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2011 Duty Hour Regulations: Pediatric Resident Perspectives
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ABSTRACTS
specifically to evaluate the learners’ ability to formulate an early differential diagnosis, a clinical summary and a final, prioritized diagnosis(es) list. Three raters independently and blindly scored each clinical summary using the assessment tool. The best possible score was 12 (0-2 for each item). To enable longitudinal analysis, unique identifiers were assigned to each learner. Learners included residents (n¼25) and medical students (MS)(n¼13). Consent was obtained. A two-way random model Intraclass Correlation Coefficient (ICC) was used to assess inter-rater reliability. Independent samples t-tests were used to compare the scores across learning levels. RESULTS (FIRST EVALUATION ONLY): Thirty-eight written clinical summaries were included in analyses. The ICC indicated strong inter-rater reliability (ICC ¼ .72). The clinical reasoning tool distinguished between levels of learner (concurrent validity). The resident scores (M¼7.6 SD¼2.12) were higher than MS (M¼4.28 SD¼1.84), p<.001. Scores for PL3s (M¼9.33 SD¼1.08) were higher than PL1s (M¼6.16, SD¼1.12), p<.001. CONCLUSION: Clinical reasoning can be evaluated quantitatively and reliably using this tool. 3. 2011 DUTY HOUR REGULATIONS: PEDIATRIC RESIDENT PERSPECTIVES Sarah B. Whittle, MD, Pediatric Fellow, Texas Children’s Hospital/Baylor U, Houston, Texas, Brian C. Drolet, MD, Resident, Dept. of Plastic Surgery, Rhode Island Hospital, Staci A. Fischer, MD, DIO/Rhode Island Hospital, Adam Pallant, MD, PhD, Pediatric Residency Director, Hasbro Children’s Hospital, Providence, RI METHODS: Designated Institutional Officials at all 682 ACGME-accredited institutions were contacted and asked to distribute an anonymous, electronic survey to all residents at each sponsoring institution. The survey was administered to 1709 pediatric residents at 47 institutions between December 2011 and February 2012. RESULTS: A large, demographically representative sample of residents (n¼590) was identified as training in pediatrics. A majority of residents reported no improvements in patient safety (53.2%) and availability of supervision (77.9%), while most felt that work schedules (55.3%) and preparation for senior roles (57.9%) are worse. Quality of life for interns was generally reported as improved (52.9%), while quality of life of senior residents seems to be worse (57.4%). A majority of residents report increased handoffs (84.7%) and a shift of junior responsibilities to senior residents (72.7%). Finally, a majority (59.7%) of residents report work-hour noncompliance, and nearly 40% report both duty hour falsification and 80-hour work week overage. CONCLUSIONS: Overall, pediatric residents disapprove of the 2011 ACGME duty hour regulations (57.1%). Some consequences of these regulations appear to be a shift of intern responsibility to senior residents, as well as a decreased level of preparedness for more senior roles. Furthermore, patient safety, availability of supervision and resident quality of life seem to be unimproved or worse. Finally, noncompliance and violation of duty hours regulations appear to be prevalent issues. What this study adds: This is the first study to evaluate the perceived impact of new 2011 ACGME regulations on resident education and quality of life, as well as safety and quality of patient care. 4. LONGITUDINAL SUBSPECIALTY CLINICS IN A RESIDENCY PROGRAM Stephen Barone, MD, Steven and Alexander Cohen Children’s Medical, New Hyde Park, New York
ACADEMIC PEDIATRICS BACKGROUND: The 2013 RRC guidelines allow residents the option to switch from a ½ day general pediatric clinic to a ½ day subspecialty clinic during their PGY3 year. Many program directors are concerned about this potential decrease in general pediatric ambulatory experience. At CCMC, residents during their PGY2 & PGY3 year are assigned to a full day longitudinal ambulatory experience. This is divided between a ½ day general pediatric clinic and a ½ day subspecialty clinic of their choice. METHODS: A survey was conducted via Survey Monkey, in 2012, of residents who graduated between the years 2006-12 to evaluate their attitudes towards this ambulatory curriculum. RESULTS: 179 residents responded to the query. 79% of residents elected to participate in an additional ½ day subspecialty clinic and 21% elected a full day general pediatric clinic. When they selected their clinic 35% of PGY2 residents were sure of their future goals, and 38% rated them as probable. After one year in the subspecialty clinic 52% of residents were sure of their career goals and 11% had changed their goals. 23% of residents switched their clinics between their PGY2 & PGY3 year. 64% of residents pursued a fellowship in field of their PGY3 clinic. 33% of residents did not pursue a particular subspecialty because of an unfavorable opinion of the field after their clinic experience. 69% of residents felt their specialty clinic training had an extremely or very important effect on their decision to pursue subspecialty training. 24% of residents would have not chosen their subspecialty if it was not for the clinic. 20% of residents felt they would have made a wrong decision in regards to a career choice if a clinic was not offered. Given the choice between a ½ day general pediatric clinic for three years with an additional ½ day subspecialty clinic for two years vs. a ½ day general pediatric clinic for 2 years followed by a ½ day subspecialty clinic in their PGY3 year, 79% of residents choose the former. CONCLUSIONS: A two year ½ per week subspecialty clinic, in a resident’s field of choice, aids them in making a correct career choice. 5. ASSESSING THE EFFICACY OF PEDIATRIC INTERN HAND-OFF TRAINING Dana W. Ramirez, MD, Children’s Hospital of the King’s Daughters, Rebecca C. Britt, MD, Eastern Virginia Medical School, Mark W. Scerbo, PHD, Brittany Anderson-Montoya, Old Dominion University, Norfolk, Virginia INTRODUCTION: In 2003, the ACGME restricted resident work hours to 80 per week, significantly increasing patient hand-offs, many of which contribute to care failures. The ACGME now requires residents to be competent in handing over patients. The current study evaluated a method for training and assessing hand-offs based on a combination of formalized education and a checklist of key information to be relayed. METHODS: Twenty-two pediatric interns were randomized into trained and untrained groups. The trained group received curriculum and the checklist. The untrained group served as the control. All interns participated in three standardized patient ED encounters and were required to hand off the patients to a standardized resident. Next, they read four written inpatient scenarios and performed a second hand-off to a standardized resident. All hand-offs were videotaped and scored by two blind raters using a 5-point Likert scale addressing six areas: organization, economy, confidence, order of presentation, seeks comprehension, professionalism. RESULTS: The ratings were summed across the scales to obtain an overall hand-off score (lower scores reflect better
ABSTRACTS
specifically to evaluate the learners’ ability to formulate an early differential diagnosis, a clinical summary and a final, prioritized diagnosis(es) list. Three raters independently and blindly scored each clinical summary using the assessment tool. The best possible score was 12 (0-2 for each item). To enable longitudinal analysis, unique identifiers were assigned to each learner. Learners included residents (n¼25) and medical students (MS)(n¼13). Consent was obtained. A two-way random model Intraclass Correlation Coefficient (ICC) was used to assess inter-rater reliability. Independent samples t-tests were used to compare the scores across learning levels. RESULTS (FIRST EVALUATION ONLY): Thirty-eight written clinical summaries were included in analyses. The ICC indicated strong inter-rater reliability (ICC ¼ .72). The clinical reasoning tool distinguished between levels of learner (concurrent validity). The resident scores (M¼7.6 SD¼2.12) were higher than MS (M¼4.28 SD¼1.84), p<.001. Scores for PL3s (M¼9.33 SD¼1.08) were higher than PL1s (M¼6.16, SD¼1.12), p<.001. CONCLUSION: Clinical reasoning can be evaluated quantitatively and reliably using this tool. 3. 2011 DUTY HOUR REGULATIONS: PEDIATRIC RESIDENT PERSPECTIVES Sarah B. Whittle, MD, Pediatric Fellow, Texas Children’s Hospital/Baylor U, Houston, Texas, Brian C. Drolet, MD, Resident, Dept. of Plastic Surgery, Rhode Island Hospital, Staci A. Fischer, MD, DIO/Rhode Island Hospital, Adam Pallant, MD, PhD, Pediatric Residency Director, Hasbro Children’s Hospital, Providence, RI METHODS: Designated Institutional Officials at all 682 ACGME-accredited institutions were contacted and asked to distribute an anonymous, electronic survey to all residents at each sponsoring institution. The survey was administered to 1709 pediatric residents at 47 institutions between December 2011 and February 2012. RESULTS: A large, demographically representative sample of residents (n¼590) was identified as training in pediatrics. A majority of residents reported no improvements in patient safety (53.2%) and availability of supervision (77.9%), while most felt that work schedules (55.3%) and preparation for senior roles (57.9%) are worse. Quality of life for interns was generally reported as improved (52.9%), while quality of life of senior residents seems to be worse (57.4%). A majority of residents report increased handoffs (84.7%) and a shift of junior responsibilities to senior residents (72.7%). Finally, a majority (59.7%) of residents report work-hour noncompliance, and nearly 40% report both duty hour falsification and 80-hour work week overage. CONCLUSIONS: Overall, pediatric residents disapprove of the 2011 ACGME duty hour regulations (57.1%). Some consequences of these regulations appear to be a shift of intern responsibility to senior residents, as well as a decreased level of preparedness for more senior roles. Furthermore, patient safety, availability of supervision and resident quality of life seem to be unimproved or worse. Finally, noncompliance and violation of duty hours regulations appear to be prevalent issues. What this study adds: This is the first study to evaluate the perceived impact of new 2011 ACGME regulations on resident education and quality of life, as well as safety and quality of patient care. 4. LONGITUDINAL SUBSPECIALTY CLINICS IN A RESIDENCY PROGRAM Stephen Barone, MD, Steven and Alexander Cohen Children’s Medical, New Hyde Park, New York
ACADEMIC PEDIATRICS BACKGROUND: The 2013 RRC guidelines allow residents the option to switch from a ½ day general pediatric clinic to a ½ day subspecialty clinic during their PGY3 year. Many program directors are concerned about this potential decrease in general pediatric ambulatory experience. At CCMC, residents during their PGY2 & PGY3 year are assigned to a full day longitudinal ambulatory experience. This is divided between a ½ day general pediatric clinic and a ½ day subspecialty clinic of their choice. METHODS: A survey was conducted via Survey Monkey, in 2012, of residents who graduated between the years 2006-12 to evaluate their attitudes towards this ambulatory curriculum. RESULTS: 179 residents responded to the query. 79% of residents elected to participate in an additional ½ day subspecialty clinic and 21% elected a full day general pediatric clinic. When they selected their clinic 35% of PGY2 residents were sure of their future goals, and 38% rated them as probable. After one year in the subspecialty clinic 52% of residents were sure of their career goals and 11% had changed their goals. 23% of residents switched their clinics between their PGY2 & PGY3 year. 64% of residents pursued a fellowship in field of their PGY3 clinic. 33% of residents did not pursue a particular subspecialty because of an unfavorable opinion of the field after their clinic experience. 69% of residents felt their specialty clinic training had an extremely or very important effect on their decision to pursue subspecialty training. 24% of residents would have not chosen their subspecialty if it was not for the clinic. 20% of residents felt they would have made a wrong decision in regards to a career choice if a clinic was not offered. Given the choice between a ½ day general pediatric clinic for three years with an additional ½ day subspecialty clinic for two years vs. a ½ day general pediatric clinic for 2 years followed by a ½ day subspecialty clinic in their PGY3 year, 79% of residents choose the former. CONCLUSIONS: A two year ½ per week subspecialty clinic, in a resident’s field of choice, aids them in making a correct career choice. 5. ASSESSING THE EFFICACY OF PEDIATRIC INTERN HAND-OFF TRAINING Dana W. Ramirez, MD, Children’s Hospital of the King’s Daughters, Rebecca C. Britt, MD, Eastern Virginia Medical School, Mark W. Scerbo, PHD, Brittany Anderson-Montoya, Old Dominion University, Norfolk, Virginia INTRODUCTION: In 2003, the ACGME restricted resident work hours to 80 per week, significantly increasing patient hand-offs, many of which contribute to care failures. The ACGME now requires residents to be competent in handing over patients. The current study evaluated a method for training and assessing hand-offs based on a combination of formalized education and a checklist of key information to be relayed. METHODS: Twenty-two pediatric interns were randomized into trained and untrained groups. The trained group received curriculum and the checklist. The untrained group served as the control. All interns participated in three standardized patient ED encounters and were required to hand off the patients to a standardized resident. Next, they read four written inpatient scenarios and performed a second hand-off to a standardized resident. All hand-offs were videotaped and scored by two blind raters using a 5-point Likert scale addressing six areas: organization, economy, confidence, order of presentation, seeks comprehension, professionalism. RESULTS: The ratings were summed across the scales to obtain an overall hand-off score (lower scores reflect better