Caroline E. Rassbach

All Publications

• Tips for developing a coaching program in medical education. Medical education online Miller-Kuhlmann, R., Sasnal, M., Gold, C. A., Nassar, A. K., Korndorffer, J. R., Van Schaik, S., Marmor, A., Williams, S., Blankenburg, R., Rassbach, C. E. 2024; 29 (1): 2289262

  Abstract

  This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.

  View details for DOI 10.1080/10872981.2023.2289262

  View details for PubMedID 38051864

• Preparing Physician-Scientists for the Future of Academic Medicine. Pediatrics Burns, A. M., Moore, D. J., Rassbach, C. E., Boyer, D., Gildner, C., Byrne, B., Harris, K. W., Iness, A., Powell, W. T., Callaway, D., Lajiness, J., Forster, C. S., Orange, J. S., Ackerman, K. G., Thammasitboon, S. 2024

  Abstract

  The changing field of academic medicine presents unique challenges for physician-scientists, who intricately weave the complexities of research and patient care. These challenges have significantly lengthened the time needed for scientific discoveries to be applied in clinical practice. In response to these escalating demands, the training trajectory for physician-scientists has notably expanded over recent decades. In anticipation of and preparation for future training requirements, the National Pediatrician-Scientist Collaborative Workgroup facilitated a series of convenings with a diverse array of stakeholders vested in physician-scientist training. The framework Strategic Foresight was used to explore possible future scenarios and develop strategic plans. Seven pivotal themes, termed "performance zones," emerged from this endeavor: (1) revolution in education through technology-enhanced learning, (2) educational outcomes beyond content mastery, (3) artificial intelligence-empowered research portfolios and expansive networks, (4) evolution of high-performance inclusive, equitable, distributed, and agile teams, (5) evolution of antifragile systems, (6) a multiparadigmatic program of research, and (7) interdependence and commitments to a common agenda for collective impact. These identified zones underscore the imperative for physician-scientists to acquire novel skill sets essential for navigating the impending shifts in the health care landscape. These findings are poised to steer policy initiatives and educational advancements, fortifying the foundation for future physician-scientist training needs.

  View details for DOI 10.1542/peds.2024-067045

  View details for PubMedID 39359193

• Competency based medical education and trust in the learning environment. Current problems in pediatric and adolescent health care Hsu, D., Rassbach, C., Leaming-Van Zandt, K., Morrow, A., Rubenstein, J., Tatem, A., Turner, D. A., Poitevien, P., Barone, M. A. 2024: 101640

  View details for DOI 10.1016/j.cppeds.2024.101640

  View details for PubMedID 38876832

• Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study. Academic pediatrics Hoang, K., Mollie Grow, H., Rooholamini, S. N., McPhillips, H., Selling, S. K., Rassbach, C. E., Blankenburg, R. 2024

  Abstract

  OBJECTIVE: Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates.METHODS: In July to November 2020, we conducted an IRB-approved qualitative study with semi-structured interviews of residency graduates from two pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness.RESULTS: We interviewed 34 residency graduates from two institutions and identified four themes on how coaches influenced residency graduates' PIF by 1) a presence of a trusting relationship, 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback, 3) integrating clinical skill, career interests, and work-life integration, and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency.CONCLUSIONS: Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.WHAT'S NEW: This study is the first to explore how clinical coaching can be used to develop and enhance residents' professional identity formation both during and after residency and provides strategies coaches and residents can use to facilitate PIF.

  View details for DOI 10.1016/j.acap.2024.04.012

  View details for PubMedID 38729301

• Impact of a coaching program on resident perceptions of communication confidence and feedback quality. BMC medical education Gold, C. A., Jensen, R., Sasnal, M., Day, H. S., Miller-Kuhlmann, R. K., Blankenburg, R. L., Rassbach, C. E., Morris, A. M., Korndorffer, J. R., Nassar, A. K. 2024; 24 (1): 435

  Abstract

  While communication is an essential skill for providing effective medical care, it is infrequently taught or directly assessed, limiting targeted feedback and behavior change. We sought to evaluate the impact of a multi-departmental longitudinal residency communication coaching program. We hypothesized that program implementation would result in improved confidence in residents' communication skills and higher-quality faculty feedback.The program was implemented over a 3-year period (2019-2022) for surgery and neurology residents at a single institution. Trained faculty coaches met with assigned residents for coaching sessions. Each session included an observed clinical encounter, self-reflection, feedback, and goal setting. Eligible residents completed baseline and follow-up surveys regarding their perceptions of feedback and communication. Quantitative responses were analyzed using paired t-tests; qualitative responses were analyzed using content analysis.The baseline and follow-up survey response rates were 90.0% (126/140) and 50.5% (46/91), respectively. In a paired analysis of 40 respondents, residents reported greater confidence in their ability to communicate with patients (inpatient: 3.7 vs. 4.3, p < 0.001; outpatient: 3.5 vs. 4.2, p < 0.001), self-reflect (3.3 vs. 4.3, p < 0.001), and set goals (3.6 vs. 4.3, p < 0.001), as measured on a 5-point scale. Residents also reported greater usefulness of faculty feedback (3.3 vs. 4.2, p = 0.001). The content analysis revealed helpful elements of the program, challenges, and opportunities for improvement. Receiving mentorship, among others, was indicated as a core program strength, whereas solving session coordination and scheduling issues, as well as lowering the coach-resident ratio, were suggested as some of the improvement areas.These findings suggest that direct observation of communication in clinical encounters by trained faculty coaches can facilitate long-term trainee growth across multiple core competencies. Future studies should evaluate the impact on patient outcomes and workplace-based assessments.

  View details for DOI 10.1186/s12909-024-05383-5

  View details for PubMedID 38649901

  View details for PubMedCentralID PMC11036561

• CRISP: An Inpatient Pediatric Curriculum for Family Medicine Residents Using Clinical Reasoning and Illness Scripts. MedEdPORTAL : the journal of teaching and learning resources Madduri, G. B., Torwekar, E. L., Demirel, S., Durham, M., Hauff, K. I., Kaul, R., Nichols, T., Ravid, N. L., Shaner, M. A., Rassbach, C. E. 2024; 20: 11393

  Abstract

  Clinical reasoning enables safe patient care and is an important competency in medical education but can be challenging to teach. Illness scripts facilitate clinical reasoning but have not been used to create pediatric curricula.We created CRISP (Clinical Reasoning with Illness Scripts in Pediatrics), a curriculum comprising four 1-hour learning sessions that deliberately incorporated clinical reasoning concepts and illness scripts to organize how four common chief complaints were taught to family medicine residents on inpatient pediatric rotations. We performed a multisite curriculum evaluation project over 6 months with family medicine residents at four institutions to assess whether the use of clinical reasoning concepts to structure CRISP was feasible and acceptable for learners and instructors and whether the use of illness scripts increased knowledge of four common pediatric chief complaints.For all learning sessions, family medicine residents and pediatric hospitalists agreed that CRISP's format was preferable to traditional didactic lectures. Pre-/posttest scores showed statistically significant increases in family medicine resident knowledge (respiratory distress [n = 42]: pretest, 72%, posttest, 92%; abdominal pain [n = 44]: pretest, 82%, posttest, 96%; acute febrile limp [n = 44]: pretest, 68%, posttest, 81%; well-appearing febrile infant [n = 42]: pretest, 58%, posttest, 73%; ps < .05).By using clinical reasoning concepts and illness script comparison to structure a pediatric curriculum, CRISP represents a novel instructional approach that can be used by pediatric hospitalists to increase family medicine resident knowledge about diagnoses associated with common pediatric chief complaints.

  View details for DOI 10.15766/mep_2374-8265.11393

  View details for PubMedID 38524942

  View details for PubMedCentralID PMC10957791

• Laying the Foundation: How to Develop Rigorous Health Professions Education Scholarship. Hospital pediatrics Gilliam, C., Ramos, M., Hilgenberg, S., Rassbach, C., Blankenburg, R. 2024

  View details for DOI 10.1542/hpeds.2023-007162

  View details for PubMedID 38178786

• Spiritual Care in PICUs: A U.S. Survey of 245 Training Fellows 2020-2021. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Stevens, P. E., Rassbach, C. E., Qin, F., Kuo, K. W. 2023

  Abstract

  To understand the perspectives of pediatric fellows training in critical care subspecialties about providing spiritual care.Cross-sectional survey of United States National Residency Matching Program pediatric fellows training in critical care specialties.Online survey open from April to May 2021.A total of 720 fellows (165 cardiology, 259 critical care, and 296 neonatology) were contacted, with a response rate of 245 of 720 (34%).None.We assessed fellows' survey responses about spiritual care in neonatal and pediatric critical care units. Categorical data were compared using chi-square test or Fisher exact tests. The Wilcoxon rank-sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Free-text responses were independently coded by two research investigators. A total of 203 of 245 (83%) responding fellows had never received training about spiritual care and 176 of 245 (72%) indicated that they would be likely to incorporate spiritual care into their practice if they received training. Prior training was associated with increased familiarity with a framework for taking a spiritual history (p < 0.001) and increased knowledge of spiritual practices that could influence medical care (p = 0.03). Prior training was also associated with increased self-reported frequency of taking a spiritual history (p < 0.001) and comfort in referring families to spiritual care resources (p = 0.02). Lack of time and training were the most reported barriers to providing spiritual care.Providing spiritual care for families is important in critical care settings. In 2020-2021, in the United States, 245 pediatric critical care fellows responded to a survey about spiritual care in their practice and reported that they lacked training in this subject. An opportunity exists to implement spiritual care curricula into pediatric fellowship training.

  View details for DOI 10.1097/PCC.0000000000003429

  View details for PubMedID 38088772

• Development of Scholarship Core Competencies for Pediatric Hospital Medicine Fellowship Programs. Hospital pediatrics Thomson, J. E., Rassbach, C. E., Shah, N., Walker, J., Wilson, K., Shah, S. S., Jerardi, K. 2023

  Abstract

  The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.

  View details for DOI 10.1542/hpeds.2023-007360

  View details for PubMedID 38073321

• Benefits and challenges of combined pediatrics-anesthesiology residency programs: A qualitative study. Paediatric anaesthesia Nguyen, C., Xie, J., Brandford, E., Wang, T., Rassbach, C. E. 2023

  Abstract

  BACKGROUND: The combined pediatrics-anesthesiology residency program was created in 2011 for trainees interested in careers within both specialties. Prior studies have cited challenges of combined training, but none have systematically identified benefits.AIMS: Our objective was to describe the perceived educational and professional benefits and challenges of combined pediatrics-anesthesiology residency programs.METHODS: In this qualitative study using a phenomenological approach, all graduates of combined pediatrics-anesthesiology residency programs from 2016 to 2021, program directors, associate program directors, and faculty mentors were invited to participate in surveys and interviews. Study members conducted interviews using a semi-structured interview guide. Each transcript was coded inductively by two authors and themes were developed using thematic analysis through the lens of self-determination theory.RESULTS: 43 of 62 graduates and faculty responded to our survey (69% response rate), and 14 graduates and five faculty were interviewed. Survey and interview data represented seven programs, including five currently accredited combined programs. Themes emerged regarding benefits of training: it 1) fosters residents' clinical expertise in managing critically ill and medically complex children; 2) provides residents with exceptional knowledge and skills in communicating between medical and perioperative services; and 3) affords unique academic and career opportunities. Other themes emerged regarding the challenges of long duration of training and transitions between pediatrics and anesthesiology rotations.CONCLUSIONS: This is the first study to describe the perceived educational and professional benefits of combined pediatrics-anesthesiology residency programs. Combined training affords exceptional clinical competence and autonomy in the management of pediatric patients and the ability to skillfully navigate hospital systems, and leads to robust academic and career opportunities. However, the duration of training and challenging transitions may threaten residents' sense of relatedness to colleagues and peers, and their self-perceived competence and autonomy. These results can inform mentoring and recruitment of residents to combined pediatrics-anesthesiology programs and career opportunities for graduates.

  View details for DOI 10.1111/pan.14727

  View details for PubMedID 37435637

• Building an Anti-Racist Department through an Experiential Department-Wide Anti-Racism Curriculum. Academic pediatrics Guerin, A., Lee, J., Floyd, B., Yemane, L., Fassiotto, M., Griffith, E., Blankenburg, R., Hilgenberg, S. L., Dali, S., De Araujo, M., Jones, K., Kuo, K., Rassbach, C. E. 2023

  View details for DOI 10.1016/j.acap.2023.06.001

  View details for PubMedID 37422256

• Leadership & professional development: Coaching to develop clinicians, teachers, and leaders. Journal of hospital medicine Hoang, K., Rassbach, C. E. 2023

  View details for DOI 10.1002/jhm.13150

  View details for PubMedID 37301729

• A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills. Journal of palliative medicine Goyal, T., Merrell, S. B., Weimer-Elder, B., Kline, M., Rassbach, C. E., Gold, C. A. 2023

  Abstract

  Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p=0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p=0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p<0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.

  View details for DOI 10.1089/jpm.2022.0371

  View details for PubMedID 36952327

• Supportive and collaborative interdependence: Distinguishing residents' contributions within healthcare teams. Medical education Sebok-Syer, S. S., Lingard, L., Panza, M., Van Hooren, T. A., Rassbach, C. E. 2023

  Abstract

  Individual assessments disregard team contributions, while team assessments disregard an individual's contributions. Interdependence has been put forth as a conceptual bridge between our educational traditions of assessing individual performance and our imminent challenge of assessing team-based performance without losing sight of the individual. The purpose of this study was to develop a more refined conceptualization of interdependence to inform the creation of measures that can assess the interdependence of residents within healthcare teams.Following a constructivist grounded theory approach, we conducted 49 semi-structured interviews with various members of healthcare teams (e.g., physicians, nurses, pharmacists, social workers, patients) across two different clinical specialties - Emergency Medicine and Pediatrics - at two separate sites. Data collection and analysis occurred iteratively. Constant comparative inductive analysis was used and coding consisted of three stages: initial, focused, and theoretical.We asked participants to reflect upon interdependence and describe how it exists in their clinical setting. All participants acknowledged the existence of interdependence, but they did not view it as part of a linear spectrum where interdependence becomes independence. Our analysis refined the conceptualization of interdependence to include two types: supportive and collaborative. Supportive interdependence occurs within healthcare teams when one member demonstrates insufficient expertise to perform within their scope of practice. Collaborative interdependence, on the other hand, was not triggered by lack of experience/expertise within an individual's scope of practice, but rather recognition that patient care requires contributions from other team members.In order to assess a team's collective performance without losing sight of the individual, we need to capture interdependent performances and characterize the nature of such interdependence. Moving away from a linear trajectory where independence is seen as the end goal can also help support efforts to measure an individual's competence as an interdependent member of a healthcare team.

  View details for DOI 10.1111/medu.15064

  View details for PubMedID 36822577

• ADDRESSING PATIENT AND FAMILY SPIRITUAL NEEDS: A NATIONAL NEEDS ASSESSMENT OF PEDIATRIC FELLOWS Stevens, P., Kuo, K., Rassbach, C. LIPPINCOTT WILLIAMS & WILKINS. 2023: 276

  View details for Web of Science ID 000921450900540

• Birth of a Social Mediatrician: Adopting Slack, Twitter, and Instagram for Residents. Cureus Lee, J., Nguyen, B., Scanlon, S., Rassbach, C. 2022; 14 (12): e32569

  Abstract

  Introduction Physicians have increasingly used social media platforms to review new research, expand networks, and communicate. However, few studies have evaluated how the integration of social media into residency programs affects training. This is relevant during the COVID-19 pandemic, with a shift towards virtual formats for medical education, community building, and recruitment. Objective The objective of this study was to evaluate how the integration of social media platforms, including Slack, Twitter, and Instagram, influences education, social connectedness, and recruitment within a residency program. Methods In 2020, pediatric residents at one institution were encouraged to create personal Twitter and Instagram accounts if they did not already have one and follow the residency program's Twitter and Instagram accounts. Residents were also encouraged to enroll in a private Slack network within the residency program. We surveyed residents in May and June 2020 (pre-intervention) and March 2021 (post-intervention). Analytics from the residency program's social media accounts and Slack were recorded. Data were analyzed using a mixed-methods approach. Results Response rates from residents regarding the impact of social media interventions on education, connectedness, and recruitment were 98% (100/102) pre-intervention and 74.5% (76/102) post-intervention. During the study period from May 2020 to March 2021, chief resident posts on the residency program's Twitter and Instagram accounts garnered 447,467 and 151,341 impressions, respectively. Posts with the highest average impressions were those related to advocacy. After the intervention, residents reported increased connectedness to residents in other classes and increased usage of their personal Twitter and Slack accounts for learning and education. Residents rated the program's Instagram account as a useful recruitment tool. Feasibility of posting was assessed by the number of posts by chief residents during the study period (Twitter n=806, Instagram n=67). There were no costs. Conclusion Our data shows that social media in residency is feasible, cost-effective, and valuable for education, connectedness, and recruitment. We outlined specific ways social media was feasible and useful in these domains.

  View details for DOI 10.7759/cureus.32569

  View details for PubMedID 36654560

  View details for PubMedCentralID PMC9840559

• The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation. Academic medicine : journal of the Association of American Medical Colleges Selling, S. K., Rooholamini, S. N., Grow, H. M., McPhillips, H., Hoang, K., Blankenburg, R., Rassbach, C. 2022

  Abstract

  PURPOSE: Coaching programs have been implemented in medical education to improve skill development and feedback for trainees. As more faculty take on coaching roles, it is critical to understand how being a coach affects faculty as well as trainees. This study examined the effects of coaching residents on faculty members' relationships, learning, and professional identity formation (PIF), as they move through intersecting communities across landscapes of practice.METHOD: From July 2020 to January 2021, the authors conducted a mixed-methods study of current and former coaches at 2 institutions with longitudinal pediatric resident coaching programs. They used a concurrent triangulation design in which qualitative and quantitative data were collected simultaneously and integrated during data analysis. A survey explored the impact of coaching on faculty members' learning, relationships, and PIF, and semi-structured interviews further examined coaches' experiences. The interview transcripts were analyzed inductively guided by the sensitizing principles of PIF and landscapes of practice.RESULTS: Of 43 eligible coaches, 32 (74%) completed the survey, and 18 completed interviews. Four themes emerged from the interviews. (1) Coaches' relationships supported belonging in multiple communities. (2) Coaching enabled multidimensional learning. (3) Relationships served as mechanisms of learning for coaches. (4) Coaches' relationships and learning catalyzed PIF. Furthermore, there was a significant difference in the effects of coaching on career growth by faculty rank (P = .02). Coaches' strengthened PIF increased a sense of purpose, meaning, and professional fulfillment, and inspired new career directions. Survey data further supported these findings.CONCLUSIONS: Being a coach deepened faculty members' professional identities through their varied relationships, multidimensional learning, and sense of belonging in intersecting communities. This study introduces a framework to understand the factors mediating coaches' PIF and highlights how investing in coaching leads to important benefits for coaches.

  View details for DOI 10.1097/ACM.0000000000005011

  View details for PubMedID 36205486

• Resident and nurse perspectives on the use of secure text messaging systems. Journal of hospital medicine Aziz, S., Barber, J., Singh, A., Alayari, A., Rassbach, C. E. 2022

  Abstract

  BACKGROUND: As hospitals shift away from pagers and towardssecure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors.OBJECTIVE: This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital.DESIGN: This was a qualitative study with focus groups.SETTING AND PARTICIPANTS: Participants were pediatric residents and nurses at Lucile Packard Children's Hospital.INTERVENTION: Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached.MAIN OUTCOME AND MEASURES: Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being.RESULTS: Three resident focus groups (n=14) and three nurse focus groups (n=21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume.CONCLUSION: Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.

  View details for DOI 10.1002/jhm.12953

  View details for PubMedID 36036216

• Developing a multi-departmental residency communication coaching program. Education for health (Abingdon, England) Nassar, A. K., Sasnal, M., Miller-Kuhlmann, R. K., Jensen, R. M., Blankenburg, R. L., Rassbach, C. E., Smith-Bentley, M., Vyas, A., Korndorffer, J. R., Gold, C. A. 2022; 35 (3): 98-104

  Abstract

  Local needs assessments in our institution's surgery and neurology residency programs identified barriers to effective communication, such as no shared communication framework and limited feedback on nontechnical clinical skills. Residents identified faculty-led coaching as a desired educational intervention to improve communication skills. Three university departments (Surgery, Neurology, and Pediatrics) and health-care system leaders collaborated closely to develop an innovative communication coaching initiative generalizable to other residency programs.Coaching program development involved several layers of collaboration between health-care system leaders, faculty educators, and departmental communication champions. The efforts included: (1) creating and delivering communication skills training to faculty and residents; (2) hosting frequent meetings among various stakeholders to develop program strategy, discuss opportunities and learnings, and engage other medical educators interested in coaching; (3) obtaining funding to implement the coaching initiative; (4) selecting coaches and providing salary and training support.A multi-phased mixed-methods study utilized online surveys and virtual semi-structured interviews to assess the program's quality and impact on the communication culture and the satisfaction and communication skills of residents. Quantitative and qualitative data have been integrated during data collection and analysis using embedding, building, and merging strategies.Establishing a multi-departmental coaching program may be feasible and can be adapted by other programs if similar resources and focus are present. We found that stakeholders' buy-in, financial support, protected faculty time, flexible approach, and rigorous evaluation are crucial factors in successfully implementing and sustaining such an initiative.

  View details for DOI 10.4103/efh.efh_357_22

  View details for PubMedID 37313890

• A survey of program directors for combined pediatrics and medical genetics and genomics residency programs: Perspectives when evaluating applicants. American journal of medical genetics. Part A Niehaus, A. D., Rassbach, C. E., Stevenson, D. A. 2022

  Abstract

  While combined pediatrics and medical genetics and genomics residency programs are growing in number and applicants, there are still workforce shortages within the medical genetics field. Medical students would benefit from additional information on the training pathways and insight into the application process itself. Program Directors of combined pediatrics and medical genetics and genomics residency programs were surveyed to characterize factors that influence interview selection and rank list decisions, application logistics, recruitment, and training pathways. When evaluating applicants, representatives from both pediatrics and medical genetics are involved in the screening process. Additionally, both groups value prior research experience, but do not have a clear preference for a particular subcategory or domain of research. Most program directors think that all currently-available training pathways can provide optimal training. Further action is needed to provide medical students with the knowledge to make more informed decisions about their career and medical school advisors with objective data to counsel students. There was support among program directors to initiate consideration of creating a pathway for medical students to match directly into a medical genetics and genomics residency.

  View details for DOI 10.1002/ajmg.a.62846

  View details for PubMedID 35633299

• Sense of Belonging and Professional Identity Among Combined Pediatrics-Anesthesiology Residents. Academic pediatrics Brandford, E., Wang, T., Nguyen, C., Rassbach, C. E. 2022

  Abstract

  Combined pediatrics-anesthesiology programs uniquely prepare residents to care for critically ill children, but trainees in these combined programs face challenges as residents within two specialties. Social belonging predicts motivation and achievement and protects against burnout. The objective of our study was to evaluate sense of belonging and self-identified professional identity of current combined pediatrics-anesthesiology residents.All current residents in combined pediatrics-anesthesiology programs were invited to participate in an anonymous survey assessing sense of belonging and professional identity. Open-ended responses were qualitatively analyzed using an inductive coding process and thematic analysis. Likert questions were analyzed using paired t-tests.32/36 residents completed the survey (89% response rate). 92% of respondents had a lower sense of belonging in pediatrics than anesthesiology (3.32 vs 3.94) and more self-identified as anesthesiologists than pediatricians. Thematic analysis yielded five themes: (1) the team-based nature of pediatrics results in strong initial bonds, but feelings of isolation as training pathways diverge; (2) the individual nature of anesthesiology results in less social interaction within daily work, but easier transitions in and out of anesthesiology; (3) divergent training timelines result in feeling left behind socially and academically; (4) residents identify different professional and personal characteristics of pediatricians and anesthesiologists that impact their sense of belonging; and (5) the structure of the combined program results in experiences unique to combined residents.Most residents in combined pediatrics-anesthesiology programs had a higher sense of belonging and self-identification in anesthesiology than pediatrics. Program structure and autonomy had significant impacts.

  View details for DOI 10.1016/j.acap.2022.05.017

  View details for PubMedID 35623550

• Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents ACADEMIC PEDIATRICS Gold, J. M., Yemane, L., Keppler, H., Balasubramanian, V., Rassbach, C. E. 2022; 22 (4): 698-704

  View details for Web of Science ID 000832839400025

• A survey of program directors for combined pediatrics-medical genetics and genomics residency programs: Perspectives when evaluating applicants Niehaus, A., Rassbach, C., Stevenson, D. ELSEVIER SCIENCE INC. 2022: S369-S370

  View details for DOI 10.1016/j.gim.2022.01.591

  View details for Web of Science ID 000796586200334

• Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents. Academic pediatrics Gold, J. M., Yemane, L., Keppler, H., Balasubramanian, V., Rassbach, C. E. 2022

  Abstract

  BACKGROUND: Gender disparities in academic medicine continue to be pervasive. Written evaluations of residents may provide insight into perceptions of residents by faculty, which may influence letters of recommendation for positions beyond residency and reinforce perceived stereotype threat experienced by trainees.OBJECTIVE: To examine language used in faculty evaluations of pediatrics residents to determine if there are differences in language used with respect to gender of resident.DESIGN/METHODS: All faculty evaluations of residents in 3 consecutive intern classes from 2016-2018 were collected and redacted for name and gender identifiers. We performed a qualitative analysis of written comments in 2 mandatory free text sections. The study team initially coded text collectively, generating a code book, then individually to apply the coding scheme. Next, evaluations were unblinded to gender. Code applications were aggregated by resident, and frequencies of code application by resident were compared by standardized mean differences (SMD) to detect imbalances between genders.RESULTS: A total of 448 evaluations were analyzed: 88 evaluations of 17 male residents, and 360 evaluations of 70 female residents. Codes more frequently applied to women included "enthusiasm," and "caring," while codes more frequently applied to men included "intelligence," and "prepared." A conceptual model was created to reflect potential impacts of these differences using a lens of social role theory.CONCLUSION: We identified differences in the way male and female residents are evaluated by faculty, which may have negative downstream effects on female residents, who may experience negative self-perception, differential development of clinical skills, and divergent career opportunities as a result.

  View details for DOI 10.1016/j.acap.2022.02.004

  View details for PubMedID 35158087

• Research and Career Outcomes for Pediatric Hospital Medicine Fellowship Graduates. Hospital pediatrics Rassbach, C. E., Fiore, D., COUNCIL OF PEDIATRIC HOSPITAL MEDICINE FELLOWSHIP DIRECTORS 2021

  Abstract

  OBJECTIVES: Pediatric hospital medicine (PHM) fellowships have rapidly developed to meet established needs. The purpose of this research was to describe the research and career outcomes of PHM fellowship graduates. We hypothesized that graduates would report significant research and academic productivity.METHODS: This was an institutional review board-approved, cross-sectional survey of PHM fellowship graduates in 2018. The 88-item survey was modified from an existing survey, developed by experts to address study objectives and pilot tested, and it included quantitative and qualitative items to assess characteristics of fellowship training and research and career outcomes.RESULTS: A total of 63% of PHM fellowship graduates (143 of 228) completed the survey (graduation dates, 2000-2018). In total, 89% graduated from dedicated PHM fellowship programs, with 59% completing a 2-year fellowship and 78% now practicing primarily at a university or children's hospital. Fellows conducted research in clinical research (53%), quality improvement (41%), health services (24%), and medical education (19%). A total of 77% of graduates continued to do research after graduation, with 63% publishing and 25% obtaining grant funding. Graduates of 2- and 3-year fellowships and those with a master's degree were significantly more productive. Graduates now hold important roles in academic and health systems leadership. Graduates are highly satisfied with their decision to do PHM fellowship and identified 5 themes regarding how fellowship impacted their career outcomes.CONCLUSIONS: In this study, we document robust research activity and leadership positions among PHM fellowship graduates and can serve as a benchmark for metrics that PHM educational leaders can use to assess outcomes and improve training regarding research and career development.

  View details for DOI 10.1542/hpeds.2021-005938

  View details for PubMedID 34561241

• Impact of a relationship-centered care communication curriculum on pediatric residents' practice, perspectives, and opportunities to evelop expertise. Patient education and counseling Selling, S. K., Kirkey, D., Goyal, T., Singh, A., Gold, C. A., Hilgenberg, S. L., Weimer-Elder, B., Kuo, K. W., Rassbach, C. E. 2021

  Abstract

  OBJECTIVES: To investigate the impacts of a Relationship-Centered Care (RCC) communication curriculum with coaching on pediatric residents 1) self-reported use of RCC strategies and perspectives, and 2) opportunities to develop adaptive expertise.METHODS: Residents (n=77) completed a 4h RCC training and shared resultant RCC goals with Coaches (n=15). Data included resident surveys and reflections immediately post-training, and resident and coach surveys 6-months later. Reported use of RCC strategies were compared over time with paired t-tests. Qualitative data were analyzed using open coding guided by sensitizing principles from the RCC framework and adaptive expertise.RESULTS: Pediatric residents reported significant increases (p<0.001) in use of 4/9 RCC strategies after 6 months: eliciting all concerns, chunking information, checking for understanding, and teach-back. Resident reflections highlighted shifts in perspective around RCC. Training combined with coaching provided opportunities for residents to develop adaptive expertise through adapting and innovating across settings and contexts.CONCLUSION: Residents had significant increases in reported use of key RCC strategies after a training combined with coaching and demonstrated opportunities to develop adaptive expertise.PRACTICE IMPLICATIONS: Residency programs should include RCC training with an emphasis on the new and challenging strategies and provide opportunities to practice and receive coaching.

  View details for DOI 10.1016/j.pec.2021.08.014

  View details for PubMedID 34538683

• Physician-Scientist Training & Programming in Pediatric Residency Programs: A National Survey. The Journal of pediatrics Burns, A. M., Moore, D. J., Forster, C. S., Powell, W., Thammasitboon, S., Hostetter, M. K., Weiss, P., Boyer, D., Ward, M. A., Blankenburg, R., Heyman, M. B., Rassbach, C. E., McPhillips, H., French, A., Nguyen, S., Byrne, B. J., Parsons, D. W., Gonzalez, F., Nowalk, A. J., Ho, J., Kumar, S., Orange, J. S., Ackerman, K. G. 2021

  View details for DOI 10.1016/j.jpeds.2021.07.014

  View details for PubMedID 34280401

• Development of Goals and Objectives for Pediatric Hospital Medicine Fellowship Curricula. Hospital pediatrics Librizzi, J., Frank, E., Jerardi, K., Maniscalco, J., Rassbach, C., Shah, N., Walker, J. 2021

  View details for DOI 10.1542/hpeds.2020-003681

  View details for PubMedID 34049964

• Resident clinical experience during the pandemic: What has it cost us and what have we gained? Hospital pediatrics Nguyen, B., Barber, A., Rassbach, C. E. 2021

  View details for DOI 10.1542/hpeds.2021-005970

  View details for PubMedID 33863815

• Perspectives from the Society for Pediatric Research: advice on sustaining science and mentoring during COVID-19. Pediatric research Forster, C. S., Nguyen, S. T., Powell, W. T., Moore, D. J., Ho, J. n., Heyman, M. B., Wenger, T. L., Gonzalez, F. n., Hostetter, M. n., Nowalk, A. n., Rassbach, C. E., Boyer, D. n., Weiss, P. n., Blankenburg, R. L., Orange, J. S., Ackerman, K. G., Burns, A. M. 2021

  Abstract

  The COVID-19 pandemic will leave an indelible mark on the careers of current medical trainees. Given the disruptions to medical education, economic impact on institutions, and the uncertainties around future job prospects, trainees are facing unprecedented challenges. This situation is especially concerning for futures of pediatric physician-scientist trainees, where concerns regarding maintaining the pipeline were well documented prior to the emergence of COVID-19. In this Perspectives article, we leverage the unique expertise of our workgroup to address concerns of physician-scientist trainees and to provide suggestions on how to navigate career trajectories in the post-COVID-19 era. We identified and addressed four major areas of concern: lack of in-person conferences and the associated decrease access to mentors and networking activities, decreased academic productivity, diminished job prospects, and mental health challenges. We also suggest actions for trainees, mentors and educational leaders, and institutions to help support trainees during the pandemic, with a goal of maintaining the pediatric physician-scientist pipeline.

  View details for DOI 10.1038/s41390-020-01321-5

  View details for PubMedID 33469179

• Using Self-Determination Theory to Drive an Evidence-Based Medicine Curriculum for Pediatric Residents: A Mixed Methods Study. Academic pediatrics Dasgupta, M. N., Kirkey, D. C., Weatherly, J. A., Kuo, K. W., Rassbach, C. E. 2021

  Abstract

  The ability to incorporate evidence-based medicine (EBM) into clinical practice is an ACGME competency, yet many pediatric residents have limited knowledge in this area. The objective of this study is to describe the effect of an EBM curriculum on resident attitudes and clinical use of EBM.We implemented a longitudinal EBM curriculum to review key literature and guidelines and teach EBM principles. In this IRB-exempt mixed methods study, we surveyed residents, fellows, and faculty about resident use of EBM at baseline, 6 months, and 12 months after the beginning of the intervention. We conducted point prevalence surveys of faculty about residents' EBM use on rounds. Residents participated in focus groups, which were audio-recorded, transcribed, and coded using conventional content analysis to develop themes.Residents (N=61 pre- and 70 post-curriculum) reported an increased appreciation for the importance of EBM and comfort generating a search question. Faculty reported that residents cited EBM on rounds, with an average of 2.4 citations/week. Cited evidence reinforced faculty's plans 79% of the time, taught faculty something new 57% of the time, and changed management 21% of the time. Focus groups with 22 trainees yielded four themes: (1) increased competence in understanding methodology and evidence quality; (2) greater autonomy in application of EBM; (3) a call for relatedness from faculty role models and a culture that promotes EBM; and (4) several barriers to successful use of EBM.After implementation of a longitudinal EBM curriculum, trainees described increased use of EBM in clinical practice.

  View details for DOI 10.1016/j.acap.2021.12.018

  View details for PubMedID 34929387

• A Mixed Methods Approach to Understanding Curricular Impact of a Capstone Course on the Self-Efficacy of Fourth-Year Medical Students CUREUS Jacobs, K. G., Kugler, J., Chi, J., Stuart, E., Merrell, S., Rassbach, C. 2020; 12 (8)

  View details for DOI 10.7759/cureus.9537

  View details for Web of Science ID 000554830700009

• Fixing the leaky pipeline: identifying solutions for improving pediatrician-scientist training during pediatric residency. Pediatric research Burns, A. M., Ackerman, K., Thammasitboon, S., Rassbach, C., Ward, M. A., Blankenburg, R., Forster, C. S., McPhillips, H., Wenger, T., Powell, W., Heyman, M. B., Hogarty, M., Boyer, D., Hostetter, M., Weiss, P., Nguyen, S., Parsons, D. W., Moore, D. J., Byrne, B., French, A., Orange, J. S. 2020

  View details for DOI 10.1038/s41390-020-0837-2

  View details for PubMedID 32179872

• What are the Unique Mentorship Needs of Fourth Year Medical Students Applying to Pediatrics Residency? Academic pediatrics Lester, T. R., Rassbach, C. E., Blankenburg, R. n. 2020

  Abstract

  The qualities of good medical school mentors have been well-described. However, there is little written about the mentoring needs of medical students applying to pediatrics residency.In order to characterize pediatrics interns' perspectives on the mentorship needs of fourth year medical students applying to residency, the authors conducted an IRB-approved, qualitative modified grounded-theory study using a brief survey and semi-structured focus groups of pediatric interns in January and February 2018. Two investigators independently coded the focus group transcripts and reconciled codes to develop categories and themes using constant comparison, which were then reviewed by the third author for validation. To further ensure trustworthiness of analysis, participants were asked to comment on the themes' accuracy.Eighteen pediatrics interns participated, representing 15 medical schools. Four major themes emerged: 1) Effective mentors guide medical students to self-reflect and find their own answers about what is important to them in a residency program; 2) Multiple mentors are helpful during the residency application process; 3) Several key components of advising are often missing during the residency application process; 4) Students find it difficult to be honest with their mentors if there is a perceived conflict of interest.Medical students applying for pediatrics residency have specific mentorship needs and cite opportunities to improve this area of mentorship. Several key recommendations include utilizing multiple mentors and providing emotional support during the residency application process. In addition, near-peer mentorship is important for medical students applying to residency and should be facilitated by medical schools.

  View details for DOI 10.1016/j.acap.2020.05.002

  View details for PubMedID 32389758

• Factors and Behaviors Related to the Promotion of Pediatric Hospital Medicine Fellow Autonomy: A Qualitative Study of Faculty ACADEMIC PEDIATRICS Maniscalco, J., Davis, E., Gay, A., Ward, V., Truckenbrod, J., Denniston, S. F., Rassbach, C. E. 2019; 19 (6): 703–11

  View details for Web of Science ID 000481567900018

• The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents ACADEMIC PEDIATRICS Mahoney, D., Bogetz, A., Hirsch, A., Killmond, K., Phillips, E., Bhavaraju, V., McQueen, A., Orlov, N., Blankenburg, R., Rassbach, C. E. 2019; 19 (5): 555–60

  View details for DOI 10.1016/j.acap.2018.12.002

  View details for Web of Science ID 000475720600014

• Factors and Behaviors Related to the Promotion of Pediatric Hospital Medicine Fellow Autonomy: A Qualitative Study of Faculty. Academic pediatrics Maniscalco, J. n., Davis, E. n., Gay, A. C., Ward, V. n., Truckenbrod, J. n., Denniston, S. F., Rassbach, C. E. 2019

  Abstract

  To identify factors that influence faculty to promote or reduce the expression of autonomy for pediatric hospital medicine (PHM) fellows and describe behaviors faculty employ to support fellow autonomy in the clinical setting.This is a multi-center, qualitative study utilizing semi-structured interviews with core faculty in PHM fellowships. Data were transcribed verbatim and analyzed using a phenomenological approach. Each transcript was coded independently by two trained reviewers who then met to reconcile differences. Codes were identified using an iterative approach and organized into themes. Investigators engaged in peer debriefing during data collection, and member checking confirmed the results.Interviews were conducted December 2016 to January 2017 with 20 faculty from five PHM fellowships. Most participants were female (12, 60%) and assistant (13, 65%) or associate (6, 30%) professors. Data analysis yielded six themes. Themes reflect the importance of faculty experience, style, and approach to balancing patient care with education in the provision of autonomy for PHM Fellows. Faculty appreciation for the role of autonomy in medical education, investment in their roles as educators, and investment in PHM fellowship training are also influential factors. Finally, fellow clinical, educational, leadership, and communication skills influence the provision of autonomy. Faculty employ various levels of supervision, scaffolding techniques, and direct observation with feedback to support fellow autonomy. Professional development was considered essential for developing these skills.We identified six themes related to faculty provision of autonomy to PHM fellows, as well as strategies employed by faculty to support fellow autonomy.

  View details for PubMedID 31077880

• Breaking a Cycle of Dependence to Improve Neurology Education: A Qualitative Study Exploring Pediatric Residents' Perspectives. Clinical pediatrics Nguyen, T. n., Pavitt, S. n., Wusthoff, C. n., Rassbach, C. n. 2019: 9922819870557

  Abstract

  Objective. To understand pediatric residents' experiences and attitudes toward learning neurology; and to identify facilitators and barriers to learning neurology during residency. Study Design. Qualitative study using focus groups of pediatric residents at Stanford during November 2017. Focus groups were audio-recorded and transcribed verbatim. Investigators independently coded the transcripts and reconciled codes to develop themes using constant comparison associated with grounded theory. Results. Eighteen pediatric residents participated in 3 focus groups. Four themes emerged: (1) residents feel unprepared and uncomfortable; (2) intrinsic and extrinsic factors contribute to residents' dependence on neurologists; (3) residents desire more teaching; and (4) residents are motivated to overcome their dependence on neurologists and optimize their learning. Conclusion. Pediatric residents are motivated to acquire more skills to assess and manage patients with neurological conditions. They recognize key factors that contribute to a cycle of dependence that impedes their learning and offer strategies to overcome these barriers.

  View details for DOI 10.1177/0009922819870557

  View details for PubMedID 31455089

• The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents. Academic pediatrics Mahoney, D., Bogetz, A., Hirsch, A., Killmond, K., Phillips, E., Bhavaraju, V., McQueen, A., Orlov, N., Blankenburg, R., Rassbach, C. E. 2018

  Abstract

  OBJECTIVE: The ACGME calls for residency programs to incorporate multisource feedback, which may include patient feedback, into resident competency assessments. Program directors face numerous challenges in gathering this feedback. This study assesses the feasibility and acceptability of patient feedback collection in the inpatient and outpatient setting at three institutions.METHODS: Patient feedback was collected using a modified version of the Communication Assessment Tool (CAT). Trained research assistants (RAs) administered the CAT to eligible patients/families in pediatric ward, intensive care (ICU), and outpatient settings from July-October 2015. Completion rates and reasons for non-completion were recorded. Patient satisfaction with the CAT was assessed on a five-point Likert scale.RESULTS: 860/1413 (61%) patients completed the CAT. Completion rates in the pediatric ward and ICU settings were 45% and 38% respectively, compared to 91% in the outpatient setting. In inpatient settings, survey non-completion was typically due to participant unavailability; this was rarely a reason in the outpatient setting. 93.4% of patients were satisfied or very satisfied with using the CAT. 6.36 hours of RA time would be required to gather a valid quantity of patient feedback for a single resident in the outpatient setting, compared to 10.14 hours in the inpatient setting.CONCLUSIONS: While collecting feedback using our standardized protocol is acceptable to patients, obtaining sufficient feedback requires overcoming several barriers and a sizable time commitment. Feedback collection in the outpatient setting may be higher-yield than the inpatient setting due to greater patient/family availability. Future work should focus on innovative methods to gather patient feedback in the inpatient setting to provide program directors with a holistic view of their residents' communication skills.

  View details for PubMedID 30576788

• THE EFFECT OF FACULTY COACHING ON RESIDENT ATTITUDES, CONFIDENCE, AND PATIENT-RATED COMMUNICATION: A MULTI-INSTITUTION STUDY. Academic pediatrics Rassbach, C. E., Bogetz, A. L., Orlov, N., McQueen, A., Bhavaraju, V., Mahoney, D., Leibold, C., Blankenburg, R. L. 2018

  Abstract

  OBJECTIVE: Despite a national focus on physician-patient communication, there is a paucity of literature on how patient and family feedback (PFF) can be used as a tool to help residents learn communication skills. The purpose of this study was to assess the effect of coaching on residents' attitudes towards PFF, self-confidence in communication, and patient-rated communication skills.METHODS: This was an IRB-approved, randomized-controlled trial with pediatric residents at three institutions in 2015-2016. Pre- and post-intervention, residents completed a self-assessment of their attitudes and self-confidence in communication. PFF was collected for each resident using the Communication Assessment Tool (CAT), which has been validated in other medical disciplines. Intervention group residents reviewed their baseline PFF with a faculty coach; control group residents reviewed their PFF independently.RESULTS: 114 residents completed the study, 57 in each arm. Intervention group residents were significantly more likely to ask for PFF compared with control group residents (mean change 0.36 vs. -0.11, p=.01). There were no other significant differences in resident attitudes, confidence, or patient-rated communication between groups. Both groups had increased self-confidence over time and with increasing PGY level. Patient ratings of resident communication did not differ over time or between groups.CONCLUSIONS: Residents who reviewed PFF with a faculty coach were significantly more likely to report they would ask patients for feedback than residents who reviewed PFF independently, suggesting review of feedback with a coach may enhance appreciation of patient feedback. Though self-confidence improved over time in both groups, patient ratings of resident communication skills were not significantly different over time or between groups.

  View details for DOI 10.1016/j.acap.2018.10.004

  View details for PubMedID 30368034

• How Residents Learn From Patient Feedback: A Multi-Institutional Qualitative Study of Pediatrics Residents' Perspectives. Journal of graduate medical education Bogetz, A. L., Orlov, N., Blankenburg, R., Bhavaraju, V., McQueen, A., Rassbach, C. 2018; 10 (2): 176-184

  Abstract

  Residents may view feedback from patients and their families with greater skepticism than feedback from supervisors and peers. While discussing patient and family feedback with faculty may improve residents' acceptance of feedback and learning, specific strategies have not been identified.We explored pediatrics residents' perspectives of patient feedback and identified strategies that promote residents' reflection on and learning from feedback.In this multi-institutional, qualitative study conducted in June and July 2016, we conducted focus groups with a purposive sample of pediatrics residents after their participation in a randomized controlled trial in which they received written patient feedback and either discussed it with faculty or reviewed it independently. Focus group transcripts were audiorecorded, transcribed, and analyzed for themes using the constant comparative approach associated with grounded theory.Thirty-six of 92 (39%) residents participated in 7 focus groups. Four themes emerged: (1) residents valued patient feedback but felt it may lack the specificity they desire; (2) discussing feedback with a trusted faculty member was helpful for self-reflection; (3) residents identified 5 strategies faculty used to facilitate their openness to and acceptance of patient feedback (eg, help resident overcome emotional responses to feedback and situate feedback in the context of lifelong learning); and (4) residents' perceptions of feedback credibility improved when faculty observed patient encounters and solicited feedback on the resident's behalf prior to discussions.Discussing patient feedback with faculty provided important scaffolding to enhance residents' openness to and reflection on patient feedback.

  View details for DOI 10.4300/JGME-D-17-00447.1

  View details for PubMedID 29686757

  View details for PubMedCentralID PMC5901797

• Exploring the Educational Value of Patient Feedback: A Qualitative Analysis of Pediatric Residents' Perspectives ACADEMIC PEDIATRICS Bogetz, A. L., Rassbach, C. E., Chan, T., Blankenburg, R. L. 2017; 17 (1): 4-8

  View details for Web of Science ID 000391349100002

  View details for PubMedID 27965014

• Development of a Curricular Framework for Pediatric Hospital Medicine Fellowships. Pediatrics Jerardi, K. E., Fisher, E. n., Rassbach, C. n., Maniscalco, J. n., Blankenburg, R. n., Chase, L. n., Shah, N. n. 2017; 140 (1)

  Abstract

  Pediatric Hospital Medicine (PHM) is an emerging field in pediatrics and one that has experienced immense growth and maturation in a short period of time. Evolution and rapid expansion of the field invigorated the goal of standardizing PHM fellowship curricula, which naturally aligned with the field's evolving pursuit of a defined identity and consideration of certification options. The national group of PHM fellowship program directors sought to establish curricular standards that would more accurately reflect the competencies needed to practice pediatric hospital medicine and meet future board certification needs. In this manuscript, we describe the method by which we reached consensus on a 2-year curricular framework for PHM fellowship programs, detail the current model for this framework, and provide examples of how this curricular framework may be applied to meet the needs of a variety of fellows and fellowship programs. The 2-year PHM fellowship curricular framework was developed over a number of years through an iterative process and with the input of PHM fellowship program directors (PDs), PHM fellowship graduates, PHM leaders, pediatric hospitalists practicing in a variety of clinical settings, and other educators outside the field. We have developed a curricular framework for PHM Fellowships that consists of 8 education units (defined as 4 weeks each) in 3 areas: clinical care, systems and scholarship, and individualized curriculum.

  View details for DOI 10.1542/peds.2017-0698

  View details for PubMedID 28600448

• A Novel Pediatric Residency Coaching Program: Outcomes After One Year. Academic medicine : journal of the Association of American Medical Colleges Rassbach, C. E., Blankenburg, R. n. 2017

  Abstract

  The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement.The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback.Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before.Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.

  View details for DOI 10.1097/ACM.0000000000001825

  View details for PubMedID 28700460

• Subacute Sclerosing Panencephalitis: The Foothold in Undervaccination JOURNAL OF PEDIATRICS Holt, R. L., Kann, D., Rassbach, C. E., Schwenk, H. T., Ritter, J. M., Rota, P. A., Elbers, J. 2016; 179: 259-262

  Abstract

  Subacute sclerosing panencephalitis (SSPE) is a fatal complication of measles infection. We present a case of a fully vaccinated 3-year-old boy who was diagnosed with and treated for autoimmune encephalitis before arriving at a diagnosis of SSPE. We discuss the challenges of diagnosing SSPE in developed countries.

  View details for DOI 10.1016/j.jpeds.2016.08.051

  View details for PubMedID 27634625

• The Current State of Pediatric Hospital Medicine Fellowships: A Survey of Program Directors JOURNAL OF HOSPITAL MEDICINE Shah, N. H., Rhim, H. J., Maniscalco, J., Wilson, K., Rassbach, C. 2016; 11 (5): 324-328

  Abstract

  Pediatric hospital medicine (PHM) fellowship programs have grown rapidly over the last 20 years and have varied in duration and content. In an effort to standardize training in the absence of a single accrediting body, PHM fellowship directors now meet annually to discuss strategies for standardizing and enhancing training.To explore similarities and differences in curricular structure among PHM fellowship programs in an effort to inform future curriculum standardization efforts.An electronic survey was distributed by e-mail to all PHM fellowship directors in April 2014. The survey consisted of 30 multiple-choice and short-answer questions focused on various curricular aspects of training developed by the authors.Twenty-seven of 31 fellowship programs (87%) responded to the survey. Duration of most programs was 2 years (63%), with 6, 1-year programs (22%) and 4 (15%) 3-year programs making up the remainder. The average amount of clinical time among programs was 50% (range approximately 20%-65%). In addition to general inpatient pediatric service time, most programs require other clinical rotations. The majority of programs allow fellows to bill independently for their services. Most programs offer certificate courses, courses for credit or noncredit courses, with 11 programs offering masters' degrees. Twenty-one (81%) programs provide a scholarship oversight committee for their fellows. Current fellows' primary areas of research are varied.Though variability exists regarding program length, clinical composition, and nonclinical offerings, several common themes emerged that may help inform the development of a standard curriculum for use across all programs. This information provides a useful starting point if pediatric hospital medicine obtains formal subspecialty status. Journal of Hospital Medicine 2016;11:324-328. © 2016 Society of Hospital Medicine.

  View details for DOI 10.1002/jhm.2571

  View details for PubMedID 27042818

• A Strategic Approach to Implementation of Medical Mentorship Programs. Journal of graduate medical education Caruso, T. J., Steinberg, D. H., Piro, N., Walker, K., Blankenburg, R., Rassbach, C., Marquez, J. L., Katznelson, L., Dohn, A. 2016; 8 (1): 68-73

  Abstract

  Mentors influence medical trainees' experiences through career enhancement and psychosocial support, yet some trainees never receive benefits from involved mentors.Our goals were to examine the effectiveness of 2 interventions aimed at increasing the number of mentors in training programs, and to assess group differences in mentor effectiveness, the relationship between trainees' satisfaction with their programs given the presence of mentors, and the relationship between the number of trainees with mentors and postgraduate year (PGY).In group 1, a physician adviser funded by the graduate medical education department implemented mentorships in 6 residency programs, while group 2 involved a training program with funded physician mentoring time. The remaining 89 training programs served as controls. Chi-square tests were used to determine differences.Survey responses from group 1, group 2, and controls were 47 of 84 (56%), 34 of 78 (44%), and 471 of 981 (48%, P = .38), respectively. The percentages of trainees reporting a mentor in group 1, group 2, and the control group were 89%, 97%, and 79%, respectively (P = .01). There were no differences in mentor effectiveness between groups. Mentored trainees were more likely to be satisfied with their programs (P = .01) and to report that faculty supported their professional aspirations (P = .001). Across all programs, fewer first-year trainees (59%) identified a mentor compared to PGY-2 through PGY-8 trainees (84%, P < .001).A supported mentorship program is an effective way to create an educational environment that maximizes trainees' perceptions of mentorship and satisfaction with their training programs.

  View details for DOI 10.4300/JGME-D-15-00335.1

  View details for PubMedID 26913106

  View details for PubMedCentralID PMC4763391

• Training Health Care Professionals for 21st-Century Practice: A Systematic Review of Educational Interventions on Chronic Care ACADEMIC MEDICINE Bogetz, J. F., Rassbach, C. E., Bereknyei, S., Mendoza, F. S., Sanders, L. M., Braddock, C. H. 2015; 90 (11): 1561-1572

  Abstract

  To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care.A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner's chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller's classification of clinical competence was used to assess the quality of learner achievements for each educational intervention.A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner's CCM and showed high-level learner competence according to Miller's classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives.The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.

  View details for DOI 10.1097/ACM.0000000000000773

  View details for PubMedID 26039140

• Caring for Children With Medical Complexity: Challenges and Educational Opportunities Identified by Pediatric Residents ACADEMIC PEDIATRICS Bogetz, J. F., Bogetz, A. L., Rassbach, C. E., Gabhart, J. M., Blankenburg, R. L. 2015; 15 (6): 621-625

  Abstract

  High-quality care for children with medical complexity (CMC) is in its infancy. Residents have the opportunity to view care for CMC with a fresh perspective that is informed by their work across diverse health care settings and significant time spent at the bedside. This study aimed to identify the challenges and potential solutions for complex care delivery and education from their perspectives.We conducted three 60-minute focus groups with a purposeful sample of residents and recent graduates at a US tertiary-care medical center. Data were transcribed verbatim, and themes were identified using an iterative approach and modified grounded theory.Sixteen participants identified 4 major challenges to caring for CMC: 1) lack of care coordination; 2) complex technology management; 3) patients' pervasive psychosocial needs; and 4) lack of effective health care provider training. Participants identified 3 solutions: 1) greater integration of primary care providers; 2) attention to psychosocial needs through shared decision making; and 3) integration of longitudinal patient relationships into provider training. We found that residents who experienced longitudinal relationships with CMC felt more efficacious and better equipped to handle challenges of caring for CMC as a result of their broader understanding of patients' priorities and of their role as providers.Residents recognize important challenges and offer thoughtful solutions to caring for CMC. Although multiple solutions exist, formal integration of longitudinal patient experiences into residency training may better prepare residents to understand patient priorities and identify when their own attitudinal changes can guide them into more efficacious roles as providers.

  View details for Web of Science ID 000364802300009

  View details for PubMedID 26409304

• Caring for Children With Medical Complexity: Challenges and Educational Opportunities Identified by Pediatric Residents. Academic pediatrics Bogetz, J. F., Bogetz, A. L., Rassbach, C. E., Gabhart, J. M., Blankenburg, R. L. 2015; 15 (6): 621-625

  Abstract

  High-quality care for children with medical complexity (CMC) is in its infancy. Residents have the opportunity to view care for CMC with a fresh perspective that is informed by their work across diverse health care settings and significant time spent at the bedside. This study aimed to identify the challenges and potential solutions for complex care delivery and education from their perspectives.We conducted three 60-minute focus groups with a purposeful sample of residents and recent graduates at a US tertiary-care medical center. Data were transcribed verbatim, and themes were identified using an iterative approach and modified grounded theory.Sixteen participants identified 4 major challenges to caring for CMC: 1) lack of care coordination; 2) complex technology management; 3) patients' pervasive psychosocial needs; and 4) lack of effective health care provider training. Participants identified 3 solutions: 1) greater integration of primary care providers; 2) attention to psychosocial needs through shared decision making; and 3) integration of longitudinal patient relationships into provider training. We found that residents who experienced longitudinal relationships with CMC felt more efficacious and better equipped to handle challenges of caring for CMC as a result of their broader understanding of patients' priorities and of their role as providers.Residents recognize important challenges and offer thoughtful solutions to caring for CMC. Although multiple solutions exist, formal integration of longitudinal patient experiences into residency training may better prepare residents to understand patient priorities and identify when their own attitudinal changes can guide them into more efficacious roles as providers.

  View details for DOI 10.1016/j.acap.2015.08.004

  View details for PubMedID 26409304

• Outcomes of a Randomized Controlled Educational Intervention to Train Pediatric Residents on Caring for Children With Special Health Care Needs CLINICAL PEDIATRICS Bogetz, J. F., Gabhart, J. M., Rassbach, C. E., Sanders, L. M., Mendoza, F. S., Bergman, D. A., Blankenburg, R. L. 2015; 54 (7): 659-666

  Abstract

  Objective. To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). Methods. Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. Results. Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. Conclusion. SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease.

  View details for DOI 10.1177/0009922814564050

  View details for PubMedID 25561698

• Continuing education needs of pediatricians across diverse specialties caring for children with medical complexity. Clinical pediatrics Bogetz, J. F., Bogetz, A. L., Gabhart, J. M., Bergman, D. A., Blankenburg, R. L., Rassbach, C. E. 2015; 54 (3): 222-227

  Abstract

  Objective. Care for children with medical complexity (CMC) relies on pediatricians who often are ill equipped, but striving to provide high quality care. We performed a needs assessment of pediatricians across diverse subspecialties at a tertiary academic US children's hospital about their continuing education needs regarding the care of CMC. Methods. Eighteen pediatricians from diverse subspecialties were asked to complete an online anonymous open-ended survey. Data were analyzed using modified grounded theory. Results. The response rate was 89% (n = 16). Of participants, 31.2% (n = 5) were general pediatricians, 18.7% (n = 3) were hospitalists, and 50% (n = 8) were pediatric subspecialists. Pediatricians recognized the need for skills in care coordination, giving bad news, working in interprofessional teams, and setting goals of care with patients. Conclusions. Practicing pediatricians need skills to improve care for CMC. Strategically incorporating basic palliative care education may fill an important training need across diverse pediatric specialties.

  View details for DOI 10.1177/0009922814564049

  View details for PubMedID 25561699

• Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis. Academic pediatrics Leyenaar, J. K., Bergert, L., Mallory, L. A., Engel, R., Rassbach, C., Shen, M., Woehrlen, T., Cooperberg, D., Coghlin, D. 2015; 15 (1): 61-68

  Abstract

  Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement.We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes.Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care.This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives.

  View details for DOI 10.1016/j.acap.2014.07.004

  View details for PubMedID 25444655

• Pediatric discharge content: a multisite assessment of physician preferences and experiences. Hospital pediatrics Coghlin, D. T., Leyenaar, J. K., Shen, M., Bergert, L., Engel, R., Hershey, D., Mallory, L., Rassbach, C., Woehrlen, T., Cooperberg, D. 2014; 4 (1): 9-15

  Abstract

  Professional medical societies endorse prompt, consistent discharge communication to primary care providers (PCPs) on discharge. However, evidence is limited about what clinical elements to communicate. Our main goal was to identify and compare the clinical elements considered by PCPs and pediatric hospitalists to be essential to communicate to PCPs within 2 days of pediatric hospital discharge. A secondary goal was to describe experiences of the PCPs and pediatric hospitalists regarding sending and receiving discharge information.A survey of physician preferences and experiences regarding discharge communication was sent to 320 PCPs who refer patients to 16 hospitals, with an analogous survey sent to 147 hospitalists. Descriptive statistics were calculated, and χ(2) analyses were performed.A total of 201 PCPs (63%) and 71 hospitalists (48%) responded to the survey. Seven clinical elements were reported as essential by >75% of both PCPs and hospitalists: dates of admission and discharge; discharge diagnoses; brief hospital course; discharge medications; immunizations given during hospitalization; pending laboratory or test results; and follow-up appointments. PCPs reported reliably receiving discharge communication significantly less often than hospitalists reported sending it (71.8% vs 85.1%; P < .01), and PCPs considered this communication to be complete significantly less often than hospitalists did (64.9% vs 79.1%; P < .01).We identified 7 core clinical elements that PCPs and hospitalists consider essential in discharge communication. Consistently and promptly communicating at least these core elements after discharge may enhance PCP satisfaction and patient-level outcomes. Reported rates of transmission and receipt of this information were suboptimal and should be targeted for improvement.

  View details for DOI 10.1542/hpeds.2013-0022

  View details for PubMedID 24435595

• Special Care Optimization for Patients and Education (SCOPE): Training Pediatric Residents About Children With Special Health Care Needs. Available from: www.mededportal.org/publication/9627 MedEdPORTAL Bogetz, J., Gabhart, J., Rassbach, C., Sanders, L., Mendoza, F., Bergman, D., Blankenburg, R. 2013
• A 6-Year-Old Girl with Extensive Bullous Skin Lesions PEDIATRIC ANNALS Rassbach, C., Shah, N., Davis, A. 2012; 41 (6): 229-231

  View details for DOI 10.3928/00904481-20120525-05

  View details for Web of Science ID 000306363600012

  View details for PubMedID 22694233

• A boy with fever and vomiting. Infectious Diseases in Children. Rassbach C, Jantausch B 2008; August
• Streptococcal pyomyositis of the psoas - Case reports and review PEDIATRIC EMERGENCY CARE Kern, L., Rassbach, C., OTTOLINI, M. 2006; 22 (4): 250-253

  Abstract

  We present two unusual cases of pyomyositis of the psoas muscle caused by Group A beta-hemolytic streptococcus (GABHS) in children presenting with fever, emesis and leg pain. Pyomyositis secondary to GABHS is rare in children and cases involving the psoas muscle have not been previously reported. In our discussion, we review the epidemiology, presentation, diagnosis and treatment of GABHS psoas myositis in comparison with staphylococcal pyomyositis. Prompt recognition of the signs and symptoms of GABHS psoas pyomyositis is essential for treatment of this life-threatening infection.

  View details for Web of Science ID 000237260600010

  View details for PubMedID 16651916

• Lyme disease, a review. Infectious Diseases in Children. Rassbach C, Jantausch B 2006; February