Latha Chandran

Guidelines for Evaluating the Educational Performance of Medical School Faculty: Priming a National Conversation

Background: The academic community needs a sound framework for the promotion and advancement of educators. The Group on Educational Affairs of the Association of American Medical Colleges organized a consensus conference that affirmed the use of five domains for documenting the quantity and quality of scholarly engagement in educational activities: teaching, curriculum, advising/mentoring, educational leadership/administration, and learner assessment. Summary: In this article, we offer detailed guidelines to evaluate these five domains of educator performance and the essential elements of scholarly activity. The guidelines are adapted from our developmental educator portfolio template and educator portfolio analysis tool, previously published in MedEdPORTAL. A short tool for educator performance evaluation that summarizes items in the guidelines is proposed for discussion. Conclusions: Our goal in this article is to itemize criteria for systematic faculty evaluation that can be applied in any institutional setting to assist promotion decision makers in their task of evaluating medical school faculty.

Evaluating the Performance of Medical Educators: A Novel Analysis Tool to Demonstrate the Quality and Impact of Educational Activities

Purpose Traditional promotion standards rely heavily on quantification of research grants and publications in the curriculum vitae. The promotion and retention of educators is challenged by the lack of accepted standards to evaluate the depth, breadth, quality, and impact of educational activities. The authors sought to develop a practical analysis tool for the evaluation of educator portfolios (EPs), based on measurable outcomes that allow reproducible analysis of the quality and impact of educational activities. Method The authors, 10 veteran educators and an external expert evaluator, used a scholarly, iterative consensus-building process to develop the tool and test it using real EPs from educational scholars who followed an EP template. They revised the template in parallel with the analysis tool to ensure that EP data enabled valid and reliable evaluation. The authors created the EP template and analysis tool for scholar and program evaluation in the Educational Scholars Program, a three-year national certification program of the Academic Pediatric Association. Results The analysis tool combines 18 quantitative and 25 qualitative items, with specifications, for objective evaluation of educational activities and scholarship. Conclusions The authors offer this comprehensive, yet practical tool as a method to enhance opportunities for faculty promotions and advancement, based on well-defined and documented educational outcome measures. It is relevant for clinical educators across disciplines and across institutions. Future studies will test the interrater reliability of the tool, using data from EPs written using the revised template.

Lead Poisoning: Basics and New Developments

1. Latha Chandran, MD, MPH* 2. Rosa Cataldo, DO† 1. *Editorial Board. 2. †Assistant Clinical Instructor, Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY. After completing this article, readers should be able to: 1. Delineate the disparities of pediatric lead poisoning among socioeconomic and racial groups. 2. List three common sources of lead. 3. Describe the emerging data on immediate and long-term neurotoxic effects of lead on the developing brain. 4. Discuss two chelating agents and their common adverse effects. 5. Employ a multipronged, multidisciplinary approach in the overall management of pediatric lead poisoning. For many centuries, starting as early as 4000 BC, lead has been used for a variety of purposes. Ancient Romans used lead for glazing pottery, piping, cooking utensils, and sweetening of wine. Lead toxicities were well documented in Egyptian papyrus rolls, describing its use for homicidal purposes. Over the centuries, lead poisoning was noted by different terms such as “the miners disease,” “lead blindness,” “lead colic,” “lead gout,” and “plumbism.” It was a common cause of morbidity and mortality among shipbuilders, wine drinkers, and potters. Lead encephalopathy and lead psychosis also were recognized early in human history, when potters were described as “paralytic, splenetic, lethargic, cachectic, and toothless.” The use of lead became widespread during the industrial revolution. Use of lead-based paints, gasoline, and food containers resulted in profound environmental contamination. The toxic clinical effects of lead poisoning in children were linked to lead-based paint used in the early 20th century. More than half of the homes built in the United States before 1950 contained lead paint. Lead-based paints were banned in the United States in 1977 (the maximum allowable amount is now 0.07 mg/cm2), and the United States Environmental Protection Agency phased out lead from gasoline between 1975 and 1986. Due to measures such …

Evaluating educators using a novel toolbox: applying rigorous criteria flexibly across institutions

Valuing faculty as educators is essential for medical schools to fulfill their unique mission of educating physicians. The 2006 Consensus Conference on Educational Scholarship, sponsored by the Association of American Medical Colleges (AAMC) Group on Educational Affairs, provided educators seeking academic promotion with a portfolio-based format for documenting activities in five domains, using evidence of quantity, quality, a scholarly approach, and educational scholarship. Yet, the lack of a rigorous, widely accepted system to assess educator portfolio submissions during the promotion and tenure process continues to impede the ability to fully value educators and educational scholars. The AAMC Task Force on Educator Evaluation was formed in 2010 to establish consensus guidelines for use by those responsible for the rigorous evaluation of the educational contributions of faculty. The task force delineated the educational contributions currently valued by institutions and then fulfilled its charge by creating the Toolbox for Evaluating Educators, a resource which contains explicit evidence-based criteria to evaluate faculty in each of the five domains of educator activity. Adoption of such criteria is now the rate-limiting step in using a fair process to recognize educators through academic promotion. To inform institutional review and implementation of these criteria, this article describes the iterative, evidence- and stakeholder-based process to establish the criteria. The authors advocate institutional adoption of these criteria so that faculty seeking academic promotion as educators, like their researcher colleagues, can be judged and valued using established standards for the assessment of their work.

Impact of Physical Activity Intervention Programs on Self-Efficacy in Youths: A Systematic Review

Lack of physical activity has contributed to the nations childhood obesity crisis, but the impact of physical activity on self-efficacy as a mediator of behavior change has not been examined. This systematic review (SR) describes the published evidence related to the impact of physical activity intervention programs on self-efficacy among youths. From January 2000 to June 2011, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to identify publications from PubMed, PsychInfo, Web of Knowledge, and the Cochran Database of Systematic Reviews. The Cochrane Population, Intervention, Control, Outcome, Study Design (PICOS) approach guided this SR articles selection and evaluation process. Of the 102 publications screened, 10 original studies matched the SR inclusion criteria. The types of physical activity interventions and self-efficacy assessments for these 10 studies were diverse. Of the 10 included articles, 6 articles identified an improvement in post-self-efficacy assessments compared to baseline and 4 showed no effect. In conclusion, physical activity intervention programs may improve self-efficacy in youths. A standardized approach to classify and measure self-efficacy is required. Further research is needed to quantify the association of self-efficacy ratings after completing physical activity interventions with objective health improvements, such as weight loss.

Investment in Faculty as Educational Scholars: Outcomes from the National Educational Scholars Program

From the Department of Pediatrics, Cincinnati Children’s Hospital Medical Center/ University of Cincinnati College of Medicine, Cincinnati, OH; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX; Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY; and Department of Pediatrics, University of Rochester Medical Center, A cademic institutions have strong incentives to develop faculty who are productive researchers, master clinicians, and educators. Forward-thinking institutions are encouraging their educators to become not only stellar teachers, but also productive scholars through peerreviewed dissemination of rigorously developed and evaluated curricular innovations, evaluation tools, and teaching methodologies. This emphasis on evaluation is imperative to ensure that educational programs effectively and efficiently meet the needs of the learners and the healthcare system. Even though many educator development programs train faculty to be good teachers, relatively few emphasize educational scholarship and research. Moreover, few of these are national programs offering participants the benefits of national mentoring and networking. The Educational Scholars Program (ESP) is a competitive national faculty development program created by the Academic Pediatric Association in 2006. The ESP is designed to cultivate skills in developing and evaluating curricula, conducting methodologically sound educational research, and effectively disseminating scholarly work. Mentorship and networking are key components of the ESP; each scholar is paired with a local project mentor and a national advisor with proven educational scholarship skills. Cohorts of scholars complete a 3-year longitudinal curriculum, including day-long sessions at 3 Pediatric Academic Society meetings and 6 online learning modules, each focused on specific educational scholarship skills. The cohorts form learning communities and serve as peer mentors. Scholars create an educator portfolio documenting their teaching activities and scholarly accomplishments. They also complete an educational project that they disseminate via peerreviewed publication or national presentation. The goal of this study was to describe the professional impact and value of the ESP on graduates and their institutions.

Reforming the 4th-Year Curriculum as a Springboard to Graduate Medical Training: One School's Experiences and Lessons Learned.

ABSTRACT Problem: Concerns regarding the quality of training in the 4th year of medical school and preparation of graduates to enter residency education persist and are borne out in the literature. Intervention: We reviewed the published literature regarding Year 4 concerns as well as institutional efforts to improve the 4th-year curriculum from several schools. Based on input from key stakeholders, we established 4 goals for our Year 4 curriculum reform: (a) standardize the curricular structure, (b) allow flexibility and individualization, (c) improve the preparation for residency, and (d) improve student satisfaction. After the reform, we evaluated the outcomes using results from the Association of American Medical Colleges Questionnaire, student focus groups, and program director surveys. Context: This article describes the context, process, and outcomes of the reform of the Year 4 curriculum at Stony Brook University School of Medicine. Outcome: We were able to achieve all four stated goals for the reform. The significant components of the change included a flexible adaptable curriculum based on individual needs and preferences, standardized learning objectives across the year, standardized competency-based evaluations regardless of discipline, reinforcement of clinical skills, and training for the transition to the workplace as an intern. The reform resulted in increased student satisfaction, increased elective time, and increased preparedness for residency training as perceived by the graduates. The Program Director survey showed significant changes in ability to perform a medical history and exam, management of common medical conditions and emergencies, clinical reasoning and problem-solving skills, working and communication with the healthcare team, and overall professionalism in meeting obligations inherent in the practice of medicine. Lessons Learned: Lessons learned from our 4th-year reform process are discussed. Listening to the needs of the stakeholders was an important step in ensuring buy-in, having an institutional champion with an organizational perspective on the overall institutional mission was helpful in building the guiding coalition for change, building highly interactive collaborative interdisciplinary teams to work together addressed departmental silos and tunnel vision early on, and planning a curriculum is exciting but planning the details of the implementation can be quite tedious.

Arthritis in children and adolescents.

1. Janice John, DO, MS, MPH* 2. Latha Chandran, MD, MPH* 1. *Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY. * ANA: : antinuclear antibody ARF: : acute rheumatic fever CRP: : C-reactive protein ESR: : erythrocyte sedimentation rate FDA: : Food and Drug Administration GAS: : group A Streptococcus HLA: : human leukocyte antigen Ig: : immune globulin JIA: : juvenile idiopathic arthritis MRI: : magnetic resonance imaging NSAIDs: : nonsteroidal anti-inflammatory drugs RF: : rheumatoid factor SCFE: : slipped capital femoral epiphysis After reading this article, readers should be able to: 1. Identify the common causes of arthritis in children. 2. Develop a broad differential diagnosis for arthritis in the pediatric population. 3. Distinguish toxic synovitis from septic arthritis. 4. Recognize and manage a patient with septic arthritis. 5. Discuss the diagnostic and treatment approaches to reactive arthritis, acute rheumatic fever, Lyme arthritis, toxic synovitis, and juvenile idiopathic arthritis. Arthritis is simply defined as inflammation of a joint. Arthritis may affect one or more joints and often is accompanied by swelling, redness, tenderness, warmth, and pain with movement. The pathophysiology of this inflammatory process varies depending on the underlying cause of arthritis. Monoarthritis is inflammation limited to one joint. In the context of juvenile idiopathic arthritis (JIA), oligoarthritis is defined as arthritis involving fewer than five joints, whereas polyarthritis is arthritis of five or more joints. Although there is a broad differential diagnosis, a thorough history and physical examination should provide sufficient information to direct the evaluation and management of the patient with arthritis. An overview of pediatric arthritis as well as a discussion of the most common causes, evaluation, and treatment is offered in this article. It is important to differentiate arthralgia from arthritis. Arthralgia is the presence of joint pain without objective signs of inflammation (warmth, erythema, tenderness, and swelling) on physical examination. Several rheumatologic diseases, such as systemic lupus erythematosus, may present with arthralgia early in the course; it is also important to consider viral as well as other causes of arthralgia. Children who have arthritis may present with pain, limited range of motion, limp, and refusal to use or move the affected joint. …

Chlamydial Infections in Children and Adolescents

1. Latha Chandran, MD, MPH* 2. Rachel Boykan, MD† 1. *Editorial Board 2. †Assistant Professor of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY After completing this article, readers should be able to: 1. Describe the varied clinical manifestations of Chlamydia trachomatis infection in neonates, children, and adolescents. 2. Know the clinical manifestations of Chlamydophila pneumoniae infection. 3. List the various diagnostic criteria and methods for C trachomatis and C pneumoniae infections. 4. Discuss the treatments for C trachomatis and C pneumoniae infections. Chlamydiae are obligate intracellular organisms that cause a wide spectrum of human and animal disease, including conjunctivitis, pneumonia, and genital tract infections. C trachomatis and C pneumoniae are significant human pathogens; C psittaci is a less common cause of human disease. The earliest descriptions of what is believed to have been trachoma are found in ancient Chinese and Egyptian manuscripts. In 1907, Halberstaedter and von Prowazek found what they assumed (correctly) to be the causal agent in trachoma when they noted intracytoplasmic vacuoles with numerous particles in Giemsa-stained epithelial cells. Subsequently, similar inclusions were described in specimens taken from the eyes of babies who had ophthalmia neonatorum, from their mothers’ uteruses, and from men who had urethritis. From 1929 to 1930, outbreaks of an “atypical pneumonia” acquired from psittacine birds stimulated more research, which led to Bedsons description of the characteristic developmental life cycle of all Chlamydiales . His accurate description of “an obligate intracellular parasite with bacterial affinities” was not fully appreciated for several decades because these new agents initially were believed to be viruses. Under the 2000 taxonomy, the order Chlamydiales was divided into four families: Chlamydiaceae, Parachlamydiaceae, Waddliaceae , and Simkaniaceae . The family Chlamydiaceae was divided further into two genera, Chlamydophila and Chlamydia , based on ribosomal sequence analysis that showed less than 95% homology between Chlamydia and Chlamydophila. Chlamydophila includes the species C pneumonia, C psittaci , and nonhuman pathogens; the family Chlamydia includes C trachomatis and nonhuman pathogens. (1 …

Vomiting in Children: Reassurance, Red Flag, or Referral?

1. Latha Chandran, MD, MPH* 2. Maribeth Chitkara, MD† 1. *Editorial Board 2. †Assistant Professor of Pediatrics and Emergency Medicine, Pediatric Hospitalist, State University of New York at Stony Brook, Stony Brook, NY After completing this article, readers should be able to: 1. Discuss the most common causes of vomiting in children of different age groups. 2. Understand the physiology behind the process of vomiting. 3. Recognize common causes of vomiting based on the pattern and nature of emesis. 4. Be familiar with the basic diagnostic evaluation and treatment strategies for different causes of vomiting. A 1-month-old boy who has had postprandial vomiting for 1 week is admitted from the emergency department. He was born at term with no complications and had regained his birthweight by the second week after birth, feeding on a milk protein formula. He has been vomiting curdled milk intermittently for the past week, and on the day of admission was noted by his pediatrician to have lost 4 oz in weight since his last check-up . On physical examination, the infant is slightly lethargic and has a sunken fontanelle. The rest of his physical examination findings, including evaluation of his abdomen, are normal. Abdominal ultrasonography shows normal width and length of the pylorus. However, no food movement past the pylorus is observed. An echogenic density in the prepyloric area is noted. An upper gastrointestinal (GI) radiographic series and endoscopy reveal an antral web, which is excised surgically . Vomiting involves the forceful expulsion of the contents of the stomach and is a highly coordinated, reflexive process. It is a feature of many acute and chronic disorders, including those causing increased intracranial pressure, metabolic diseases, and anatomic and mucosal GI abnormalities. Descent of the diaphragm and constriction of the abdominal musculature on relaxation of the gastric cardia force gastric contents back up the esophagus. The process is coordinated by the “vomiting center” in the central nervous system. The vomiting center receives sensory input from the vestibular nucleus (cranial nerve VIII), the GI tract …