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Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Management of referral and consultation is an entrustable professional activity for pediatric residents; however, few tools exist to teach these skills. We designed and implemented tools to prompt discussion, feedback, and reflection about the process of referral, notably including the family's perspective., (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: The Council on Medical Student Education in Pediatrics and Association of Pediatric Program Directors developed a Pediatric Subinternship (CAPS) curriculum for use with an individualized learning plan (ILP). The authors determined which learning objectives (LOs) pediatric subinterns selected when provided the CAPS curriculum, summarized students' self-reported progress, and determined feasibility of ILPs in subinternship., Methods: Students from 10 medical schools completed a standardized ILP during pediatric subinternship. Students listed ≥3 LOs using CAPS curriculum as a guide and self-assessed their progress. Students reviewed ILPs with faculty preceptors; preceptors completed questionnaires on time and effort spent. Authors mapped student LOs to CAPS curriculum objectives and grouped in Accreditation Council for Graduate Medical Education competency domains., Results: Two hundred four students documented 850 LOs. Authors mapped student LOs to 61 of the 69 CAPS objectives (88%). Students most commonly chose Patient Care LOs, with the top 3 related to oral presentations, time management, and management plans. Student LOs not in CAPS addressed nutrition, child development, test interpretation, and cost. No students chose LOs related to health disparities, shared decision making, informed consent, or patient safety. Students self-reported significant progress on most LOs (73%). Faculty met with students ≥1 time and 93% met for a total of ≤1 hour. According to faculty, students required little or no help completing ILPs., Conclusions: Students chose a wide range of LOs when provided the CAPS curriculum. Revision to include additional student-identified LOs would enhance CAPS curriculum's comprehensiveness. Using this curriculum with an ILP during subinternship is feasible, but gaps between educator-identified and student-identified objectives require further exploration., (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the impact of transitioning from noon conference (NC) to academic half day (AHD) on conference attendance, interruptions, and perceived protected educational time and to describe pediatric resident experiences with AHD., Methods: In this mixed-methods study, data before and after AHD implementation were collected. Quantitative data were analyzed with a 2-variable t test or chi-square test. Five focus groups and 5 individual interviews of pediatric residents were conducted. Data were analyzed using constant comparative methods, and were collected until reaching saturation. In accordance with grounded theory methodology, we developed codes using an iterative approach and identified major themes., Results: After AHD implementation, resident attendance increased from 55% (of residents expected at NC) to 94% (of residents scheduled for AHD) (P < .001); interruptions decreased from 0.25 to 0.01 per resident per hour (P < .001). Positive responses regarding perceived protected educational time improved from 50% to 95% (2015 class) and from 19% to 50% (2016 class) (P < .001). Thirty-two residents participated in focus groups and interviews. Analysis yielded 5 themes: aids and barriers to AHD attendance; teaching; curricular content; learning and engagement; and resident well-being. Residents felt aided attending AHD when clinical supervisors supported their educational time. Compared to NC, residents noted better topic selection but fewer covered topics. Residents valued protected educational time without clinical responsibilities and thought that small-group discussions at AHD facilitated learning. Although cross-covering was stressful, AHD positively contributed to resident well-being., Conclusions: AHD improves resident attendance, interruptions, and perceived learning, and it contributes to resident wellness. More work is needed to mitigate the workload of cross-covering residents., (Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To explore pediatric interns' perspectives on the educational value of general pediatric ward rounds, in particular their rounding experiences with and without an attending physician., Methods: Qualitative study using individual interviews of pediatric interns (2013-2014) rotating on 2 general pediatric inpatient services at different institutions with different rounding team structures. In accordance with grounded theory methodology, data were analyzed using the constant comparative method. Codes were built using an iterative approach and organized into themes., Results: Twenty pediatric interns participated in 25 interviews. Data analysis yielded 4 themes: what is being learned; learning environment on rounds; learning and work; and ways of learning. Senior residents generally taught practical aspects of patient care and attending physicians taught broader concepts with references to the medical literature. Rounds without an attending physician were perceived as less formal and promoted collaborative discussions with senior residents. Interns were more uncomfortable during rounds with an attending physician but appreciated how that facilitated their learning. Although patient care tasks provided opportunities for experiential learning, interns frequently perceived them to impede learning during rounds. Intern learning during ward rounds occurred via self-directed learning, interactive learning, and through caring for patients. Brief, clinically relevant teaching pearls and questioning clinical reasoning in a respectful manner were helpful., Conclusions: Interns learn different content and learn in different ways depending on the presence or absence of an attending physician at rounds. There might be educational value from rounding with teams that include and do not include an attending physician., (Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Purpose: Medical education aims to equip physicians for lifelong learning, an objective supported by the conceptual framework of self-regulated learning (SRL). Learning goals have been used to develop SRL skills in learners across the medical education continuum. This study's purpose was to elicit residents' perspectives on learning goal use and to develop explanations suggesting how aspects of the learning environment may facilitate or hinder the meaningful use of learning goals in residency., Method: Resident focus groups and program director interviews were conducted in 2012-2013, audio-recorded, and transcribed. Programs were selected to maximize diversity of size, geographic location, type of program, and current use of learning goals. Data were analyzed using the constant comparative method associated with grounded theory. Further analysis compared themes frequently occurring together to strengthen the understanding of relationships between the themes. Through iterative discussions, investigators built a grounded theory., Results: Ninety-five third-year residents and 12 program directors at 12 pediatric residency programs participated. The analysis identified 21 subthemes grouped into 5 themes: program support, faculty roles, goal characteristics and purposes, resident attributes, and accountability and goal follow-through. Review of relationships between the themes revealed a pyramid of support with program support as the foundation that facilitates the layers above it, leading to goal follow-through., Conclusions: Program support facilitates each step of the SRL process that leads to meaningful use of learning goals in residency. A strong foundation of program support should include attention to aspects of the implicit curriculum as well as the explicit curriculum.

Objective: To explore medical students' experiences working with frequently rotating pediatric inpatient attending physicians., Methods: We performed a qualitative study using focus groups and individual interviews of medical students who rotated on the general pediatric inpatient service at Children's Hospital Colorado. The majority of inpatient pediatric attending physicians worked 1-week blocks. We used a semistructured interview guide and analyzed data using the constant comparative method. In accordance with the grounded theory method, codes were developed using an iterative approach, and major themes were identified. Analysis indicated theoretical saturation was achieved. We created a theory that arose from analysis of the data., Results: Twenty-seven medical students participated. Data analysis yielded 6 themes: learning climate, continuity, student resilience, opportunity to progress, growth into a physician, and evaluation. In the learning climate, the emotional environment was often stressful, although students valued exposure to different patient care and teaching styles. Senior resident continuity promoted student function; lack of continuity with attending physicians inhibited relationship development. Students were resilient in adjusting to changing faculty with different expectations. In the context of frequently rotating faculty, students had difficulty showing improvement to a single attending physician after feedback, which limited students' opportunities to progress. Students perceived summative evaluation as less meaningful in the absence of having a relationship with their attending physicians., Conclusions: Medical students valued exposure to different patient care and teaching styles. However, frequently changing attending physicians caused students stress and limited students' perceived ability to achieve and show professional growth., (Copyright © 2014 by the American Academy of Pediatrics.)

Purpose: To provide validity evidence for use of the Learning Goal Scoring Rubric to assess the quality of written learning goals and residents' goal writing skills., Method: This two-part study used the rubric to assess University of Colorado third-year pediatric residents' written learning goals to obtain validity evidence. In study 1, five raters independently scored 48 goals written in 2010-2011 and 2011-2012 by 48 residents, who also responded to the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). In study 2, two raters independently scored 48 goals written in 2011-2012 by 12 residents. Intraclass correlation coefficients (ICCs) assessed rater agreement to provide evidence for response process. Generalizability theory assessed internal structure. Independent-samples Mann-Whitney U tests and correlations assessed relationship to other variables. Content was matched to published literature and instructional methods., Results: The ICC was 0.71 for the overall rubric. In study 1, where the generalizability study's (G study's) object of measurement was learning goals, the phi coefficient was 0.867. In study 2, where the G study's object of measurement was the resident (goal writing skill), the phi coefficient was 0.751. The total mean score of residents with goal writing training was significantly higher than that of those without (7.54 versus 4.98, P < .001). Correlation between goal quality and JeffSPLL score was not significant. Investigators agreed that the content matched the published literature and instructional methods., Conclusions: Preliminary validity evidence indicates that this scoring rubric can assess learning goal quality and goal writing skill.

Objective: To determine the proportion of abstracts submitted to the 2010 Pediatric Academic Societies (PAS) meeting that were exclusively qualitative, and to examine whether these abstracts were more or less likely than all others to be designated as platform, poster, or publish only., Methods: The database of abstracts submitted to the 2010 PAS meeting was searched using qualitative terms. Authors reviewed abstracts to identify exclusively qualitative abstracts. The proportions and mean score ± standard deviation for qualitative abstracts and those designated platform, poster, or publish only were calculated. Student's t test was used to analyze mean differences; pairwise comparisons and odds ratios (ORs) were used to examine differences in the disposition of qualitative versus all other abstracts. The main outcome was the proportion of abstracts designated as platform, poster, or publish only., Results: Of 4057 abstracts, 1.6% used only qualitative methods. Scores for qualitative and all other abstracts were 4.26 ± 0.60 and 3.88 ± 0.92, respectively (P < .001). The disposition of qualitative abstracts among platform, poster, and publish only differed from all other abstracts (P = .04). Compared with all others, qualitative abstracts had lower odds of platform presentation (OR 0.36; 95% confidence interval [CI] 0.15-0.91), demonstrated a nonsignificant trend toward publish only (OR 1.6; 95% CI 0.95-2.7), and were equally likely to be posters (OR 1.1; 95% CI 0.65-1.8)., Conclusions: Compared with all other abstracts, qualitative abstracts were about 3 times less likely to be chosen for platform presentations; in addition, they demonstrated a trend toward greater odds of publish only. These findings may be the result of inferior quality or an inadequate review process., (Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

This paper provides a primer for qualitative research in medical education. Our aim is to equip readers with a basic understanding of qualitative research and prepare them to judge the goodness of fit between qualitative research and their own research questions. We provide an overview of the reasons for choosing a qualitative research approach and potential benefits of using these methods for systematic investigation. We discuss developing qualitative research questions, grounding research in a philosophical framework, and applying rigorous methods of data collection, sampling, and analysis. We also address methods to establish the trustworthiness of a qualitative study and introduce the reader to ethical concerns that warrant special attention when planning qualitative research. We conclude with a worksheet that readers may use for designing a qualitative study. Medical educators ask many questions that carefully designed qualitative research would address effectively. Careful attention to the design of qualitative studies will help to ensure credible answers that will illuminate many of the issues, challenges, and quandaries that arise while doing the work of medical education., (Copyright © 2011 Academic Pediatric Association. All rights reserved.)

Medical students highly value a learning environment in which they feel part of the health care team, their views are valued, and they make significant contributions to the care of patients.An orientation that includes an enthusiastic welcome, an opportunity to get to know from where the students have come and where they want to go, and setting mutually agreeable SMART objectives helps create a supportive and effective learning environment.

To explore how pediatric hospitalist attendings can recognize, prevent, and mitigate moral distress among pediatric residents. We conducted a qualitative study, utilizing a deductive approach, from August 2019 to February 2020 at 4 university-affiliated, freestanding children's hospitals in the United States using semistructured, one-on-one interviews with pediatric residents and pediatric hospitalist attendings. All transcripts were coded by pairs of research team members. Using constant comparative analysis, codes were categorized into themes and subsequently grouped into domains. We then conceptualized the relationships between the domains. We interviewed 40 physicians (18 residents, 22 attendings) and identified specific strategies for attendings to help residents navigate moral distress, which were categorized into 4 proactive and 4 responsive themes. The proactive themes included strategies employed before morally distressing events to minimize impact: ensuring attendings' awareness of residency factors influencing residents' moral distress; knowing available support resources; creating a learning environment that lays the foundation for mitigating distress; and recognizing moral distress in residents. The responsive themes included strategies that help mitigate the impact of morally distressing situations after they occur: partnering with the senior resident to develop a team-specific plan; consideration of who will participate in, the timing of, and content of the debrief. We present multiple strategies that attendings can implement to learn to recognize, prevent, and mitigate moral distress among residents. Our findings highlight the need for both proactive and reactive strategies and offer a possible roadmap for attending physicians to help their residents navigate moral distress. [ABSTRACT FROM AUTHOR]

Abstract: Background/Objectives: Pediatricians manage skin conditions such as atopic dermatitis (AD) but report that their dermatologic training is inadequate. Online modules may enhance medical education when sufficient didactic or clinical teaching experiences are lacking. We assessed whether an online module about AD improved pediatric residents’ knowledge and changed their clinical management of AD. Methods: Target and control cohorts of pediatric residents from two institutions were recruited. Target subjects took a 30‐question test about AD early in their residency, reviewed the online module, and repeated the test 6 months and 1 year later. The control subjects, who had 1 year of clinical experience but had not reviewed the online module, also took the test. The mean percentage of correct answers was calculated and compared using two‐sided, two‐sample independent t tests and repeated‐measures analysis of variance. For a subset of participants, clinical documentation from AD encounters was reviewed and 13 practice behaviors were compared using the Fisher exact test. Results: Twenty‐five subjects in the target cohort and 29 subjects in the control cohort completed the study. The target cohort improved from 18.0 ± 3.2 to 23.4 ± 3.4 correctly answered questions over 1 year (P < .001). This final value was greater than that of the control cohort (20.7 ± 4.5; P = .01). Meaningful differences in practice behaviors were not seen. Conclusion: Pediatric residents who reviewed an online module about AD demonstrated statistically significant improvement in disease‐specific knowledge over time and had statistically significantly higher scores than controls. Online dermatology education may effectively supplement traditional clinical teaching. [ABSTRACT FROM AUTHOR]

The article offers a framework for coaching medical students to understand clinical relevance and increase their efficiency in patient care. Topics discussed include challenges faced by medical students when moving from the classroom to the clinical setting, a key challenge for clinical teachers, and a discussion on priming students to focus on pertinent information during clinical encounters.

Background The traditional 1-month training blocks in pediatrics may fail to provide sufficient exposure to develop the knowledge, skills, and attitudes residents need for practice and may not be conducive to mentoring relationships with faculty and continuity with patients. Intervention We created a 4-month career-focused experience (CFE) for third-year residents. The CFE included block time and longitudinal experiences in different content areas related to residents' choice of urban and rural primary care, hospitalist medicine, or subspecialty care (prefellowship). Content was informed by graduate surveys, focus groups with primary care pediatricians and hospitalists, and interviews with fellowship directors. Outcomes were assessed via before and after surveys of residents' attitudes and skills, assessment of skills with an objective structured clinical examination (OSCE), and interviews with residents and mentors. Results Twenty-three of 49 third-year residents took part in the first 2 years of CFE. Two residents dropped out, leaving 21 who completed the 4-month experience (9 in primary care, 2 in hospitalist medicine, and 10 in a subspecialty). Residents reported improvement in their clinical skills, increased satisfaction with faculty mentoring and evaluation, and the ability to focus on what was important to their careers. OSCE performance did not differ between residents who completed the CFE and those who did not. Administrative burden was high. Conclusions Four-month career-focused training for pediatrics residents is feasible and may be effective in meeting part of the new requirement for 6 months of career-focused training during pediatrics residency. [ABSTRACT FROM AUTHOR]