A Qualitative Exploration of the Intern Experience in Assessing Medical Student Performance.

BACKGROUND: Interns play a key role in medical student education, often observing behaviors that others do not. Their role in assessment, however, is less clear. Despite accreditation standards pertaining to residents' assessment skills, they receive little guidance or formal training in it. In order to better prepare residents for their role in medical student assessment, we need to understand their current experience. OBJECTIVE: We aimed to describe the first-year resident experience assessing students' performance and providing input to faculty for student clinical performance assessments and grades in the inpatient setting. METHODS: Pediatric interns at Children's National Hospital (CN) from February 2018 to February 2019 were invited to participate in semistructured interviews about their experience assessing students. Constant comparative methodology was used to develop themes. Ten interviews were conducted, at which point thematic saturation was reached. RESULTS: We identified 4 major themes: 1) Interns feel as though they assess students in meaningful, unique ways. 2) Interns encounter multiple barriers and facilitators to assessing students. 3) Interns voice varying levels of comfort and motivation assessing different areas of student work. 4) Interns see their role in assessment limited to formative rather than summative assessment. CONCLUSIONS: These findings depict the intern experience with assessment of medical students at a large pediatric residency program and can help inform ways to develop and utilize the assessment skills of interns.

Strategies for Teaching Medical Students: A Faculty Development Workshop for Pediatric Preceptors in the Community Setting.

Introduction: An increasing number of medical students complete clerkships outside of traditional university-affiliated medical centers despite little faculty development geared specifically for the community preceptor. Moreover, the community setting presents a unique set of challenges, including fewer educational resources, greater expectation of clinical productivity, and a wide geographic distribution of preceptors. Methods: This 90-minute workshop provided pediatric community preceptors with effective teaching strategies that could be used in their setting. First, participants identified opportunities and challenges for medical student education in the community setting. Then, participants discussed approaches to strengthen the students' learning experience in small-group breakout sessions. Finally, workshop leaders emphasized specific teaching resources and methods to empower participants. Results: This workshop was presented at three national pediatric conferences and had at least 57 participants (40 total respondents). Over the three iterations, participants consistently rated this workshop as highly effective and engaging, with the small-group breakout session rated most engaging. Over time, modifications to the workshop included lengthening breakout sessions, shortening didactic materials to enhance audience discussion, and expanding content to include the outpatient setting. In later iterations, participants identified a specific medical education challenge at their institution and committed to using a technique they learned from the workshop. Discussion: This workshop targeted inpatient and outpatient pediatric preceptors to address the community-based faculty development gap. After completing the workshop, community preceptors can enhance the medical education experience by optimizing invaluable opportunities in the community setting and applying targeted strategies and resources.

Patient Outcomes in a Pediatric Hospital Medicine Service Staffed With Physicians and Advanced Practice Providers.

OBJECTIVES: Hospitals are employing more nurse practitioners and physician assistants on inpatient pediatric units. With this study, we compared patient outcomes in high-volume inpatient diagnoses on pediatric hospital medicine services staffed by attending physician hospitalists and residents (hospitalist and resident service [HRS]) with 1 staffed by attending physician hospitalists and advanced practice providers (HAPPS). METHODS: A historical cohort study was implemented by using administrative data for patients admitted to HRS and HAPPS from 2007 to 2011 with asthma, bronchiolitis, cellulitis, and pneumonia with severity levels 1 and 2 for all-patient refined diagnosis-related groups. Length of stay, readmission, ICU transfer, and hospital charges were compared. RESULTS: After controlling for clinical, demographic, and socioeconomic differences, the average probability of discharge was 10% greater each day (event ratio [ER] = 1.1 [1.06-1.14]) on HAPPS compared with HRS. By diagnosis, this trend persisted with asthma (ER = 1.07 [1.02-1.12]), cellulitis (ER = 1.2 [1.1-1.3]), and pneumonia (ER = 1.17 [1.08-1.28]) but not for bronchiolitis (ER = 0.99 [0.92-1.06]). Both 3- and 30-day readmissions were higher for HRS discharges with bronchiolitis (odds ratio = 5.9 [1.3-28.6] and 2.0 [1.3-3.3], respectively) but not for the other diagnoses. Hospital charges were 13% higher for patients on HRS than HAPPS. ICU transfers did not differ statistically. CONCLUSIONS: Within the limitations of the design, HAPPS performed at least as well as HRS with respect to length of stay, readmissions, ICU transfers, and charges for 4 of the most common inpatient diagnoses with severity levels 1 to 2. Indicated in these results is that in this configuration, advanced practice providers on pediatric hospitalist services represent a viable model for other institutions to consider and test.

Management of apparent life-threatening events in infants: a systematic review.

OBJECTIVE: To determine in patients who are well-appearing and without a clear etiology after an apparent life-threatening event (ALTE): (1) What historical and physical examination features suggest that a child is at risk for a future adverse event and/or serious underlying diagnosis and would, therefore, benefit from testing or hospitalization? and (2) What testing is indicated on presentation and during hospitalization? STUDY DESIGN: Systematic review of clinical studies, excluding case reports, published from 1970 through 2011 identified using key words for ALTE. RESULTS: The final analysis was based on 37 studies; 18 prospective observational, 19 retrospective observational. None of the studies provided sufficient evidence to fully address the clinical questions. Risk factors identified from historical and physical examination features included a history of prematurity, multiple ALTEs, and suspected child maltreatment. Routine screening tests for gastroesophageal reflux, meningitis, bacteremia, and seizures are low yield in infants without historical risk factors or suggestive physical examination findings. CONCLUSION: Some historical and physical examination features can be used to identify risk in infants who are well-appearing and without a clear etiology at presentation, and testing tailored to these risks may be of value. The true risk of a subsequent event or underlying disorder cannot be ascertained. A more precise definition of an ALTE is needed and further research is warranted.

Apparent life-threatening event: a review.

An "apparent life-threatening event" (ALTE) refers to an episode that is of concern to the caregiver and is associated with a combination of apnea, color change, change in tone, choking, or gagging. Although the natural history of ALTE is most often benign, there is a risk for subsequent morbidity and mortality. The provider must stabilize the infant as needed, obtain key history, identify and address any underlying causes, educate the caregivers, and provide a safe disposition. This article summarizes the body of literature concerning ALTE, with specific attention to the diagnosis and management of these cases.