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Inequities in the application of newborn screening for cystic fibrosis
This Month in
THE JOURNAL OF
PEDIATRICS September 2008 • Volume 153 • Number 3 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES In-training examination and the general pediatric certification examination: Are there lessons? Althouse and McGuinness present and analyze performance of several cohorts of pediatric residents at various training levels (PL-1 through PL-3) on the in-training examination (ITE) and the subsequent general pediatric (GP) certifying examination. Not unexpectedly, performance on one predicts performance on other ITEs and the GP certifying examination, even though substantial variance in scores is not accounted for. Although program directors have seen performance data for years and use the ITE as a tool for counseling, it is useful for the general academic community to think about some educational issues as the American Board of Pediatrics engages stakeholders broadly in reassessing the design of residency education in pediatrics. One noteworthy finding of this study is that knowledge (as assessed by this single, imperfect tool) surged through the PL-1 year and again through the PL-3 year, with only middling gains through the PL-2 year. Wasted year? Wrong testing tool for actual skills gained? Additional gains as a result of supervising and teaching as a PL-3 resident? Circumstantial to PL-1s just having to improve beyond their medical student knowledge base, and PL-3s recognition that they just have to study for the certifying examination? Go figure—really. We are challenged by 360° questions of how a pediatrician should operate to optimize the healthcare of children, what knowledge, skills, and tools a pediatrician needs to do so, and how board certification and maintenance of certification assure the public that doctors have such competencies. Any measurements, such as those provided by Althouse and McGuinness, cannot help but enlighten the circle.
Adults with ADHD have increased physical dependence on smoking In this issue of The Journal, Wilens et al from Harvard Medical School have investigated the relationship between ADHD in young adults and cigarette smoking severity. The results show that both male and female smokers with ADHD demonstrate more severe physical dependence on tobacco compared with controls. Environmental factors such as friends who are smoking, peer smoking, and living with smokers all increase the risk for smoking in youth with ADHD, more than in controls. This is an important issue, given the high prevalence of ADHD, and prevention and early intervention strategies should be developed. More detailed studies of the underlying neurobiology would also be of value.
—Robert W. Wilmott, MD page 414
Inequities in the application of newborn screening for cystic fibrosis A commentary on the public health aspects of newborn screening for cystic fibrosis has been written by Ross at the University of Chicago. The pros and cons of various approaches are presented. The thesis of this article is that for universal access, the choice of methodology matters. The choice of genetic mutations selected for the DNA testing part of screening can be problematic if they are not well matched to the screened population. The implications of false negative diagnoses and ethical issues are discussed.
—Robert W. Wilmott, MD page 308
—Sarah S. Long, MD page 425
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
September 2008
A1
THE JOURNAL OF
PEDIATRICS September 2008 • Volume 153 • Number 3 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES In-training examination and the general pediatric certification examination: Are there lessons? Althouse and McGuinness present and analyze performance of several cohorts of pediatric residents at various training levels (PL-1 through PL-3) on the in-training examination (ITE) and the subsequent general pediatric (GP) certifying examination. Not unexpectedly, performance on one predicts performance on other ITEs and the GP certifying examination, even though substantial variance in scores is not accounted for. Although program directors have seen performance data for years and use the ITE as a tool for counseling, it is useful for the general academic community to think about some educational issues as the American Board of Pediatrics engages stakeholders broadly in reassessing the design of residency education in pediatrics. One noteworthy finding of this study is that knowledge (as assessed by this single, imperfect tool) surged through the PL-1 year and again through the PL-3 year, with only middling gains through the PL-2 year. Wasted year? Wrong testing tool for actual skills gained? Additional gains as a result of supervising and teaching as a PL-3 resident? Circumstantial to PL-1s just having to improve beyond their medical student knowledge base, and PL-3s recognition that they just have to study for the certifying examination? Go figure—really. We are challenged by 360° questions of how a pediatrician should operate to optimize the healthcare of children, what knowledge, skills, and tools a pediatrician needs to do so, and how board certification and maintenance of certification assure the public that doctors have such competencies. Any measurements, such as those provided by Althouse and McGuinness, cannot help but enlighten the circle.
Adults with ADHD have increased physical dependence on smoking In this issue of The Journal, Wilens et al from Harvard Medical School have investigated the relationship between ADHD in young adults and cigarette smoking severity. The results show that both male and female smokers with ADHD demonstrate more severe physical dependence on tobacco compared with controls. Environmental factors such as friends who are smoking, peer smoking, and living with smokers all increase the risk for smoking in youth with ADHD, more than in controls. This is an important issue, given the high prevalence of ADHD, and prevention and early intervention strategies should be developed. More detailed studies of the underlying neurobiology would also be of value.
—Robert W. Wilmott, MD page 414
Inequities in the application of newborn screening for cystic fibrosis A commentary on the public health aspects of newborn screening for cystic fibrosis has been written by Ross at the University of Chicago. The pros and cons of various approaches are presented. The thesis of this article is that for universal access, the choice of methodology matters. The choice of genetic mutations selected for the DNA testing part of screening can be problematic if they are not well matched to the screened population. The implications of false negative diagnoses and ethical issues are discussed.
—Robert W. Wilmott, MD page 308
—Sarah S. Long, MD page 425
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
September 2008
A1