Lauren S. Starnes

To improve the transition to residency, the Coalition for Physician Accountability recently recommended a post-Match, learner-driven educational handover. Few studies have analyzed students’ perspectives on the content of handovers, especially the inclusion of personal values or self-care goals. We surveyed graduating medical students at our institution on their perspectives about the content in an educational handover to residency programs. A subset agreed with sending goals, personal values, and learning style to program directors. Students expressed concerns with sending feedback or grades and the potential to perpetuate prior perceptions.

Introduction: Medical students feel poorly prepared to examine pediatric patients during clerkship. Our institution’s introduction to clinical skills course lacked practice with pediatrics physical examination skills. We developed a novel clinical skills curriculum to increase students’ confidence in examining pediatric patients. Methods: Ericsson’s deliberate practice conceptual framework guided curriculum design. We utilized a flipped-classroom model to teach the newborn examination. Students watched a video, then practiced with manikins and patients. For the child examination, students attended a lecture and practiced with hospitalized children and facilitators. Students then participated in a Home, Education, Eating/Exercise, Activities/Employment, Drugs, Suicidality, Sexuality, Safety (HEEADSSS) didactic and role play activity. Before and after participation, students completed REDCap surveys ranking confidence in performing pediatric examinations and identifying normal examination findings on a Likert scale (1 = “Not at all confident,” 4 = “Extremely confident”). We analyzed data using Wilcoxon rank sum tests. Results: A total of 97 students participated in the curriculum. Respectively, 56 (58%) and 32 (30%) students completed pre- and post-participation surveys. Post-participation, students reported increased confidence in identifying normal infant (median [interquartile range]; (2 [2,2] vs 4 [3,4]; p < 0.001) and child (2 [2,2] vs 3 [3,4]; p < 0.001) examination findings as well as HEEADSSS assessment components (2 [1.5,2] vs 4 [3,4]; p < 0.001), and had significantly higher scores on confidence performing infant (2 [2,2.5] vs 4 [3,4]; p < 0.001), child (2 [2,2] vs 3 [3,4]; p < 0.001), and HEEADSSS assessment (2 [2,3] vs 4 [3,4]; p < 0.001). Discussion: This multi-modal curriculum emphasizing pediatric examination skills improved students’ confidence in pediatric-specific knowledge and skills prior to clerkship.

Background: Children with high‐intensity neurologic impairment (HINI) have an increased risk of urinary tract infection (UTI) and prolonged intravenous (IV) antibiotic exposure.Objective: To determine the association between short (≤3 days) and long (>3 days) IV antibiotic courses and UTI treatment failure in hospitalized children with HINI.Methods: We performed a retrospective cohort study examining UTI hospitalizations at 49 hospitals in the Pediatric Health Information System from 2016 to 2021 for children (1–18 years) with HINI. The primary outcome was UTI readmission within 30 days. Our secondary outcome was the association of hospital‐level variation in short IV antibiotic course use with readmission. Readmission rates were compared between short and long courses using multivariable regression.Results: Of 5612 hospitalizations, 3840 (68.4%) had short IV antibiotic courses. In our adjusted model, children with short IV courses were less likely than with long courses to have a 30‐day UTI readmission (4.0%, 95% CI [3.6%, 4.5%] vs. 6.3%, 95% CI [5.1%, 7.8%]). Despite marked hospital‐level variation in short IV course use (50.0%–87.5% of hospitalizations), there was no correlation with readmissions.Conclusions: Children with HINI hospitalized with UTI had low UTI readmission rates, but those who received long IV antibiotic courses were more likely to experience UTI readmission versus those receiving short courses. While residual confounding may influence our results, we did not find that short IV courses impacted readmission at the hospital level despite variation in use across institutions. Long IV antibiotic courses are associated with risks and may not confer benefit in this population.

Background: Multisystem inflammatory syndrome in children (MIS‐C) is a rare but serious complication of severe acute respiratory syndrome coronavirus 2 infection. Features of MIS‐C overlap with those of Kawasaki disease (KD).Objective: The study objective was to develop a prediction model to assist with this diagnostic dilemma.Methods: Data from a retrospective cohort of children hospitalized with KD before the coronavirus disease 2019 pandemic were compared to a prospective cohort of children hospitalized with MIS‐C. A bootstrapped backwards selection process was used to develop a logistic regression model predicting the probability of MIS‐C diagnosis. A nomogram was created for application to individual patients.Results: Compared to children with incomplete and complete KD (N = 602), children with MIS‐C (N = 105) were older and had longer hospitalizations; more frequent intensive care unit admissions and vasopressor use; lower white blood cell count, lymphocyte count, erythrocyte sedimentation rate, platelet count, sodium, and alanine aminotransferase; and higher hemoglobin and C‐reactive protein (CRP) at admission. Left ventricular dysfunction was more frequent in patients with MIS‐C, whereas coronary abnormalities were more common in those with KD. The final prediction model included age, sodium, platelet count, alanine aminotransferase, reduction in left ventricular ejection fraction, and CRP. The model exhibited good discrimination with AUC 0.96 (95% confidence interval: [0.94–0.98]) and was well calibrated (optimism‐corrected intercept of −0.020 and slope of 0.99).Conclusions: A diagnostic prediction model utilizing admission information provides excellent discrimination between MIS‐C and KD. This model may be useful for diagnosis of MIS‐C but requires external validation.

Objective: Prolonged pre‐procedural fasting in children is associated with decreased patient and family satisfaction and increased patient hemodynamic instability. Practice guidelines recommend clear liquid fasting times of 2 h. We aimed to decrease pre‐procedural clear liquid fasting time from 10 h 13 min to 5 h for pediatric hospital medicine (PHM) patients.Methods: All children admitted to the PHM service at a quaternary care children's hospital with an NPO (nil per os) order associated with a procedure requiring general anesthesia or sedation from November 2, 2017 to September 19, 2021 were included. The primary outcome measure was the average time from clear liquid fasting end time to anesthesia start time. The process measure was the percent of NPO orders including a documented clear liquid fasting end time. Balancing measures were aspiration events and case delays/cancellations. Statistical process control charts were used to analyze outcomes.Results: Shortly after implementation of a SmartPhrase in the NPO order, there was special cause variation resulting in a centerline shift from a mean of 10 h 13 min to 6 h 37 min and an increase in the process measure from a baseline of 2%–52%. Following implementation of a hospital‐wide change to the NPO order format, another centerline shift to 6 h 7 min occurred which has been sustained for 6 months. No aspiration events and four NPO violations occurred during the intervention period.Conclusion: Quality improvement methodology and higher reliability interventions safely decreased the average pre‐procedural fasting time in hospitalized children.