settings: at the bedside, in private or academic practice, in the laboratory, and in wider society. Whether their leadership is the result of innate ability, technical expertise, or educational experience, patients, colleagues, academic centers, and communities turn to physicians for leadership. But where do these physicians learn this complex skill? Physicians do acquire leadership skills, but mainly through interaction with role models and in a hit or miss fashion. This article provides a theoretical framework for medical leadership education and describes a leadership-focused educational seminar that has been offered to pediatric hematology-oncology fellows at Texas Childrens Cancer Center since 1995. Retrospective pre/post evaluations by fellows indicated significant improvement in self-rated ability for all 24 dimensions assessed, including a variety of items drawn from the roster of the Accreditation Council for Graduate Medical Education Core Competencies. In this article we extend the concept of physician leadership from its roots in practice and present a comprehensive model that prepares pediatric hematologist/oncologists for leadership in clinical, research, and educational arenas.

EAP structure: a model for ethical appraisal.

Diversity is necessary for the survival and success of both biological and social systems including societies. There is a lack of diversity, particularly the proportion of women and minorities in leadership positions, within medicine [Leadley. AAMC 2009. Steinecke and Terrell. Acad Med 2010;85:236–245]. In 2009 a group of ASPHO members recognized the need to support the career advancement of women and minority members. This article reports the results of a survey designed to characterize the comparative career pathway experience of women and minority ASPHO members.