Robert Hilliard

How well do paediatric residency programmes prepare residents for clinical practice and their future careers

Context  Educators across Canada are presently discussing whether the current 4‐year residency programmes adequately prepare paediatricians for their future careers. Studies carried out in the USA have repeatedly shown areas of weakness in residency training, but there are no studies looking at the overall adequacy of training across Canada.

Needs Assessment in Postgraduate Medical Education:A Review

Abstract: Although the concept of needs assessment in continuing medical education is well accepted, there is limited information on needs assessment in postgraduate medical education. We discuss the learning needs of postgraduate trainees and review the various methods of needs assessment such as: questionnaire surveys, interviews, focus groups, chart audits, chart-stimulated recall, standardized patients, and environmental scans in the context of post graduate medical education.

Technical Skills in Paediatrics: A Qualitative Study of Acquisition, Attitudes and Assumptions in the Neonatal Intensive Care Unit

Purpose  While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting.

Experience of moral distress among pediatric surgery trainees

PURPOSE The aim of this study was to identify and qualify the ethical dilemmas faced by pediatric surgery trainees. METHODS An online survey was sent to pediatric surgery trainees graduating between 2005 and 2008. Consent was obtained, and study investigators were blinded to the identity of the respondents during data analysis. RESULTS Of the 40 respondents, only 59% felt they had received adequate training in bioethics to handle ethical issues pertaining to the care of critically ill children. Although 83% of respondents routinely participated in palliative care discussions, 30% of respondents desired to have more opportunities to discuss end-of-life issues with their staff. Moral conflicts were resolved through direct discussions with the medical staff, family, or friends. Despite the presence and awareness of institutional policies on ethical behavior, 58% of respondents did not believe that ethical conflicts were resolved as a result of these policies, whereas 31% of respondents felt that reporting of unethical conduct would result in personal reprisals. CONCLUSION Pediatric surgery trainees face ethical and moral conflicts, but some are fearful of reprisals if these concerns are reported. A neutral forum to raise such issues may facilitate open discussions and eventual resolution of these conflicts.

Measuring Educational Workload: A Pilot Study of Paper-based and PDA Tools

Background: Teaching is an important professional role for most faculty members in academic health sciences centres. Careful delineation of educational workload is needed to foster and reward teaching efforts, and to facilitate equitable allocation of resources. Aims: To promote recognition in teaching and facilitate equitable resource allocation, we developed, piloted, and qualitatively assessed a tool for delineating the educational workload of pediatric faculty in an academic health sciences centre. Methods: A prototype educational workload measurement tool was developed. Between 2002 and 2004, three successive phases of pilot implementation were conducted to (1) assess the face validity of the tool, (2) assess its feasibility, and (3) develop and assess the feasibility of a PDA (Personal Digital Assistant) version. Participants were interviewed regarding strengths, weaknesses, and barriers to completion. Data were analyzed for recurrent themes. Results: Faculty found that the tool was usable and represented a broad range of educational activities. The PDA format was easier to use and better received. Technical support would be imperative for long-term implementation. The greatest barriers to implementation were skepticism about the purpose of the tool and concerns that it would promote quantity over quality of teaching. Conclusion: We developed a usable tool to capture data on the diverse educational workload of pediatric faculty. PDA technology can be used to facilitate collection of workload data. Faculty skepticism is an important barrier that should be addressed in future work.

A Comparison of Canadian Pediatric Resident Career Plans in 1998 and 2006

OBJECTIVES. Studies of pediatric resident career plans and preferences help to forecast changes in the demographic profile and practice patterns of North American pediatricians, providing insights that can guide child health care and medical education policy making. With this study we aimed to compare 4 aspects of Canadian pediatric resident career plans in 1998 and 2006: (1) weekly work hours; (2) scope of practice; (3) professional activities; and (4) community size. METHODS. Canadian pediatric residents were invited to participate in a national cross-sectional survey to explore career plans and preferences in 1998 (mailing) and 2006 (on-line). RESULTS. Response rates were 69% in 1998 and 52% in 2006. In both survey years, the majority of respondents were female (69% and 73%, respectively). Overall, residents planned to work a similar number of weekly hours in both survey years (47.8 vs 48.8). Women planned to work significantly fewer hours than men; this gap was wider in 2006 than in 1998 (1998: 2.8 fewer hours; 2006: 7.8 fewer hours). After adjusted analysis, the association between proportion of time in primary care and study year became significant; however, time in consultant general or subspecialty pediatrics remained nonsignificantly changed. Residents planned to spend less time in clinical work in 2006 than 1998 (64.4% vs 58.1%), and more planned to work and reside in metropolitan areas (68% vs 78% of decided respondents). CONCLUSIONS. Between 1998 and 2006, there was no overall change in the number of hours that Canadian pediatric residents planned to work, but the gender gap widened because of an increase in planned weekly work hours among men. The results also suggest that new strategies may be needed to improve future pediatrician availability in small communities by addressing barriers to nonmetropolitan practice, especially for women.

Paediatric challenges in Sub-Saharan Africa

The United Nations Millennium Development Goals (MDGs) project is coming to an end in 2015 and is being replaced by ambitious and aspirational Sustainable Development Goals (SDGs). Although the MDGs have been nearly achieved, this is not true in Sub-Saharan Africa where there is still unnecessarily high infant and childhood mortality and where there are many challenges to providing modern child health care. To achieve the SDGs in the next fifteen years, in low-income countries, national ministries of health and community health leaders will need to set reasonable goals and quality improvement projects. Attention needs to paid to economical, evidence-based effective health care; to education of children and youth and of health professional; health promotion and prevention of illness; a balance between expensive health care in large urban hospitals and community health projects; and most importantly to the social determinants of health. But the SDGs are achievable with coordinated and sustained national commitments and increased financial commitments from Western countries.