BACKGROUND: Pediatric Hospital Medicine (PHM) was approved as a subspecialty in 2016. Perspectives of pediatric and combined pediatric residents regarding barriers and facilitators to pursuing PHM fellowships have not previously been assessed. METHODS: A survey to explore residents’ perspectives on PHM fellowships, with questions regarding demographics, likelihood of pursuing PHM after fellowship introduction, and influencing factors was distributed to pediatric and combined pediatric residents via program directors. RESULTS: The survey was distributed to an estimated 2657 residents. A total of 855 (32.2%) residents completed the survey; 89% of respondents had at least considered a career in PHM, and 79.4% reported that the introduction of the PHM fellowship requirement for subspecialty certification made them less likely to pursue PHM. Intent to practice in a community setting or only temporarily practice PHM, Combined Internal Medicine and Pediatric trainee status, and high student loan burden were associated with decreased likelihood of pursuing PHM (P < .05). Most respondents reported that forfeited earnings during fellowship, family and student loan obligations, and perceived sufficiency of residency training discouraged them from pursuing PHM fellowship. Half of respondents valued additional training in medical education, quality improvement, hospital administration, research, and clinical medicine. CONCLUSIONS: Many survey respondents expressed interest in the opportunity to acquire new skills through PHM fellowship. However, the majority of respondents reported being less likely to pursue PHM after the introduction of fellowship requirement for board certification, citing financial and personal opportunity costs. Understanding factors that residents value and those that discourage residents from pursuing PHM fellowship training may help guide future iterations of fellowship design.
BackgroundIt is a common educational practice for medical students to engage in case-based learning (CBL) exercises by working through clinical cases that have been developed by faculty. While such faculty-developed exercises have educational strengths, there are at least two major drawbacks to learning by this method: the number and diversity of cases is often limited; and students decrease their engagement with CBL cases as they grow accustomed to the teaching method. We sought to explore whether student case creation can address both of these limitations. We also compared student case creation to traditional clinical reasoning sessions in regard to tutorial group effectiveness, perceived gains in clinical reasoning, and quality of student–faculty interaction.MethodsTen first-year medical students participated in a feasibility study wherein they worked in small groups to develop their own patient case around a preassigned diagnosis. Faculty provided feedback on case quality afterwards. Students completed pre- and post-self-assessment surveys. Students and faculty also participated in separate focus groups to compare their case creation experience to traditional CBL sessions.ResultsStudents reported high levels of team engagement and peer learning, as well as increased ownership over case content and understanding of clinical reasoning nuances. However, students also reported decreases in student–faculty interaction and the use of visual aids (P < 0.05).ConclusionThe results of our feasibility study suggest that student-generated cases can be a valuable adjunct to traditional clinical reasoning instruction by increasing content ownership, encouraging student-directed learning, and providing opportunities to explore clinical nuances. However, these gains may reduce student–faculty interaction. Future studies may be able to identify an improved model of faculty participation, the ideal timing for incorporation of this method in a medical curriculum, and a more rigorous assessment of the impact of student case creation on the development of clinical reasoning skills.
Introduction: Interval assessment of systolic function in patients with Duchenne Muscular Dystrophy (DMD) is challenging by echocardiography (echo). Cardiac magnetic resonance imaging (CMR) has been limited due to study duration and patient experience. We developed an abbreviated CMR (aCMR) protocol which consisted only of cine acquisitions in the short axis, 4 chamber and vertical long axis planes, and compared it to echo in regard to: exam duration, patient satisfaction, clinical utility and image quality scores. Methods: DMD patients were recruited prospectively to undergo simultaneous echo and aCMR. Exclusion criteria included need for continuous positive pressure ventilation (PPV) and inability to lay supine ≥ 30 minutes. Subjects completed a patient satisfaction survey (PSS) comparing modalities. The clinical cardiologist completed a survey (CUS) assessing the clinical utility of each modality. A blinded expert reviewer completed an image quality survey (GQAS) for each modality. Results were compared using the Wilcoxon signed-rank test and Spearman correlation. Results: 19 DMD patients participated. PSS scores and exam duration were equivalent between modalities, while CUS and GQAS scores favored aCMR. ACMR scored particularly higher than echo in RV visualization and judgement of atrial size. Older age had a statistically significant negative correlation with echo GQAS and CUS scores, as well as aCMR PSS scores. Nighttime PPV requirement and non-ambulatory status were associated with worse echo CUS scores. Poor image quality precluding quantification existed in 4 (21%) echo and 0 aCMR studies. Conclusions: The aCMR protocol resulted in improved clinical utility and quality scores relative to echocardiography, without detriment in patient satisfaction or exam duration. For DMD patients known to have challenging echo acoustic windows, aCMR should be considered in lieu of echocardiography for interval assessment of systolic function.
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