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Purpose: To better understand the barriers and facilitators to precepting midwifery students from across the healthcare ecosystem in New Jersey., Background: Growing the midwifery workforce is a crucial step to alleviating disparately poor perinatal health outcomes and expanding access to care. Difficulty recruiting and retaining preceptors has been identified as a barrier to graduating more midwives., Methods: In-depth qualitative interviews were conducted with 19 individuals involved in different stages of the clinical training process: midwives, physicians, and administrators. Transcripts were coded using the tenets of qualitative description and thematic analysis. Analysis was guided by the Promoting Action on Research Implementation in Health Services framework., Results: The following themes were identified and organized within the domains identified by our conceptual framework. Evidence: (mis)understanding the benefits of midwifery care and impacts on patient care. Context: the time and energy it takes to precept and practice considerations. Facilitations: developing the next generation of healthcare providers and the quiet and ever-present role of money in healthcare., Conclusions: Findings from this study support the importance of approaching midwifery precepting as a multifaceted endeavor, one that necessitates the full support of individuals within many different roles in an organization., Implications for Practice and Research: Getting buy-in from various levels of the healthcare ecosystem requires a flexible approach but must include a targeted effort toward showing the value of midwifery care in terms of patient outcomes, satisfaction, and cost., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change., Design: Prospective cohort study., Setting: Twenty-five PICUs at various children's hospitals across the United States., Patients: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children)., Intervention: None., Measurements and Main Results: Prospective cohort study in which all primary tracheal intubations occurring in the United States from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children) were analyzed. Participating PICU leaders were also asked to describe their local airway management training for residents. Resident participation trends over time, stratified by presence of a Pediatric Critical Care Medicine fellowship and airway training curriculum for residents, were described. A total of 9,203 tracheal intubations from 25 PICUs were reported. Pediatric residents participated in 16% of tracheal intubations as first laryngoscopists: 14% in PICUs with a Pediatric Critical Care Medicine fellowship and 34% in PICUs without one (p < 0.001). Resident participation decreased significantly over time (3.4% per year; p < 0.001). The decrease was significant in ICUs with a Pediatric Critical Care Medicine fellowship (p < 0.001) but not in ICUs without one (p = 0.73). After adjusting for site-level clustering, patient characteristics, and Pediatric Critical Care Medicine fellowship presence, the Accreditation Council for Graduate Medical Education guideline change was not associated with lower participation by residents (odds ratio, 0.86; 95% CI, 0.59-1.24; p = 0.43). The downward trend of resident participation was similar regardless of the presence of an airway curriculum for residents., Conclusion: Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.