Background: In recent years, the Accreditation Council for Graduate Medical Education (ACGME), and the Ambulatory Pediatric Association (APA) have developed detailed resident learning objectives and competencies. Maintaining adequate documentation that residents are fulfilling these objectives and competencies is a challenge. Objectives: To develop and evaluate use of an internet based curriculum, EPIC (East Tennessee Pediatric Internet Curriculum) to facilitate teaching and evaluation of the core competencies. Methods: Goals and content for the site were developed based on literature review and input from a pediatric internet committee. Resident internet-based learning is being evaluated using pre- and post- surveys over a six month period. Results: EPIC is a central location for residents to access information, including announcements, phone lists, and scheduling information. Educational content is organized around the six core competencies for resident education. For example, “Medical Knowledge”consists of a portfolio system developed for the ambulatory clinic. Portfolios include a checklist of pertinent information to be covered during a patient encounter and a related downloadable article to enhance resident knowledge. The section also includes links to other learning resources. An interactive discussion forum exists to facilitate discourse on medical and residency-related topics. Residents also complete online pre- and post- test questions during every clinical rotation and receive instant feedback on their responses. All 11 residents completed the pre-survey. Frequent or very frequent internet use was reported by 54% of residents to answer specific clinical questions and 45% of residents for general medical learning during the work day. Conclusion: Pediatric residents already utilize the internet to access medical information. EPIC accommodates residents’varying schedules and is a useful adjunct to other teaching and evaluation methods.

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Background: The process of level of care (LOC) determination has been traditionally fraught with unreliability and lack of objectivity. There is a similar need for reliable objective LOC determination tools for youth in the juvenile justice systems, which have high prevalence of psychiatric disorders and unmet mental health needs and are disproportionately from minority backgrounds. The CASII has already demonstrated significant interrater reliability and validity in studies with mental health and child welfare populations. Method: In 2004 and 2005, the Tennessee CPORT team reviewed 206 youth in the juvenile justice system ages 13 and older, 92.8% male, with 37.4% Caucasian, 55.8% African American. Instruments used included the CASII, CAFAS, CBCL, YSR, TRF, and the CPORT Child and Family Indicators. Results: There was a significant correlation between all of the CASII subscales and the CAFAS Total Scores (Pearson coefficients 0.210 to 0.618). The CASII Total Score and the CASII LOC were both highly correlated to CBCL, the YSR, and the TRF total scores and sub-scales. Significant correlations between the CASII LOC were found in 10 of the 13 CPORT Child and Family Indicators, while actual LOC placement was significantly correlated with only 4 of the 13 dimensions. The actual LOC placement was significantly different than recommended CASII LOC (p < 0.0000), with the majority of recommended LOCs being lower. Conclusions: This LOC tool is demonstrating high levels of reliability and validity in different systems of care settings, including juvenile justice, child welfare, and mental health contexts. Use of the CASII could result in significant savings in resources that could be used to provide services for adolescent offenders, and in reduction in unnecessary restrictiveness of placements.

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Haiti is a Caribbean island with a humanitarian medical center providing healthcare services to 90,000 residents. Pregnant women visiting the medical clinic for prenatal care often do not return for delivery; instead, they return home to deliver alone or with the assistance of a traditional matron. Home-birth practices increase maternal-child health morbidity and mortality in an already fragile country. The purpose of this project was to gain a deeper understanding of Haitian pregnant women's preferences to deliver at home or at the healthcare clinic. The transtheoretical model for behavior change and the Johns Hopkins nursing evidence-based practice model guided the project. Two focus groups of 10 pregnant women total were recruited in the community of Delmas 32, Haiti. Group 1 was comprised of 5 women who delivered at home with matrons and Group 2 was comprised of 5 women who delivered at the clinic. Structured questions were asked to identify themes related to delivery location preferences. Focus group transcripts were analyzed guided by the Krueger and Casey strategy model. The thematic analysis was aligned with the peer-reviewed literature. Findings revealed that lack of access to care, lack of education and sensitization, and the attitude of healthcare personnel impacted women's preference for delivery at the clinic. Findings also supported a need to educate staff and the community in the best options for maternal-child care. A workshop was developed, based on the project findings, to share the recommendations with the clinic staff. The clinical leadership have indicated that they will implement the project recommendations. This project has the potential to support social change by reducing maternal-child deaths in Delmas 32 and across the Caribbean.