Sharon M. Unti

Teaching pediatrics residents how to obtain informed consent.

Background Few physicians view informed consent as a critical component of the physician–patient relationship or as a way to improve individual and population health. We hypothesized that formal education about informed consent would affect first-year pediatrics residents’ knowledge and attitudes. Method Twenty-seven first-year pediatrics residents participated in a randomized controlled trial with a wait-list control group. The one-hour interactive intervention consisted of a lecture, video, and small-group discussion. Outcomes were measured after randomization at baseline and after the intervention group received the intervention. Data were analyzed using multivariate analysis and between and within group t tests. Qualitative data were obtained after the wait-list control group’s exposure to the intervention. Results The quantitative analyses demonstrated that the intervention yielded statistically significant improvements in the measured outcomes. The qualitative analyses confirm the quantitative findings. Conclusion A formal session on informed consent in the pediatrics residency educational program positively affects residents’ knowledge and attitudes about informed consent.

Research during residency training

This report describes the experience of one residency program in which completion of a research project is a requirement. Although the goals and structure of the requirement are very specific, residents are free to design and conduct any project of their choice that is original, ethical, and scientifically sound. Over the period of this requirement, more than 300 residents have completed a project. Since inauguration of new guidelines for this requirement in 1985, nearly one third of the projects has been published or presented at a regional or national meeting. The benefits of the requirement on resident education and career development are discussed.

The Critical First Year of Life: History, Physical Examination, and General Developmental Assessment

An effective communication style allows the pediatrician to implement optimal health care in a childs critical first year of life. During each encounter with the infant, the pediatrician should strive to elicit the best possible history and perform the best possible physical examination, to provide parents with timely anticipatory guidance, and to enrich the overall therapeutic health care alliance between himself or herself and the patient and family. The rewards for this effort can be exceptionally satisfying and can ideally be lifelong for both the patient and the pediatrician.

Epidemic Adolescent Binge Drinking at Lollapalooza, A Music Festival in Chicago

Supplemental digital content is available in the text. Objectives Lollapalooza (LP) is an annual 3-day outdoor music festival in Chicago. Underage drinking and drug use are believed to be common, but the burden on emergency departments (EDs) has not been documented. We assessed the burden on health care resources associated with this music festival. Methods We performed a retrospective chart review of adolescent (aged 11–20 years) ED visits during LP weekend and 4 summer comparison weekends at Lurie Children’s Hospital in Chicago, Ill, in 2014 (n = 356). We then analyzed adolescent alcohol- and drug-related hospital visits to all Chicago hospitals for each weekend in 2014 0 using Illinois hospital discharge data. Results Adolescents accounted for a greater proportion of our ED visits during LP weekend than comparison weekends (25% vs 19%, P < 0.02). Lollapalooza weekend patients were more likely female (P = 0.025), older (P = 0.0067), more often unsupervised (P < 0.0001), and less likely to live in the city (P < 0.001) than adolescents seen during comparison weekends. Thirty-one underage adolescents who attended LP were treated in our ED; 84% were intoxicated (blood alcohol content, 88–328 mg/dL). Citywide there was an 11-fold increase in adolescent alcohol-related hospital visits during LP weekend compared with an average weekend. Drug intoxication was much less common. Conclusions Adolescents seen in our ED the weekend of LP were older, more often female, frequently unsupervised, and less likely to be city residents than those seen during comparison weekends. Those who attended LP had high rates of alcohol intoxication. This surge of intoxicated adolescent patients affected numerous EDs in the city.

Critical care rotation impact on pediatric resident mental health and burnout

BackgroundBurnout and depression are common among medical trainees and intensive care unit providers, negatively impacting both providers and patients. We hypothesized that at the end of the pediatric intensive care unit (PICU) rotation, there would be an increased prevalence of depression and burnout in pediatric residents when compared to the beginning.MethodsPediatric residents were assessed prior to and following their PICU rotation using the Maslach Burnout Inventory, the Center for Epidemiologic Studies Depression Screen and a survey assessing positive and negative aspects of the rotation.ResultsSixty residents were eligible to participate and initial response rate was 40%. The prevalence of positive depression screen increased from 4% to 41% during the PICU rotation. Regarding burnout, the prevalence of residents meeting criteria for emotional exhaustion increased from 41% to 59% and depersonalization increased from 41% to 53%. Fewer residents had low personal accomplishment scores at the end of the rotation, 13% to 0%. Autonomy, procedural opportunities, and interactions with non-trainee PICU providers were commonly cited negative aspects of the rotation. Resident education, patient acuity, and nursing-integrated rounding were consistently rated positively.ConclusionCompared to the beginning, at the end of the PICU rotation there is a significantly higher prevalence of depression, emotional exhaustion, and depersonalization among pediatric residents. Pediatric residents may have a more favorable PICU experience if they feel involved in procedural aspects of patient care, are allowed more autonomy in decision making, and there is a continued focus on resident education and team-based care.