- Email: [email protected]
70. CHARACTERISTICS OF US GRADUATING PEDIATRIC RESIDENTS BY GENDER, 2003-2018
TAGEDENe32
ABSTRACTS
BACKGROUND: Effective means of preparing interns for transition to residency remains elusive. Recent studies indicate program directors perceive new interns to be underprepared for residency. While intern orientation is ubiquitous, content can vary greatly and often does not assess trainee competence. OBJECTIVE: To determine the content of intern orientation across several pediatric residency programs and evaluate intern perceptions of the effectiveness of orientation. METHODS: This cross-sectional study included pediatric residency programs in the Mid-America region. A survey with questions regarding orientation activities including content, allotted time, format, and assessment was sent to 24 program directors. Current interns at these programs were surveyed regarding their perceptions of the effectiveness of activities completed during orientation. Descriptive statistics were used to analyze survey responses. RESULTS: Fifty-eight percent of program directors responded to the initial survey. Median time in orientation was 65.5 hours (range 30-120). Variation was noted across programs in content and format. Only 9 activities were represented among all survey participants. Additionally, 93 interns from 15 programs completed the intern survey. Approximately 80% of interns perceived the overall time spent in orientation was “just right”; however, 37% felt too little time was spent on orientation to intern roles, and 38% perceived that too little time was spent on review of clinical skills. Fifty-four percent of respondents felt electronic health record training was slightly or not at all effective. CONCLUSIONS: Pediatric intern orientation varied across the institutions surveyed and intern responses indicate that time on clinical skills and intern roles should be increased. This study is the first to characterize the activities included in pediatric orientation and their perceived value to interns. Next steps include expanding the study to additional pediatric programs and utilizing findings to help inform best practices for orientation and onboarding of pediatric residents. 69. A MILESTONE-BASED PEDIATRIC INTERN BOOT CAMP: AN EDUCATIONAL INTERVENTION TO MINIMIZE THE JULY EFFECT Ann Novosel, MD, Monica van de Ridder, PhD, Candace Smith-King, MD, Michael McLeod, MD, MBA, Justin Triemstra, MD, FAAP, Spectrum Health/Michigan State University/Helen DeVos Children’s Hospital, Grand Rapids, MI INTRO: The transition from student to intern is difficult and highlighted by performance missteps often referred to as the July Effect. Some pediatric institutions have implemented intern boot camps (IBC) to better prepare interns at the start of residency. Such pediatric boot camps described in the literature have not specifically targeted the ACGME/ABP Pediatric Milestones. We implemented an IBC that utilized these milestones to improve the interns’ confidence, knowledge, and skills. METHODS: 19 new interns participated in the IBC at the HDVCH/MSU Pediatric Residency Program. We used Kerns Six-Step Approach as a conceptual framework and targeted 3 levels of Kirkpatrick’s level of evaluation (reaction, learning, and behavior). A needs assessment from residents and faculty was used to identify specific milestones. We designed our IBC to include lectures, workshops and clinical experiences to target these milestones. A questionnaire containing 15-confidence (Likert Scale 1-5) and 10 knowledge-based questions was given before and after the IBC. The paired t-test was used to assess
ACADEMIC PEDIATRICS total confidence scores and pre/post knowledge measures. The sign test was used to compare individual confidence questions. Block 1 milestone evaluations were analyzed for pre-IBC (2016, 2017) and post-IBC interns (2018). Significance was assessed at p<0.05. RESULTS: Interns demonstrated a significant improvement in their overall confidence score (Pre: 47.7+/-4.1, Post: 58.6+/-5.3; p<0.001). All individual confidence questions showed increases. Interns demonstrated a significant improvement in perceived pediatric knowledge on the post-IBC test (Pre: 5.2+/-1.5, Post: 6.8+/-1.3; p=0.004). Block 1 evaluations from 7/2018 did not show improved evaluations when compared to pre-IBC cohorts. CONCLUSIONS: Incoming interns demonstrated a significant improvement in confidence and perceived knowledge of the targeted pediatric milestones after participating in the IBC. Our innovative approach of targeting pediatric milestones in an IBC suggests that such a targeted curriculum helps the difficult transition for interns.
TAGEDPEN
TAGEDFIUR
TAGEDEN
70. CHARACTERISTICS OF US GRADUATING PEDIATRIC RESIDENTS BY GENDER, 2003-2018 Daniel J. Schumacher, MD, MEd, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, William Cull, PhD, Blake Sisk, PhD, Mary Pat Frintner, MSPH, American Academy of Pediatrics, Itasca, IL BACKGROUND: Approximately three-quarters of pediatric residents are women. Yet, little is known about how women and men compare on family and financial characteristics and satisfaction with training. OBJECTIVE: Compare family characteristics, financial characteristics, and satisfaction of graduating pediatric residents by gender across time. METHODS: National, random samples of up to 1,000 graduating pediatric residents each year from 2003-2018; 58% completed the surveys (48-64% across years). Cross-sectional responses were pooled; chi-square tests and t-tests were used to examine the association of gender with a) family characteristics, b) financial characteristics, and c) satisfaction with residency training. Multivariable logistic regression models examined the independent effect of gender on married and have children (controlling for survey year and international medical school graduate-IMG), part-time job (controlling for year, IMG, married, and children), and satisfaction with training (controlling for year, IMG, married, children, program size and educational debt). Ordinary least squares regression models estimated the adjusted difference in graduates’ debt and starting salary between men and women. RESULTS: Overall, 74% of residents in the sample were women (consistent across survey years, p=.23). Women were
TAGEDENACADEMIC PEDIATRICS less likely than men to be married (69% vs 73%, p<.001) and have children (29% vs 38%, p<.001). They had higher educational debt (women: $162,645 vs men: $141,365, p<.001). Among residents starting primary care or hospitalist positions following residency, more women than men had part-time jobs (19% of women and 6% of men, p<.001), and full-time starting salaries were not significantly different ($147,369 vs $149,954, p=.08). Nearly all were satisfied with their training; 95% of women and 91% of men, p<.001. All bivariate relationships remained significant in multivariable models [Table]. CONCLUSION: Starting salaries for residents entering primary care or hospitalist positions do not vary by gender. Men and women do vary on several other dimensions, including that women report more educational debt than men.
TAGEDPEN
ABSTRACTS
e33
satisfaction with full-day continuity clinics (p<.01). Freeresponse comments highlighted the benefits of improved work balance, learning, and patient care, but also raised concerns about reduced inpatient coverage and having fewer overall days in clinic. CONCLUSION: Full-day continuity clinics improved perceptions of residents balance of inpatient and outpatient obligations, continuity of care, patient ownership, and overall clinic satisfaction.
TAGEDPEN
TAGEDFIUR
TAGEDFIUR
TAGEDEN TAGEDEN
71. FULL-DAY CONTINUITY CLINICS: RESIDENT AND ATTENDING PERSPECTIVES ON WORK BALANCE, PATIENT OWNERSHIP, AND CONTINUITY OF CARE Michelle E. Kiger, MD, Thomas M. Bertagnoli, DO, Erica Bautista, MD, Korre Fairman, MD, Caitlin Hammond, MD, Kara Dickey, DO, Wright State University, Dayton, OH, Sebastian Uijtdehaage, PhD, Ting Dong, PhD, Lara Varpio, PhD, Holly Meyer, PhD, Not Affiliated with Program/ Institution listed above, Bethesda, MD, Ann Burke, MD, Wright State University, Dayton, OH OBJECTIVE: Within residency programs, half-day continuity clinics can lead to difficulties transitioning between inpatient and outpatient obligations and achieving continuity of care. We examined resident and attending perceptions of a switch to fullday continuity clinics in order to determine its impact on work balance, continuity of care, patient ownership, and clinic satisfaction. METHODS: In January 2018, a pediatric residency program transitioned to full-day continuity clinics. From six to eight months after the transition, we administered a retrospective prepost implementation survey to gauge resident and attending perceptions of the change. Surveys included 20 matched pairs of 5point Likert-style questions for residents and 18 matched pairs for attendings, with two free-response questions asking for specific benefits or problems encountered. Survey responses pre vs. post-implementation were compared using two-tailed, paired ttests. RESULTS: 32/46 residents (70%) and 6/8 attendings (75%) completed the survey. Residents and attendings agreed that fullday continuity clinics made it easier for residents to balance inpatient and outpatient obligations (p<.01), huddle with care teams prior to clinic (p<.01), prepare for continuity lectures (p<.01), and pre-read on continuity patients (p<.01 residents; p=.03 attendings). Residents, but not attendings, reported fullday continuity clinics allowed them to personally respond to patient telephone communications and laboratory results, feel ownership over patient care, and schedule patient follow up visits more often (all p<.01). Residents reported higher overall
72. IMPROVING COMPLIANCE: PEDIATRIC RESIDENT ACCOUNTABILITY USING PEER PRESSURE Avni Bhatt, PhD, Daniel Castro, MD, Sydur Rahman, MD, Sony Kuruppacherry, Tammy Bleeker, MEd, Nicole Paradise Black, MD, MEd, University of Florida, Gainesville, FL University of Florida Pediatric Residency program developed peer groups, or collaborative professional communities (CPCs), to maintain compliance with mandatory tasks and improve overall resident wellness. Prior to 2017, residents were regularly reminded to complete mandatory tasks by the medical education staff. For the 2017-18 academic year, administrative pressure was replaced with peer pressure through the introduction of CPCs. CPCs meet for monthly educational events and compete for quarterly wellness prizes awarded to the CPC with the highest compliance in various work-related tasks. Pediatric residents were compared before and after the introduction of CPCs, corresponding to Post Graduate Year (PGY) 1,2 residents in the 201617 year and PGY 2,3 residents in 2017-18. Compliance was determined per resident for completion of 4 faculty evaluations per academic quarter and duty hour logging within 14 days. Yearly wellness data were collected by the Pediatric Residency Burnout Resilience Study Consortium (PRBRSC). The transition from administrative to peer pressure did not significantly change resident compliance with completion of quarterly faculty evaluations (Panel A). Though a reduction in duty hour logging compliance was observed, the decrease in compliance from 88% to 76% was not of practical significance (Panel B). Overall, residents reported no significant change in metrics of cognitive and effective mindfulness, resilience, perceived stress, spirituality, or physical and mental health. A reduction in burnout scores was reported for the PGY3 residents for the 2017-18 academic year (0%) compared to 2016-17 (31%). From these data, it would suggest that CPC activities have fostered team spirit that could improve resident well-being. Additionally, the transition to CPCs reduced the burden on staff to enforce compliance, anecdotally allowing for higher staff wellness. Peer pressure was determined to be sufficient for maintaining resident compliance and CPCs will continue to be utilized at our institution. Overall,
ABSTRACTS
BACKGROUND: Effective means of preparing interns for transition to residency remains elusive. Recent studies indicate program directors perceive new interns to be underprepared for residency. While intern orientation is ubiquitous, content can vary greatly and often does not assess trainee competence. OBJECTIVE: To determine the content of intern orientation across several pediatric residency programs and evaluate intern perceptions of the effectiveness of orientation. METHODS: This cross-sectional study included pediatric residency programs in the Mid-America region. A survey with questions regarding orientation activities including content, allotted time, format, and assessment was sent to 24 program directors. Current interns at these programs were surveyed regarding their perceptions of the effectiveness of activities completed during orientation. Descriptive statistics were used to analyze survey responses. RESULTS: Fifty-eight percent of program directors responded to the initial survey. Median time in orientation was 65.5 hours (range 30-120). Variation was noted across programs in content and format. Only 9 activities were represented among all survey participants. Additionally, 93 interns from 15 programs completed the intern survey. Approximately 80% of interns perceived the overall time spent in orientation was “just right”; however, 37% felt too little time was spent on orientation to intern roles, and 38% perceived that too little time was spent on review of clinical skills. Fifty-four percent of respondents felt electronic health record training was slightly or not at all effective. CONCLUSIONS: Pediatric intern orientation varied across the institutions surveyed and intern responses indicate that time on clinical skills and intern roles should be increased. This study is the first to characterize the activities included in pediatric orientation and their perceived value to interns. Next steps include expanding the study to additional pediatric programs and utilizing findings to help inform best practices for orientation and onboarding of pediatric residents. 69. A MILESTONE-BASED PEDIATRIC INTERN BOOT CAMP: AN EDUCATIONAL INTERVENTION TO MINIMIZE THE JULY EFFECT Ann Novosel, MD, Monica van de Ridder, PhD, Candace Smith-King, MD, Michael McLeod, MD, MBA, Justin Triemstra, MD, FAAP, Spectrum Health/Michigan State University/Helen DeVos Children’s Hospital, Grand Rapids, MI INTRO: The transition from student to intern is difficult and highlighted by performance missteps often referred to as the July Effect. Some pediatric institutions have implemented intern boot camps (IBC) to better prepare interns at the start of residency. Such pediatric boot camps described in the literature have not specifically targeted the ACGME/ABP Pediatric Milestones. We implemented an IBC that utilized these milestones to improve the interns’ confidence, knowledge, and skills. METHODS: 19 new interns participated in the IBC at the HDVCH/MSU Pediatric Residency Program. We used Kerns Six-Step Approach as a conceptual framework and targeted 3 levels of Kirkpatrick’s level of evaluation (reaction, learning, and behavior). A needs assessment from residents and faculty was used to identify specific milestones. We designed our IBC to include lectures, workshops and clinical experiences to target these milestones. A questionnaire containing 15-confidence (Likert Scale 1-5) and 10 knowledge-based questions was given before and after the IBC. The paired t-test was used to assess
ACADEMIC PEDIATRICS total confidence scores and pre/post knowledge measures. The sign test was used to compare individual confidence questions. Block 1 milestone evaluations were analyzed for pre-IBC (2016, 2017) and post-IBC interns (2018). Significance was assessed at p<0.05. RESULTS: Interns demonstrated a significant improvement in their overall confidence score (Pre: 47.7+/-4.1, Post: 58.6+/-5.3; p<0.001). All individual confidence questions showed increases. Interns demonstrated a significant improvement in perceived pediatric knowledge on the post-IBC test (Pre: 5.2+/-1.5, Post: 6.8+/-1.3; p=0.004). Block 1 evaluations from 7/2018 did not show improved evaluations when compared to pre-IBC cohorts. CONCLUSIONS: Incoming interns demonstrated a significant improvement in confidence and perceived knowledge of the targeted pediatric milestones after participating in the IBC. Our innovative approach of targeting pediatric milestones in an IBC suggests that such a targeted curriculum helps the difficult transition for interns.
TAGEDPEN
TAGEDFIUR
TAGEDEN
70. CHARACTERISTICS OF US GRADUATING PEDIATRIC RESIDENTS BY GENDER, 2003-2018 Daniel J. Schumacher, MD, MEd, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, William Cull, PhD, Blake Sisk, PhD, Mary Pat Frintner, MSPH, American Academy of Pediatrics, Itasca, IL BACKGROUND: Approximately three-quarters of pediatric residents are women. Yet, little is known about how women and men compare on family and financial characteristics and satisfaction with training. OBJECTIVE: Compare family characteristics, financial characteristics, and satisfaction of graduating pediatric residents by gender across time. METHODS: National, random samples of up to 1,000 graduating pediatric residents each year from 2003-2018; 58% completed the surveys (48-64% across years). Cross-sectional responses were pooled; chi-square tests and t-tests were used to examine the association of gender with a) family characteristics, b) financial characteristics, and c) satisfaction with residency training. Multivariable logistic regression models examined the independent effect of gender on married and have children (controlling for survey year and international medical school graduate-IMG), part-time job (controlling for year, IMG, married, and children), and satisfaction with training (controlling for year, IMG, married, children, program size and educational debt). Ordinary least squares regression models estimated the adjusted difference in graduates’ debt and starting salary between men and women. RESULTS: Overall, 74% of residents in the sample were women (consistent across survey years, p=.23). Women were
TAGEDENACADEMIC PEDIATRICS less likely than men to be married (69% vs 73%, p<.001) and have children (29% vs 38%, p<.001). They had higher educational debt (women: $162,645 vs men: $141,365, p<.001). Among residents starting primary care or hospitalist positions following residency, more women than men had part-time jobs (19% of women and 6% of men, p<.001), and full-time starting salaries were not significantly different ($147,369 vs $149,954, p=.08). Nearly all were satisfied with their training; 95% of women and 91% of men, p<.001. All bivariate relationships remained significant in multivariable models [Table]. CONCLUSION: Starting salaries for residents entering primary care or hospitalist positions do not vary by gender. Men and women do vary on several other dimensions, including that women report more educational debt than men.
TAGEDPEN
ABSTRACTS
e33
satisfaction with full-day continuity clinics (p<.01). Freeresponse comments highlighted the benefits of improved work balance, learning, and patient care, but also raised concerns about reduced inpatient coverage and having fewer overall days in clinic. CONCLUSION: Full-day continuity clinics improved perceptions of residents balance of inpatient and outpatient obligations, continuity of care, patient ownership, and overall clinic satisfaction.
TAGEDPEN
TAGEDFIUR
TAGEDFIUR
TAGEDEN TAGEDEN
71. FULL-DAY CONTINUITY CLINICS: RESIDENT AND ATTENDING PERSPECTIVES ON WORK BALANCE, PATIENT OWNERSHIP, AND CONTINUITY OF CARE Michelle E. Kiger, MD, Thomas M. Bertagnoli, DO, Erica Bautista, MD, Korre Fairman, MD, Caitlin Hammond, MD, Kara Dickey, DO, Wright State University, Dayton, OH, Sebastian Uijtdehaage, PhD, Ting Dong, PhD, Lara Varpio, PhD, Holly Meyer, PhD, Not Affiliated with Program/ Institution listed above, Bethesda, MD, Ann Burke, MD, Wright State University, Dayton, OH OBJECTIVE: Within residency programs, half-day continuity clinics can lead to difficulties transitioning between inpatient and outpatient obligations and achieving continuity of care. We examined resident and attending perceptions of a switch to fullday continuity clinics in order to determine its impact on work balance, continuity of care, patient ownership, and clinic satisfaction. METHODS: In January 2018, a pediatric residency program transitioned to full-day continuity clinics. From six to eight months after the transition, we administered a retrospective prepost implementation survey to gauge resident and attending perceptions of the change. Surveys included 20 matched pairs of 5point Likert-style questions for residents and 18 matched pairs for attendings, with two free-response questions asking for specific benefits or problems encountered. Survey responses pre vs. post-implementation were compared using two-tailed, paired ttests. RESULTS: 32/46 residents (70%) and 6/8 attendings (75%) completed the survey. Residents and attendings agreed that fullday continuity clinics made it easier for residents to balance inpatient and outpatient obligations (p<.01), huddle with care teams prior to clinic (p<.01), prepare for continuity lectures (p<.01), and pre-read on continuity patients (p<.01 residents; p=.03 attendings). Residents, but not attendings, reported fullday continuity clinics allowed them to personally respond to patient telephone communications and laboratory results, feel ownership over patient care, and schedule patient follow up visits more often (all p<.01). Residents reported higher overall
72. IMPROVING COMPLIANCE: PEDIATRIC RESIDENT ACCOUNTABILITY USING PEER PRESSURE Avni Bhatt, PhD, Daniel Castro, MD, Sydur Rahman, MD, Sony Kuruppacherry, Tammy Bleeker, MEd, Nicole Paradise Black, MD, MEd, University of Florida, Gainesville, FL University of Florida Pediatric Residency program developed peer groups, or collaborative professional communities (CPCs), to maintain compliance with mandatory tasks and improve overall resident wellness. Prior to 2017, residents were regularly reminded to complete mandatory tasks by the medical education staff. For the 2017-18 academic year, administrative pressure was replaced with peer pressure through the introduction of CPCs. CPCs meet for monthly educational events and compete for quarterly wellness prizes awarded to the CPC with the highest compliance in various work-related tasks. Pediatric residents were compared before and after the introduction of CPCs, corresponding to Post Graduate Year (PGY) 1,2 residents in the 201617 year and PGY 2,3 residents in 2017-18. Compliance was determined per resident for completion of 4 faculty evaluations per academic quarter and duty hour logging within 14 days. Yearly wellness data were collected by the Pediatric Residency Burnout Resilience Study Consortium (PRBRSC). The transition from administrative to peer pressure did not significantly change resident compliance with completion of quarterly faculty evaluations (Panel A). Though a reduction in duty hour logging compliance was observed, the decrease in compliance from 88% to 76% was not of practical significance (Panel B). Overall, residents reported no significant change in metrics of cognitive and effective mindfulness, resilience, perceived stress, spirituality, or physical and mental health. A reduction in burnout scores was reported for the PGY3 residents for the 2017-18 academic year (0%) compared to 2016-17 (31%). From these data, it would suggest that CPC activities have fostered team spirit that could improve resident well-being. Additionally, the transition to CPCs reduced the burden on staff to enforce compliance, anecdotally allowing for higher staff wellness. Peer pressure was determined to be sufficient for maintaining resident compliance and CPCs will continue to be utilized at our institution. Overall,