Sarah Hilgenberg

All Publications

• 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

• Pediatric residents' procedural competency requirements: a national needs assessment of program directors and chief residents. Academic pediatrics Nguyen, E. L., Cunanan, K., Liu, Y., Hilgenberg, S. L. 2023

  Abstract

  BACKGROUND: There is increased learner competition for a shrinking pool of procedural training opportunities and indications in pediatrics. This study aimed to describe pediatric residency program directors' (PDs) and chief residents' (CRs) perspectives about whether procedural requirements for pediatric residents should be reformed and individualized.METHODS: This was a survey-based, mixed methods study of PDs and CRs affiliated with the Association of Pediatric Program Directors. We used descriptive statistics to analyze demographics and perspectives, logistic regressions to examine individual and program factors, and thematic analysis for qualitative data.RESULTS: Forty-seven percent (95/203) of PDs and 16% (64/392) of CRs responded, representing APPD membership across program setting, size, and region (average standard mean deviation 0.28). Ninety-one percent of PD respondents considered one or more of the current Accreditation Council for Graduate Medical Education required procedures non-essential; 74% favored individualizing procedural training. CR responses mirrored PD responses. Program size, setting, and access to procedural teams did not significantly associate with likelihood to favor individualization.CONCLUSION: The majority of PD and CR respondents believe that current ACGME procedures should be reformed and individualized to future career goals. This change could allow maximization of limited time in residency in this era of decreased opportunity.

  View details for DOI 10.1016/j.acap.2023.12.009

  View details for PubMedID 38159599

• Impact of an Interactive, Animation-Based Electroencephalography Curriculum on Learner Confidence and Knowledge. Pediatric neurology Silverman, A., Hilgenberg, S., Shen, S., Spelbrink, E. M., Klotz, J. 2023; 151: 96-103

  Abstract

  BACKGROUND: There is a national need for innovative electroencephalography (EEG) education with efficacy evaluated by rigorous statistical analysis. We created a dynamic, online resource that includes a series of animated videos at a single academic medical center.METHODS: For the animations and interactive module, we used VideoScribe and Articulate, respectively. The module comprised three chapters: (1) Origin & Technical Aspects of EEG, (2) Normal Adult EEG in Wakefulness & Sleep, and (3) Abnormal EEG, with appendices on artifacts, variants, activation procedures, seizure/epilepsy classification, and neonatal/pediatric EEG. The curriculum and knowledge assessments were reviewed independently by two fellowship-trained physicians before distribution. Linear mixed-effects models with bootstrapping were used to compare paired pre- and post-tests as well as Likert scale questionnaires.RESULTS: Forty-nine learners participated in the pretest survey; 38 matched participants completed post-tests (78%). Learners across fields perceived benefit (100% would recommend to colleagues), indicated improved self-efficacy (P<0.0001), and performed better on post-test knowledge assessments (54.1 vs 88.2%, P<0.0001). In the neurology providers subgroup (n=20), pretest scores correlated with years in training (Spearman r=0.52, P=0.039), neurology rotations (r=0.70, P=0.003), epilepsy/EEG rotations (r=0.6, P=0.014), and EEG teaching hours (r=0.62, P=0.01); content knowledge and self-efficacy improvement for neurology providers remained significant in a multivariate model adjusting for these covariates.CONCLUSIONS: This animation-based, interactive EEG module proved effective in elevating learner confidence and knowledge across several medical specialties and training levels. Further study across institutions and subspecialties is needed to substantiate broad applicability, but our data appear promising for early EEG learners.

  View details for DOI 10.1016/j.pediatrneurol.2023.11.015

  View details for PubMedID 38141555

• 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

• Enhancing Learner Engagement Through Experiential Learning With Learner-Generated Data ACADEMIC PEDIATRICS Li, S. T., Abramson, E., Hilgenberg, S., Lichtenstein, C., Lockspeiser, T. 2023; 23 (4): 846-848

  View details for Web of Science ID 001009575100001

• MODIFIED ASSESSMENT OF COMPETENCY IN THORACIC SONOGRAPHY (ACTS) SCALE IN THE NICU AND PICU Dasani, R., Bhargava, V., Chan, B., Hamilton, C., Seekins, J., Halabi, S., Chen, D., Reddy, C., Hilgenberg, S., Haileselassie, B., Bhombal, S. LIPPINCOTT WILLIAMS & WILKINS. 2023: 302

  View details for Web of Science ID 000921450900590

• Pediatric Resident Perspectives on the Impact of COVID-19 on Training. Hospital pediatrics Winn, A. S., Myers, R., Grow, H. M., Hilgenberg, S., Lieberman, R., Naifeh, M. M., Unaka, N. I., Schwartz, A. 2021

  Abstract

  OBJECTIVES: At the onset of the coronavirus disease 2019 pandemic, disruptions to pediatric care and training were immediate and significant. We sought to understand the impact of the pandemic on residency training from the perspective of pediatric residents.METHODS: We conducted a cross-sectional survey of categorical pediatric residents at US training programs at the end of the 2019-2020 academic year. This voluntary survey included questions that explored the impact of the coronavirus disease 2019 pandemic on resident training experiences, postresidency employment plans, and attitudes and perceptions. Data were analyzed by using descriptive statistics and mixed-effects regression models. We performed a sensitivity analysis using respondents from programs with a >40% response rate for questions regarding resident attitudes and perceptions.RESULTS: Residents from 127 of 201 training programs (63.2%) completed the survey, with a response rate of 18.9% (1141 of 6032). Respondents reported multiple changes to their training experience including rotation schedule adjustments, clinic cancellations, and an increase in the use of telemedicine. Respondents also reported inconsistent access to personal protective equipment and increased involvement in the care of adult patients. Graduating resident respondents reported concerns related to employment. Respondents also noted a negative impact on their personal wellness.CONCLUSIONS: Responding residents reported that nearly every aspect of their training was impacted by the pandemic. Describing their experiences may help residency program and hospital leaders supplement missed educational experiences, better support residents through the remaining months of the pandemic, and better prepare for extraordinary circumstances in the future.

  View details for DOI 10.1542/hpeds.2021-005994

  View details for PubMedID 34808671

• 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

• Categorical Pediatric Residency Program Curriculum Needs: A Study of Graduating Residents and Residency Program Leadership ACADEMIC PEDIATRICS Hilgenberg, S. L., Frintner, M., Blankenburg, R. L., Haftel, H. M., Gellin, C. E. 2021; 21 (4): 589-593

  View details for Web of Science ID 000669628900002

• Advancing Our Understanding of Pediatric Resident Communication Skills and Disruptive Behavior and Mistreatment Strategies. Academic pediatrics Hilgenberg, S. L., Bogetz, A. L., Leibold, C., Blankenburg, R. L. 2020

  View details for DOI 10.1016/j.acap.2020.10.017

  View details for PubMedID 33220461

• Virtual Cafes: An Innovative Way for Rapidly Disseminating Educational Best Practices and Building Community During COVID-19. Academic pediatrics Blankenburg, R., Poitevien, P., Gonzalez Del Rey, J., Degnon, L., Virtual Cafe Study Team 2020; 20 (6): 756–57

  View details for DOI 10.1016/j.acap.2020.05.025

  View details for PubMedID 32502535

• Righting the Autonomy-Supervision Pendulum: Understanding the Impact of Independent Rounds on Medical Students, Residents, and Faculty. Academic medicine : journal of the Association of American Medical Colleges Moriarty, J. A., Vellanki, S. n., Trope, L. A., Hilgenberg, S. L., Blankenburg, R. L. 2020

  Abstract

  To explore trainee and faculty perspectives on an independent rounding intervention on general pediatrics wards at 2 institutions.In July 2018, the authors introduced independent rounds 1 to 2 times a week at 2 training sites. In this qualitative study, the authors conducted semi-structured focus groups with a purposive sample of junior trainees (clerkship medical students and PGY1 residents), senior trainees (PGY2 and PGY3-5 residents), and hospital medicine faculty between October 2018 and May 2019. Focus groups were audio-recorded, transcribed verbatim, and analyzed for themes using the constant comparative approach associated with grounded theory.Focus groups included 27 junior trainees, 20 senior trainees, and 18 faculty. Six themes emerged: (1) Independent rounds contributed to all trainees' development; (2) Senior residents described increased motivation to take full ownership of their patients and educational needs of the team; (3) Faculty expressed concerns about decreased opportunities for teaching and feedback, however all trainees reported unique learning from having faculty both present and absent from rounds; (4) No significant patient safety events were reported; (5) All participants identified communication and patient progression concerns; (6) A tension emerged between decreased faculty and enhanced trainee career satisfaction. Participants identified solutions to identified barriers to further improve this educational intervention.As a result of independent rounding, trainees described increased motivation to take ownership of their patients and team. Both rounding experiences contributed to their development as physicians in different ways. Further studies should explore patient and caregiver perspectives and concerns about communication and patient care progression when designing future interventions to promote resident autonomy.

  View details for DOI 10.1097/ACM.0000000000003645

  View details for PubMedID 32769470

• De-escalating Angry Caregivers: A Randomized Controlled Trial of a Novel Communication Curriculum for Pediatric Residents. Academic pediatrics Hilgenberg, S. L., Bogetz, A. L., Leibold, C., Gaba, D., Blankenburg, R. L. 2018

  Abstract

  OBJECTIVE: Medical providers struggle when communicating with angry patients and their caregivers. Pediatric residents perceive communication competencies as an important priority for learning, yet they lack confidence and desire more training in communicating with angry families. Few curricula exist to support trainees with de-escalation skill development. We developed, implemented, and evaluated the impact of a novel de-escalation curriculum on pediatric resident communication skills.METHODS: Randomized controlled trial of a 90-minute de-escalation curriculum for pediatric residents in August-September 2016. Trained standardized patient (SP) actors rated residents' communication skills following two unique encounters before and after the intervention/control session. Residents completed a retrospective pre-post communication skills self-assessment and curriculum evaluation. We used independent and paired t-tests to assess for communication improvements.RESULTS: 84 of 88 (95%) eligible residents participated (43 intervention, 41 control). Residents reported frequent encounters with angry caregivers. At baseline, interns had significantly lower mean SP-rated de-escalation skills than other residents (P = .03). Intervention residents did not improve significantly more than controls on their pre-post change in mean SP-rated de-escalation skills. Intervention residents improved significantly on their pre-post mean self-assessed de-escalation skills (P ≤ .03).CONCLUSIONS: Despite significant self-assessed improvements, residents' SP-rated de-escalation skills did not improve following a skills-based intervention. Nevertheless, our study illustrates the need for de-escalation curricula focused on strategies and peer discussion, suggests optimal timing of delivery during fall of intern year, and offers an assessment tool for exploration in future studies.

  View details for DOI 10.1016/j.acap.2018.10.005

  View details for PubMedID 30368036

• Well-Appearing Newborn With a Vesiculobullous Rash at Birth. Pediatrics Stewart, S. E., Lin, J. L., Everhart, J. L., Pham, T. H., Marqueling, A. L., Rieger, K. E., Hilgenberg, S. L. 2018

  Abstract

  A term, appropriate-for-gestational-age, male infant born via normal spontaneous vaginal delivery presented at birth with a full-body erythematous, vesiculobullous rash. He was well-appearing with normal vital signs and hypoglycemia that quickly resolved. His father had a history of herpes labialis. His mother had an episode of herpes zoster during pregnancy and a prolonged rupture of membranes that was adequately treated. The patient underwent a sepsis workup, including 2 attempted but unsuccessful lumbar punctures, and was started on broad-spectrum antibiotics and acyclovir, given concerns about bacterial or viral infection. The rash evolved over the course of several days. Subsequent workup, with particular attention to his history and presentation, led to his diagnosis.

  View details for PubMedID 29437933

• Outcomes of a Novel Curriculum on De-Escalating Angry Caregivers for Pediatric Residents (Descriptive Abstract) Academic Pediatrics Hilgenberg, S. L., Bogetz, A. L., Leibold, C., Gaba, D., Blankenburg, R. L. 2017; 17 (5): e3
• “Recipient of a finding incidental to research” Incidental Findings in Research, Presidential Commission for the Study of Bioethical Issues Hilgenberg, S. http://bioethics.gov/node/1617. 2013
• Analysis of factors that modify susceptibility and rate of progression in amyotrophic lateral sclerosis (ALS) AMYOTROPHIC LATERAL SCLEROSIS Qureshi, M. M., Hayden, D., Urbinelli, L., Ferrante, K., Newhall, K., Myers, D., Hilgenberg, S., Smart, R., Brown, R. H., Cudkowicz, M. E. 2006; 7 (3): 173-182

  Abstract

  We conducted case-control and prospective longitudinal studies to examine risk factors and predictors of disease progression for ALS. Ninety-five subjects with ALS and 106 healthy control subjects were enrolled. All subjects completed a risk factor questionnaire at enrollment. The ALS subjects were prospectively followed for one year to define factors that influence the rate of disease progression, measured by rate of change in percent predicted forced vital capacity (%FVC) and the ALS functional rating scale (ALSFRS) score. The association of each potential risk factor with ALS was determined using univariate logistic regression. A random slope model was used to determine the association of each risk factor with disease progression. The demographic characteristics of ALS subjects and controls at enrollment did not differ. Significant risk factors for ALS included reported exposure to lead (p = 0.02) and pesticides (p = 0.03). Disease progression was faster in the ALS subjects having bulbar onset and a shorter time period between onset of symptoms and diagnosis. Pertinent variables not associated with either causation or progression of ALS included physical activity, cigarette smoking and a history of physical trauma or other clinical disorders.

  View details for DOI 10.1080/14660820600640596

  View details for Web of Science ID 000241153900007

  View details for PubMedID 16963407

• Transformation: from medical student to patient. Annals of internal medicine Hilgenberg, S. 2006; 144 (10): 779-780

  View details for PubMedID 16702597

• Increased plasma levels of matrix metalloproteinase-9 in patients with Alzheimer's disease NEUROCHEMISTRY INTERNATIONAL Lorenzl, S., Albers, D. S., Relkin, N., Ngyuen, T., Hilgenberg, S. L., Chirichigno, J., Cudkowicz, M. E., Beal, M. F. 2003; 43 (3): 191-196

  Abstract

  Matrix metalloproteinases (MMPs) may play a role in the pathophysiology of Alzheimer's disease (AD). MMP-9 and tissue inhibitors of metalloproteinases (TIMPs) are elevated in postmortem brain tissue of AD patients. MMPs and TIMPs are found in neurons, microglia, vascular endothelial cells and leukocytes. The aim of this study was to determine whether circulating levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 are elevated in the plasma of AD patients. We compared AD patients to age- and gender-matched controls as well as to Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) patients. There was constitutive expression of gelatinase A (MMP-2), and gelatinase B (MMP-9), in all the samples as shown by zymographic analysis. Levels of MMP-9 were significantly (P=0.003) elevated in the plasma of AD patients as compared to controls. Plasma levels of MMP-2, TIMP-1 and TIMP-2 were unchanged. There were no significant changes of MMP-2, MMP-9, TIMP-1 and TIMP-2 levels in PD and ALS samples. TIMP-1 and TIMP-2 were significantly correlated with MMP-9 in the AD patients. ApoE genotyping of plasma samples showed that levels of MMP-2, TIMP-1 and TIMP-2 and MMP-9 were not significantly different between the ApoE subgroups. These findings indicate that circulating levels of MMP-9 are increased in AD and may contribute to disease pathology.

  View details for DOI 10.1016/S0197-0186(03)00004-4

  View details for Web of Science ID 000182900400002

  View details for PubMedID 12689599

• Tissue inhibitors of matrix metalloproteinases are elevated in cerebrospinal fluid of neurodegenerative diseases JOURNAL OF THE NEUROLOGICAL SCIENCES Lorenzl, S., Albers, D. S., LeWitt, P. A., Chirichigno, J. W., Hilgenberg, S. L., Cudkowicz, M. E., Beal, M. F. 2003; 207 (1-2): 71-76

  Abstract

  Matrix metalloproteinases (MMPs) are implicated in the pathogenesis of diseases such as Alzheimer's Disease (AD) and amyotrophic lateral sclerosis (ALS). Increased expression of MMP-9 and TIMPs has been reported in postmortem AD and ALS brain tissue, as well as in ALS cerebrospinal fluid (CSF) and plasma. Although individual studies of MMP and TIMP expression in CSF have included AD and ALS samples, there are no studies comparing the expression of these proteins between neurodegenerative diseases. We measured the levels of matrix metalloproteinases (MMPs)-2 and -9 and the tissue inhibitor of MMPs (e.g. TIMP-1 and TIMP-2) in CSF samples from patients with Parkinson's Disease (PD), Huntington's Disease (HD), AD and ALS as compared to age-matched control patients. There was constitutive expression of the proform of gelatinase A (proMMP-2) on zymography gels in all CSF samples. Unexpectedly, there was an additional gelatinolytic band at 130 kDa of unknown etiology in the CSF samples of patients with PD (61% of patients studied), AD (61%), HD (25%) and ALS (39%). Levels of TIMP-1 were significantly elevated in CSF samples from all disease groups. TIMP-2 was significantly increased in CSF of AD and HD patients. MMP-2 levels did not differ significantly between groups. These findings show that TIMPs are elevated in the CSF of patients with neurodegenerative diseases suggesting a potential role of these endogenous inhibitors of matrix metalloproteinases in neurodegenerative diseases.

  View details for Web of Science ID 000181533500012

  View details for PubMedID 12614934