Faculty Bibliography

PURPOSE/OBJECTIVE:Five pediatric residency programs implemented true X+Y scheduling in 2018 where residents have continuity clinic in "blocks" rather than half-day per week experiences. We report the impact X+Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences over a three-year timeframe. METHODS:Electronic surveys were sent to residents and faculty of the participating programs prior to implementing X+Y scheduling and annually thereafter (2018 - 2021). Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotations. Data were analyzed using z-tests for proportion differences. RESULTS:186 residents were sent the survey pre-implementation and 254-289 post-implementation with response rates ranging from 47%-69%. 378- 395 faculty members were sent the survey with response rates ranging from 26%-51%. Statistically significant (p<0.05) sustained perceived improvements over three years with X+Y were seen in outpatient continuity, inpatient workflow, and time for teaching both inpatient and in continuity clinic. CONCLUSIONS:X+Y scheduling can lead to perceived improvements in various aspects of pediatric residency programs. Our study demonstrates these improvements have been sustained over three years in the participating programs. WHAT'S NEW/UNASSIGNED:X+Y scheduling in pediatric residency programs is rather novel and there is a paucity of literature evaluating its use. We report three years of outcome data from the only ACGME-approved pilot of X+Y scheduling in pediatric residency.

OBJECTIVE:Variation in bronchiolitis management by race and ethnicity within emergency departments (EDs) has been described in single-center and prospective studies, but large-scale assessments across EDs and inpatient settings are lacking. Our objective is to describe the association between race and ethnicity and bronchiolitis management across 37 US free-standing children's hospitals from 2015 to 2018. METHODS:Using the Pediatric Health Information System, we analyzed ED and inpatient visits from November 2015 to November 2018 of children with bronchiolitis 3 to 24 months old. Rates of use for specific diagnostic tests and therapeutic measures were compared across the following race/ethnicity categories: 1) non-Hispanic white (NHW); 2) non-Hispanic black (NHB); 3) Hispanic; and 4) other. Sub-analyses of ED patients only and children <1 year old were performed. Mixed-effect logistic regression was performed to compare the adjusted odds of receiving specific test/treatment using NHW children as the reference group. RESULTS:A total of 134,487 patients met inclusion criteria (59% male, 28% NHB, 26% Hispanic). Adjusted analysis showed that NHB children had higher odds to receive medication associated with asthma (OR=1.27, 95% CI=1.22-1.32) and lower odds to receive diagnostic tests (blood cultures, complete blood counts, viral testing, chest x-rays, OR=0.78, 95% CI=0.75-0.81) and antibiotics (OR=0.58, 95% CI=0.52-0.64) than NHW children. Hispanic children had lower odds to receive diagnostic testing (OR=0.94, 95% CI=0.90-0.98), asthma-associated medication (OR=0.92, 95% CI=0.88-0.96), and antibiotics (OR=0.74, 95% CI=0.66-0.82) compared to NHW children. CONCLUSION/CONCLUSIONS:NHB children more often receive corticosteroid and bronchodilator therapies; NHW children more often receive antibiotics and chest radiography. Given that current guidelines generally recommend supportive care with limited diagnostic testing and medical intervention, these findings among NHB and NHW children represent differing patterns of overtreatment. The underlying causes of these patterns require further investigation.

PURPOSE/OBJECTIVE:Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME to create X+Y scheduling where residents have continuity clinic in "blocks" rather than half-day per week experiences. The aim of this study is to assess the impact X+Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences. METHODS:Electronic surveys were sent to residents and faculty of the participating programs both prior to and 12 months after implementing X+Y scheduling. Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotation experiences using a 5-point Likert Scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. RESULTS:126 out of 186 residents (68%) responded pre-implementation and 120 out of 259 residents (47%) responded post-implementation. 384 faculty members were sent the survey with 51% response pre-implementation and 26% response at 12 months. Statistically significant (p<0.05) improvements were noted in resident and faculty perceptions of ability to have continuity with patients and inpatient workflow affected by clinic scheduling. CONCLUSIONS:From both resident and faculty perspectives, X+Y scheduling may improve several aspects of patient care and education. X+Y scheduling could be considered as a potential option by pediatric residency programs, especially if validated with more objective data.

Background: Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME in 2018 to create true X+Y scheduling models where residents see continuity clinic patients in blocks rather than half-day per week experiences.
Objective(s): Assess the impact X+Y scheduling has on pediatric faculty perceptions of patient care and other educational experiences.
Method(s): Surveys were sent via REDCap to faculty of the five participating X+Y pilot programs both prior to and 12 months after implementing an X+Y scheduling model. The surveys elicited the clinical focus of the faculty (general pediatrics, hospital medicine, or other subspecialties). Questions were then tailored to the area of clinical focus to determine the impact continuity clinic schedules had on general pediatrics, hospitalist, and subspecialty rotation experiences using a 5-point Likert scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents.
Result(s): 384 faculty members were sent the survey with 51% response pre-implementation and 32% response at 12 months. Each general pediatrics faculty outcome was improved in the X+Y model compared to traditional clinic schedules (p<0.05) including ability to have continuity with patients (64% pre to 93% post) and having adequate time for teaching (39% to 93%). Hospitalists noted decreased impacts on inpatient workflow with X+Y (79% to 29%). There was no statistical difference noted in teaching time by hospitalist or other subspecialty faculty.
Conclusion(s): General pediatric and hospitalist faculty perceive improved patient continuity and enhanced educational opportunities in X+Y scheduling compared to traditional half-day per week continuity clinics. Hospitalist and other subspecialty faculty note no significant impact on educational time after X+Y schedule implementation.
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Background: Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME in 2018 to create true X+Y scheduling models where residents see continuity clinic patients in "blocks" rather than half-day per week experiences.
Objective(s): Assess the impact X+Y scheduling has on pediatric resident perceptions of patient care and other educational experiences.
Method(s): Surveys were sent via REDCap to pediatric residents of the five participating X+Y pilot programs both prior to and 12 months after implementing an X+Y scheduling model. Survey questions measured resident perception of outpatient continuity, clinic schedule satisfaction, and the impact continuity clinic schedules had on inpatient and subspecialty rotation experiences using a 5-point Likert scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents.
Result(s): 126 out of 183 residents responded to the pre survey and 122 out of 259 residents responded to the post-implementation survey. Each outcome measure evaluated showed significant difference (p<0.01) between the pre and post-implementation surveys including the ability to have continuity with patients (27% pre-X+Y to 60% post-X+Y), quality of handoffs affected by clinic scheduling (69% pre to 10% post), and allowing adequate time for teaching on inpatient rotations (36% pre to 63% post) and in continuity clinic (35% pre to 72% post).
Conclusion(s): Residents perceive improved patient continuity and better quality of inpatient handoffs along with enhanced educational opportunities in X+Y scheduling compared to traditional half-day per week continuity clinic scheduling.
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