What Do Pediatric Subinterns Say About Their Learning and Assessment? A Qualitative Analysis of Individual Learning Plans.

OBJECTIVE: To perform a qualitative content analysis of learning and assessment strategies that pediatric subinterns describe in Individualized Learning Plans (ILPs) and to explore barriers and facilitators to their learning. METHODS: We analyzed ILPs from medical students enrolled in pediatric subinternships at 10 US medical schools that utilized a standardized curriculum and were recruited to reflect diversity in geographic location, funding, and enrollment. Students used an ILP to record 3 or more selected learning objectives, rationale for selection, and reflection on learning and assessment strategies. Investigators used the constant comparative method to perform a content analysis of the ILPs, grouping codes into themes, and verifying relationships between codes within themes. RESULTS: Two hundred and four ILPs that included student reflections on 850 learning objectives were analyzed. Content was analyzed in 5 categories: rationale for selecting objectives, learning strategies, assessment strategies, challenges to learning, and facilitators of learning. Students showed strong commitment to individualized, self-directed learning, developed a wide range of creative learning strategies, and relied heavily on self-reflection to assess their progress. The learning environment both helped and hindered students' ability to make and assess progress on their selected learning objectives. CONCLUSIONS: Through ILP-guided reflection and a formal curriculum, students can choose well-justified learning objectives and demonstrate resourcefulness and independence in developing self-directed learning and assessment strategies. The strategies that students identified in this study provide a menu of learning and assessment options for subinterns. Identified challenges and facilitators of learning provide guidance for educators who seek to enhance the clinical learning environment.

Pediatric trauma centers: correlation of ACS-verified trauma centers with CDC statewide pediatric mortality rates.

BACKGROUND: Research on the impact of pediatric trauma centers (PTCs) on mortality has been conflicting, most likely owing to differing methodologies. Using a population-based approach, we assessed whether American College of Surgeons (ACS)-verified trauma centers are associated with reduced overall state pediatric injury mortality rates. METHODS: A population-based study of state pediatric injury mortality rates (per 100,000 children ≤ 18 years) using data for 2008 from Centers for Disease Control and Prevention-National Center for Injury Prevention and Control. The availability of verified PTCs (vPTCs) and ACS-verified adult trauma centers in each state was determined and compared with mortality rates using regression, adjusting for injury mortality covariates. Correlation of mortality with type of trauma centers available was determined. The mortality versus number of PTCs per pediatric population was also examined. RESULTS: vPTCs were present in 36% of states, including 24% of states with Level I vPTCs. The mean (SD) pediatric injury mortality for the 32 states without a vPTC was 20.6 (6.6) per 100,000 children 18 years or younger. Presence and higher verification level of vPTC within a state correlated with decreasing pediatric injury mortality (p(unadjusted)= 0.005; p(adjusted) = 0.004). Mortality was 37% lower among states with only Level I vPTCs (12.9 [2.2]). Mortality was inversely correlated with the number of Level I vPTCs (p(unadjusted) = 0.006; p(adjusted) = 0.06) and lowest for states with two Level I vPTCs (11.8 [1.7]). Higher ratios of Level I vPTCs per population correlated with lower mortality rates (ß = -3.53, p = 0.003). CONCLUSION: The findings highlight a correlation between state pediatric injury mortality rates and presence of ACS-verified Level I PTCs. LEVEL OF EVIDENCE: Prognostic study, level IV.