Trio of studies tackles trends affecting pediatric residents
AT PEDIATRIC HOSPITAL MEDICINE 2013
Other predictors of making a correct diagnosis were obtaining a patient history (adjusted OR, 1.35) and obtaining an exam, labs, and radiology (aOR, 1.47).
"It’s obvious that residents lack insight into the causes of premature closure, but this does set us up for some opportunities for education," Dr. Nassetta said. "We can use simulated cases to demonstrate diagnostic error, discuss premature closure, and strategies for avoiding it."
Strategies she employs with residents include stressing the importance of the history and physical exam, having residents ask what doesn’t fit the diagnosis they have in mind, encouraging them to come up with one alternative diagnosis for every patient they see, and having residents describe rather than diagnose the patient at the time of handoff.
Are residents perceived as pricey?
Most pediatric hospitalists surveyed think residents increase the quality of care, but do so at increased cost to the hospital, according to a 15-item, anonymous, electronic survey of 127 pediatric hospitalists at 113 institutions.
Overall, 60% of respondents thought residents increase the quality of care, 23% said they have no impact, and 17% thought they actually decrease quality, said Dr. David P. Johnson, of Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tenn.
Subgroup analyses showed that 71% of hospitalists who always work with residents thought residents improve the quality of care, whereas only 43% of those who sometimes do, and 53% who never do felt the same (P less than .05).
Hospitalists affiliated with academic hospitals were also significantly more likely to say residents improve quality than were those at community hospitals (65% vs. 38%), he said.
In all, 72% of respondents said residents increase hospital costs, while 23% said they had no impact and 6% said they decrease costs.
In subgroup analyses, however, the perception that residents increase costs was similar no matter how much respondents worked with residents (71%, 71%, 73%; always, sometimes, never) or what their affiliation was (69% academic, 83% community), Dr. Johnson said.
One of the most intriguing findings from the survey was that 78% of hospitalists deny having any formal training in resource utilization, yet 91% think they provide cost-effective care, and 81% feel they are qualified to teach it, Dr. Johnson said.
"A gap exists between what we think we know and the training that we received," he said. "I don’t think that’s necessarily a bad thing, but it’s something we need to be cognizant of, both as we are taking care of our patients and teaching our residents."
Dr. Johnson hypothesized that informal training, reading, and being at the right place at the right time might explain some of the hospitalists’ confidence in the absence of formal training, but that experience may also matter.
Hospitalists with more than 10 years of experience were significantly more likely to say they had the knowledge to provide cost-effective care, compared with those with 6-10 years of experience or 5 years or less (100% vs. 91% vs. 85%; P less than .05). A similar, but nonsignificant, trend was present when respondents were asked whether they were qualified to teach cost-effective care (93% vs. 77% vs. 75%).
At baseline, 31% of respondents had been in practice for more than 10 years, 28% for 6-10 years, and 41% for 0-5 years. The majority had an academic affiliation (81%); 55% always worked with residents, 33% sometimes, and 12% never.
Dr. Oshimura, Dr. Nassetta, and Dr. Johnson reported having no financial disclosures.
