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The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community’s innovations, including the use of virtual cafés to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.

To explore the design, implementation, and efficacy of a faculty development program in a cohort of early career junior faculty.Interested junior faculty members were divided into interdisciplinary small groups led by senior faculty facilitators. The groups met monthly for 1.5 hours to review a modular curriculum from 2011 to 2013. Using a survey at two time points (September 2011 and 2013) and an interim program evaluation, the authors collected data on participants' demographics, faculty interconnectedness, and self-reported knowledge, skills, and attitudes (KSA) in the domains of professional development and scholarship, including the ability to write career goals and align activities with those goals.A total of 104 junior faculty participated in the program. They demonstrated changes in self-reported KSA in the domains of professional development (P = .013, P = .001) and scholarship (P = .038, P = .015) with an increase in ability to write career goals (P.001), ability to align activities with those goals (P.001), and number of and amount of time spent pursuing activities related to those goals (P = .022). These changes were more significant among female faculty and were not affected by academic rank or time since last training. Interconnectedness among faculty increased during the period of study-the number of nodes and ties between nodes within the network increased.This facilitated peer mentoring program for junior faculty was effective in improving the KSA necessary to promote early career advancement and peer networking, especially for women.

Objectives: Multi-institutional research increases the generalizability of research findings. However, little is known about characteristics of collaborations across institutions in health sciences education research. Using a systematic review process, the authors describe characteristics of published, peer-reviewed multi-institutional health sciences education research to inform educators who are considering such projects.Methods: Two medical librarians searched MEDLINE, the Education Resources Information Center (ERIC), EMBASE, and CINAHL databases for English-language studies published between 2004 and 2013 using keyword terms related to multi-institutional systems and health sciences education. Teams of two authors reviewed each study and resolved coding discrepancies through consensus. Collected data points included funding, research network involvement, author characteristics, learner characteristics, and research methods. Data were analyzed using descriptive statistics.Results: One hundred eighteen of 310 articles met inclusion criteria. Sixty-three (53%) studies received external and/or internal financial support (87% listed external funding, 37% listed internal funding). Forty-five funded studies involved graduate medical education programs. Twenty (17%) studies involved a research or education network. Eighty-five (89%) publications listed an author with a master’s degree or doctoral degree. Ninety-two (78%) studies were descriptive, whereas 26 studies (22%) were experimental. The reported study outcomes were changes in student attitude (38%; n=44), knowledge (26%; n=31), or skill assessment (23%; n=27), as well as patient outcomes (9%; n=11).Conclusions: Multi-institutional descriptive studies reporting knowledge or attitude outcomes are highly published. Our findings indicate that funding resources are not essential to successfully undertake multi-institutional projects. Funded studies were more likely to originate from graduate medical or nursing programs.

WGEA 2015 CONFERENCE ABSTRACT (EDITED). Faculty Perceptions of Receiving Feedback From Third-Year Clerkship Students. Amanda Kost, Heidi Combs, Sherilyn Smith, Eileen Klein, Patricia Kritek, and Lynne Robins. PHENOMENON: In addition to giving feedback to 3rd-year clerkship students, some clerkship instructors receive feedback, requested or spontaneous, from students prior to the clerkship's end. The concept of bidirectional feedback is appealing as a means of fostering a culture of respectful communication and improvement. However, little is known about how teachers perceive this feedback in practice or how it impacts the learning environment.We performed 24 semistructured 30-minute interviews with 3 to 7 attending physician faculty members each in Pediatrics, Internal Medicine, Family Medicine, Surgery, Psychiatry, and Obstetrics and Gynecology who taught in 3rd-year required clerkships during the 2012-2013 academic year. Questions probed teachers' experience with and attitudes toward receiving student feedback. Prompts were used to elicit stories and obtain participant demographics. Interviews were audio-recorded, transcribed, and entered into Dedoose for qualitative analysis. Researchers read transcripts holistically for meaning, designed a coding template, and then independently coded each transcript. A constant comparative approach and regular meetings were used to ensure consistent coding between research team members.Participants ranged in age from 37 to 74, with 5 to 35 years of teaching experience. Seventy-one percent were male, and 83% identified as White. In our preliminary analysis, our informants reported a range of experience in receiving student feedback prior to the end of a clerkship, varying from no experience to having developed mechanisms to regularly request specific feedback about their programs. Most expressed openness to actively soliciting and receiving student feedback on their teaching during the clerkship although many questioned whether this process was feasible. Actual responses to receiving student feedback were mixed. Some reported having received feedback that motivated change, and others rejected the feedback they received on the grounds that it lacked validity or was inappropriate. Others expressed uncertainty about how they would react to student feedback. Faculty expressed a preference for receiving feedback about behaviors and items that were within their control. INSIGHTS: These findings suggest there is opportunity to pilot implementation of a structured student feedback mechanism, separate from teacher evaluations, in selected 3rd-year clerkships. Materials should developed to help faculty solicit, understand, and respond to student feedback and to help students frame and provide the kinds of feedback to teachers that will lead to suggested improvements. Both these endeavors have the potential to improve the clinical learning environment during 3rd-year clerkships through the cultivation of respectful communication and the encouragement of improvement in teaching efforts.

This article focuses on teaching and evaluating oral presentation skills as part of the ongoing Council on Medical Student Education in Pediatrics (COMSEP) series on skills and strategies used by superb clinical teachers. While oral presentations by students can be used to enhance diagnostic reasoning,1 we will focus this article on the characteristics of high-quality oral presentations by medical students, highlight several common pitfalls, and reinforce the connection between effective oral presentations and clinical reasoning. A model for evaluating student clinical performance, the RIME model, will be reviewed. Students often struggle with what is expected of them when asked to give an oral presentation of a patient encounter. Many preceptors have asked a student to present a case, only to be answered with the question, “What would you like to hear?” Students frequently perceive the oral presentation as “a rule-based, data-storage activity governed by order and structure.”2 Clinicians, however, view the oral presentation as a flexible form of communication, with content determined by the clinical context and audience. The first step in bridging this gap is to set explicit expectations. Students should be told early in the clinical experience the commonly accepted and expected style for oral presentations and the rationale for the organization. The ultimate goal of the presentation is to provide the justification for diagnostic and therapeutic decisions. Table 1 summarizes the elements of an effective oral presentation.3 View this table: TABLE 1 Oral Presentation Expectations Checklist3 ### Chief Complaint: Who Are We Talking About? Presenting information in an expected order makes it easier for listeners to process information. This begins with the chief complaint. Either a direct quote (eg, “My tummy hurts”) or an identifying statement (“A 6-year-old girl with fever and abdominal pain”) sets the context for this patient’s story from the first line (a different context than that … Address correspondence to Michael Dell, MD, Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave, Cleveland, OH 44122. E-mail: michael.dell{at}uhhospitals.org

There were 65 third-year medical students and 59 pediatric residents who participated. The intervention was a 40-minute multimedia program that teaches how to counsel parents about childhood aggression. Comparing pre- and 2-month postintervention data, there was an increase in the proportion of medical students (11% pre vs 92% post; P < .001) and residents (3% pre vs 95% post; P < .001) who felt that their ability to counsel parents about hurtful behavior was high or very high. Compared with baseline, a higher proportion of trainees at the 2-month follow-up recommended redirecting (11% pre vs 69% post; P < .001), promoting empathy (13% pre vs 42% post; P < .001), and not using physical punishment (25% pre vs 50% post; P < .001). A brief, independently viewed curriculum addition expanded the repertoire of health care trainees related to counseling parents about childhood aggression. These findings have implications for violence prevention.

To determine whether the integration of an automated electronic clinical portfolio into clinical clerkships can improve the quality of feedback given to students on their patient write-ups and the quality of students' write-ups.The authors conducted a single-blinded, randomized controlled study of an electronic clinical portfolio that automatically collects all students' clinical notes and notifies their teachers (attending and resident physicians) via e-mail. Third-year medical students were randomized to use the electronic portfolio or traditional paper means. Teachers in the portfolio group provided feedback directly on the student's write-up using a web-based application. Teachers in the control group provided feedback directly on the student's write-up by writing in the margins of the paper. Outcomes were teacher and student assessment of the frequency and quality of feedback on write-ups, expert assessment of the quality of student write-ups at the end of the clerkship, and participant assessment of the value of the electronic portfolio system.Teachers reported giving more frequent and detailed feedback using the portfolio system (p = 0.01). Seventy percent of students who used the portfolio system, versus 39% of students in the control group (p = 0.001), reported receiving feedback on more than half of their write-ups. Write-ups of portfolio students were rated of similar quality to write-ups of control students. Teachers and students agreed that the system was a valuable teaching tool and easy to use.An electronic clinical portfolio that automatically collects students' clinical notes is associated with improved teacher feedback on write-ups and similar quality of write-ups.

Background: The Liaison Committee on Medical Education (LCME) recently reinterpreted ED-2, their quantified patient criteria requirement. Purpose: The purpose is to describe pediatric clerkship directors' response to ED-2. Method: We used a survey of U.S. and Canadian pediatric clerkship directors. Results: Survey response rate was 76% (108/142). The most frequent categories that clerkship directors used to describe quantified patient criteria were age group (77%), organ systems (65%), or symptoms (61%). Computer simulations were the alternative patient experience in 83% of clerkships. Patient logs (90%) and checklists (31%) tracked student completion of ED-2. Thirty-two respondents had an LCME visit since ED-2 was reinterpreted, and 69% reported that LCME had concerns about their clerkships' fulfillment of ED-2. There was no difference in method of ED-2 implementation between schools who were cited by LCME and those who were not. Conclusions: Clerkship directors have used a variety of approaches to speci...

1. Joseph Gigante, MD* 1. *Division of General Pediatrics, Vanderbilt Children’s Hospital, Nashville, Tenn After completing this article, readers should be able to: 1. Describe the indications for a tonsillectomy and adenoidectomy. 2. Know the complications of a tonsillectomy and adenoidectomy. 3. Recognize the serious outcomes that may be associated with tonsillar or adenoidal hypertrophy or both. 4. Discuss the importance of proper evaluation of velopharyngeal insufficiency in a child being considered for tonsillectomy, adenoidectomy, or both. Although the number of tonsillectomy and adenoidectomy procedures has declined over the past 50 to 60 years, these operations continue to be among the procedures performed most commonly in the United States, second only to myringotomy with tube insertion. According to the most recent compilation of national health statistics (1996), more than 287,000 children younger than age 15 years underwent tonsillectomies with and without adenoidectomy; approximately 129,000 children underwent adenoidectomy without tonsillectomy. Despite being common procedures, the indications for tonsillectomy and adenoidectomy remain controversial. There have been few randomized, controlled clinical trials to help the primary care practitioner recommend which children to refer for tonsillectomy or adenoidectomy. Clinicians often feel pressured by parents and families to recommend such procedures. Tonsillectomies are performed most commonly on children who have obstructive sleep apnea syndrome (OSAS) and recurrent throat infections. The primary indication for adenoidectomy is adenoid hypertrophy, with resultant upper airway obstruction. Waldeyer ring is a ring of lymphatic tissue in the oral cavity and nasopharynx. Tonsils and adenoids are part of this lymphatic ring. The term tonsil usually refers to the palatine tonsil, which is bounded anteriorly by the palatoglossus muscle (anterior tonsillar pillar) and posteriorly by the palatopharyngeus muscle (posterior tonsillar pillar). The palatine tonsils form the lateral aspects of the ring. The adenoids, or pharyngeal tonsils, located in the nasopharynx, form the superior aspect of the ring. The lingual tonsil, which resides at the base of the tongue, forms the …

Further dissemination of medical education work presented at national meetings is limited.The purpose of this study was to explore dissemination outcomes of scholarly work in pediatric medical education.Council on Medical Student Education in Pediatrics (COMSEP) members who presented at COMSEP national meetings from 1998 to 2008 received a questionnaire about scholarly dissemination outcomes. Descriptive statistics and chi-square analysis explored variables related to dissemination. Qualitative analysis of free text comments explored barriers to dissemination.Outcomes were determined for 81% of presentations (138/171). The dissemination rate was 67% (92/138 presentations), with 47 publications (34%). Dissemination rates did not vary by presentation type (poster vs. oral) or project type. There was no relationship between presentation type, project type, and dissemination method. Barriers included perceived inadequate time, mentorship, and methodological skills for scholarly work.Most projects were further disseminated. Additional resources including mentoring and protected time for scholarly work are needed by educators to optimize dissemination.

Clinical teachers aspire to improve the knowledge and skills of their learners, but deliberate teaching of clinical reasoning can seem overwhelming and even impossible. Expert clinicians unconsciously run through checklists, leap past details and take short cuts to reach correct diagnoses. How can this clinical reasoning process be taught in a stepwise fashion to learners? Our students and residents must learn the skills of clinical reasoning for the care of their patients, for communication with colleagues, and for the education of those they teach. Relying on time and experience to develop these skills is insufficient. Clinical teachers should facilitate this process despite its challenges. Using the concepts of illness scripts, problem representations [1], and semantic qualifiers [2] clinical teachers can create a foundation for learner’s to guide clinical reasoning development and improve learner’s abilities to communicate an effective patient assessment. Novice clinicians struggle to understand what a “good” assessment is because they lack the ability to create succinct yet accurate problem representations. A problem representation is the one sentence summary in which specific patient details (history, physical examination) are synthesized into abstract terms called semantic qualifiers. For example, imagine a student in their second year of medical school who is learning about appendicitis. A patient with “two days of 9 out of 10 abdominal pain” should be described as having “acute and severe” abdominal pain. “Acute” and “severe” are examples of semantic qualifiers. Semantic qualifiers generally exist in divergent pairs, such as acute vs. chronic and severe vs. mild. When a learner uses semantic qualifiers to synthesize the details of a patient’s history and physical into abstract terms, they are creating an illness script. Illness scripts are the mental constructs that clinicians use to create clinical memories of their experiential knowledge about diseases and conditions. These

Objective: To determine how obstetricians' opinions regarding universal screening of pregnant women for group B streptococcus (GBS) and their responses to positive culture results vary from American Academy of Pediatrics recommendations, and to determine the physician characteristics that predict divergent opinions. Methods: One hundred ninety-four practicing obstetricians in the middle Tennessee region were queried by a mail survey. They were asked if they agreed with universal screening for GBS and to indicate whether they would prescribe antibiotics for women in labor, represented by six scenarios that differed with respect to presence or absence of preterm labor, premature rupture of membranes (ROM), prolonged ROM, and a positive GBS cervical culture. They were also asked to describe their practice and personality characteristics. Results: Completed surveys were returned by 135 of 194 obstetricians (70%). Although only 28% of the respondents agreed with routine prenatal screening for GBS, most (74%) said they would treat a patient on the basis of a positive culture alone. Other risk factors, when added to a positive culture, slightly increased the decision to treat (from 74 to 88%). Multiple logistic regression, used to assess the relative effect of clinical and physician characteristics on treatment decisions, revealed that chemoprophylaxis for GBS was predicted most strongly by a positive culture at 28 weeks' gestation followed by prolonged ROM and preterm labor. Practicing in an urban location and seeing fewer than 20 patients per day also influenced the decision to treat. Conclusion: Although most obstetricians in the middle Tennessee region do not believe in universal screening, most will prescribe intrapartum antibiotics on the basis of a positive screening culture. However, other clinical risk factors and physician characteristics significantly and independently affect the decision to treat as well.

* Abbreviations: HSP — : Henoch-Schonlein Purpura RLQ — : right lower quadrant As part of the ongoing Council on Medical Student Education in Pediatrics series on skills and strategies used by great clinical teachers,1–6 this article focuses on practical knowledge and skills for teaching clinical reasoning. Building on SNAPPS and One Minute Preceptor models,6 we will address the clinical assessment portion of oral and written presentations that represents the culmination of the clinical reasoning process. Using the concepts of problem representation,7 semantic qualifiers,8 and illness scripts7,9,10 defined below, we will outline how you can guide your students’ clinical reasoning development. A problem representation is “the one-liner” at the end of a presentation that synthesizes the entire patient story (history details, physical findings, and investigations) into 1 “big picture” statement.7 To create a problem representation, physicians restructure pertinent patient details into abstract terms called semantic qualifiers. Semantic qualifiers are abstractions in medical rather than lay terminology and generally exist in divergent pairs, such as acute versus chronic and severe versus mild (Table 1, step 2).8 Here is an example of a problem representation, with the semantic qualifiers in italics: A previously well, 2-year-old unimmunized girl presents with an acute history of respiratory distress. She is febrile , looks unwell , and is drooling. View this table: TABLE 1 Teaching Steps for Clinical Reasoning Novice clinicians can be taught to generate problem representations by using semantic qualifiers. First, have your students write out a 1- to 2-sentence problem representation (summary of patient information) based on either a written … Address correspondence to Joseph Gigante, MD, Department of Pediatrics, Vanderbilt University School of Medicine, 8232 Doctor’s Office Tower, Nashville, TN 37232-9225. E-mail: joseph.gigante{at}vanderbilt.edu

This article is the fourth in a series by the Council on Medical Student Education in Pediatrics (COMSEP) reviewing the critical attributes and skills of superb clinical teachers. The previous article in this series reviewed the vital importance of direct observation of students.1 The purpose of this article is to describe how to use the information gained from the direct observation, namely the role of feedback. Although too often used interchangeably, encouragement, evaluation, and feedback are quite distinct. Encouragement (eg, “good job!”) is supportive but does nothing to improve the learner's skills. Evaluation is summative and is the final judgment of the learner's performance. Feedback, however, is designed to improve future performance. This article focuses on feedback—what it is, why it is important, some of the barriers to effective feedback, and how to give helpful feedback.

BackgroundThe Accreditation Council for Graduate Medical Education promotes direct observation of residents as a key assessment tool for competency in patient care, professionalism, and communication skills. Although tools exist, validity and reliability have not been demonstrated for most, and many tools may have limited feasibility because of time constraints and other reasons. We conducted a study to measure feasibility of a simplified observation tool to evaluate these competencies and provide timely feedback.MethodsIn the pediatric resident continuity clinic of a large children's hospital, we used a direct observation form with a 3-point scale for 16 items in the domains of patient care, professionalism, and communication skills. The form was divided by portion of visit, with specific items mapped to 1 or more of the competencies, and was used to provide direct oral feedback to the resident. Faculty and residents completed surveys rating the process (ease of use, satisfaction, and self-assessed usefulness) on a 5-point Likert scale.ResultsThe study encompassed 89 surveys completed by attending physicians; 98% (87 of 89) of the time the form was easy to use, 99% (88) of the time its use did not interfere with patient flow, and 93% (83) of the observations provided useful information for resident feedback. Residents completed 70 surveys, with the majority (69%, 48) reporting they were comfortable about being observed by an attending physician; 87% (61) thought that direct observation did not significantly affect their efficiency. Ninety-seven percent of the time (68) residents reported that direct observation provided useful feedback.ConclusionThe data suggest the form was well-received by both faculty and residents, and enabled attending physicians to provide useful feedback.

This study examined the effects of diagnosis (functional versus organic), physician practice orientation (biomedical versus biopsychosocial), and maternal trait anxiety (high versus low) on mothers’ responses to a child’s medical evaluation for chronic abdominal pain. Mothers selected for high (n = 80) and low (n = 80) trait anxiety imagined that they were the mother of a child with chronic abdominal pain described in a vignette. They completed questionnaires assessing their negative affect and pain catastrophizing. Next, mothers were randomly assigned to view one of four video vignettes of a physician actor reporting results of the child’s medical evaluation. Vignettes varied by diagnosis (functional versus organic) and physician practice orientation (biomedical versus biopsychosocial). Following presentation of the vignettes, baseline questionnaires were re-administered and mothers rated their satisfaction with the physician. Results indicated that mothers in all conditions reported reduced distress pre- to post-vignette; however, the degree of the reduction differed as a function of diagnosis, presentation, and anxiety. Mothers reported more post-vignette negative affect, pain catastrophizing, and dissatisfaction with the physician when the physician presented a functional rather than an organic diagnosis. These effects were significantly greater for mothers with high trait anxiety who received a functional diagnosis presented by a physician with a biomedical orientation than for mothers in any other condition. Anxious mothers of children evaluated for chronic abdominal pain may be less distressed and more satisfied when a functional diagnosis is delivered by a physician with a biopsychosocial rather than a biomedical orientation.

Traditional methods allowing medical students and residents to review their work and receive feedback are lacking. We developed a web-based portfolio system that collects all clinical documentation and allows teachers to give feedback electronically. In a randomized control trial, we found that this system significantly increased feedback to students, often exceeding clerkship expectations. Seventy-five percent of students found the system a "valuable teaching tool". Students in control and portfolio groups agreed that the system increased feedback.

Objective To determine the impact of adding audio-feed to an online lecture on screening given to medical students who were participating in an outpatient clerkship. Design Prospective, randomised, controlled study. Setting Vanderbilt University School of Medicine, Nashville and Wake Forest Medical School, Winston-Salem. Participants A total of 59 Years 3 and 4 medical students. Main outcome measures Students' use of time, satisfaction with the lecture experience, and knowledge. Educational intervention The online lecture was developed at Vanderbilt University. At Vanderbilt, 16 Year 4 medical students were randomised to the lecture on screening with audio and 17 Year 4 medical students were randomised to the same lecture without audio. At Wake Forest, 13 Year 3 medical students were randomised to the lecture on screening with audio and 13 Year 3 students were randomised to the same lecture without audio. Results The audio lecture required 20 more minutes to complete than the non-audio lecture. Students in the audio group were more satisfied with their experience than students in the non-audio group. Students in the audio-feed group achieved a trend for higher post-intervention knowledge scores, with the difference attributed to the students at Vanderbilt. Conclusion Audio narration is an important aspect of an online lecture. The distribution of online lectures to students at different sites and different training levels requires further study.

OBJECTIVE: To determine the impact of an online lecture versus a live lecture on screening given to medical students who are participating in an outpatient clerkship. DESIGN: Prospective, randomized, controlled study. PARTICIPANTS AND SETTING: Ninety-five senior medical students in a primary care medicine clerkship based at university and distant clinic sites. INTERVENTION AND MEASUREMENTS: Forty-eight medical students were randomized to the live lecture on screening (live lecture group), and forty-seven medical students were randomized to the online lecture on screening (online lecture group). Outcome measures included students’ knowledge, use of time, and satisfaction with the lecture experience. RESULTS: Compared to students in the live lecture group, students in the online lecture group demonstrated equal post-intervention knowledge of screening (P=.91) and expended 50 minutes less time to complete the lecture. Online lecture students who used the audio feed of the lecture were equally satisfied with the lecture as the live lecture students. Without the audio feed, online lecture students were less satisfied. CONCLUSIONS: An online lecture on screening is a feasible, efficient, and effective method to teach students on outpatient clerkships about principles of screening.

Background: The American Academy of Pediatrics strategy to prevent early-onset neonatal sepsis with group B streptococcus (GBS) relies on maternal antepartum GBS cultures, while the American College of Obstetrics and Gynecology strategy does not. Objective: To evaluate the impact of the 2 strategies on the care of asymptomatic full-term newborns. Design/Setting: Self-administered survey mailed to a national random sample of US pediatricians who were members of the American Academy of Pediatrics. Participants: A total of 461 members of the American Academy of Pediatrics who routinely care for newborns. Main Outcome Measure: Self-report of diagnostic and treatment strategies for asymptomatic full-term new-borns who were born under different clinical scenarios. Maternal risk factors, antepartum maternal GBS screening status, and maternal treatment with intrapartum antibiotics were varied across the scenarios. Results: Pediatricians treating asymptomatic full-term newborns born to risk factor–negative mothers reported ordering tests (63.3% in GBS-positive cases vs 6.7% with GBS unknown;P=.001) and antibiotics (21.5% in GBS-positive cases vs 0.9% with GBS unknown;P=.001) more frequently when presented with a positive maternal GBS screening result. Maternal intrapartum treatment had little impact on pediatric practice when risk factors were absent. In risk factor–positive mothers, pediatricians reported an increase in their antibiotic usage in response to a positive maternal GBS screen (61.8% in GBS-positive cases vs 36.9% with GBS unknown;P=.001). In risk factor–positive mothers with unknown results of GBS screening, use of intrapartum antibiotics increased the number of pediatricians who reported that they would prescribe antibiotic therapy. Conclusions: Obstetrical strategies to decrease the risk of neonatal GBS sepsis increase pediatric services provided to full-term healthy newborns. This increase in services by pediatric practices is likely to be greater with the screening-based strategy recommended by the American Academy of Pediatrics. Arch Pediatr Adolesc Med. 1996;150:802-808

Context.—The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care.Objective.—To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994.Design.—Before and after retrospective cohort analysis.Setting and Population.—Births to women residing in Tennessee between 1990 and 1995 with complete demographic information on birth certificates, with a focus on women enrolled in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare).Outcome Measures.—Late prenatal care (after the fourth month of pregnancy) or inadequate prenatal visits, low and very low birth weight, and death in the first 60 days of life.Results.—Tennessee residents had 72014 study births in 1993 and 72278 in 1995, of which 37543 (52.1%) and 35707 (49.4%) were to women enrolled in Medicaid at delivery. For these Medicaid births, there were no changes after TennCare in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995), inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%), very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6% both years). These findings were unchanged in multivariate analysis, in analysis of high-risk subgroups, and in analysis of women with demographics characteristic of Medicaid women.Conclusion.—Study perinatal outcomes did not change among Medicaid births following the transition to TennCare.