- Email: [email protected]
Advances in Scholarship in Pediatric Education
Advances in Scholarship in Pediatric Education James M. Perrin, MD methods would miss, and builds on other recent studies of the continuity experience.4,5 The study indicates that preceptors more aware of their role modeling did a better job of it, and the results indicate how much residents valued and recognized this teaching task. Methods such as those pioneered by Balmer et al. should help a great deal in understanding critical elements of the educational process and developing new ways to strengthen the continuity experience for residents. Adler and colleagues from Northwestern worked on the development of measures to assess resident competencies, an interest high on the agenda of accrediting bodies. Their work created four pediatric simulation cases in a careful and systematic way – relating to apnea, asthma, supraventricular tachycardia, and sepsis.6 This study helps to develop new, reliable, and relatively inexpensive means to assess competency – it too builds on previous work in other methods of simulation.7 Changes in faculty time commitments among other reasons call for better and reliable methods of evaluation that do not require major time commitments such as direct clinical observation. Brooks et al. from Boston Medical Center similarly looked at the reliability of ways to determine medical student competency – here using tobacco counseling in pediatric practice as the study example.8 Rather than develop simulation methods, these investigators examined the relationship between student self-report and direct observation by trained research assistants. Although certainly not achieving 100% correlations, these methods showed adequate comparability to encourage the use of much less expensive self-report in future medical student assessment. McCaskill and colleagues from the University of Florida at Jacksonville examined (in one institution only) how medical student scores on the United States Medical Licensing Examination (USMLE) correlate with later scores on the American Board of Pediatrics certifying examination.9 Increasingly, pediatric educational scholarship should address whether training experiences affect longer term outcomes – such as residency performance or competence in later clinical practice. This study provides only limited information about these relationships, but it does offer some direction for additional research – hopefully including multiple institutions and examining learning experiences in more depth – that can provide links to future performance. These papers and previous publications in this journal suggest that educational scholarship is alive and well in pediatrics. These papers particularly address new ways to assess educational experiences and link them to performance. Research in pediatric education takes a good deal
Ambulatory Pediatrics 2007;7:145–146
Medical education attracts many talented clinicians and teachers who invest substantial parts of their careers to improving the education of medical students and young physicians. Having developed well beyond the notion of the “born teacher” to the recognition that even excellent teachers need to develop and refine their skills and that the process of medical education requires ways to assure quality in education and appropriate outcomes, medical education has drawn imaginative scholarship in methods of assessment and improving critical outcomes. Pediatrics has particularly attracted a large number of excellent teachers with much interest in understanding and improving the educational experience of students and residents. New organizations, such as the Federation of Pediatric Organizations, in concert with the American Board of Pediatrics and the American Academy of Pediatrics, provide much direction in innovative ways to assure quality of pediatric care and the education leading up to that care. The Ambulatory Pediatric Association (APA) has long provided leadership in these efforts, with its emphases on pediatric scholarship, the development of curricula in pediatric education, and the several efforts to improve faculty development in systematic ways. Highlights among the many APA efforts include the work of the large team led by Diane Kittredge to develop the APA Educational Guidelines for Pediatric Residency1 and the work begun and fully developed under Lucy Osborn’s direction in faculty development (see the supplement to Ambulatory Pediatrics in January-February 20042). Indeed the journal has published over 30 manuscripts related to faculty development since 2000. This work of course continues and expands, especially through the guidance of the APA Education Committee. This issue of Ambulatory Pediatrics includes four papers that expand knowledge in pediatric education and represent new thinking and evaluation strategies. Dorene Balmer, with her colleagues at the University of Pennsylvania, carried out an imaginative qualitative and observational study examining role modeling in pediatric continuity clinics and how the experience with practicing clinicians affects the development of practice skills among pediatric residents.3 This study uses careful and appropriate qualitative methods to address a number of issues in pediatric education that more traditional quantitative
Editor in Chief, Ambulatory Pediatrics, 50 Staniford Street, #901, Boston, MA 02114 (e-mail address: [email protected]).
AMBULATORY PEDIATRICS Copyright © 2007 by Ambulatory Pediatric Association
145
Volume 7, Number 2 March–April 2007
146
Perspectives
of imagination, involvement of multiple disciplines in design and implementation, and development of new methods. Richmond and Fein, in a recent overview of the past half century or more of change in medical care, note the resilience of medical education, in the context of limited funding to support innovation and research.10 They note, appropriately for pediatrics, that despite the limited funding base, medical education has long attracted committed clinician educators and that the “self-conscious concern that medical school faculty members exhibit about the quality of medical education generates tensions that on the whole have had a favorable effect (page 206).” The papers in this issue and other recent work in this journal document well the work of committed educators to continued improvement in the educational experience.
AMBULATORY PEDIATRICS
4.
5.
6.
7.
8.
REFERENCES 1. http://www.ambpeds.org/site/education/education_guidelines.htm (accessed February 9, 2007). 2. Osborn LM, Roberts KB, Greenberg L, DeWitt T, Devries JM, Wilson M, Simpson DE. The APA/HRSA Faculty Development Scholars Program: Introduction to the Supplement. Ambul Pediatr. 2004;4:83– 87. 3. Balmer D, Serwint JR, Ruzek SB, Ludwig S, Giardino AP. Learning
9.
10.
Behind the Scenes: Role Modeling in Pediatric Residents’ Continuity Experience. Ambul Pediatr. 2007;7: this issue. [UPDATE] Serwint JR, Feigelman S, Dumont-Driscoll M, Collins R, Zhan M, Kittredge D. Factors Associated With Resident Satisfaction With Their Continuity Experience. Ambul Pediatr. 2004;4:4 –10. Feigelman S, Olsson J, Drutz J, Dungy CI, Lopreiato J, Serwint JR. Changes in Pediatric Residents’ Perceptions of Their Continuity Experience During Their Training: A National Study. Ambul Pediatr. 2005;5:221–227. Adler MD, Trainor JL, Siddall VJ, McGaghie WC. Development and Evaluation of High-Fidelity Simulation Case Scenarios for Pediatric Resident Education. Ambul Pediatr. 2007;7: this issue [UPDATE] Bergus G, Kreiter C, Woodhead J, Lawrence J, Franklin E. Using Infant Mannequins in Objective Standardized Clinical Examinations: Are There Unintended Consequences? Ambul Pediatr. 2006;6:235–238. Brooks KR, Siegel B, Lash TL, Geller AC, Fitzgerald A, Tracy C, Prout MN. Validating medical students’ self-report of smokingrelated communication skills and educational experiences. Ambul Pediatr. 2007;7:this issue [UPDATE] McCaskill QE, Kirk JJ, Barata DM, Wludyka PS, Zenni EA, Chiu TT. USMLE Step 1 Scores as a Significant Predictor of Future Board Passage in Pediatrics. Ambul Pediatr. 2007;7:this issue [UPDATE] Richmond JB, Fein R. The Health Care Mess. Harvard University Press, Cambridge MA, 2005
Perspectives: A New Section in Ambulatory Pediatrics Ambulatory Pediatrics is delighted to announce a new section on Perspectives, providing new and organized reviews in areas of importance in academic general pediatrics. And we are particularly pleased to announce that Elena Fuentes-Afflick, MD, MPH, professor of pediatrics and epidemiology at the University of California, San Francisco, will edit this new section. A brief description of Perspectives follows. As noted, these manuscripts will generally be up to 4500 to 5000 words, longer than the usual limit for a research manuscript. In most cases, the journal will solicit these perspectives, although authors wishing to propose one may contact the journal directly ([email protected]). Submissions for the Perspectives section will go through the usual journal submission Web site (http://ees.elsevier.com/ambpediatr). The Perspectives section will focus on reviews of important pediatric topics, with an emphasis on assessing research findings in the previous 5 years and identifying areas for future study. The Perspectives editor will solicit most articles, with advice regarding topics and potential authors from other members of the senior editorial group.
Authors will generally be respected authorities in the area and may include a fellow or junior faculty member as a coauthor. The manuscripts would be about 20 pages long—not as comprehensive as a Cochrane-type systematic review, but including (as noted above) an overview of key questions and recent important research in a field, indicating the recent advances in the underlying science, and ending with some vision of the key needed research or policy in the next few years. Where appropriate, Perspectives should also discuss implications for pediatric education and practice. We will work with authors as needed and encourage an annotated outline of the commentary as an intermediate step. All Perspectives manuscripts will be peer reviewed. The journal will also continue to publish brief commentaries— quick, topical pieces about what’s happening in the world, important reports in other forums (eg, an IOM report), or responses about a research article in the journal. These differ from reviews by being briefer and more focused on specific topics or questions. Generally, the editor in chief solicits these brief commentaries.
Ambulatory Pediatrics 2007;7:145–146
Medical education attracts many talented clinicians and teachers who invest substantial parts of their careers to improving the education of medical students and young physicians. Having developed well beyond the notion of the “born teacher” to the recognition that even excellent teachers need to develop and refine their skills and that the process of medical education requires ways to assure quality in education and appropriate outcomes, medical education has drawn imaginative scholarship in methods of assessment and improving critical outcomes. Pediatrics has particularly attracted a large number of excellent teachers with much interest in understanding and improving the educational experience of students and residents. New organizations, such as the Federation of Pediatric Organizations, in concert with the American Board of Pediatrics and the American Academy of Pediatrics, provide much direction in innovative ways to assure quality of pediatric care and the education leading up to that care. The Ambulatory Pediatric Association (APA) has long provided leadership in these efforts, with its emphases on pediatric scholarship, the development of curricula in pediatric education, and the several efforts to improve faculty development in systematic ways. Highlights among the many APA efforts include the work of the large team led by Diane Kittredge to develop the APA Educational Guidelines for Pediatric Residency1 and the work begun and fully developed under Lucy Osborn’s direction in faculty development (see the supplement to Ambulatory Pediatrics in January-February 20042). Indeed the journal has published over 30 manuscripts related to faculty development since 2000. This work of course continues and expands, especially through the guidance of the APA Education Committee. This issue of Ambulatory Pediatrics includes four papers that expand knowledge in pediatric education and represent new thinking and evaluation strategies. Dorene Balmer, with her colleagues at the University of Pennsylvania, carried out an imaginative qualitative and observational study examining role modeling in pediatric continuity clinics and how the experience with practicing clinicians affects the development of practice skills among pediatric residents.3 This study uses careful and appropriate qualitative methods to address a number of issues in pediatric education that more traditional quantitative
Editor in Chief, Ambulatory Pediatrics, 50 Staniford Street, #901, Boston, MA 02114 (e-mail address: [email protected]).
AMBULATORY PEDIATRICS Copyright © 2007 by Ambulatory Pediatric Association
145
Volume 7, Number 2 March–April 2007
146
Perspectives
of imagination, involvement of multiple disciplines in design and implementation, and development of new methods. Richmond and Fein, in a recent overview of the past half century or more of change in medical care, note the resilience of medical education, in the context of limited funding to support innovation and research.10 They note, appropriately for pediatrics, that despite the limited funding base, medical education has long attracted committed clinician educators and that the “self-conscious concern that medical school faculty members exhibit about the quality of medical education generates tensions that on the whole have had a favorable effect (page 206).” The papers in this issue and other recent work in this journal document well the work of committed educators to continued improvement in the educational experience.
AMBULATORY PEDIATRICS
4.
5.
6.
7.
8.
REFERENCES 1. http://www.ambpeds.org/site/education/education_guidelines.htm (accessed February 9, 2007). 2. Osborn LM, Roberts KB, Greenberg L, DeWitt T, Devries JM, Wilson M, Simpson DE. The APA/HRSA Faculty Development Scholars Program: Introduction to the Supplement. Ambul Pediatr. 2004;4:83– 87. 3. Balmer D, Serwint JR, Ruzek SB, Ludwig S, Giardino AP. Learning
9.
10.
Behind the Scenes: Role Modeling in Pediatric Residents’ Continuity Experience. Ambul Pediatr. 2007;7: this issue. [UPDATE] Serwint JR, Feigelman S, Dumont-Driscoll M, Collins R, Zhan M, Kittredge D. Factors Associated With Resident Satisfaction With Their Continuity Experience. Ambul Pediatr. 2004;4:4 –10. Feigelman S, Olsson J, Drutz J, Dungy CI, Lopreiato J, Serwint JR. Changes in Pediatric Residents’ Perceptions of Their Continuity Experience During Their Training: A National Study. Ambul Pediatr. 2005;5:221–227. Adler MD, Trainor JL, Siddall VJ, McGaghie WC. Development and Evaluation of High-Fidelity Simulation Case Scenarios for Pediatric Resident Education. Ambul Pediatr. 2007;7: this issue [UPDATE] Bergus G, Kreiter C, Woodhead J, Lawrence J, Franklin E. Using Infant Mannequins in Objective Standardized Clinical Examinations: Are There Unintended Consequences? Ambul Pediatr. 2006;6:235–238. Brooks KR, Siegel B, Lash TL, Geller AC, Fitzgerald A, Tracy C, Prout MN. Validating medical students’ self-report of smokingrelated communication skills and educational experiences. Ambul Pediatr. 2007;7:this issue [UPDATE] McCaskill QE, Kirk JJ, Barata DM, Wludyka PS, Zenni EA, Chiu TT. USMLE Step 1 Scores as a Significant Predictor of Future Board Passage in Pediatrics. Ambul Pediatr. 2007;7:this issue [UPDATE] Richmond JB, Fein R. The Health Care Mess. Harvard University Press, Cambridge MA, 2005
Perspectives: A New Section in Ambulatory Pediatrics Ambulatory Pediatrics is delighted to announce a new section on Perspectives, providing new and organized reviews in areas of importance in academic general pediatrics. And we are particularly pleased to announce that Elena Fuentes-Afflick, MD, MPH, professor of pediatrics and epidemiology at the University of California, San Francisco, will edit this new section. A brief description of Perspectives follows. As noted, these manuscripts will generally be up to 4500 to 5000 words, longer than the usual limit for a research manuscript. In most cases, the journal will solicit these perspectives, although authors wishing to propose one may contact the journal directly ([email protected]). Submissions for the Perspectives section will go through the usual journal submission Web site (http://ees.elsevier.com/ambpediatr). The Perspectives section will focus on reviews of important pediatric topics, with an emphasis on assessing research findings in the previous 5 years and identifying areas for future study. The Perspectives editor will solicit most articles, with advice regarding topics and potential authors from other members of the senior editorial group.
Authors will generally be respected authorities in the area and may include a fellow or junior faculty member as a coauthor. The manuscripts would be about 20 pages long—not as comprehensive as a Cochrane-type systematic review, but including (as noted above) an overview of key questions and recent important research in a field, indicating the recent advances in the underlying science, and ending with some vision of the key needed research or policy in the next few years. Where appropriate, Perspectives should also discuss implications for pediatric education and practice. We will work with authors as needed and encourage an annotated outline of the commentary as an intermediate step. All Perspectives manuscripts will be peer reviewed. The journal will also continue to publish brief commentaries— quick, topical pieces about what’s happening in the world, important reports in other forums (eg, an IOM report), or responses about a research article in the journal. These differ from reviews by being briefer and more focused on specific topics or questions. Generally, the editor in chief solicits these brief commentaries.