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The purpose of this paper is to demonstrate burnout syndrome among internal medicine and pediatrics residents in a country that does not have the working time directive (WTD) and also to determine the risk factors and consequent impact on efficient functioning in clinical areas.

A 57-item questionnaire was given to internal medicine and pediatrics residents. Responses from 22 pediatrics and 33 internal medicine residents were evaluated.

Demographic findings, burnout scores, having hobbies, social activities and reading books unrelated to medicine were similar between the two groups. Six pediatrics residents (27.3 per cent) and 11 (33.3 per cent) internal medicine residents met the criteria for clinically significant burnout. Personal accomplishment scores and reading books unrelated to medicine were found to be related to burnout.

Burnout is a syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal accomplishment. It is important to document burnout in countries where WTDs are not implemented. Further studies might demonstrate burnout's effect on patient safety, service quality and physician's performance.

Although incarceration may have life-long negative health effects, little is known about associations between child incarceration and subsequent adult health outcomes. The paper aims to discuss this issue.

The authors analyzed data from 14,689 adult participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) to compare adult health outcomes among those first incarcerated between 7 and 13 years of age (child incarceration); first incarcerated at>or=14 years of age; and never incarcerated.

Compared to the other two groups, those with a history of child incarceration were disproportionately black or Hispanic, male, and from lower socio-economic strata. Additionally, individuals incarcerated as children had worse adult health outcomes, including general health, functional limitations (climbing stairs), depressive symptoms, and suicidality, than those first incarcerated at older ages or never incarcerated.

Despite the limitations of the secondary database analysis, these findings suggest that incarcerated children are an especially medically vulnerable population.

Programs and policies that address these medically vulnerable children’s health needs through comprehensive health and social services in place of, during, and/or after incarceration are needed.

Meeting these unmet health and social service needs offers an important opportunity to achieve necessary health care and justice reform for children.

No prior studies have examined the longitudinal relationship between child incarceration and adult health outcomes.

The prevalence of pediatric anxiety disorders is on the rise but youth have challenges in accessing specialty evidence-based mental health care. As a result, families turn to their pediatric primary care provider (PCP) for assessment and management of anxiety. To increase PCPs’ abilities to manage anxiety, the Extension for Community Healthcare Outcomes (“Project ECHO”) was used. The purpose of this study is to explore the impact of Project ECHO on participating PCPs’ knowledge, self-efficacy and interventions surrounding the assessment and management of anxiety.

Data were collected pre- and post-course across five cohorts. Participants completed a clinical knowledge test, ratings of self-efficacy and self-reported frequencies of in-office interventions. Satisfaction was also measured.

Attendance remained strong, and participants rated high satisfaction. From pre- to post-course, participants demonstrated increased knowledge on almost all objective questions. Participants reported increased self-efficacy across all domains. Finally, participants endorsed increased use of several in-office interventions.

This study highlights the importance of Project ECHO as a continuing education model to enhance PCPs’ abilities and confidence in the assessment and management of anxiety. Future continuing education endeavors should consider Project ECHO as a means of increasing PCPs’ capacity to manage mental health conditions.

To the best of the authors’ knowledge, this is the first study that applied the Project ECHO model to pediatric anxiety as a mechanism of increasing knowledge, self-efficacy and in-office interventions with PCPs.

This study aims to investigate the dynamics of knowledge sharing in health care, exploring some of the factors that are more likely to influence the evolution of idea sharing and advice seeking in health care.

The authors engaged 50 pediatricians representing many subspecialties at a mid-size US children’s hospital using a social network survey to map and measure advice seeking and idea sharing networks. Through the application of Stochastic Actor-Oriented Models, the authors compared the structure of the two networks prior to a leadership program and eight weeks post conclusion.

The models indicate that health-care professionals carefully and intentionally choose with whom they share ideas and from whom to seek advice. The process is fluid, non-hierarchical and open to changing partners. Significant transitivity effects indicate that the processes of knowledge sharing can be supported by mediation and brokerage.

Hospital administrators can use this method to assess knowledge-sharing dynamics, design and evaluate professional development initiatives and promote new organizational structures that break down communication silos. This work contributes to the literature on knowledge sharing in health care by adopting a social network approach, going beyond the dyadic level and assessing the indirect influence of peers’ relationships on individual networks.

Computer-Assisted Learning in Pediatrics Program (CLIPP) and National Board of Medical Examiners Pediatric Subject Examination (NBMEPSE) are used to assess students’ performance during pediatric clerkship. International Foundations of Medicine (IFOM) assessment is organized by NBME and taken before graduation. This study explores the ability of CLIPP assessment to predict students’ performance in their NBMEPSE and IFOM examinations.

This cross-sectional study assessed correlation of students’ CLIPP, NBMEPSE and IFOM scores. Students’ perceptions regarding NBMEPSE and CLIPP were collected in a self-administered survey.

Out of the 381 students enrolled, scores of CLIPP, NBME and IFOM examinations did not show any significant difference between genders. Correlation between CLIPP and NBMEPSE scores was positive in both junior (r = 0.72) and senior (r = 0.46) clerkships, with a statistically significant relationship between them in a univariate model. Similarly, there was a statistically significant relationship between CLIPP and IFOM scores. In an adjusted multiple linear regression model that included gender, CLIPP scores were significantly associated with NBME and IFOM scores. Male gender was a significant predictor in this model. Results of survey reflected students’ satisfaction with both NBMEPSE and CLIPP examinations.

Although students did not perceive a positive relationship between their performances in CLIPP and NBMEPSE examinations, this study demonstrates predictive value of formative CLIPP examination scores for their future performance in both summative NBMEPSE and IFOM. Therefore, students with poor performance in CLIPP are likely to benefit from feedback and remediation in preparation for summative assessments.

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

This study seeks to determine how process and latent errors in the interpersonal, organizational, health system, and public health domains impact doctor/patient communication and patient safety.

There were 278 physicians from Manitoba, Canada who completed a self‐report questionnaire during 2006. The largest specialty was family medicine, followed by internal medicine and pediatrics. Mean years of practice was 16, and 60 percent of the respondents were male. Respondents indicated the extent to which difficulties were encountered when communicating with patients.

The study finds that physicians had more difficulties with patients in the 0‐20 year age bracket on 12 of the 18 communication statements. Psychiatry and pediatrics reported more difficulties with language interpreters. Pediatrics reported more difficulties with patients using culturally‐based alternative medicine. Internal medicine had more difficulty with patients not appearing to trust or participate in treatment decisions. Patients in the 41‐60 years age bracket had the highest mean for non‐adherence to treatment plans, health maintenance and needed lifestyle change. The female physician‐female patient dyad had fewer communication difficulties on all statements.

Further research should examine how family structure influences health‐care delivery and health outcomes. Health care organizations can contribute to improving quality of care by seeking out and correcting sources of latent errors, and by supporting professional development and practice interventions.

Few studies exist that have linked communication difficulties to adverse events. This study provides insight on sources of interpersonal errors in communication that directly impact the physician/patient relationship and which may represent threats to patient safety.

Three years after the COVID epidemic and the measures put in place by governments, the authors still cannot measure the full impact of them on the well-being and mental health of adolescents. This population was particularly impacted by this crisis, and some subgroups of young people, such as those from migration backgrounds, have been confronted with additional challenges. This paper aims to explore and describe the perspective and experience of migrant adolescents during the lockdown period

The authors performed 13 semi-structured interviews with migrant adolescents (nine females, median age 16) at the pediatric policlinic of Lausanne University Hospital in Switzerland between November 2020 and January 2021. Participants had been living in Switzerland for an average of 2.3 years. Three of them were staying in a refugee reception centre. A thematic content analysis was carried out to extract themes and topics.

Participants had difficulty understanding information about COVID-19 in general. Remote learning was described as stressful due to various factors and lockdown had an impact on their future plans, such as finding an apprenticeship. Some young people were already socially isolated, but families were generally supportive. They expressed particular concerns, such as the family’s financial situation and the difficulty of living in refugee reception centres.

In the event of further lockdown, special attention must be paid to these adolescents to ensure their proper development and integration. Comprehensive follow-up of this population during and after the pandemic is essential.

This study provides a better understanding of the pandemic experience of migrant adolescents and underlines their difficulties.

Annual screening for cystic fibrosis-related-diabetes (CFRD) using oral glucose tolerance test (OGTT) is recommended, but national testing rates are low. The purpose of this paper is to implement the quality improvement (QI) initiative to improve cystic fibrosis (CF) annual screening rates among patients at one CF center.

To improve screening for CFRD at the CF Center, the authors used the Dartmouth Microsystem Improvement Ramp method and formed a collaborative working group. A process map was created to outline the steps and a fishbone analysis was performed to identify barriers and to utilize resources for implementing new interventions.

Prior to these interventions, 21 percent of eligible patients had completed annual screening and after the intervention, it rose to 72 percent. The initial completion rate with the first prescription was only 50 percent, but it improved steadily to 54/75 (72 percent) in response to reminder letters sent six weeks after the initial script was given.

Close tracking and reminder letters can improve adherence with annual OGTT screening for CFRD among CF patients, with special emphasis on high-risk patients.

There should be a special emphasis on screening for CFRD in high-risk CF patients (those with low BMI or higher age). This QI initiative brought about several operational changes in the annual OGTT screening process that have now become the standard operating procedure at the center.

The transition from pediatric to adult health care is challenging for youth with autism spectrum disorder (ASD). Many tools have been developed to facilitate transition but studies have not assessed their utility or readiness to be implemented in primary care practices. The purpose of this paper is to rate existing health care transition tools to identify tools ready for use in primary care clinics and develop a set of transition principles.

Four pediatric and family medicine providers from community health centers reviewed 12 transition tools and provided ratings and in-depth responses about the usefulness and feasibility of each tool through online surveys and telephone interviews. A conference call was used to discuss the findings and develop a set of transition principles.

The top rated tools included three youth self-management tools, two tools focused on ASD information and one tool focused on communication. No one tool was top rated by all providers and none of the tools was ready to be implemented without revisions. The transition principles developed focused on the use of selected tools to involve all youth in regular conversations about transition at every well child visit beginning at age 14 and adapting that process for youth with special needs.

This study is unique in asking primary care providers to assess the applicability of incorporating existing and publicly available transition tools in their own practices and developing a set of transition principles.