Heather McPhillips

Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn

To determine the prevalence of persistent pulmonary hypertension of the newborn (PPHN) among infants whose mothers were exposed to antidepressants in the third trimester of pregnancy compared to the prevalence among infants whose mothers were not exposed to antidepressants in the third trimester.

Teaching professionalism to residents.

The need to teach professionalism during residency has been affirmed by the Accreditation Council for Graduate Medical Education, which will require documentation of education and evaluation of professionalism by 2007. Recently the American Academy of Pediatrics has proposed the following components of professionalism be taught and measured: honesty/integrity, reliability/responsibility, respect for others, compassion/empathy, self-improvement, self-awareness/knowledge of limits, communication/collaboration, and altruism/advocacy. The authors describe a curriculum for introducing the above principles of professionalism into a pediatrics residency that could serve as a model for other programs. The curriculum is taught at an annual five-day retreat for interns, with 11 mandatory sessions devoted to addressing key professionalism issues. The authors also explain how the retreat is evaluated and how the retreats topics are revisited during the residency, and discuss general issues of teaching and evaluating professionalism.

Risks of congenital malformations and perinatal events among infants exposed to calcium channel and beta-blockers during pregnancy

Calcium channel blockers and beta‐blockers (BBs) are widely used during pregnancy, but data on their safety for the developing infant are scarce. We used population‐based data from 5 HMOs to study risks for perinatal complications and congenital defects among infants exposed in‐utero.

Professionalism and the Match: A Pediatric Residency Program's Postinterview No-Call Policy and Its Impact on Applicants

OBJECTIVE. The National Residency Matching Program allows match participants to recruit each other and try to influence future ranking decisions in their favor, but it also states that participants “must not make statements implying commitment.” The National Residency Matching Program cautions against statements such as, “We plan to rank you very highly on our list,” because they can be misinterpreted as an informal commitment. To avoid issues around miscommunication, the University of Washington Pediatric Residency Program instituted a postinterview no-call policy with applicants. The purpose of this study was to determine this policys impact on applicants. METHODS. A Web-based, anonymous survey was sent after the National Residency Matching Program deadline for submitting rank lists but before match day to applicants who interviewed at our program from 2003 to 2006. Applicants were asked whether our programs position on their rank list would have been influenced more favorably, less favorably, or not at all had they received a telephone call from our program. RESULTS. The survey response rate was 53% (n = 468). A total of 10.3% (n = 48) of the applicants to our program would have been favorably influenced by a telephone call after their interview. Significantly more applicants reported that a recruiting call from our program would have caused them to rank our program more favorably in 2006 (17.2%) than in 2003–2005 combined (8.4%). CONCLUSIONS. We identified a vulnerable applicant population whose rank lists are potentially influenced by questionable postinterview communication from residency programs. To protect the integrity and fairness of the match, we call for more explicit guidelines regarding postinterview communication with applicants.

Children hospitalized early and increased risk for future serious injury.

Objective—To determine if infants hospitalized for any reason before 90 days of age are at increased risk for future serious injury. Setting—Washington State. Methods—A population based retrospective cohort study, using data from Washington State birth and death certificates linked to a statewide hospital discharge database for the years 1989 through 1997. Participants included healthy full term infants born in Washington State between 1989 and 1995. A total of 29 466 infants hospitalized <90 days of age (early hospitalization) were compared to 29 750 randomly selected infants not hospitalized early. The primary outcome was an injury resulting in hospitalization or death between 3–24 months. Results—Among infants hospitalized early, 76/10 000 had a subsequent serious injury before age 2, compared with 47/10 000 infants without an early hospitalization (relative risk (RR) 1.6; 95% confidence interval (CI) 1.3 to 2.0). In a multivariate model including maternal age and parity, the adjusted RR for serious injury associated with early hospitalization was 1.5 (95% CI 1.2 to 1.8). Infants hospitalized early were three times as likely to be hospitalized between 3–24 months of age for intentional injury compared with infants not hospitalized early (RR 3.3; 95% CI 1.1 to 10.1). Conclusions—Infants hospitalized in the first three months of life for any reason were 50% more likely to have a subsequent serious injury compared with infants not hospitalized early and were also at increased risk of intentional injury. This identifiable group of infants might be suitable for targeted childhood injury prevention programs including those involving prenatal and postnatal visits.

Conducting Quantitative Medical Education Research: From Design to Dissemination

Rigorous medical education research is critical to effectively develop and evaluate the training we provide our learners. Yet many clinical medical educators lack the training and skills needed to conduct high-quality medical education research. We offer guidance on conducting sound quantitative medical education research. Our aim is to equip readers with the key skills and strategies necessary to conduct successful research projects, highlighting new concepts and controversies in the field. We utilize Glassicks criteria for scholarship as a framework to discuss strategies to ensure that the research question of interest is worthy of further study and how to use existing literature and conceptual frameworks to strengthen a research study. Through discussions of the strengths and limitations of commonly used study designs, we expose the reader to particular nuances of these decisions in medical education research and discuss outcomes generally focused on, as well as strategies for determining the significance of consequent findings. We conclude with information on critiquing research findings and preparing results for dissemination to a broad audience. Practical planning worksheets and comprehensive tables illustrating key concepts are provided in order to guide researchers through each step of the process. Medical education research provides wonderful opportunities to improve how we teach our learners, to satisfy our own intellectual curiosity, and ultimately to enhance the care provided to patients.

Strengthening the associate program director workforce: needs assessment and recommendations.

From the Department of Pediatrics, Duke University Medical Center, Durham, NC (Dr Narayan); Department of Pediatrics, University of Washington, Seattle,Wash (DrMcPhillips); Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo (Dr Anderson); Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga (Dr Gardner); Department of Pediatrics, University of Vermont, Burlington, Vt (Dr Larrabee); Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio (Dr Poynter); Department of Pediatrics, University of Missouri—Kansas City School of Medicine and Children’s Mercy Hospitals and Clinics, Kansas City, Mo (Dr Mann); and Department of Pediatrics Drexel University College of Medicine, Section of General Pediatrics St. Christopher’s Hospital for Children, Philadelphia, Pa (Dr Spector) The authors declare that they have no conflict of interest. Address correspondence to Aditee P. Narayan, MD, MPH, Duke University Medical Center, Pediatrics, DUMCBox 3127, Durham, NC 27710 (e-mail: aditee.narayan@duke.edu). Received for publication May 12, 2014; accepted May 12, 2014.

View From the Association of Pediatric Program DirectorsStrengthening the Associate Program Director Workforce: Needs Assessment and Recommendations

From the Department of Pediatrics, Duke University Medical Center, Durham, NC (Dr Narayan); Department of Pediatrics, University of Washington, Seattle,Wash (DrMcPhillips); Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo (Dr Anderson); Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga (Dr Gardner); Department of Pediatrics, University of Vermont, Burlington, Vt (Dr Larrabee); Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio (Dr Poynter); Department of Pediatrics, University of Missouri—Kansas City School of Medicine and Children’s Mercy Hospitals and Clinics, Kansas City, Mo (Dr Mann); and Department of Pediatrics Drexel University College of Medicine, Section of General Pediatrics St. Christopher’s Hospital for Children, Philadelphia, Pa (Dr Spector) The authors declare that they have no conflict of interest. Address correspondence to Aditee P. Narayan, MD, MPH, Duke University Medical Center, Pediatrics, DUMCBox 3127, Durham, NC 27710 (e-mail: aditee.narayan@duke.edu). Received for publication May 12, 2014; accepted May 12, 2014.

How to Use Learning Preferences to Optimize Teaching Effectiveness

Learners differ in their preferences and aptitudes for acquiring, consolidating, and integrating new information. Similarly, teachers have a variety of preferences, strategies, and strengths for teaching. While it is conceptually attractive to imagine that simply matching “learning styles” and “teaching styles” will lead to better educational outcomes, this conclusion is not supported by the available research. Rather, understanding learning and teaching styles allows the clinical teacher to improve educational outcomes by (a) presenting information in a variety of styles and (b) troubleshoot challenging teacher-student interactions.

The University of Washington Pediatric Alaska Track: A Novel Approach to Training Primary Care Pediatricians

The University of Washington School of Medicine (UWSOM) has been a leading medical school in training primary care physicians. Yet due to the small number of residency positions in the Pacific Northwest, the 5-state region of Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) has some of the lowest physician-to-population, graduate medical education (GME) positions-to-population ratios in the nation, and has the lowest pediatrician-to-child ratio in the country. The UW Pediatric Alaska Track was designed to increase the number of primary care pediatricians serving rural and underserved populations. The goals are to increase quality and access to health care for children and families throughout the WWAMI region, and to improve the learning environment for residents with a career interest in primary care pediatric practice.