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Competency-based medical education relies on repeated longitudinal assessments of learners. Frequent attending physician transitions within clinical rotations present a significant barrier to the educational continuity required in competency-based medical education. Learner handoffs (LHs), or the transfer of information regarding learners on a team among faculty supervisors, is a potential solution. Although literature is available on educational leader and clinical faculty perspectives on LHs, perspectives of the learners have been less well described.This qualitative study used thematic analysis of pediatric resident focus groups from 3 programs of varying size and geographic location from July to December 2021. Two authors independently read the first 3 transcripts to generate a codebook and then coded the remaining transcripts independently to ensure thematic saturation. Emerging themes were discussed and revised until a consensus was achieved.Forty-four pediatric residents from 3 programs participated in 8 focus groups. Themes were identified regarding LHs' positive impact on the (1) learner, (2) clinical practice, and (3) learning environment. participants described numerous positive benefits to their own development, team functioning, trust, and patient safety. This experience was counterbalanced by risk of bias in the current LH context. Suggestions for the implementation of a structured LH framework were provided, with a focus on the content (what information), process (who is involved), and format (how is it delivered) of LHs. Participants believed that the creation of a structured LH tool may mitigate perceived challenges, including bias and lack of transparency.Residents recognize potential benefits to learners themselves, their clinical practice, and their learning environment through LHs but express concerns regarding further propagating bias. The development of a structured and learner-centered LH tool could accelerate learner professional development while mitigating perceived challenges. Future research should define essential components of an LH model with input from all key stakeholders.

1. Talin Nora Arslanian, MD* 2. Myriam Almeida-Jones, MD† 3. Sarah Myrlee Gustafson, MD*,‡ 1. *Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA 2. †Department of Pediatric Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 3. ‡Department of Pediatrics, Harbor UCLA Medical Center, Torrance, CA 1. Address correspondence to: Talin N. Arslanian, MD, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, 757 Westwood Plaza Box 951752, Los Angeles, CA 90095-1752. Email: tarslanian{at}mednet.ucla.edu A 26-day-old girl who was born at 39 weeks and 4 days’ gestational age via normal spontaneous vaginal delivery is brought in by ambulance for an episode of limpness and pallor. Her mother reports that she had been doing well until the morning of presentation when she became irritable during a diaper change, then became pale and limp. The episode was brief and had resolved by the time of paramedic arrival. This has not happened before. There are no other symptoms, no changes in feeding patterns, and review of systems is unremarkable. Prenatal, perinatal, postnatal courses are reviewed and noted to be uncomplicated, though there is no record of a prenatal anatomy ultrasound. Her temperature is 97.9oF (36.6oC), respirations are 36 breaths/min, heart rate is 160 beats/min, blood pressure is 88/63 mmHg, and oxygen saturation is 100% on room air. Physical exam reveals normal facies, regular rate and rhythm, a 2/6 holosystolic murmur at the left sternal border, and 2+ femoral pulses without brachio-femoral delay. There are also 5 well-circumscribed hypopigmented patches of varying sizes located on the chest, arm, abdomen, leg, and buttocks; the largest patch measures 2 cm by 1 cm. Labs show a white blood cell count of 8.7×103/mcL (8.7×109/L), hemoglobin of 15.2 g/dL, and platelets of 396 ×103/mcL (396×109/L). A chemistry panel reveals no electrolyte abnormalities; glucose is 103 g/dL, and total bilirubin …

Advancing Health Equity Through Innovations and Technology This year’s summit was unique given the COVID-19 pandemic: a major global outbreak that has imposed severe restrictions in all aspects of our life. At the outset, we were faced with three mutually exclusive options. First option was to cancel the summit in its entirety: this was the easiest and most obvious choice once the COVID-19 pandemic forced a near total lockdown all over the country with unprecedented disruptions of normal daily activities as the disease announced its thunderous touchdown on United States (US) soil. It was also the most-logical response faced with uncertainty regarding summit logistics and expected poor attendance due to the raging pandemic. Second option was to conduct a digital summit restricted to local audiences at Baylor College of Medicine: this option entailed implementing a virtual summit with attendance restricted to participants from our institution only. It sounded like a reasonable choice but that would impede the presence of diversity of topics, perspectives, insights and experiential learning opportunities, which are what render the summit exciting and worth attending. And finally, the last option was to conduct a digital unrestricted summit open to all interested audiences throughout the US. The conduct of a virtual summit open to all participants from around the country was initially considered daunting given the likelihood of amplified technical problems associated with an array of internet access differentials around the country, which would require a strong Information Technology (IT) presence throughout the sessions. Nonetheless, the attractiveness of going national with a virtual summit, despite the pandemic and logistical challenges, slowly gained converts and became the dominant choice. The response and level of participation in this first virtual summit showed an unanticipated surge despite the increase in registration fees to cover IT costs. This year, we had attendees from all regions of the US as well as from the United Kingdom. The range of topics was quite diverse encompassing health disparities in relation to cancers, nutrition, musculo-skeletal disorders, amputation rates, vaccination uptakes and COVID-19 infections. Various solutions were passionately presented to address these disparities including novel health technologies, community engagement and partnerships, improvement in health literacy and alternative therapeutics. There were no hitches despite the complex breakout sessions, and above all, attendees were satisfied and offered outstanding evaluation scores. This was definitely a summit that metamorphosed from pessimism to a triumphant success! Copyright © 2020 Salihu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

1. Sarah Gustafson, MD*,† 2. Darien Nguyen, MD* 3. Michael Bolaris, MD*,† 1. *Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA 2. †David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA A previously healthy 10-year-old boy presents with 12 days of headache, 8 days of fever, and 3 days of generalized weakness. His headaches are associated with photophobia and localize to the right retro-orbital region. The headaches and daily fevers (102o–104oF [38.9o–40oC]) are unresponsive to medications. On the day of hospital admission he has developed worsening fatigue, weakness, intermittent pain in his posterior thighs and calves, and a limp favoring his left side, and he has started dropping objects. His eyes also appeared red 1 day before admission. His mother notes a 2-lb weight loss during the past week. There is no congestion, rhinorrhea, sore throat, chest pain, abdominal pain, emesis, hematuria, dysuria, diarrhea, rash, easy bruising, or easy bleeding. He lives in a suburban home with 4 dogs and 1 cat. Other animal exposures include multiple rats in the backyard but no known direct contact with the patient. He has not traveled recently and denies new food exposures or sick contacts. He is fully immunized. His temperature is 103.1oF (39.5oC), heart rate is 146 beats/min, blood pressure is 115/64 mm Hg, respirations are 22 breaths/min, and oxygen saturation is 100% on room air. On physical examination he is tired but well-appearing, with no pallor or jaundice. No conjunctivitis is noted. There is pain on passive neck flexion. A 1-cm left anterior cervical lymph node is palpated. Mucous membranes are dry, lips are cracked, and he is tachycardic with a 2/6 systolic murmur at the left sternal border. Neurologic and musculoskeletal examination findings are normal except for an antalgic gait favoring the left side. Laboratory evaluation is significant for the following values: white blood cell count …

To describe the current processes and priorities for pediatric chief resident (CR) selection, to characterize pediatric CR demographics in the past 5 years nationally, and to identify opportunities for addressing bias in the process of pediatric CR selection.We used a cross-sectional study design with an anonymous national survey of pediatric program directors (PDs) through a web-based platform in January 2020.A total of 92 of 200 (46%) of PDs responded. About 16% of CR are underrepresented in medicine (UIM) by race/ethnicity. The influential factors most commonly cited in selection were nominations from faculty (84%) and peers (77%), followed by fit with other co-chiefs (68%). Only 17% reported having a specific method to mitigate bias in CR selection, most commonly involving multiple stakeholders in the process.Current CR selection relies on processes with the potential to introduce bias. Programs have opportunities to address bias in the CR selection process by reevaluating methods vulnerable to bias, including peer/faculty nominations, fit with peers, ITE scores, and assessments through the use of more objective selection tools.

Background: An ideal method for acquiring diversity literacy during graduate medical education (GME) training remains controversial. Common barriers include competing demands for knowledge acquisition and increasingly limited time constraints. Trainee input about preferred learning methods may assist in identifying effective strategies. Methods: One Institution’s Pediatric Residency Diversity Committee created the Diversity Assessment (DA) after literature review and internal discussion. Anonymized, optional questionnaires were administered …

This chapter contributes to the literature on Tocqueville’s “strange liberalism” by wondering: Would Tocqueville endorse a “free market of ideas”? In order to answer this question, it explores the salutary limits he would set to the democratic imagination through religion, mores, and the leadership and authority of public intellectuals. To do so, it enlists comparisons with Plato and Rousseau as thinkers similarly concerned with the relationship between ideas and political life. Standing at the margins of democratic and aristocratic society, Tocqueville tries to temper democratic materialism with spiritualism and aristocratic virtue and liberty. Given scholarship continues to try to define Tocqueville as belonging to one ideological party or another, it remains crucial to highlight where his normatively thick liberalism differs from that of other liberals.

Background The number of residents who self-identify as underrepresented minorities in medicine (URM) is low, and this pipeline becomes even leakier as training progresses, with URM rates at 8.7% for academic pediatric faculty in the US. Chief residents (CR) potentially have an advantage in securing academic positions and play a vital role in recruitment and education of residents. It is unknown what the current URM representation in CRs is and what strategies are used to recruit and select more chief residents who are URM. Methods An online survey was developed by pediatric PDs/APDs with content expertise and piloted with active pediatric PDs. Questions focused on resident and CR demographics and processes and priorities for CR selection. It was IRB and APPD-approved and distributed to all pediatric PDs in late 2019. Summary statistics were used to report the percent of CRs who identify with underrepresented groups, characteristics of CR position, whether formal criteria for CR selection are used, and identification of the people who have influence on selection. We will conduct a content analysis of written comments of PD priorities in CR selection. Results The survey was sent out three times, with final data expected in mid-January. 79 of 198 (40%) PDs have responded to date. Preliminary analysis indicates that 18% of residents identify as URM, compared with 15% of PD and APD leadership and 15% of CRs. The average number of CRs per program is 2.4, with a range of 1-4 per year. Only 6% of CRs are paid a faculty salary. No programs report using USMLE scores in the selection of CRs, but 24% use ITE results. 17% report having a specific method to mitigate bias in CR selection. Conclusions The anticipated insights into the demographics and potential sources of bias in the process and priorities for chief resident selection are relevant to PDs, CRs, all APPD members, and other stakeholders outside of APPD, including leadership in UME and governing bodies in pediatrics, who are invested in improving URM representation in academic pediatrics at the resident and faculty levels.

Adaptive learning emerges when precise assessment informs delivery of educational materials. This study will demonstrate how data from Human Dx, a case-based e-learning platform, can characterize an individual's diagnostic reasoning skills, and deliver tailored content to improve accuracy.Pearson Chi-square analysis was used to assess variability in accuracy across three groups of participants (attendings, residents, and medical students) and three categories of cases (core medical, surgical, and other). Logistic regression analyses were conducted to explore the relationship between solve duration and accuracy. Mean accuracy and duration were calculated for 370 individuals. Repeated measures analysis of variance (ANOVA) were used to assess variability for an individual solver across the three categories.There were significant differences in accuracy across the three groups and the three categories (p 0.001). Individual solvers have significant variance in accuracy across the three categories. Shorter solve duration predicted higher accuracy. Patterns of performance were identified; four profiles are highlighted to demonstrate potential adaptive learning interventions.Human Dx can assess diagnostic reasoning skills. When weaknesses are identified, adaptive learning strategies can push content to promote skill development. This has implications for customizing curricular elements to improve the diagnostic skills of healthcare professionals.

Background As in many other residency programs, night rotations comprise a significant portion of the curriculum at Harbor-UCLA. The National Pediatric Nighttime curriculum is a robust educational resource that was created to address the gap in nighttime education and has been provided to our residents through a residency website, though limited data existed about usage after implementation. In our program, there are no in-house hospitalist attendings at night, which requires residents to independently lead learning. Our residents were not formally trained in teaching methods until this year. Methods Resident feedback about the inpatient pediatric night rotation was solicited in the form of an online survey. Respondents were asked to rate agreement with statements on a five-point scale. Prior to the implementation of changes to the nighttime curriculum, residents participated in a Resident as Teacher lecture series. Results We obtained responses from 20 of 30 residents. 90% were not satisfied with the current state of nighttime education, and 95% did not use the nighttime curriculum. However, 80% stated that senior residents were preferred teachers. Based on these results, a strategy to increase accountability was instituted, while the Resident as Teacher intervention was ongoing. At the outset of the night rotation, expectations are now formally reviewed with assigned modules and associated questions which map to board content specifications. Completion will be tracked on the website. Resident satisfaction will be assessed in a follow-up survey at the end of the rotation, the first set of which will be available in February 2019. Conclusions In spite of the availability of nighttime curriculum, it is not being used at our program. This may indicate the need for increased mechanisms for accountability with residents, with the strategy of incorporating Resident as Teacher training to build confidence and positively frame teaching experiences. The interventions planned may be useful at other institutions with similar remote supervision from hospitalists.

We studied cultured hippocampal neurons from embryonic wildtype, major histocompatibility complex class I (MHCI) heavy chain-deficient (K(b)D(b)-/-) and NSE-D(b) (which have elevated neuronal MHCI expression) C57BL/6 mice. K(b)D(b)-/- neurons displayed slower neuritogenesis and establishment of polarity, while NSE-D(b) neurons had faster neurite outgrowth, more primary neurites, and tended to have accelerated polarization. Additional studies with ß2M-/- neurons, exogenous ß2M, and a self-MHCI monomer suggest that free heavy chain cis interactions with other surface molecules can promote neuritogenesis while tripartite MHCI interactions with classical MHCI receptors can inhibit axon outgrowth. Together with the results of others, MHCI appears to differentially modulate neuritogenesis and synaptogenesis.