Diagnosis and testing practices for adolescent pertussis among a national sample of primary care physicians.
ABSTRACT Adolescents are a primary reservoir for propagating pertussis infection. This study aimed to describe diagnosis and testing practices for adolescent pertussis among a national sample of primary care physicians.
From January to March, 2007 we administered a written survey to a United States sample of American Medical Association physicians that included 725 family practitioners (FPs) and 725 general pediatricians (PDs).
Response rate was 60% (n=702). Overall, 16% of respondents indicated that they did not test adolescents for pertussis as part of their clinical practice. A similar proportion did not recognize the clinical manifestations of pertussis in a standardized adolescent case patient. FPs were less likely than PDs to test for pertussis in general and to diagnose the case patient with pertussis. Barriers to testing adolescents for pertussis included delay in obtaining test results (52%), inconvenience of sample collection (29%), lack of testing supplies (29%), lack of familiarity with testing protocols (28%) and cost (22%).
Our results suggest that a substantial number of primary care physicians do not utilize pertussis testing and may not be able to recognize the clinical symptoms of this infection in adolescents. Interventions to improve physician knowledge about this important public health issue may be warranted.
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ABSTRACT: This study investigates the predictive validity of the In-Training Examination (ITE). Although studies have confirmed the predictive validity of ITEs in other medical specialties, no study has been done for general pediatrics. Each year, residents in accredited pediatric training programs take the ITE as a self-assessment instrument. The ITE is similar to the American Board of Pediatrics General Pediatrics Certifying Examination. First-time takers of the certifying examination over a 5-year period who took at least 1 ITE examination were included in the sample. Regression models analyzed the predictive value of the ITE. The predictive power of the ITE in the first training year is minimal. However, the predictive power of the ITE increases each year, providing the greatest power in the third year of training. Even though ITE scores provide information regarding the likelihood of passing the certification examination, the data should be used with caution, particularly in the first training year. Other factors also must be considered when predicting performance on the certification examination. This study continues to support the ITE as an assessment tool for program directors, as well as a means of providing residents with feedback regarding their acquisition of pediatric knowledge.The Journal of pediatrics 06/2008; 153(3):425-8. DOI:10.1016/j.jpeds.2008.03.012 · 3.74 Impact Factor
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ABSTRACT: To explore the use and perceived impact of pediatric hospitalists as teaching attendings among pediatric residency and clerkship programs. Between November 2007 and February 2008, the authors conducted a mail-based survey of all pediatric residency program directors (170) and pediatric clerkship directors (131) in the United States as identified by the Association of Pediatric Program Directors and Council on Medical Student Education in Pediatrics. The surveys focused on the responsibilities of pediatric hospitalists in training programs and their perceived impact on the roles of pediatric residents and medical students. The response rate for residency directors was 86% (146/170) and 87% (114/131) for clerkship directors. One hundred thirteen (77%) residency programs and 91 (80%) clerkship programs used hospitalists as teaching attendings. Among these programs, 65% (73) of residency program directors and 64% (58) of clerkship directors reported that pediatric hospitalists are responsible for all general inpatient services. The majority of residency (76%, 84) and clerkship directors (71%, 64) reported that hospitalists are more accessible to trainees than traditional attendings. A minority of residency program directors (36%, 39) reported that use of hospitalists has decreased senior resident autonomy. The role of hospitalists in resident and student education will likely continue to evolve over the next decade.Additional refinement of the roles and responsibilities of hospitalists will address lingering concerns in some programs about resident autonomy.Academic medicine: journal of the Association of American Medical Colleges 11/2009; 84(11):1617-21. DOI:10.1097/ACM.0b013e3181bb1f0d · 3.47 Impact Factor