Objective To assess whether utilization of a validated communication tool corresponds with faculty assessment and resident self-assessment on the pediatric communication milestone continuum. Methods Pediatric residents were recruited to participate in the communication skills assessment. Continuity clinic faculty completed an assessment of each residents communication skills utilizing the 6 pediatric milestones that address interpersonal and communication skills. Each participating resident completed a self-assessment of their own communication skills utilizing the same milestones. After being placed on the milestones, the residents participated in a standardized patient interview that was recorded and subsequently evaluated by a faculty observer utilizing the Common Ground Instrument. Results 16/16 of pediatric residents participated in the study. The milestones and common ground instrument were scored on a scale from 1 to 5 with 5 representing an expert rating. For PGY-1 residents, the average faculty score on the milestones was 3.17, self-assessed average score was 2.92 and common ground average score was 3.67. For PGY-2 residents, the average faculty score on the milestones was 4.40, self-assessed score average was 4.10 and common ground average score was 3.20. For PGY-3 residents, the average faculty score on the milestones was 4.70, self-assessed score average was 4.10 and common ground average score was 3.60. PGY-1s had significantly lower self and faculty assessments than PGY-2s or -3s. There were no significant differences among PGYs on the Common Ground Interview score. Faculty rated residents significantly higher than they rated themselves. Previous clinical skills training, standardized patient training, and English as a first language had no significant effect on the self-assessment, faculty assessment or Common Ground Instrument score. Conclusion Faculty and residents observe an improvement in communication skills as residents progress through training; however, scores on a validated communication tool do not reflect this improvement.

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Introduction: Efforts to improve health care in the US are focusing on the Quadruple Aim which targets enhanced patient experiences, population health management, control of costs and improved provider satisfaction. Traditional academic centers have fallen behind in preparing pediatricians to practice in this new milieu; pediatric residents consistently report feeling least competent in systems-based practice. To better prepare residents to enter the work force, we introduced a team based care curriculum for pediatric residents in the 2016-2017 academic year. Methods: Participants in the new curriculum included all 21 residents in our academic based residency program. An inter-professional team developed a curriculum consisting of six core modules: team care, team communication, quality improvement, health care roles, champion teams and advanced communications. Prior to participation, residents completed a pre-test of knowledge and the validated Attitudes Toward Health Care Teams scale. The same instruments were administered after completion of the modules. Results: All 21 pediatric residents completed the pre and post-tests. Resident knowledge significantly improved from a pre-test score of 63% to a post test score of 70% (p< 0.05). The Quality Improvement and Team Roles subtests showed significant improvement (p<0.05). On the Attitudes Towards Health Care Teams scale, the residents had a favorable attitude toward team value and team efficiency; these did not significantly change from pre to post-test. Pediatric residents’ attitudes toward physicians shared role in the team improved significantly (p<0.01). They reported enhanced attitudes regarding two key constructs: 1) shared team leadership and responsibility and 2) limits on physician control of team function. Conclusions: While pediatric residents in general had a favorable view of team-based care, participation in a team-based care curriculum positively affected their views of the physician’s role on a team. Understanding shared labor within a team, may help residents to achieve the fourth Quadruple Aim of satisfaction in healthcare by all providers.

Made available in DSpace on 2016-06-02T19:44:02Z (GMT). No. of bitstreams: 1 1615.pdf: 2019572 bytes, checksum: 6255d6f489ad11448457b2441c3dfab5 (MD5) Previous issue date: 2007-05-31 / Studies have shown that developmental surveillance is an important task to be performed by the pediatrician and its objective is to precociously identify children who may need more complex evaluation as well as provide information about their development and not only their physical health. It also makes possible a definite diagnosis and the elaboration of an interdisciplinary plan of care for children in order to undergo early intervention. Other studies indicate that the pediatricians´ knowledge regarding developmental surveillance and their use of instruments to accomplish this practice is defective. Despite the fact that just a few perform developmental surveillance, they consider this issue important and demonstrate interest in updating themselves. According to these studies, the pediatricians should update their knowledge concerning development aspects and risk factors, use sorting techniques and lead the child presenting development delay to early stimulation programs. The general objective of this work is to analyze the knowledge related to health promotion, developmental surveillance and pediatric residents´ perception of babies´ delays in the state of São Paulo by analyzing the curriculum description and the performance in questionnaires. The curriculum guidelines from MEC (Brazilian Education Ministry) for pediatric residence teaching, the relation of vacancies for this specialty and the curriculum of seven medical pediatric residence courses in the state of São Paulo were analyzed, with the objective of identify elements concerning developmental surveillance in pediatric teaching (first stage). In the second stage of this study, the data regarding developmental surveillance practices and the knowledge about children s development were collected and correlated. It was carried out by the replication of two questionnaires, which were answered by 65 first and second-year pediatric residents of five specialization courses in the state of São Paulo. According to the analysis of MEC´s curriculum guidelines in relation to the subjects to be studied about developmental surveillance, it is possible to assert that they are general and non-specific, and the curriculums are superficial and not clear enough to make the identification of the practices related to developmental surveillance possible. Only one course of this research has the necessary requirements that allow the identification of elements related to this topic. The results of the second stage has shown that the majority of pediatric residents has different attitudes compared to the ones performed by doctors who are dealing with children s health for longer time. These different attitudes may reduce the efficacy of the developmental surveillance carried out by pediatricians. The correlation between the pediatric teaching and the residents´ knowledge about developmental surveillance has shown that the courses which have higher average in the questionnaires also have better developmental surveillance s contents described in their curriculums. The residents who justified why they ask or not the mothers about development and the ones who confirmed the use of evaluation scales had higher scores in the questionnaire. This study proposes further investigation related to the continuous professional development for pediatric residents, distance learning, the use of Moodle tools and topics such as: Promotion of health concept and developmental surveillance, non-identified precocious delays consequences, protocols about developmental surveillance, guidelines for normal infant development to the pediatricians, identification of development delays, and quick and easy measures to be used during practice and inserted in institutional dynamics. Using these results as a basis, a contribution to the pediatrician s mobilization regarding the importance of developmental surveillance and precocious identification of children with development delay is expected. / Estudos têm mostrado que a vigilância do desenvolvimento é uma importante tarefa do pediatra e tem a função de identificar precocemente crianças que podem necessitar de avaliação mais complexa; fornecer informações sobre o seu desenvolvimento e não somente sobre sua saúde física; possibilitar o diagnóstico definitivo e a elaboração de um plano de atendimento interdisciplinar para a criança visando a intervenção precoce de deficiências. Outros estudos indicam que o conhecimento dos pediatras sobre vigilância do desenvolvimento e uso de instrumentos para realizá-la é falho. Entretanto, dão importância ao tema e demonstram interesse em atualizar-se, mas poucos praticam a vigilância do desenvolvimento. Para desempenhar essa tarefa o pediatra deveria, segundo tais estudos, atualizar seus conhecimentos sobre os aspectos do desenvolvimento e fatores de risco, utilizar técnicas de triagem e encaminhar a criança que apresenta atraso de desenvolvimento a programas de estimulação precoce. O objetivo geral deste trabalho consiste em analisar alguns conhecimentos relacionados à promoção de saúde, vigilância do desenvolvimento e a percepção de atrasos em bebês junto a residentes em pediatria do estado de São Paulo, considerando a descrição da grade curricular e o seu desempenho em questionários. Foi realizada análise documental das diretrizes curriculares do MEC para o ensino da residência médica em pediatria, da relação de vagas para a especialidade e das grades curriculares de sete cursos de residência em pediatria no estado de São Paulo, com o objetivo de identificar elementos sobre a vigilância do desenvolvimento no ensino da pediatria (primeira etapa). A segunda etapa do estudo levantou e correlacionou dados sobre as práticas em vigilância do desenvolvimento e o conhecimento sobre áreas do desenvolvimento infantil junto a 65 residentes de pediatria de primeiro e segundo ano de cinco cursos de especialização do estado de São Paulo, por meio da replicação de dois questionários. Os dados gerais da análise do ensino de pediatria mostraram que os referenciais curriculares do MEC quanto às disciplinas que deveriam abordar o tema vigilância do desenvolvimento na residência em pediatria são gerais e inespecíficos; as grades apresentam conteúdo superficial quanto à abordagem da vigilância do desenvolvimento e não estão claras suficientemente para permitir a visualização de ações relacionadas a esta temática e apenas um curso participante da pesquisa reúne os requisitos necessários que permitem identificar elementos relacionados ao tema. Os resultados da segunda etapa mostraram que a maioria dos residentes em pediatria apresenta atitudes diferenciadas dos médicos que atuam já há mais tempo em atenção à saúde da criança, mas também apresentam alguns problemas que podem comprometer a eficácia da vigilância do desenvolvimento realizada por pediatras. As correlações entre o ensino de pediatria e o conhecimento dos residentes sobre a vigilância do desenvolvimento mostraram que os cursos que apresentam o desempenho médio mais alto nos questionários têm também a melhor descrição do conteúdo de vigilância do desenvolvimento em suas grades curriculares; os residentes que justificaram porque perguntam ou não sobre desenvolvimento às mães e os que afirmaram utilizar escalas de avaliação em sua prática acertaram maior número de questões do questionário. A partir de tais resultados, apresenta-se como proposta para futuros estudos a elaboração de um programa de formação continuada para residentes em pediatria na forma de ensino à distância, utilizando as ferramentas do ambiente de aprendizagem Moodle, contendo tópicos como: conceito de promoção de saúde e vigilância do desenvolvimento, conseqüências da não identificação precoce de atrasos, protocolos sobre vigilância do desenvolvimento, rota de ações para o pediatra envolvendo o desenvolvimento normal do bebê, a identificação de atrasos do desenvolvimento, uso de instrumentos rápidos e fáceis de serem aplicados na prática clínica e inseridos na dinâmica institucional. Com base nos resultados encontrados, espera-se contribuir para a mobilização do pediatra quanto à importância da vigilância do desenvolvimento e da identificação precoce de crianças com atrasos de desenvolvimento.