Lewis R. First

The Infant or Young Child with Developmental Delay

The practitioner should attempt to identify the infant and young child with developmental delay as early as possible, so that appropriate services can be provided. Ongoing surveillance is required, rather than one-time screening. The practitioner should also serve as an advocate for children with developmental delay. He or she should ensure that appropriate services exist within the childs community and that they are readily accessible. This requires ongoing communication not only with the child and the family, but also with schools and community agencies.

What did we learn about the impact on community-based faculty? Recommendations for recruitment, retention, and rewards.

All ten schools participating in the Interdisciplinary Generalist Curriculum (IGC) Project were required to offer students significant generalist longitudinal preceptorship experiences during the first two years of medical school. Each school needed to recruit and then retain many new preceptors to meet the continued large demand. Effective recruitment was usually carried out by established community physicians and/or qualified staff coordinators. Retention of preceptors required establishing regular and succinct communications, quick response to problems, and flexible faculty development programs. For rewards, preceptors primarily requested acknowledgment and appreciation, along with tangible rewards such as decreased fees for continuing medical education and library or e-mail access. Preceptors continue to state that they teach because of the “joys of teaching” even in the current environment with increased demands for productivity. This article describes what has been learned about recruitment, retention, and rewards for community preceptors and how to maximize the positive impacts and minimize the negative impacts of teaching for community preceptors.

Linking Process to Outcome: Are We Training Pediatricians to Meet Evolving Health Care Needs?

The Residency Review and Redesign in Pediatrics (R3P) Project began in 2005 and will have been completed in 2009. The purpose was to conduct a comprehensive reassessment of general pediatric residency education. The project convened 3 major colloquia supplemented by numerous meetings of an R3P committee and by surveys of residents, subspecialty fellows, and generalist and subspecialty practitioners. A principal conclusion was that resident learning opportunities should be more flexibly directed toward the variety of career choices available to pediatricians. Another conclusion was that reasonable expectations for residency education are most likely if learning is regarded as an integrated continuum, beginning in medical school and continuing throughout a career in practice. The R3P Committee declined to create a list of recommendations for immediate changes in residency education; instead, it recommends that changes be based on evidence of education outcomes that are important to improving the health of children, adolescents, and young adults.

Report of Colloquium III: Challenges for Pediatric Graduate Medical Education and How to Meet Them—A Quality Improvement Approach to Innovation in Pediatric Graduate Medical Education

Participants of the third colloquium of the Residency Review and Redesign in Pediatrics (R3P) Project concluded that pediatricians who practice ambulatory, hospital-based, a combination of ambulatory and hospital-based, and subspecialty pediatrics are sufficiently different to justify differences in general pediatric residency training. This conclusion along with others of previous colloquia led to the creation of a list of goals for innovative change in residency education and a draft of a quality improvement process by which they might be achieved.

A New Framework for Quality Partnerships in Children's Hospitals

Childrens hospitals and their affiliated departments of pediatrics often pursue separate programs in quality and safety; by integrating these programs, they can accelerate progress. Hospital executives and pediatric department chairs from 14 childrens hospitals have been exploring practical approaches for integrating quality programs. Three components provide focus: (1) alignment of quality priorities and resources across the organizations; (2) education and training for physicians in the science of improvement; and (3) professional development and career progression for physicians in recognition of quality-improvement activities. Process and resource requirements are identified for each component, and specific, actionable steps are identified. The action steps are arrayed on a continuum from basic to advanced integration. The resulting matrix serves as an “integration framework,” useful to a hospital and its pediatric academic department at any stage of integration for assessing its current state, plotting a path toward further integration, tracking its progress, and identifying potential collaborators and models of advanced integration. The framework contributes to health cares quality-improvement movement in multiple ways: it addresses a basic impediment to quality and safety improvement; it is an implementable model for integrating quality programs; it offers career-advancement potential for physicians interested in quality; it helps optimize investments in quality and safety; and it can be applied both within a single childrens hospital and across multiple childrens hospitals. Widespread adoption of the integration framework could have a transformative effect on the childrens hospital sector, not the least of which is improved quality and safety on a large scale.

Strategies to Design an Effective Mentoring Program

From the Penn State College of Medicine, Department of Pediatrics, Penn State Children’s Hospital, Hershey, PA (M.G.); the Department of Pediatrics, University of Pennsylvania School of Medicine, Children’s Hospital of Pennsylvania, Philadelphia, PA (S.L.); the Department of Pediatrics, University of Florida College of Medicine – Jacksonville, Jacksonville, FL (E.Z.); and the Department of Pediatrics, University of Vermont College of Medicine and Vermont Children’s Hospital at Fletcher Allen Health Care, Burlington, VT (L.F.)

The Gateway to Journal Improvements

* Abbreviation: AAP — : American Academy of Pediatrics A year ago we heralded the start of a new Congress and the 65th anniversary of Pediatrics with an enormous amount of optimism for continued improvement in health care reform and care for children and families. Although many would question our optimism regarding the work of our federal government as it ground to a halt for a few weeks last fall, we hope no one would say the same is true for our journal. Not only did we initiate a number of changes in our publication last year—we are again implementing some changes this upcoming year as part of our process of ongoing quality improvement to make our journal as responsive to the needs of our readers and the children and families who benefit from what we publish every month. As we look toward 2014, our Editorial Board and Managing Editorial Staff wish to share with you what you can expect in terms of those additional changes that should get you excited not just about the journal, but about the field of pediatrics and where it’s going. The number of American Academy of Pediatrics (AAP) members using mobile devices to discover and read scholarly articles is growing rapidly. In fact, 60% of our readers are now using a tablet … Address correspondence to Lewis R. First, MD, MS, Editor-in-Chief, Pediatrics Editorial Office, University of Vermont College of Medicine, 89 Beaumont Ave, Given Courtyard S250, Burlington, VT 05405. E-mail: lewis.first{at}uvm.edu

Quality, Cost, and Value of Clinical Skills Assessment

The introduction of the Step 2 Clinical Skills program to the United States Medical Licensing Examination was a vital step in assuring that physicians seeking a license to practice medicine in this country demonstrate the patient-centered skills that are essential to practice.

Introducing Quality Reports

Nearly a decade has passed since the Institute of Medicine released its landmark report Crossing the Quality Chasm ,1 which called for a redesign of the health care system to deliver care that is safe, effective, patient-centered, timely, efficient, and equitable. The importance of engaging in this process is underscored by the requirement that pediatricians now participate in quality-improvement activities to maintain board certification. Unfortunately, opportunities to share the results of well-designed quality-improvement projects, regardless of their success, have been limited. This is a critical missed opportunity for spreading innovation. Recognizing this need, this month we introduce a new section in Pediatrics , Quality Reports, under the direction of assistant editor Alex Kemper, MD; this section will feature reports of the implementation and outcomes of quality-improvement projects. In addition to providing insight about improving care delivery, we hope that these reports … Address correspondence to Alex R. Kemper, MD, MPH, MS, Department of Pediatrics, Duke University, 2400 Pratt St, Room 0311 Terrace Level, Durham, NC 27705. E-mail: alex.kemper{at}duke.edu

Editorial Transitions: Continuing to Build on the Strong Foundation of Our Predecessors

This month marks the 61st anniversary of the inaugural issue of Pediatrics and, with it, a change in editorial leadership as the two of us (Drs First and Moyer) assume the roles of editor and deputy editor, respectively. We are amazed that only 4 editors have preceded us over the past 6 decades: Hugh McCullough (1948–1954), Charles D. May (1955–1961), Clement Smith (1962–1973), and, with the longest tenure of any peer-reviewed journal editor in this country, Jerold F. Lucey (1974–2008). Each of these 4 individuals brought new features and innovation to the journal—but always with the purpose of making sure that the information contained within was of great relevance to the members of the American Academy of Pediatrics (AAP). Dr Lucey in particular introduced commentaries and articles that went from the bench to the bedside and into the community; he also introduced the foreign-language editions and the online version of the journal to reach out to pediatricians all over the world and enable international pediatricians to share more of their research discoveries with us. During his … Address correspondence to Lewis R. First, MD, MS, University of Vermont College of Medicine, Department of Pediatrics, 89 Beaumont Ave, Burlington, VT 05405. E-mail: lewis.first{at}uvm.edu