Sports are the leading injury-related cause for pediatric primary care visits. Pediatric residency education guidelines suggest incorporating sports medicine (SM) education into curricula; however, research is lacking regarding effective teaching methods.
To assess reported US pediatric residency SM curricula, teaching methods, and resident evaluation of SM education.
Chief residents (CRs) and third-year residents (PL3s) from 100 randomly selected US Accreditation Council for Graduate Medical Education-accredited residency programs, stratified by size and geographic location, received surveys regarding programs' SM curriculum and teaching methods and individuals' methods for learning SM.
Response rates were 63% and 39% for CRs and PL3s, respectively. According to CRs, 34% of programs had no one in charge of their SM curriculum. Lecture (77%) was the primary method used for teaching SM. Hands-on teaching (37%) was used less frequently. CRs stated that 29% of programs did not include musculoskeletal examination teaching in their curriculums; 24% did not include formal teaching of concussion management, and 29% did not include reasons for medical disqualification. PL3s rated teaching of joint examinations and the preparticipation physical as the most poorly taught components of the physical examination. PL3s rated hands-on teaching and patient experience as the best methods for improving SM education. CRs reported that only 36% of programs have discussed incorporating more SM into their curriculum.
SM education is deficient in US pediatric residency programs. Standardized curricula should be developed with a focus on hands-on training as a means for teaching SM to pediatric residents.
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"In a 2004 survey of 100 randomly selected ACGMEaccredited residency programs, third-year pediatric residents rated teaching of joint examinations and the preparticipation sports medicine physical as the most poorly taught components of the physical examination. Of the programs surveyed, 29% did not include any specific musculoskeletal or joint examination teaching in their curriculum1415161718. Formulaic subspecialty referral patterns contribute to delays in appropriate diagnosis and treatment due to conformity or a lack of critical, informed judgment . "
[Show abstract][Hide abstract]ABSTRACT: For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier.
Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care.
A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills.
Changing demographics and persistent reimbursement disparities will require workplace innovation and legislative reform. Reimbursement reform is utterly essential to extending patient access to subspecialty care. In practice settings characterized by a proportion of Medicaid-subsidized patients in excess of the national average (> 41%), institutional support is vital. Accelerating access to care will require the most efficient deployment of existing, limited resources. Practice redesign of such resources can also improve access, e.g., group appointments and an escalating role for physician extenders. Multidisciplinary, team-oriented care and telemedicine have growing evidence basis as solutions to limited access to pediatric rheumatology services.
Full-text · Article · Aug 2011 · Pediatric Rheumatology
[Show abstract][Hide abstract]ABSTRACT: The continued demographic trend of the "aging of America" has many implications for U.S. society. Although their population has remained relatively constant, children are becoming a smaller proportion of the overall population. The rapidly changing age-related U.S. demographics raises issues we have not yet chosen to address. These changes have important implications for children and will become manifest in the financing of both public programs and private markets for health, education, and social services, whether or not specific political actions are taken. Investment in children's health can affect the health and productivity of the next generation of Americans.
[Show abstract][Hide abstract]ABSTRACT: To assess whether primary care physicians, via referrals or other mechanisms, are now providing proportionally less care for children with specific common diagnoses, thus driving greater demand for specialist services.
Secondary data analysis (1993-2001) from one of the largest commercial healthcare organizations in the United States. Evaluation and management (E/M) common procedural terminology (CPT) visit codes and International Classification of Diseases (ICD) codes pertaining to asthma, constipation, headache, and heart murmurs were selected. Visits were then assigned to the specialty of physician providing care. Significant differences between and among categories of physicians were tested using logistic regression.
Overall, pediatrician generalists and specialists provided a greater proportion of E/M visits to children in 2001 than in 1993, compared with nonpediatrician providers. However, although the absolute increase in the proportion of all E/M visits by children <18 years of age to pediatrician generalists was greater than that of pediatrician subspecialists (4.77% vs 0.69%; P <.0001), the relative increase was much smaller for the generalists (8.9% vs 19.7%; P <.0001). Findings were consistent for most of the specific diagnoses examined.
The increases in both the proportion and number of visits made to specialists has not been accompanied by a decrease in visits to generalists.
Full-text · Article · Jan 2005 · Journal of Pediatrics