Faculty Bibliography

Background: Resident didactics often occur during noon conferences. In 2017, the New York University School of Medicine Pediatric Residency Program transitioned from daily noon conferences to a weekly 3-hour Academic Half Day (AHD). While internal medicine residency programs have shown an association between AHD and higher in-training exam (ITE) scores¹, the impact of AHD on pediatric resident ITE scores or satisfaction with preparation for the General Pediatric Board Exam is not well studied.
Objective(s): To investigate the impact of AHD on resident ITE scores and satisfaction with board preparation.
Method(s): We compared PGY2 raw ITE scores between the 2018 and 2019 graduating resident classes using a 2-sample t-test. We performed the same comparison for the PGY3 raw ITE scores. For the year between exams, the Class of 2018 received noon conferences, while the Class of 2019 received AHD. To assess resident satisfaction with board preparation, residents completed a survey prior to starting AHD and after 1 year. Satisfaction was reported on a Likert scale. Responses were categorized as "agree", "neutral", or "disagree" and analyzed with a chi-square test.
Result(s): There was no significant difference between the mean PGY2 ITE scores for the Class of 2018 (63.8 +/- 7.2) and 2019 (63.3 +/- 7.2) (p=0.8). The Class of 2019 had a significantly higher PGY3 ITE score (73.8 +/- 5.2) than the Class of 2018 (67.7 +/- 7.4) (p=0.01). When rating the statement "the current curriculum prepares me to take the boards", the percent of residents responding "agree" was 18% pre-AHD and 73% 1-year post-AHD. The association between initiation of AHD and satisfaction with exam preparation was statistically significant (X2=23.1, p<0.001).
Conclusion(s): The transition to an AHD had a positive impact on ITE scores and resident satisfaction with board preparation.
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BACKGROUND: The time during training that pediatric residents decide about career path is varied. Approximately half of residents plan to pursue fellowship; a percentage that is fairly stable across the 3 years of training. Individual priorities such as worklife balance, educational debt and career structure (i.e. time spent on direct patient care, research, education or administration) impact the decision. Exposure to possible career options early in training may help decision making.
OBJECTIVE(S): To determine interns perception of the usefulness of a 2-week individualized career exploration (CE) rotation.
METHOD(S): In July 2016 we implemented a 2-week CE rotation for interns that was individually designed to expose them to an area within pediatric medicine of their choosing that they are considering for their career. The experience was specifically tailored to emphasize aspects they may not typically be exposed to during an elective, such as faculty scholarship, career path and lifestyle. Interns were surveyed before and after their CE rotation. We used descriptive statistics to analyze intern's perceptions of preparedness to decide about post-residency career path.
RESULT(S): 24 interns completed pre and post CE rotation surveys. On the pre-rotation survey, when asked how prepared they felt to decide about their post-residency career 13% were neutral and 54% felt un-prepared. We found no association between timing of CE rotation during intern year and level of confidence to make a career decision. 79% felt positive that a CE rotation would help with making a career decision. On the post-rotation survey 83% of interns felt better prepared to make a career decision and 100% of interns felt the CE rotation was worthwhile. When asked which of the assigned rotation activities where most useful 42% of interns chose faculty shadowing, 32% chose conducting a faculty mini-interview, and 25% chose the self-reflection exercise.
CONCLUSION(S): A CE rotation during intern year can increase perceptions of preparedness to decide about post-residency career path

Background: Cyclic intravenous pamidronate therapy has been successfully used to treat children and adolescents with Osteogenesis Imperfecta (OI) and other bone disorders. Zoledronic acid (ZOL) is a newer bisphosphonate with higher potency and shorter infusion time that has been indicated for the treatment of adult osteoporosis. However, there is limited data on its side effect profile and effect on bone turnover in children and adolescents with bone disorders. Methods: We performed a retrospective chart analysis of clinical and biochemical findings in 8 children and adolescents who were treated with ZOL. They included 5 children with OI, 1 with osteoporosis with fractures, and 2 with avascular necrosis (AVN) of the femoral head. Subjects received an initial dose of 0.0125 mg/kg if they were bisphosphonate-nave or 0.025 mg/kg if bisphosphonate non-nave infused over 30 to 60 minutes. Patients received 3 or 4 cycles of ZOL for a total dose of 0.1 mg/kg over approximately 6 months. All patient charts were reviewed for side effects. Bone turnover markers, serum alkaline phosphatase and osteocalcin, before and after treatment were assessed for all patients. In addition, for the OI group, DEXA scan lumbar spine (LS) BMD Z-scores and fracture history were reviewed before and after treatment. Results: Mean age at start of ZOL treatment was 10.1 years (range 2 to 16). Average duration of treatment was 7 months (range 5 to 11). Four patients had received prior treatment with pamidronate. During ZOL treatment, 3 patients developed transient post-infusion hypocalcemia, 1 developed mild hyperkalemia, 2 developed low-grade fever, and 3 had other symptoms including nausea, vomiting, fatigue, body aches, headache, dyspepsia, abdominal pain, and foot pain. Serum total alkaline phosphatase levels decreased on average by 24% after three infusions (p=0.037). There was no significant change in the serum levels of osteocalcin before and after treatment. In the OI group, average LS BMD Z-score increased from -3.8 to -2.1 after ZOL therapy. There was reduction in the number of fractures after ZOL therapy compared to baseline. Mean number of fractures pre-treatment since birth was 8.3, whereas mean number of fractures during ZOL treatment and follow-up for 12 months was 0.75. Two patients had significant improvement in mobility after ZOL. Growth was normal, with no change in mean height Z-score at baseline and follow-up in all patients. Conclusions: Intravenous ZOL demonstrates short-term safety and efficacy in the treatment of children and adolescents with OI and offers a more convenient infusion protocol than pamidronate. Our study shows that ZOL therapy promotes both clinical and radiological benefit in the form of reduction of number of fractures and increase in bone mineral density on DEXA scan. Further studies are necessary to establish long-term safety and efficacy of ZOL for OI and other pediatric bone disorders

BACKGROUND: Standardized pediatric hospitalist and orthopaedic co-management of spinal fusion patients may improve quality processes and outcomes. This approach has not been studied in a general academic center. OBJECTIVE: Estimate relative effects and feasibility of the interventions on quality outcomes, length of stay (LOS), catheter-acquired urinary tract infections (CAUTI), medica- tion errors, and pain scores. DESIGN AND SETTING: Retrospective cohort using inter- rupted time series, analyzing data from 83 patients aged 5 to 18 years admitted for posterior spinal fusion (PSF) in 2009 (N = 27), 2010 (N = 28), and 2011 (N = 28) on a children's service at a general academic tertiary care center. INTERVENTIONS: Multimodal approach to standardizing pediatric PSF postoperative care with interdepartmental development of order sets, clinical care guidelines, and routine pediatric hospitalist co-management of all pediatric PSF patients. MEASUREMENTS: Chi-square analysis of order set use, guideline use measured by proxy medication and documenta- tion data. ANOVA for comparison of CAUTI and medication error rate and multivariate linear regression of LOS and pain scores. RESULTS: Pediatric hospitalist co-management documen- tation increased from 64% to 80%. Guideline use increased from 40% to 79%, and order set use was < 15%. CAUTI and medication error ratios remained low. Adjusted mean LOS decreased by 0.8 days (p = 0.039, 95% CI 0.7, 1.1). Pain scores did not differ. CONCLUSION: Interdisciplinary, clinical guideline devel- opment and postoperative co-management significantly decreased hospital LOS in pediatric PSF patients. In a general academic medical center, this change may be at- tributed to a pediatric hospitalist academic team, a universal co-management process with well-communicated roles, and a pediatric hospital-based physician development of and adherence to standardized practice.