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Participants of the third colloquium of the Residency Review and Redesign in Pediatrics (R 3 P) Project concluded that pediatricians who practice ambulatory, hospital-based, a combination of ambulatory and hospital-based, and subspecialty pediatrics are sufficiently different to justify differences in general pediatric residency training. This conclusion along with others of previous colloquia led to the creation of a list of goals for innovative change in residency education and a draft of a quality improvement process by which they might be achieved. Pediatrics 2009;123:S22-S25 T HE THIRD AND final colloquium of the Residency Review and Redesign in Pediatrics (R 3 P) Project was held on August 1 through 3, 2007. At the first colloquium, participants envisioned the creation of a set of new recommendations for training programs that would meet the needs of pediatric residents and their patients in the future. By the third colloquium, there was agreement that a simple revision of current Accreditation Council of Graduate Medical Education (ACGME) requirements for pediatric training 1 would be insufficient. Taking into account the uncertainties identified in the first colloquium regarding the future needs of children and how to meet them, it was clear that there are too many variables and no easy solutions. There is an obvious need for a sustainable process that can respond to changing health care needs, new models of assessment, and variations in health care-delivery systems, as opposed to recommendations developed at one point in time. Therefore, participants decided to support the creation of a supple system that would continuously seek improvements in what and how pediatricians are taught.The third colloquium had 4 primary goals. The first goal was to determine if the competencies needed for 4 different types of pediatric practice (ambulatory, hospital based, comprehensive general practice [a combination of ambulatory and hospital based], and subspecialty care) were sufficiently different to justify differences in general pediatric residency training. The second goal was to refine and prioritize a list of problems requiring innovative solutions in residency training. These were formatted as guidelines or goals for innovative program change. The third goal was to determine how the initiatives begun as part of R 3 P might continue into the future, and the fourth goal was to consider administrative aspects of how to deal with residency improvement initiatives. PROCESSThe colloquium began with a keynote presentation by Dr David Leach, former chief executive officer of the ACGME. Dr Leach emphasized the importance of clear aims for any change that might be proposed. He went on to note that people are attracted to the novelty and challenge of change but seldom like the inconvenience of transition, so we will need to work to minimize the disruptions. He encouraged us to see the future as "larger than we are" and, thus, something that can be noticed but not really "redesigned." He urged us to observe what is "...

Objectives:To compare endourethral swabs and urine as diagnostic specimens for the detection of genital Chlamydia trachomatis infection using the polymerase chain reaction (PCR), in male patients attending a genitourinary clinic and to assess whether the first endourethral swab used solely for diagnosing gonococcal infection could be used for C trachomatis detection as well. Methods: Two endourethral swabs were taken from 80 male patients, in whom the likelihood of genital C trachomatis infection was high. The first swab was used for microscopy and culture for Neisseria gonorrhoeae, before being used for C trachomatis detection. First voided urine specimens were collected from 61 of these patients. All three specimens were processed for C trachomatis DNA detection using the Roche Cobas Amplicor PCR. A diagnosis of genital C trachomatis infection was made if any one of the specimens tested reproducibly positive. Samples from 13 patients showing discrepant PCR results between swabs and/or urine were retested by ligase chain reaction (LCR). Results: Chlamydia trachomatis DNA was detected in 35 (43.8%) of the 80 patients. In 17 of the 35 patients (48.6%), all the genital specimens were positive. However, in 18 (51.4%) patients, one or more of the genital specimens had negative PCR results. Among the 18 patients with discrepant results, urine was found to be a more sensitive diagnostic specimen than the second urethral swab picking up 13 out of 16 positives (81.3%) as opposed to five out of 18 (27.8%). There was no significant diVerence between the two swabs. Retesting by LCR, of the samples from 13 of the 18 patients with discrepant PCR results confirmed them all as true positives, although as with PCR, not all specimens in the set were concordantly positive. LCR detected all the 13 positives in urine, while there was no diVerence in the detection rate between the first and the second urethral swabs. Conclusions: Urine appeared to be a better diagnostic specimen than the conventional second endourethral swab for C trachomatis detection by PCR in this cohort of male patients. There was no diVerence between the first swab, intended primarily for N gonorrhoeae testing and the second swab intended for C trachomatis detection. This raises questions over the need for the conventional second swab for detecting C trachomatis. (Sex Transm Inf 2001;77:423-426)

ABSTRACT. Objective. To describe types of injuries, mechanisms of injury, and treatment of injuries caused by scooter use in children, and to discuss issues of injury prevention in children who use scooters.Study Design. Data were collected from 14 children seen by a general pediatrician and an orthopedic surgeon over a 3-month period in the summer of 2000. Detailed histories were obtained from patients and their families, and medical records were reviewed.Results. Eleven of the 14 patients suffered fractures. The injuries in the other 3 patients were a large abrasion, a laceration, and a septic knee. Half (7) of the children were injured within the first day of riding their scooter, and 13 of the 14 injuries occurred within the first month of scooter use. Only 5 patients used protective gear at the time of their injuries, and those patients were injured in unprotected parts of their bodies.Conclusions. The popularity of scooters presents a new cause of pediatric injuries and a significant health hazard to children. In our study, most injuries occurred shortly after children began scooter use, and younger children suffered the most severe injuries. Additional studies are needed to determine how scooter-related injuries can be prevented or minimized. Pediatrics 2001; 108(1). URL: http://www.pediatrics.org/cgi/content/full/ 108/1/e2; scooters, injuries.

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