e8 ABSTRACTS ACADEMIC PEDIATRICS

month.However,most fellowshipPDs (67%) indicated that fellow-ship start dates were not flexible. The majority of categorical PDsand fellowship PDs favored creation of a delayed, uniform fellow-ship start date that could solve these issues.CONCLUSIONS: These data indicate that both categorical and

fellowship PDs are dissatisfied with the current status of fellow-ship start dates and favor delaying the start of fellowship. Adetailed analysis of the problem should be performed and shouldinvolve others, such as Designated Institutional Officials and PDsfrom other specialties, e.g., internal medicine and surgery, whoare likely affected by the same issues.

18. UNSETTLING SITUATIONS IN THE PEDIATRICINTENSIVE CARE UNIT: A CURRICULUM FORIMPROVING RESIDENT CONFIDENCE ANDCOMPETENCE WHEN NEGOTIATING CHALLENGINGENCOUNTERSMelissa J. Sacco, MD, University of Virginia Children’sHospital, Charlottesville, VA, Khaliah A. Johnson, MD,Children’s Healthcare of Atlanta, Atlanta, GA,Nicole A. Shilkofski, MD, Lewis H. Romer, MD,Janet R. Serwint, MD, The Johns Hopkins University Schoolof Medicine, Baltimore, MD

BACKGROUND: Past research has shown that residents rotatingthrough the Pediatric Intensive Care Unit (PICU) feel unequippedto manage 3 unsettling situations: angry parents, acute de-compensation of a previously healthy patient, and conflictbetween provider teams. There is a dearth of residency curriculumdesigned to address the management skills for these situations.OBJECTIVE: To implement and evaluate the impact of a PICU

based, experiential curriculum on resident knowledge, behavior,and competence when negotiating unsettling situations.DESIGN/METHODS: The curriculum included four small group

sessions presenting strategies for managing unsettling situationsand a systematic self-care plan. Study design was a modified,randomized controlled trial with residents randomly assigned bymonth to either the intervention group (experiential curriculumplus standard) or to the control group (standard curriculum). Partic-ipants completedpre andpost surveys to assessknowledge, attitudes,and behavior regarding unsettling situations. Residents participatedin 2 simulated unsettling situations, with blinded standardizedpatients and blinded clinician observers scoring their performanceon a standardized check list. IRB approval was obtained.RESULTS: Fifty-two residents were approached; 50 consented

and were randomized during the 2011-12 academic year. Resi-dents exposed to the curriculum were more likely to agree/strongly agree that they would use a standardized approach tomanaging unsettling situations (85% vs 31%) and were morelikely to voluntarily engage in difficult situations (95% vs78%). There was a trend towards intervention residents perform-ing better on standardized checklist compared to control groupresidents. Additional data analysis on performance scoring isunderway.CONCLUSION: Creating and implementing an experiential

curriculum in the PICU not only improved resident confidenceregarding managing unsettling situations, but indicated a trendtoward improved resident competence in negotiating thesescenarios.

19. PEDIATRIC PROGRAM DIRECTOR PERCEPTIONSOF 2011 DUTY HOUR REGULATIONSBrian C. Drolet, MD, Mamoona T. Khokhar, MD, BrownUniversity/Rhode Island Hospital, Providence, Rhode

Island, Sarah B. Whittle, Texas Children’s Cancer andHematology Centers, Houston, TX, Adam Pallant, MD, PhD,Brown University/Hasbro Children’s Hospital, Providence,RI

OBJECTIVE: To determine pediatric program director percep-tions of the 2011 ACGME Common Program Requirements.METHODS:All program directors (PDs) in pediatrics (n ¼ 181)

were identified from the ACGME database. An extensive searchwas performed to obtain individual contact information for eachPD; functional e-mails were identified for 164 (89.0%). AfterInstitutional Review Board approval, three individualizede-mail requests were sent asking each PD to complete a 32-ques-tion anonymous, electronic survey. Independence of meanproportions was established by non-overlapping 99% confidenceintervals.RESULTS: A total of 151 responses were obtained (92.1%

survey response). The majority of respondents were between 40and 60 years old (62.9%) with nearly half new to their position,reporting 0 to 5 years experience as a PD (48.3%). Most programs(41.7%) ranged from 30 to 49 residents and were primarily affil-iated with an academic medical center (75.5%). Pediatric PDs re-ported approval for nearly all individual aspects of the 2011ACGME Common Program Requirements with the exceptionof 16-hour shifts for interns (72.2% disapprove). Regarding theimpact of the new standards, many areas were reportedlyunchanged, however a substantial number of PD report worsenedresident education (74.7%) and preparation for senior roles(79.9%) as well as diminished resident ownership of patients(76.8%) and continuity of care (78.8%). Finally, there was a re-ported increase in PD workload (67.6%) and use of physicianextenders (62.7%).CONCLUSIONS: Pediatric program directors report numerous

negative consequences of the 2011 Common Program Require-ments. These include worsened resident education and prepara-tion to take on more senior roles, as well as diminishedresponsibility and continuity of care. Although they support indi-vidual aspects of duty hour regulation, most pediatric programdirectors (71.3%) say there should be fewer of these regulations.As leaders in graduate medical education, program directors mustact to address the reported negative impacts on resident trainingand patient care.

20. ASSESSMENT OF PEDIATRIC RESIDENTKNOWLEDGE AND SKILLS IN EVIDENCE-BASEDMEDICINEJamie Macklin, MD, Nationwide Children’s Hospital/OSU,David Way, MEd, The Ohio State University College ofMedicine, Rajesh R. Donthi, MD, Nationwide Children’sHospital/Doctors Hospital, Alex T. Rakowsky, MD,Elise D. Berlan, MD, MPH, Nationwide Children’s Hospital/OSU, Columbus, OH

OBJECTIVE: Our objective was to validate an EBM assessmentinstrument, originally developed by Chernick et al. as a measureof baseline EBMknowledge and skills prior to significant changesto our curriculum.METHODS: We adapted the Chernick instrument to assess our

pediatric residents’ experience and comfort with EBM, self-re-ported EBM-related behaviors, and EBM knowledge. The knowl-edge section required residents to construct clinical questions, tolocate and identify best practices from the research literature, andto apply EBM concepts to patient care. Residents from 3 trainingprograms (IM/Peds, Categorical Peds, and Dual Peds) completed

ACADEMIC PEDIATRICS ABSTRACTS e9

the assessment. We evaluated the scale properties of the instru-ment using factor analysis and Cronbachs Alpha reliability anal-ysis. We validated the scoring rubric using multiple judges toscore the knowledge portion of the test. We also assessed theinstruments validity by comparing knowledge scores to experi-ence and level of training.RESULTS: Of 132 residents surveyed, we received 113 fully

completed (85.6%) and 9 partially completed assessments(6.8%). The factor and reliability analyses confirmed 3 hypothe-sized scales (Comfort, Behavior, and Knowledge). Inter-rater reli-ability between judges was high (ICC2,2¼0.974). Items were freeof floor or ceiling effects. We found that self-reported EBMbehaviors increased with comfort level (p<0.01) and that comfortlevel increased with EBM experience (p<0.05). EBM knowledgescores increased with prior EBM experiences (p<0.05) but werenot different across levels of training.CONCLUSIONS: We were able to verify the hypothesized struc-

ture of the EBM assessment instrument developed by Chernick et.al. The instrument worked well in our environment and possessesthe psychometric properties to be used by a broader audience. Wewere unable to show discriminate validity, i.e. that knowledgeincreases with years of residency training and experience. Webelieve that this may be due to increasing amounts of timedevoted to EBM education at the undergraduate medical educa-tion level.

APPD 2013 QI Abstracts

21. RESIDENT USE OF WHITEBOARDS ANDA COLLABORATIVE ADMISSION PROCESS IMPROVESPATIENT/FAMILY COMMUNICATION ANDKNOWLEDGEAmanda J. Rogers, MD, Children’s Hospital of Wisconsin,Medical College of WI, Laura Norton, MD, Children’sHospital of WI/Medical College of WI, Milwaukee, WI,Jennifer Di Rocco, DO, University of Hawaii, John A. BurnsSchool of Medici, Honolulu, Hawai’i, Lauren Giuliani, BA,CLSSBB, Mary Beth Miranda, RN, MS, Children’s Hospitalof WI, Milwaukee, WI

BACKGROUND: Lack of communication between the health careteamand families leads tomisunderstanding and frustration.Whilethis is challenging anywhere, an academic center with providers atdifferent levels of training adds an extra element of difficulty. OurNRC Picker Patient Experience Surveys show that families areoverwhelmed by information presented at admit and are unableto remember key facts. This contradicts Joint Commission require-ments that they know who their physician is and be included indeveloping the plan of care (POC). Better communication isneeded to improve families’ understanding of their hospitalization.AIM: Increase the percent of families who know their POC and

physician’s name over a five month time period.METHODS: Current state analysis and five PDSA cycles were

conducted. The primary outcome of family knowledge wasmeasured via resident administered surveys asking if familiesknew their POC and physician’s name. In cycle one, emailswere sent asking residents to write this information on white-boards in patient rooms. In cycle two, signs were posted remind-ing them to use whiteboards. In cycle three, team members metwith residents to explain the rationale behind whiteboards. Incycle four, prompts were added to whiteboards. In cycle five,a collaborative admission process began where the nurse and resi-dent presented the POC together and wrote on whiteboards.

Lessons learned from each cycle were incorporated into thenext cycle’s plan.RESULTS: 40% of families knew the POC and 15% knew their

physician’s name prior to any intervention. After cycle four, 88%knew the POC and 95% knew the physician’s name. Cycle five isin process and data will be presented in April.CONCLUSION: Documenting the POC and physician name on

whiteboards significantly increases family knowledge of this vitalinformation. Adding prompts to whiteboards helps sustain thisprocess. Next steps include analyzing the effect of a collaborativeadmission process. A multidisciplinary team may allow for aneven more powerful impact on communication and under-standing.

22. IMPLEMENTATION OF A PEER-DEVELOPEDORIENTATION BUNDLE TO IMPROVE INTERNSATISFACTION IN THE NEONATAL INTENSIVE CAREUNITSarah Spencer Welsh, MD, Nathan J. Rodgers, MD, MHA,Karen James, MD, Eric M. Heinert, DO, Reed Evers, MD,University of Rochester, Rochester, NY

BACKGROUND: Rotating in the neonatal intensive care unit(NICU) can be an intimidating experience for the pediatric intern,who typically has little or no previous exposure to neonatology.There is a steep learning curve in an environment of high intensityand unique vernacular. In our residency program, there was nostandardized approach to interns’ NICU orientation, resulting invariable experiences and intern dissatisfaction with their orienta-tion and training.AIM: Intern satisfaction with NICU orientation, as measured by

a greater than 50% proportion of “mostly” or “completely” satis-fied ratings, will improve from the 2011-12 to 2012-13 academicyears after the implementation of a bundle of newly developedpeer-to-peer orientation materials.METHODS: The first part of the quality improvement project

(based on a PDSA cycle) involved a needs assessment (Plan) bysurveying 2011-12 interns on their overall level of satisfactionwith NICU orientation and familiarity with specific tasks andexpectations in theNICU.We also asked interns andNICU leader-ship how the orientation process could be improved. Using thisinformation, we created 5 peer-to-peer materials (Do): two videos