ABSTRACT
Given the increase in the provision of telehealth services during the COVID-19 pandemic, it is important for medical and psychology providers to promote evidence-based treatments that can also demonstrate clinical utility through telehealth (1). This proof-of-concept study provides preliminary support for the clinical utility of the Williams and Zahka Cognitive Behavioral Therapy (CBT, 2) approach in reducing functional impairment and pain for pediatric patients with a Disorder of Gut-Brain Interaction (DGBI) when delivered through telehealth. A retrospective chart review was completed to examine psychological treatment duration and response among pediatric patients with DGBIs including functional abdominal pain and irritable bowel syndrome. CBT was delivered via telehealth with a licensed psychologist or supervised psychology trainee embedded in a pediatric gastroenterology clinic. Participants were 24 youth who completed initial evaluations between February and July of 2021 during the COVID-19 pandemic. Demographics, treatment characteristics, and statistical analyses are presented in Tables 1 and 2 (3,4). The Williams and Zahka CBT (2) approach utilizes a biopsychosocial framework that includes an initial focus on psychoeducation and function. Consistent with study hypotheses, non-parametric statistical analyses demonstrated statistically significant reductions in functional disability and pain with large effect sizes following treatment via telehealth. On average, patients attended approximately five sessions, including one initial evaluation and four treatment sessions, and this was not substantially different depending upon initial severity of impairment. These findings are in line with average treatment duration reported as 3 to 5 sessions in prior studies (5,6). Given the average length of treatment, patient care involved predominately psychoeducation on somatic symptoms and DGBIs along with a strong focus on functional restoration through behavioral activation, including a daily schedule and gradual return to routines and meaningful activities independent of school term status. Findings are similar to prior studies reporting reductions in functional impairment and pain following evidence-based treatment through a biopsychosocial framework for pediatric patients with DGBIs delivered in-person (5). (Table Presented).
ABSTRACT
Background: As the COVID-19 pandemic has heightened the importance of online recruitment, program websites (PW) have become increasingly instrumental for applicants to evaluate fellowship opportunities. A robust pediatric gastroenterology PW can aid applicants by illustrating a program's mission and educational opportunities. Amongst the various criteria that prospective applicants assess, perceived inclusivity and physician well-being are essential components contributing to program culture and positively influence ranking decisions. We conducted a comprehensive audit of pediatric gastroenterology PWs to identify potential opportunities to improve PW content, better serve applicants, and ultimately facilitate a more informed match process. Methods: This study evaluated 2020-2021 ACGME accredited pediatric gastroenterology PWs for the presence of binary informational, diversity, and wellness categories. We assessed the presence of 28 informational variables derived from previously published website analyses with added specialty-specific variables. Our study also considered three categories for evaluating diversity and inclusion that were adapted from inclusive online graduate medical education recruitment strategies. Wellness content was evaluated using four categories adapted from wellness curriculums and pertinent categories in previously published studies. We defined websites with 70% or more of the investigated 28 informational categories as “comprehensive websites,” a threshold used in prior studies. GraphPad software (GraphPad Prism 7, GraphPad Software, San Diego, CA) was utilized for all univariate analyses using Spearman Correlation's test, with statistical significance defined as p-value <0.05. Results: Of the 64 programs which had functional fellowship websites, 48.4% had a “comprehensive website.” Overall, programs on average filled 59.7% of all categories. 46.9% of the programs had information pertaining to at least one of the three assessed diversity categories and 56.3% of the programs had content relating to at least one of the four wellness categories. The prevalence of each category is shown in Figure 1. We found a positive association between having a more complete website and more diversity-identified website (p=0.024) or a wellness-identified website (p=0.005). Discussion & Conclusion: In an increasingly virtual world, PWs serve as an applicant's first impression, influencing the perception of a program's key initiatives. While our results suggest that PWs vary greatly in comprehensiveness, overall, pediatric gastroenterology PWs are lacking in all three of our evaluated categories. Our study found that more complete websites also tend to fill more of the diversity and wellness categories. This trend suggests that a progression towards a more complete PW includes both diversity and wellness components, rather than viewing them as separate categories. The incomplete nature of pediatric gastroenterology PWs is notable. Traditional in-person recruitment strategies allowed applicants to explore hospital facilities, interact with diverse faculty, and observe colleague camaraderie. Hence, in the era of heightened virtual recruitment, it would be beneficial for programs to effectively translate their initiatives to digital mediums. It behooves programs to highlight efforts they have made toward these important areas, both to represent themselves accurately and better cater to the interests of their prospective applicants. Ultimately, PWs are cost-effective tools in recruitment for pediatric gastroenterology fellowships and should be optimized to capture key tenets of a program's culture. By doing so, programs can strategically align with the interests and values of prospective applicants, empowering applicants to make more informed decisions that foster better matches.