Franklin Trimm

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems.

Brief Approaches to Developmental-Behavioral Promotion in Primary Care: Updates on Methods and Technology

Well-child visits are a critical opportunity to promote learning and development, encourage positive parenting practices, help children acquire behavioral self-control, enhance the development and well-being of children and their families, identify problems not amenable to brief in-office counseling, and refer for services when needed. This article outlines the communication skills, instructional methods, and resource options that enable clinicians to best assist families. Also covered is how to monitor progress and outcomes. A total of 239 articles and 52 Web sites on parent/patient education were reviewed for this study. Providers require a veritable armamentarium of instructional methods. Skills in nonverbal and verbal communication are needed to elicit the parent/patient agenda, winnow topics to a manageable subset, and create the “teachable moment.” Verbal suggestions, with or without standardized spoken instructions, are useful for conveying simple messages. However, for complex issues, such as discipline, it is necessary to use a combination of verbal advice, written information, and “teach-back,” aided by role-playing/modeling or multimedia approaches. Selecting the approaches most likely to be effective depends on the topic and family characteristics (eg, parental literacy and language skills, family psychosocial risk and resilience factors, children’s developmental-behavioral status). When providers collaborate well (with parents, patients, and other service providers) and select appropriate educational methods, families are better able to act on advice, leading to improvements in children’s well-being, health, and developmental-behavioral outcomes. Provided are descriptions of methods, links to parenting resources such as cell phone applications, Web sites (in multiple languages), interactive technology, and parent training courses.

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.

Developing Leaders in Pediatric Graduate Medical Education: The APPD LEAD Program

From the Department of Pediatrics, University of South Alabama College of Medicine, Mobile, Alabama (Dr Trimm); Department of Medical Education, Phoenix Children’s Hospital, Phoenix, Arizona (Dr Caputo); Department of Pediatrics, Weill Cornell Medical College, New York, New York (Dr Bostwick); Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Dr Frohna); Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan (Dr Haftel); Division of Infectious Diseases, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia (Dr Waggoner-Fountain); and Department of Pediatrics, University of California, Davis, Sacramento, California (Dr Li) The authors declare that they have no conflict of interest. Address correspondence to Franklin Trimm,MD, Department of Pediatrics, 1700 Center St, University of South Alabama, USAChildren’s and Women’s Hospital, Mobile, AL 36604 (e-mail: rftrimm@health.southalabama.edu).

Fostering the Career Development of Future Educational Leaders: The Success of the Association of Pediatric Program Directors Leadership in Educational Academic Development Program

A lthough the importance of educational leaders is emphasized in the program requirements set forth by the Accreditation Council of Graduate Medical Education, the process for developing those leaders has not been well described. Existing development programs have focused on educational scholarship and project driven curricula in an attempt to provide support for developing the scholarship of medical educators. In response to a lack of formal curricula for developing both educational scholarship and leadership skills in pediatric graduate medical education, the Association of Pediatric Program Directors (APPD) developed a 10-month program entitled Leadership in Educational Academic Development (LEAD) that was designed to “provide training for educators aspiring to develop the knowledge and skills needed to become leaders in medical education.” The multifaceted curriculum of APPD LEAD provides facilitated peer-mentorship for developing educational scholarship and emphasizes training in personal professional development, leadership training, and administrative skill development. The program is conducted over 3 sessions, focusing on the individual, their training program, and their interaction with others and is taught in a highly interactive format by the LEAD council, a group of experienced pediatric educators. We undertook this study to assess the change in leadership positions, scholarly productivity, and career development for the participants in the first 3 years of APPD LEAD. We analyzed characteristics of APPD LEAD participants at baseline (program entrance) and 3 years after program completion to describe changes in areas that are important for the professional development of leaders in pediatric medical education: new educational leadership positions; scholarly productivity; and national presence at educational meetings and national committee participation.