The ability to share bad news effectively is an essential skill for pediatricians. The Accreditation Council for Graduate Medical Education has recently endorsed six competencies for resident education, one of which involves the development of interpersonal and communication skills. Bad news spans a variety of circumstances, from discussing an abnormal laboratory test, a physical examination finding with uncertain prognosis, the disclosure of a life-threatening diagnosis or a child's death. During this interactive skills-based workshop, participants will identify important components of giving bad news by review of videotapes. The perspectives and reactions of parents, patients, and health care professionals in receiving and giving bad news will be explored. Useful techniques will be identified and practiced during role-plays with participants and standardized patients. Participants will develop ideas of implementation of teaching techniques and evaluation of this competency for their own institutions.

Janet R. Serwint, MD, The Johns Hopkins Children’s Center, Baltimore, MD, Larrie Greenberg, MD, Internal Consultant, Faculty Development, George Washington University School of Medicine, Washington, DC and Benjamin S. Siegel, Boston University School of Medicine, Boston Medical Center, Boston, MA

Pediatricians have traditionally been natural and effective advocates for children and youth. Increasingly, pediatricians find themselves in advocacy roles, such as helping families navigate managed care systems, persuading administrators to increase funding for pediatric health care and research, or advising community programs on how best to meet the needs of youth. However, there is a lack of consensus on what is (and is not) advocacy, and how pediatricians can be effective advocates for their patients, families, and communities. This workshop is designed to create a forum to discuss these issues. Advocacy will be defined in the context of pediatric and community health. A framework for "the doing" of advocacy will be examined through case examples of advocacy projects designed and carried out by residents from six pediatric programs funded by The Anne E. Dyson Community Pediatrics Training Initiative. Sample projects will include advocacy at the individual, local community, and state and national government levels, and will focus on projects that take an idea and create a plan of action after a thorough assessment of the perceived problem and the target community. These cases highlight the importance of community partnership and evaluation. Through this process, participants will gain a broadened understanding of the pediatrician’s role as advocate and skills that serve this role.

J. Pletcher, A. Amzel, S. Cohen, C. Derauf, J. Goepp, P. Hametz, K. Hendricks, W. Kessel, F. LeFlore, D. Schwarz, J. Skelton, H. Taras, and K. Zieselman, The Anne E. Dyson Community Pediatrics Training Initiative Advocacy Group

The Brief Structured Observation (BSO) method can be an effective way to observe, assess and help learners. It allows for structured observation and specific feedback in inpatient and outpatient settings. It is efficient, fast and patient friendly. The technique applies principles of adult learning, since we collect information that is learner-centered and provide immediate, specific feedback to the learner.

In the ‘BSO,’ a faculty member or senior resident watches a trainee (student or intern) perform a short segment of a patient encounter. During this encounter the preceptor writes verbatim the questions or statements of the student. Following the segment the preceptor debriefs the learner and uses the recorded script to provide specific feedback on the encounter.

In an interactive format, workshop participants will practice the technique by observing live medical students and simulated patients. We will also model the BSO method by giving participants feedback on their skills. We will also discuss our experience using the BSO in different settings (inpatient and outpatient) and at different institutions. This educational program won the American Academy of Pediatrics Educational Project Award for 2000.

K. Pituch, J. Fliegel, K. Layton, T. Murphy, University of Michigan Medical School, Ann Arbor, MI, S. Miller, Columbia University College of Physicians and Surgeons, New York NY, M. Gusic, Penn State University College of Medicine, M. Harris, Indiana University

In the current climate of funding opportunities, the ability to successfully obtain extramural support involves applying for grants that are appropriate for an investigator's career stage and drafting a clear and focused application. In this session, we will discuss career-stage-appropriate funding opportunities from the NIH and other agencies. We will also address how to write a grant application, focusing on strategies with proven success. The working of NIH study sections will be reviewed along with how to best address the concerns of review panels. We will also focus on how to obtain funding for fellowship postdoctoral training and early stages of an academic career.

This seminar will be a provocative interactive session on Bioethics. Through the use of cases and excerpts from literary works, participants will be encouraged to view decision-making from the perspective of parents and health care providers. The Principles of Bioethics will be presented, as well as the contextual considerations that force us all to wrestle with principles and theory, if we choose to do so. The goal is to raise the consciousness about the range of issues involved in making the best decision for the pediatric patient. In the end, choices must be made, and all those involved must live with these choices.

Clinician educators are those physicians whose career activities combine patient care and the teaching and supervision of medical students and residents, and whose scholarly activities promote excellence in medical education.

With this workshop, it is expected that participants will:

1. have a better understanding of the motivations, career plans and works responsibilities of clinician-educators and will be able to compare the motives for their careers with those of other clinician-educators.

2. learn how a mentoring program can help the clinician-educator plan and develop his/her career.

3. have a better understanding of specific faculty development activities (workshops, microteaching, teaching evaluations, teaching consultations) and the evidence for the effectiveness of these activities.

4. have a better understanding of the evaluation of teachers, and how these evaluations are used for faculty development, promotion and compensation, and will learn guidelines for developing an effective Teaching Dossier, which can be the key to successful promotion.

With increased pressures to treat patients as efficiently as possible, teaching of medical students and residents has become more of a burden or even an afterthought and less of a major priority in the clinical setting. Effective, efficient, and innovative teaching strategies are needed. This seminar will provide participants with such strategies that will in turn aid in the recruitment, faculty development, and retention of preceptors. Mock teaching codes, videotapes, and other live demonstrations will be used to highlight the techniques and innovations to be introduced. Content areas will focus on the importance of a good orientation, feedback, evaluation, and creative teaching techniques that will make teaching fun and a true learning experience for all involved.

Career and program development in Pediatric Departments is increasingly tied to the generation of resources that support these efforts as well as cost-containment efforts. This seminar will address the application of business principles and approaches that should be useful to current directors of programs, or those who aspire to be directors, as they plan and manage these programs. Concepts to be introduced in a case discussion format include cost analyses, longitudinal budgeting, mission-based budgeting, business plan development and productivity analysis and enhancement.

The seminar leaders will review the probable career paths of clinical and basic research faculty. The session will begin with a detailed description of important considerations for young faculty when choosing their first position after residency/fellowship. The various promotion tracks and sampling of a number of institutions around the country will provide concrete examples. Time management, special funding opportunities for minority faculty, innovative funding sources, mentoring and career development will be featured. Local and national support networks for a faculty will be discussed. The integration of the issues of race and medicine will be highlighted.

The goals of this workshop will be to develop effective techniques to "balance" our lives. Participants will define individual success and set personal goals and develop innovative techniques to achieve them. Through round table and small group discussions, individual exercises and role-plays, participants will explore successful approaches to working with a reduced FTE ("part-time"), developing an educator’s portfolio, tackling the promotion and tenure process, and negotiating with supervisors. Breakout session on individual topics will allow participants ample time to share experiences and to problem solve. Participants will receive relevant handout materials including information from a literature review. Creative ways to achieve success and maintain balance in life will be presented, discussed and practiced.

Back by popular demand, this seminar uses multiple real examples from the pediatric literature to teach participants how to be more discriminating consumers of statistics. Topics to be covered include standard deviation vs. standard error of the mean, commonly violated assumptions of statistical tests, including normality and independent sampling, between- vs. within-groups comparisons, "type 3" (dumb or careless) errors, odds ratios versus risk ratios, relative versus absolute effect sizes, and multiple comparisons. In the last part of the seminar, participants will have the opportunity to test what they’ve learned on a set of "unknown" examples.

This seminar is intended to help pediatric fellows and young junior faculty with challenges they face at each stage of their training including: how to identify worthwhile research projects, how to apportion time between research and course work, how to choose and work with a mentor, how to complete projects during one's fellowship, when and how to write grants, how to get and negotiate a job, how to balance career and family, and how to transition to life as a junior faculty member. This workshop will be of particular interest to current pediatric fellows of any year, but it will also provide useful insights for those who recently completed or are considering a fellowship. The facilitators will include faculty at all stages of their career and will include both clinician scientists and clinician educators. There will be ample time for open discussion and question and answer.

The process of interviewing and negotiating for a faculty position is a common experience of most fellows, and many residents and junior faculty. There is little, if any, training in this process. This seminar will 1) identify key concepts of the interviewing and negotiation process, 2) increase the awareness of residents, fellows and junior faculty of these concepts when applying for positions in academic medicine, and 3) develop skills in utilizing them. These concepts include preparation for, and elements of, the first and subsequent interviews, stages and styles of the negotiation process, and core issues such as compensation, office space, research resources, promotion guidelines and family considerations. Brief didactic presentations and case-directed discussions will highlight these concepts. Participants will have the opportunity to apply concepts learned to simulated interview situations.

Through this interactive session, the participants will 1) identify the factors that influence the mentor/mentee relationship and strategies to aid the junior faculty member in choosing a mentor, and 2) identify the needs of junior faculty in launching an academic career and the potential strategies of a mentor in meeting these needs. The workshop leaders, Dr. Carraccio and Dr. Englander, who function in a mentor/mentee relationship in their own academic careers will add their perspectives regarding these roles to the group discussion. Our hope is that participants will leave with an understanding of how to create and foster the mentor/mentee relationship.

This session will provide participants with the necessary background for developing and conducting successful multi-site collaborative research projects in inpatient and outpatient settings. The co-leaders, who have overseen numerous diverse multi-site observational studies and clinical trials, will begin the session with a focused presentation outlining the rationale for multi-site collaborations, the principles of successful collaboration, and the potential pitfalls of this type of research, answering questions about these issues. Subsequently, they will lead the participants in a step-by-step exercise of planning, developing and implementing one inpatient and one outpatient study suggested by the audience.

Academic medical centers have hired an increasing number of clinician-educators to deliver clinical care and teach. Although these physicians contribute greatly to the mission of the institution, many clinician-educators have difficulty advancing in academic rank because of inadequate scholarly activity. In this workshop, clinician-educators will learn an expanded definition of scholarship and strategies for increasing scholarly productivity within the constraints of their current position.

After a literature review on the expanded definition of scholarship and on promotion criteria for clinician-educators, in facilitated small groups the participants will define clinical, educational, and administrative duties that are part of their current positions. A panel presentation will continue with information about strategies and resources for individual faculty development and methodologies for documentation of activities (professional activity dossiers and educational portfolios). In facilitated small groups, case studies of typical clinician-educators will be discussed with development of strategies for academic success. Each participant will then develop a strategy to convert one work duty element into scholarly work. In a summary session, examples will be shared. Participants will receive detailed session notes and a bibliography.

D. Newton, Brody School of Medicine at East Carolina University, Greenville, NC, M. Grayson, New York Medical College, Valhalla, NY, and W. Anderson, Michigan State University, East Lansing, MI

The new Dean of the medical school agrees with a recent newspaper editorial that today’s doctors are scientifically competent but seem to lack compassion. He is committed to what his great grandfather, Francis Peabody, said over 70 years ago, "One of the essential qualities of a clinician is interest in humanity, for the secret of good patient care lies in caring for the patient." The Dean wants medical students to become more caring, compassionate, empathic, respectful and humanistic not just to patients and families, but to staff, faculty and each other as well.

This interactive workshop will explore specific ways to promote humanism in medicine by addressing the mandate of the new Dean. Humanism will be operationally defined through brainstorming guided by definitions of humanism from a variety of different sources. Analysis of videotape vignettes and paper cases will reveal ways to promote humanism on an individual level through educational programs and on a departmental level. An action plan will be developed by each workshop participant to promote humanism in his/her own setting.

S. Z. Miller, R. T. Sarkin and F. B. Stapleton, Departments of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, and University of Washington School of Medicine, Seattle, WA

Most faculty in academic health centers are hired because of their clinical or research prowess. Yet, these physicians, many with little training, are expected to spend a considerable portion of their time teaching medical students. Little time has been devoted to identifying and providing feedback to physicians who are not good teachers, the "problem-teachers." Identifying and either rewarding or remediating those teachers with excellent or deficient skills is imperative. This workshop will explore the scope of the problem, different faculty evaluation tools, types of "problem teachers", and appropriate reward and remediation systems. Trigger tapes, currently used evaluation tools and role play will be used to identify issues such as the strengths and weaknesses of faculty evaluation tools and reward systems and promote interactive discussion. Participants will break into teams to design and test evaluation tools during the workshop. By the conclusion of the workshop, the participant should be able to design appropriate faculty evaluation tools, identify teaching deficiencies, provide effective feedback to faculty members, and design systems to improve faculty performance.

W. Raszka and L. First, Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT

This seminar will focus on the unique issues related to the challenges of women in academic medicine. The first topic will be the various tracks within the academic community, and the expectations related to promotion within these tracks. The second topic to be discussed will be maintaining a balance between professional and personal life, and the presentation will include a discussion of the pros and cons, and ups and downs of part-time employment. The last issue to be discussed will be negotiation skills for women in academia. Problematic scenarios will be presented and strategies for solutions will be proposed.

We shall review present issues concerning the availability of research funds to institutions and the strategies that pediatric institutions might adopt to enhance an extramural research funding stream. Thoughts as to how pediatric institutions develop intramural resources will also be presented.

We shall also present suggestions concerning the structure and funding of pediatric institutions to oversee, administer, and support intramural and extramural funding for the researcher. Strategies as to how a researcher can assist in the development and administration of institutional research support and utilize these resources will also be presented.

The core of the academic meeting is the dissemination of new information through abstracts. This session will provide the young investigator with an approach to the preparation and presentation of abstracts. Innovative science requires crafting an innovative abstract to ensure program selection. Points concerning abstract presentation to enhance acceptance and the dos and don'ts of platform and poster presentations will be presented in depth.

This session will delineate the patterns of academic clinical practice. Co-led by a general pediatrician and pediatric subspecialist, the session will address the following topics.

1. How do I decide if I want to pursue a career in academic medicine or in community practice?
2. Are there models of practice that allow me to combine academic medicine and community practice?
3. How do I decide if I want to become a general pediatrician or want to subspecialize?
4. What are the requirements for a career in general academic pediatrics? What for subspecialists?
5. How and when do I apply for fellowships?
6. Who in my institution can help me with these career decisions?

Randomized controlled trials are the gold standard for determining which treatments are superior. More and more, clinicians of all specialties are demanding that randomized trials show new treatments, such as surfactant and ECMO, to be superior to current therapy (or no therapy) before the new treatments are adopted.

This workshop will cover principles of clinical trials including defining the question, assessing outcomes, defining the study and control treatments, single- versus multi-center trials, reasons for and methods of randomization, eligibility and exclusions, blinding, analysis strategies, and early stopping. The format will be didactic with extensive open discussion. Real world examples of "what can happen if you don't watch out" will be utilized. Participants are encouraged, although not required, to bring an idea for a possible clinical trial. We will use these ideas as examples during the discussion. Statistical knowledge is definitely not required.

Presenting scientific information clearly is an essential part of a successful scientific career. Colleagues will infer your scientific ability from the clarity and quality of your oral presentations. Presentation skills can be learned and improved. In this seminar, we will discuss the following topics:

- Organizing your presentation
- Choosing audio-visual aids
- Making effective slides
- Presenting data
- Handling questions
- Practical hints

In this interactive session, a junior faculty member along with her chairman will facilitate an active dialog from what core questions should be asked during the interview to how to maximize your chances for promotion. Many issues will be directly addressed, including: interviewing questions to ask and answers to have at the ready, salary negotiations, percent effort distribution, departmental commitment and support, faculty development programs, and identification of mentors.

This workshop will address multiple aspects of publication in scientific journals. Presenters will discuss preparation of materials, including the initial decision that the data are sufficient to justify publication. Issues related to manuscript writing will include length, focus, adherence to journal formats, and referencing. The editorial process, from submission to publication will be described in depth, with particular attention to ways in which authors can interact with journal editors. Another section of the workshop will cover ethical issues in publication including review boards, authorship, duplicate publication, intellectual property rights, and conflict of interest. There will be open discussion of sample cases and questions derived form the experiences of the participants.

The aims of this session are to discuss 1) preparation of a scientific manuscript for submission; 2) the peer review process; and 3) means for responding to criticism. We will consider strategies in composing the manuscript and presenting data in written, tabular and graphic form, and will compare styles and formats. We will review common flaws that interfere with understanding or acceptance of the paper. We will discuss how a manuscript is processed during the review and rebuttal. And, we will consider the responsibilities of authors, reviewers and editors in the overall process. The participants will be encouraged to discuss the materials as they are presented and engage actively in the seminar.

This workshop is aimed at the M.D. junior faculty member (or fellow) in a department of pediatrics. The goals of the workshop will be to: (1) Review career paths in academic medicine, focusing on career decisions that are key to developing an independent research program; (2) Choosing a research project (asking a good question); (3) Carrying out a research project during the earliest stages of one’s career (taking advantage of opportunities and surmounting obstacles); (4) Moving beyond a "research project" to development of a research program. In anticipation of the workshop, participants are encouraged to reflect on the career choices and research decisions they have already made, and to come prepared to participate in an open discussion about these choices.

This workshop will discuss the multiple paths to academic leadership. There will be three distinct perspectives presented: (1) leadership at an institutional level—climbing the academic ladder; (2) leadership at an organizational level—opportunities to become involved with national organizations such as the American Academy of Pediatrics, the Ambulatory Pediatric Association, American Pediatric Society; and (3) networking: differences in gender styles and opportunities. There will be a panel discussion following individual presentations and an opportunity for workshop participants to discuss their personal experiences.

The publication and dissemination of new knowledge has long been the gold standard of academic pediatrics. However, inertia remains a substantial barrier to successful publications and presentations for many faculty. A well-organized and systematic approach to the presentation of scientific data can substantially reduce the impediments to success and lead to high-quality and well-received efforts. This seminar will take a practical and focused approach to the conceptualization, derivation and presentation of scientific material to be presented as a manuscript, abstract or oral presentation. Group discussions, critique and analysis will be an inherent component of this seminar.

As healthcare organizations become more complex, "boundary-spanning" leadership roles are critical. Organizations are looking for physician leaders who can perform clinical (quality of care, performance improvement, safety) and administrative (planning, budgeting, business development) tasks. The goal is to equip these academic/clinical /research leaders with the knowledge and skills to enable them to confidently and competently move their organizations forward.

Over 2,000 management books are published each year. The essential content ultimately can be distilled into four key categories: (1) creating the vision—what you and your organization aspire to be; (2) teamwork and change—transforming the organization to enact that vision; (3) earning the right to grow by strengthening current financial performance, hiring and retaining good people, and managing your core business effectively; and (4) growth strategies—enacting the business plan and making the hard decisions.

Teaching is something we do daily. Learning, however, depends on the effectiveness of our teaching. Active learning is far superior to passive learning and is related to teaching interactively. The purpose of the seminar is to facilitate learning successful interactive techniques for planned or spontaneous lectures to large groups, small groups activities and one-on-one encounters. Both formative and summative evaluations are also essential, and the distinctions and formats for these will be discussed and demonstrated. The seminar will consist of short presentations, demonstrations, group discussions, participatory exercises and self and group assessments.

Participants in this seminar will receive information on how the NIH receives, assigns, reviews and funds applications for support of various types of research, training and career development. The variety of support mechanisms available at different career stages will be described, along with areas of special current research interest to the National Institute of Child Health and Human Development.

Observational research studies have become increasingly complex both in design and analysis. The results of observational research studies can be driven by properties other than chance or direct causation. These factors not only drive the p values of the results, they also change the appropriate interpretation.

In the first half of this workshop, we will formally define confounding, effect modification, intermediate variables, internal vs external generalizability, selection bias, and differential/nondifferential information bias. In the second half, we will use a case-based approach to illustrate examples of studies in which results are driven by these factors and compare differences in the appropriate interpretation in their presence and absence. Participants will be invited to interpret a given study and its data analysis then encouraged to consider factors presented in the first half of the workshop. Time permitting, we will specifically illustrate examples of effect modification vs confounding, intermediate variables vs confounding, selection bias in case control studies vs cohort studies, restriction vs selection bias, power in negative studies, analysis of infectious disease clusters, and the role of measurement error in determining effect estimates. While an understanding of basic study design (i.e., case control vs cohort) will be necessary, minimal math skills will be needed.

R. O. Wright, D. K. Shay, Department of Pediatrics, Brown Medical School, Providence, RI and Centers for Disease Control, Atlanta GA

The effects of parental smoking on children’s health are well known, yet pediatricians are often hesitant to actively assist parents to quit smoking. Recent research has identified methods and windows of opportunity that can be most effectively utilized by pediatricians. Brief interventions in the context of pediatric primary care have been shown to produce parental quit rates of 5–8%. Pediatricians cite lack of confidence in their ability to advise parents about how to stop, lack of true physician–patient relationship with the parent, concern that parents will receive the suggestions negatively, and lack of time as reasons to not intervene with parents who smoke.

Didactic content of this workshop includes the biology of nicotine addiction and withdrawal, behavioral and pharmacological treatment for nicotine addiction, and the AHRQ Clinical Practice Guidelines for Smoking Cessation. Effective strategies for implementing the AHRQ guidelines in pediatric offices will be discussed. There will be an opportunity to role-play smoking cessation interventions for parents. The faculty will share examples of practical office systems changes based on their experience in training pediatricians and staff to address parental tobacco use.

J. Groner, G. French, D. Moss, T. Syed, Departments of Pediatrics, The Ohio State University, Columbus, OH and University of Pittsburgh, Pittsburgh, PA

The development of measurement tools that obtain the perspectives of children and parents about child health is the most concrete example of the recent progress of pediatric outcomes research. Although several generic and disease-specific health status tools for children and adolescents are now available for use in clinical and outcomes research, it is not always obvious which measurement tool to use in a given research project. Moreover, there are important methodologic considerations inherent in obtaining children’s and adolescents’ self-reports on their health.

The purpose of this workshop is to provide participants with the knowledge and skills needed to select and use health status instruments in child health research. The workshop leaders will present a framework for choosing the right health status instrument for a specific application. Topics covered will include: conceptual models; psychometric issues unique to obtaining child and teen self-reports; measurement reliability and validity; sensitivity to developmental differences and changes in health; child vs parent proxy response; instrument scoring; and, an approach for defining measurement requirements. This framework will be used during a hands-on, interactive session during which participants will review and evaluate a variety of actual disease-specific and generic health status instruments.

C. B. Forrest and A. Riley, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Fellowship programs in Academic General Pediatrics and other related disciplines are educating the future leaders in child health research. Educational experiences in research, as well as resources for research education, are variable in these fellowship programs. In order to support fellowship programs in their research education activities, this workshop will convene fellowship directors, child health researchers, and pediatric educators with the following objectives: (1) Review the present state of knowledge of fellowship curricula and their evaluation: (2) Review existing models of fellowship research curricula, including structure (coursework, research experiences, mentorship opportunities), content, and evaluation; (3) Discuss the spectrum of fellowship research education, from minimum recommendations for all fellowship programs to centers of excellence; (4) Develop a "working" outline of a fellowship research curriculum; (5) Institute and organize working groups to take the products of this workshop and develop a proposed curriculum during the next year; (6) Consider the role of APA and sister organizations in fellowship research training, including disseminating fellowship research curricular guidelines, evaluating outcomes, and sponsoring research mini-courses to supplement research education within the fellowship programs. We welcome the involvement of pediatric educators skilled in curricular development and evaluation both before and during the workshop.

B. P. Dreyer and D. J. Schonfeld, New York University, New York, NY, and Yale University, New Haven, CT (for the Research Committee)

Numerous studies document systematic developmental stages and cultural differences in how children and adults understand physical and psychological conditions. These developmental and cultural differences are related to families’ health seeking behaviors and coping strategies. They are important to the recognition of symptoms, the understanding of diagnoses, and compliance with appropriate treatments.

In this interactive workshop, a panel of investigators will briefly present research findings from developmental psychology and pediatrics and medical anthropology that inform clinical work with children and adults across ages and cultural contexts. The panel will include, in addition to ourselves, David Schonfeld, Lee Pachter and Pradeep Gidwani whose research addresses AIDS, cancer, asthma and ADHD among other conditions. Videotaped interviews and role-plays will highlight key concepts and guide a discussion of methods to improve communications with families by integrating this body of research into clinical interactions. Break-out groups, led by each member of panel, will follow to discuss the clinical implications of this research and to develop ideas for future research.

J. M. McMenamy, E. C. Perrin, Center for Children with Special Needs, Department of Pediatrics, Tufts University/New England Medical Center, Boston, MA

This workshop is designed for Pediatric Faculty to explore the usefulness of Resident portfolios. Learning portfolios keep in step with two increasingly prominent trends in medical education: fostering self-directed learning and evaluating competencies. We will demonstrate ways our programs are using portfolios: for a PL1 Health & Development curriculum, a PL2 Behavioral-Developmental rotation, a Neonatal Intensive care rotation and a Medical Informatics rotation. Participants using this methodology are invited to bring samples of their own institution's efforts.

Objectives for participants include:

1. Identifying facets of this methodology that promote learning
2. Identifying potential difficulties with implementation of use of portfolios
3. Identifying aspects of residency education for which portfolios might or might not be useful
4. Identifying how use of portfolios might help faculty better evaluate competencies as outlined by the ACGME—especially for the constructs of Medical Knowledge, Practice-based Learning and Improvement, System-based Practice and Professionalism (i.e., those areas which are often more difficult to assess than Patient Care)

Components of the portfolios which will be discussed include: purposes, design of Learning Tasks, evaluation methods, strategies for obtaining resident and faculty participation. Participants will then have an opportunity to identify for their own program an area in which they might trial the use of portfolios. They will have time in this workshop to develop initial steps that can then be further developed on return to their home institution. We anticipate this being a very "working" workshop, with participants creating a product that can be readily adapted for implementation.

V. N. Niebuhr, P. S. Beach, S. Keeney, A. Spooner. Dept. of Pediatrics, Univ. of Texas Medical Branch, Galveston, TX, and Dept. of Pediatrics, Univ. of Tennessee at Memphis, Memphis, TN

Each year there are thousands of injuries and deaths in U.S. hospitals from medication errors. These blunders cost millions of dollars and result in loss of public confidence in our health care system. Medication errors are the second most frequent and the second most expensive event causing liability claims. Errant orders on the inpatient unit and incorrect prescriptions in the ED and clinics are common. Physicians, nurses, pharmacists, students, manufacturers and even caregivers all share responsibility. Many errors are preventable.

This workshop will focus on common sources of medical errors and ways to prevent them. Workshop leaders will discuss specific issues including:

• Root cause analysis looking at systems issues rather than individuals
• Moving toward non-punitive approaches to reporting errors
• Developing teaching programs for housestaff and students
• The role of the pharmacist—how can they help?
• New technology—are computer systems useful? Are the programs affordable?
• Creating multidisciplinary medication use process improvement teams
• Approaching the family after a medical error—legal and ethical implications

Participants will be asked to share their ideas and experiences. It is hoped that participants will be able to develop a multidisciplinary program in their own institutions to reduce and manage medical errors.

S. Selbst, S. Levine, A.I. duPont Hospital for Children, * Wilmington, DE, and J. Fein, J. Gould, M. Friedman, C. Mull, Children’s Hospital of Philadelphia, Philadelphia, PA

People often stereotype ethics as about end-of-life or as requiring an ethics committee. But everyday pediatric practice is rich with issues for teaching ethics.

This workshop will focus on identifying the ethical issues that surround pediatricians' in their routine practice and how to teach ethics from these examples. Participants will enhance their skills in ethical analysis, using the "Tools of the Trade" assembled by Dr. Burck, an ethicist at RPSLMC. The workshop will model the constructivist interactive case-based process that has been used at RPSLMC to develop the ethics noon conference curriculum. For each topic, the workshop will begin with a warm-up exercise, then small group discussion of cases, large group review of reports from small groups and closing summary of key ethics concepts and skills used. The group will go through this process multiple times in order to deepen the conceptualization and educational approach each time. Workshop participants will be able to take home the cases that have been used at RPSLMC and a summary of the "Tools of the Trade."

At workshop end, participants should more confidently identify ethical issues in daily practice, teach from them, and generalize to difficult issues, like end-of-life.

C. Gaebler and R. Burck, Department of Pediatrics and Program in Ethics, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL

As part of a national effort funded by the APA and MCHB, a set of "teaching modules" on topics related to underserved populations was created with the help of a national advisory board. Each module is centered on a case and includes a "tutor guide", audiovisual and other materials. The goal of this workshop is to provide faculty with the tools to effectively teach residents about underserved populations. Participants will also learn more about case-based teaching by observing and participating in demonstrations of these tools.

The workshop will consist of three parts: (1) A brief presentation on the development of the teaching materials, followed by an interactive discussion of case-based teaching methods. (2) A breakout session where each group will participate in a mock clinic conference. Each facilitator will model the use of a different case. (3) The entire group will reconvene for a discussion of the barriers to using this curriculum at individual institutions and strategies for overcoming those barriers. Methods for improving the curriculum and updating material will be actively solicited.

Copies of all 8 completed modules (12 more are currently in production) will be distributed. Participants are invited to contribute to the ongoing research on the materials effectiveness. These cases will also be available through the web for distribution at www.servingtheunderserved.org.

R. C. Samuels, D. M. Keller, W. Risko, W. G. Bithoney, Children’s Hospital, Boston, MA, University of Massachusetts Medical School, Worchester MA, and St. Joseph’s Children's Hospital, Patterson, NJ

Release of the Institute of Medicine Report (1999) has increased public awareness of the existence of errors in the practice of medicine. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued a directive that medical errors be disclosed to patients and families. Healthcare organizations need strategies to ensure compliance, yet many questions remain: What represents a disclosable medical error? Is there a means of reaching consensus among professionals and how does one share with families in the most constructive ways possible?

This workshop will focus on a program developed at Vanderbilt designed to help medical groups reach consensus concerning what represents an error and understand existing literature concerning the consequences of disclosure. Using a case-based approach participants will be afforded an opportunity to share such sensitive information through role-play and "audience lifeline" techniques. The program will emphasize that there is no single correct approach given the complexity of medicine and differences in families and physicians. Participants will be encouraged to use a "balance beam approach" in which physicians (pediatricians) consider all possible disclosure strategies ranging from limited to full disclosure with assignment of responsibility and the relative advantages and disadvantages of each approach. Participants should be better equipped to share highly sensitive information with families and adapt course concepts into their own institutions.

G. B. Hickson, J. W. Pichert, J. Gigante, Vanderbilt Children’s Hospital, Nashville, TN

The paradigm shift to competency-based medical education warrants a close examination of methods of evaluation of clinical competence. Through this workshop we propose to: 1) demonstrate a number of tools available for evaluation of medical students and residents and 2) discuss which tools are most appropriate for evaluation of specific competencies. Finally, we hope to create an evaluation portfolio for a virtual resident in a competency-based training program.

There will be a brief introduction to a variety of possible assessment tools, such as the Brief Structured Observation, the OSCE, 3600 evaluations, and standardized histories and physicals. Participants will then be assigned to one of six small groups, each group representing one of the six ACGME Outcomes Project competencies. Each group will be asked to identify those tools most appropriate for evaluation of a number of knowledge, skill and attitude benchmarks/performance indicators within each competency. Based on feedback from the groups, we will then create a competency-based evaluation portfolio for a virtual resident.

C. Carraccio and R. Englander, University of Maryland, Baltimore, MD

At teaching hospitals residents universally serve as teachers and are essential to the education of medical students and interns; however, residents and faculty are often not assisted in developing teaching skills. Two challenges exist: to develop residents as teachers and to develop effective teaching programs to teach them how to teach.

This interactive, hands-on workshop will provide the participants with the opportunity to analyze three Resident as Teacher programs that represent different approaches to program development and teaching. Workshop facilitators will use interactive teaching methods, small and large group formats, and audience participation to analyze how to design effective resident teaching programs. In analyzing three different approaches we will address curricular development, implementation and evaluation.

Written materials will be provided that participants can use in their own residency programs.

E. A. Rider, Dept of Pediatrics, Harvard Medical School, Boston, MA, R. T. Sarkin, Dept of Pediatrics, SUNY at Buffalo School of Medicine, Buffalo, NY, K. Pituch, Dept of Pediatrics, Univ. of Michigan School of Medicine, Ann Arbor, MI, and J. P. Hafler, Dept of Pediatrics, Harvard Medical School, Boston, MA

The Pediatric RRC now requires that residents be prepared "for the role of advocate for the health of children within the community." Programs have addressed this requirement through community block rotations, longitudinal experiences, lectures, workshops and service-learning experiences. A common problem, voiced in the APA Advocacy Training SIG meetings, is lack of preceptors to teach and model child advocacy within their programs to reinforce the message that child advocacy is part of good pediatric practice.

This workshop will allow participants to learn how to promote the teaching of child advocacy by academic and community preceptors in pediatric residency. Participants will: 1) participate in an interactive discussion of child advocacy to develop a working definition that fits their clinical setting, 2) identify faculty at their institutions who could serve as models and mentors for advocacy training, 3) discuss training methods used at our institutions (scavenger hunt/ photo essay, community connections and case-based advocacy projects) to promote teaching and learning about community involvement and child advocacy and 4) work in small groups to adapt these methods to each participant’s home institutions and present the results to the workshop. The participants will be enrolled in a post-workshop LISTSERVE to share experiences over the ensuing year.

D. M. Keller, J. A. Andrake, S. Starr and E. Schulte, UMass Medical School, Worcester, MA, SUNY Upstate Medical University, Syracuse, NY, and Albany Medical College, Albany, NY

In education, research is often focused on the determination of progress that students have made toward educational goals. These studies use methodologies that not only determine outcomes but also analyze the process with which these outcomes are derived. Researchers in medical education are often faced with the difficulty of defending their methodologies to "peer-reviewers" who are accustomed to quantitative analysis of traditional scientific papers.

The methodologies in educational research may be classified into two broad categories: quantitative and qualitative studies. For medical education research, quantitative studies focus on the outcomes of the study while qualitative studies explore the process. Both types of research are necessary and should be selected based on the research question. In addition, the view of scholarship in medical education not only encompasses the methodologies, but also the rigor with which these methodologies are applied to the program design.

This workshop will address the use of varying methodologies in medical education research by reviewing the evaluation methods for several innovative curricular programs. By comparing and contrasting the methodologies employed in each of the studies, participants will be able to appreciate the uses of quantitative and qualitative designs in medical education, generate research questions and formulate a research design for their own programs.

Kuo, G. S. Blaschke, B. S. Siegel, W. Risko, and J. P. Hafler, UCLA Medical Center, Los Angeles, CA, Naval Medical Center, San Diego, CA, Boston Medical Center, Boston, MA, Children’s Hospital, Boston, MA, and Harvard Medical School, Boston, MA

Handheld computers are rapidly evolving into an indispensable tool for the clinician. Though handheld computers have been limited in the past to scheduling, to-do lists, brief notes, and phone lists, progressive application development is providing reference tools, medical calculators, charge capture programs, electronic prescription writing software, procedure logs, web browsers, EMR integration, research databases, evidence-based medicine tools, and multimedia applications permitting access to telemedicine.

The purpose of our workshop is to provide participants with hands-on experience employing a variety of software applications on the most common handheld computers. To demonstrate the utility of applications, clinical cases will be employed. Participants will be led through the cases step-by-step so that firsthand experience in handheld computers will be acquired. A brief discussion period will follow each case to elaborate on the extended utility of presented applications, as well as other commercially available programs. In addition, guidelines will be introduced for evaluating future software and technologies, as they become available. Participants will receive a resource list to facilitate ongoing education in the growing field of handheld computing. No prior knowledge in the use of handheld computers is required.

T. L. Courtney, Children¹s Hospital of The King¹s Daughters and Eastern Virginia Medical School, Norfolk, VA, K. Johnson, Johns Hopkins University, Baltimore, MD, and A. Meyers, Boston Medical Center, Boston, MA

Clinical pediatricians are often interested in a number of potential research topics but have difficulty translating their ideas into coherent research projects. This workshop is designed to provide clinically oriented pediatricians with the basic epidemiologic and analytic tools needed to plan, design, and begin to analyze a clinical research project.

The primary activity of this workshop will be working through an exercise developed by the workshop leaders. The exercise will open with a proposed research topic. The workshop attendees and leaders will work through the exercise together to develop a research strategy that includes the development of an appropriate research hypothesis, the selection of proper outcome measures and the type of data that should be collected. The exercise will then work through a preliminary organization and analysis of data provided in the exercise. Brief didactic interludes will be woven into the workshop exercise and will focus on commonly used, and often misunderstood, statistical tools such as relative risks, odds ratios, confidence intervals and p-values. A personal computer will be used to demonstrate the use of those techniques with the data included in the exercise.

K. C. Schoendorf and W. G. Adams. National Center for Health Statistics, CDC, Hyattsville, MD, and Department of Pediatrics, Boston Medical Center, Boston, MA

This faculty workshop will help participants develop tools for the implementation of competency-based assessment in the continuity setting using the ILP as an approach to monitoring resident performance. We will review the six professional competencies determined by the ABMS and ACGME: patient care, professionalism, interpersonal and communication skills, medical knowledge, practice-based learning and improvement and systems-based practice. A draft of the pediatric RRC specialty-specific components, timeline for implementation and suggested assessment tools will also be discussed.

Attendees will break into subgroups to focus on one of three competencies particularly suited to being taught in the continuity setting: 1) professionalism; 2) interpersonal and communication skills; and 3) practice-based learning and improvement. Each subgroup collaboratively will develop an ILP for resident assessment at the outset of residency and for monitoring progress throughout training (e.g., to assess effectiveness in specific interpersonal skills and communication, programs may elect to include data in the ILP from patient/parent satisfaction surveys obtained at regularly, scheduled intervals). Subgroups will present their ILP templates for group discussion. A summary from the three subgroups will be mailed after the meeting to all participants for their use.

W. Davis, P. Algranati, R. Collins, J. Drutz, M. Dumont-Driscoll, S. Feigelman, D. Kittredge, J. Olsson, S. Riesen, and J. Serwint, APA Continuity SIG Task Force

The United States is experiencing an epidemic of pediatric obesity. However, many primary care providers report that obesity is one of the most frustrating and difficult problems in their practices. In this workshop, we will provide practical strategies for evaluating and treating obese children in primary care. To maximize learning and relevance the session will be split. Approximately one-third of the session will focus on expert committee recommendations for evaluation and behavioral treatment strategies. We will address skills for identification of obesity, screening for both rare endogenous causes of obesity and more common obesity-associated conditions or risk factors, assessment of emotional and psychosocial states, eating and activity assessment, and indications for consultation with an obesity specialist. For treatment, we will address the most successful strategies for diet and physical activity counseling, changing the household environment, self-monitoring, goal setting and contracting, parenting skills training, maintenance and relapse prevention, and the potential role of drug therapies. The other two-thirds of the session will consist of case discussions and group problem solving. Cases will address practical evaluation and management challenges facing primary care providers.

T. N. Robinson and S. E. Barlow, Dept. of Pediatrics, Stanford University, Palo Alto, CA, and Dept. of Pediatrics, St. Louis University School of Medicine, St. Louis, MO

The Cochrane Child Health Field facilitates the identification, organization, dissemination and utilization of up-to-date synthesized research evidence about effective care for children. The overall aim of child-focused systematic reviews of effectiveness should be to improve the quality of health care, and ultimately health outcomes for children. This is likely to be achieved only if relevant research findings are accessed, interpreted and appropriately incorporated into practice by health care providers.

The challenges of incorporating effective evidence-based practices into daily health care decisions are indeed large. Health care providers have access to a large volume of high quality research evidence and guidance about effectiveness, including electronic publications of systematic reviews in the Cochrane Library. What issues does the health care provider face when questioning whether evidence is applicable to a specific clinical question? What does a health care provider do when faced with results of systematic reviews that appear to report conflicting evidence?

Cochrane Child Health Field leaders will facilitate an interactive discussion with workshop participants to address the above questions, using the meta-analyses from the Cochrane library and paper-based journals as working examples. Attendees will learn how to deal with publication bias, quality of included RCTs, grey literature and RCTs published in languages other than English. Challenges with dealing with evidence from Complementary and Alternative Medicine will also be explored.

T. P. Klassen, Cochrane Child Health Field, Stollery Children’s Hospital, Professor and Chair, Department of Pediatrics, University of Alberta, Edmonton, Canada, Maureen O’Donnell, Women’s and Children’s Health Centre of British Columbia and Department of Pediatrics, University of British Columbia, Vancouver, Canada, Virginia Moyer, The University of Texas Medical School at Houston, Houston, TX, and R. Armstrong, Women’s and Children’s Health Centre of British Columbia and Department of Pediatrics, University of British Columbia, Vancouver, Canada

The United States rapidly is growing more culturally diverse. In several cities, whites already are in the minority. Culture has a profound impact on pediatrics, affecting multiple aspects of clinical care, including outcomes, processes, quality, satisfaction, obtaining an accurate history, and adherence. Cultural competency is the ability to recognize and appropriately respond to key cultural characteristics that affect clinical care in the major cultural groups seen in your practice. In this workshop, participants will learn about a model of cultural competency that can be applied to any cultural group that might be encountered by the pediatrician. This model is based on five aspects of culture that affect clinical care: 1) normative cultural values; 2) language issues; 3) folk illnesses; 4) parent beliefs; and 5) provider practices. The Latino and African-American cultures will be used to illustrate the most important ways that culture impacts pediatric care, drawing on the rich available literature and the personal experience of the workshop leaders.

Using an evidence-based approach derived from critical studies on Latino and African-American culture, workshop participants will learn and master the cultural competency model. Illustrative cases (including videotapes) will be presented to challenge participants and further solidify their skills. Participants can expect to acquire practical skills for recognizing and appropriately responding to crucial aspects of culture and language that affect pediatric care.

G. Flores and G. Askew, Department of Pediatrics, Boston Medical Center and Boston University Schools of Medicine & Public Health, Boston, MA

Adolescents who are gay or lesbian, or are questioning their sexual identity, may look to health care providers for assistance with both medical and psychosocial issues. Yet many practicing pediatricians are uncomfortable with their skills in caring for gay and lesbian adolescents. At the University of Massachusetts Medical School, we have developed a series of workshops for university and community clinicians that provide knowledge of health care needs of gay and lesbian youth and model supportive interviewing techniques. Methods include slide presentations, interactive discussion, videotapes of interviews with gay and lesbian youth and their parents, modeling of "live" interviews, and a "Teaching Kit" for helping faculty to teach students and residents about sexuality. Preceptor support for this curriculum has led us to pilot the workshop in community pediatric offices, training all office staff, including providers, social workers, managerial and clerical staff.

In this workshop participants will: 1) participate in an interactive demonstration of our general and office-based workshops; 2) discuss the barriers to teaching about sexuality in an office setting, and how to address them; and 3) develop a "Safe Office Kit" for their own practices that will allow them to train their own faculty and staff.

S. Sack, E. Ferrara, S. Starr, D. M. Keller, and E. Perrin, University of Massachusetts Medical School, Worcester, MA, and Tufts University School of Medicine, Boston, MA

Medical practitioners who work in acute care settings are likely to encounter forensic issues, such as child abuse, assault or unexpected death. However, few training programs prepare physicians to adequately manage these issues.

Objective: This workshop is designed to increase participant awareness of their pediatric patients’ forensic medical needs, and to review techniques for the acute evaluation of such patients.

Methods: Experts in the fields of Pediatric Emergency Medicine, Child Abuse and Neglect, Toxicology and Forensic Medicine will work directly with participants to teach them how to evaluate pediatric patients from a forensic perspective. Workshop participants will receive hands-on instruction in the following skills: the detection, collection and preservation of evidence, documentation of injuries (including medical photography), pattern injury recognition and interpretation of injuries, preparation for court testimony, and reporting requirements and regulations. During one of the segments, participants will rotate through stations where they will utilize these skills using state-of-the-art equipment. All registrants will also receive a comprehensive syllabus containing relevant information and recent references related to the practice of Clinical Forensic Medicine that is designed to be used as a teaching aid.

K. Bechtel, K. Santucci, L. Arnold, C. Baum J. Klig and M. D. Baker, Section of Pediatric Emergency Medicine, Yale-New Haven Children’s Hospital, New Haven, CT

Growing attention in medical literature has been dedicated to an increasingly multicultural patient population, to intersections between spirituality and medicine, and to the wide use of complementary and alternative therapies in the United States. Frequently, however, these three topics are presented as unrelated to one another. Yet in practice, they often represent intersecting fields of experience. This workshop will introduce a model that integrates the three topics and will present illustrative examples from different areas of the United States.

Workshop participants will next apply this model to their own family culture through a guided exercise. By learning to work with a conceptual framework in direct relation to their own experience, they will learn how an otherwise abstract model looks in practice. They will then engage in small group discussion of what they observed through the exercise. During the third section of the workshop, participants will engage in a role-play of history-taking. They will apply the model both as a family caretaker who has brought a child in for a consultation, and as the pediatrician. Each role-play will be followed by group discussion.

Through this workshop, participants will learn to utilize a conceptual model that integrates standard-of-care biomedical treatment, culture, spirituality, and CAM and will recognize the importance and rationale for adopting an integrative approach of this kind in pediatric practice. They will also learn tools with which to teach others this model.

L. Barnes and K. Fox, Department of Pediatrics, Boston Medical Center, Boston, MA

Domestic violence is an important public health problem in this country. The lack of domestic violence training in medical schools and residency programs hampers the ability of pediatricians to provide quality comprehensive health supervision. In order to address this problem, our multidisciplinary collaborative group on domestic violence planned and implemented a domestic violence educational program at the Children's Hospital of Pittsburgh. This program for residents and faculty was designed to increase awareness, improve knowledge, and hone skills in assessing and assisting families dealing with domestic violence. A pre- and post-intervention survey was used to assess change and pinpoint areas of further educational need. The goal of this workshop is to help others produce a similar educational program in their own academic or community setting. The workshop will involve a discussion of how the collaborative group evolved, how hospital interest was generated, and how the course was designed and implemented. Attendees will participate in the key portion of the educational program, a two-hour mini course, which includes video and didactic presentations and small group role-playing. Participants will have the opportunity to develop their own plan for creating a similar educational program in their own clinical settings.

R. Berger, S. C. Hamel, T. Syed, K. DeAntonis, J. Williams, B. Williams, D. Ploof, J. Syphan, Children's Hospital of Pittsburgh, Pittsburgh, PA

Pediatricians play a crucial role in identifying infants and toddlers who may have significant developmental needs. Recently, there has been a growing concern about possible increases in the numbers of children with an autism spectrum disorder (ASD). Early identification and intervention can significantly improve the long-term outcome for these children and their families. Unfortunately, although symptoms of the ASDs are generally present before 3 years of age, the average diagnosis is not made until 4.5 years of age. Given the unusual patterns of development shown by children with autism in communication, social, and behavioral skills, parents often report frustration associated with trying to identify the nature of their child’s needs and with accessing appropriate services. Pediatricians can provide helpful screening and diagnostic referral information. The aim of this workshop is to provide information about the early signs of children with an ASD, to identify screening instruments for the ASDs and to describe the referral process in case further assessment and intervention are warranted. Workshop activities will include presentation and discussion, video observation of children with and without ASDs and small group evaluations of clinical vignettes profiling a child in need of more detailed developmental assessment. The goal is to help pediatricians implement guidelines recently established for identifying children with an ASD by the American Academy of Pediatrics.

C. E. Rice, O. Y. Ousley*, and M. Yeargin-Allsopp, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention and *Emory University Department of Psychiatry, Atlanta, GA

Daily headlines flash new genetic discoveries revolutionizing the practice of medicine! What really has changed and what do we need to know? The goals of this workshop are to emphasize the relevancy of integrating genetics into every patient encounter, enthuse participants about the impact of rapidly exploding genetic knowledge/technology on patient care and physician responsibility and discuss the core genetic competencies our students need to acquire.

During this workshop participants will have the opportunity to review new advances in the field, including ethical, legal and social implications. All attendees will acquire the necessary tools and resources to enhance their comfort in teaching genetics through small sub-groups which will focus on stimulating interest in this area by: 1) working through at least two educational methods/materials that could be used at the participant's own site; 2) discussing cases where "missed opportunities" in genetics impacted the physician and family in an ethical, legal or social manner; and 3) locating at least three internet user-friendly sites as resources for current genetic information. The workshop, using a series of teaching exercises, role-playing and short didactic sessions will focus on our important role as generalists utilizing genetics as a unifying thread in patient care.

T. Turner, M. Dumont-Driscoll, J. Gigante, and B. Siegel

The AAP and the MCH Bureau advocate that community-based pediatric offices should be designed as Medical Homes for Children with Special Health Care Needs (CSHCN). Primary care physicians should meet the health promotion and standard medical care needs of children with a wide variety of medical and developmental needs (e.g., cerebral palsy, Down syndrome, inborn errors of metabolism, autism, HIV). Our team (of physicians, parent coordinator and project manager) will describe a partnership between the Children’s Hospital, Boston and six pediatric practices, focusing on components that have supported and enhanced Medical Homes in the community. We will discuss the following topics: 1) creating meaningful coordination between primary and tertiary care through electronic linkages, active referral networks, Individualized Health Planning; 2) provision of relevant continuing medical education programming for physicians and nurse practitioners who care for CSHCN; 3) training future physicians to practice using the medical home model; 4) conducting research on epidemiology, systems of care, condition specific issues, etc. that provide necessary data for improving the health and functional status of children with special health care needs; and 5) sponsoring consortia of physicians, parents and others interested in improving services for CSHCN .

T. Silva, E. Davidson, L. Freeman, L. Sofis, and J. Palfrey, Children’s Hospital, Boston and the East Boston Neighborhood Health Center, Boston, MA

Approximately 10% of newborn infants admitted to the Neonatal Intensive Care Unit will die. Many care providers may feel ill prepared to deal with the ethical and psychosocial aspects as well as the practical aspects of managing death.

This workshop will use a problem-based learning approach to analyze a complex neonatal case. A brief didactic lecture will review the following four aspects of care: 1) ethical aspects (withdrawal of life support, resolving decisional conflicts); 2) social aspects (cultural diversity, conflict resolution, obtaining autopsy requests); 3) palliative care aspects (pain management, managing other physical discomforts); and 4) emotional aspects (enhancing team communications, developing parent partnerships, addressing emotional needs of family/staff, creating supportive environments). Following the didactic session, participants will be divided into groups, with each group addressing one aspect of care. Groups will use decision-making models to analyze the case over sequential time periods. Following group activities, the four groups will reconvene. The workshop facilitator will orchestrate an integrative, collaborative plan based on input from the four groups.

The goal of this workshop is to provide participants with an overall model by which they can more effectively advocate for integrative health services at end of life.

C. Berseth, J. Garcia-Prats, B. Brody, and M. Walden, Baylor College of Medicine, Department of Pediatrics, Newborn and Intensive Care Sections, Houston, TX

Many residency programs are implementing interventions to expose residents to advocacy activities, enhance residency training with regard to advocacy, and better meet the needs of families within the communities in which they live. As part of these activities, programs face challenges designing and implementing appropriate evaluations to determine whether their objectives are being met. The purpose of this workshop is to highlight local evaluations being conducted at 6 pediatric residency programs as part of the Anne E. Dyson Community Pediatrics Training Initiative and engage participants in considering multiple aspects of program evaluations. Using interactive breakout groups, participants will propose possible methods and challenges of evaluating hypothetical advocacy interventions. The workshop will: articulate the usefulness and constraints of evaluating advocacy interventions; describe fundamental steps to designing and implementing successful evaluations; and highlight purposes and creative approaches for conducting program evaluations. Funded by The Dyson Foundation.

C. Minkovitz, Johns Hopkins University, Baltimore, MD, M. Aten, University of Rochester, Rochester, NY, D. Bragg, Medical College of Wisconsin, Milwaukee, WI, A. Duggan, H. Grason, Johns Hopkins University, Baltimore, MD, V. LeBlanc, Columbia University, New York, NY, K. Minot, Children’s Hospital of Philadelphia, Philadelphia, PA, M. Zuniga de Nuncio, UCSD, San Diego, CA

Same day appointment scheduling systems, commonly referred to as Open Access Scheduling (OAS), is offered as the solution to poor pediatric office efficiency. Long waits, poor access to services, malfunctioning telephone systems, disorganized patient flow, miscommunication and strained finances are reported symptoms of some ailing pediatric ambulatory practices. OAS advocates in academic pediatric continuity clinics, public sector neighborhood health centers or in private pediatric practices heartily endorse this novel appointment system as the cure for these chronic problems. OAS purports to optimize access to care while allowing the practitioner/practice to track patients who do not re-appoint in a timely manner. OAS relies on the themes of access, interaction, reliability, and vitality. In its purest form, OAS offers every patient an appointment on the day that an appointment is requested. The motto for OAS is, "Do today’s work today." During this workshop, OAS experts will provide background information and specific OAS examples from different pediatric practice settings. A point–counterpoint debate involving workshop participants will delineate and discuss the pros and cons of this model. Is your ambulatory pediatric practice in need of resuscitation? Come to this workshop to see if OAS is the cure!

J. Brown, D. Laraque, J. Cox and G. Randolph, Department of Pediatrics, Colorado School of Medicine, Denver, CO, Dept. of Pediatrics, Mt. Sinai School of Medicine, New York, NY, Dept. of Pediatrics, Harvard Medical School, Boston, MA and Dept. of Pediatrics, U of N. Carolina School of Medicine, Chapel Hill, NC and the HCD Committee

Qualitative research has steadily acquired greater popularity and respect in medical and health services research over the past two decades. Increasingly, this set of methods is viewed as complementary to traditional quantitative research approaches. Qualitative research techniques represent a diverse set of research methods featuring the collection and analysis of narrative data to capture a subject’s unfiltered view of a situation or topic. Qualitative methods hold particular promise in certain research activities such as medical education, ethics, quality of care, cultural perspectives, survey research and patient–doctor communication.

This workshop will introduce participants to qualitative methodology and its application to research questions in pediatrics by addressing two of the most commonly employed methods: focus groups and ethnographic interviewing. Participants will learn to: (1) identify research topics appropriate for the use of qualitative methods; (2) design a qualitative study using the two highlighted methods; (3) organize a paper for publication. Methodological issues such as sampling, data collection, coding, data analysis, and validity and reliability will be reviewed using examples from published literature and from participants’ own research questions.

C. Feudtner, D. C. Grossman, J. I. Takayama, Department of Pediatrics, University of Washington, Seattle, WA, and Department of Pediatrics, UCSF, San Francisco, CA

Cultural sensitivity and cultural competence have become increasingly salient topics in medical education and practice in recent years. Though no consisently agreed-upon definitions have yet been formulated for either of these terms, there is widespread consensus about many of their key elements. Among these are self-awareness; an ability to empathize with others; a willingness to try to "see through others' eyes" when differences in values and expectations make interactions challenging and understanding difficult to achieve; and a capacity to act upon all of these qualities in formulating workable action plans. Originally designed as a training tool for U.S. servicemen being stationed abroad, the cross-cultural simulation game BaFá BaFá™ (Shirts, 1974) provides an immersion experience in cross cultural interaction and its challenges and rewards. Participants are assigned membership in one of two fictitious cultures and move into separate rooms to learn the basic values framework and interaction rules of their new cultures (a roughly 15-minute process). Following this brief "enculturation," the two groups exchange smaller subgroups of visitors and observers, who interact in their host cultures and attempt to describe to their co-culturists their experiences with and interpretations of the "others." When all participants have had a chance to visit, the exchange ends and the groups reunite to discuss and analyze their experiences and insights. Successfully used in a wide variety of settings, the insights produced through participation in BaFá BaFá™ about the pervasiveness and influence of cultural norms and worldviews will here be applied to cross-cultural challenges in clinical practice and medical education.

B. O'Connor and A. Alario, Division of Pediatric Ambulatory Medicine, Rhode Island Hospital/Brown Medical School, Providence, RI

Despite advances in sophisticated imaging tools, cardiac auscultation using a simple stethoscope remains a powerful and fundamental skill used by both the generalist and specialist to discriminate disease from health. However, recent studies have shown that proficiency among residents in training is declining, pointing out the need for improvements in the teaching and assessment of this clinical skill.

This workshop is designed to improve diagnostic accuracy and teaching of cardiac auscultation through use of an interactive, internet-based virtual cardiology clinic and real-time examination of actual patients. Infrared stethophones will allow simultaneous auscultation by all participants. Echocardiography will be used to visually display pathologic lesions while listening to the associated heart sounds and murmurs. Digital technology allows slowing of heart rate, filtering of frequencies, and graphic rendering of sounds to improve learning.

Specific objectives include: 1) increasing accuracy of distinguishing innocent from pathologic murmurs, 2) improving recognition of clicks and other abnormal heart sounds, 3) introduction of this internet tool as a new means for group and individual learning as well as a method for quantitative assessment of clinical skill acquisition. The digital heart sound library can be accessed at www.murmurlab.com.

W. Reid Thompson and Jean S. Kan, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD

Workshops are a popular and versatile method of teaching adults. From teaching a procedure to teaching how to teach, from local retreats to national meetings, from precepting students to developing the skills of colleagues, workshops are widely used in medical education. This workshop will give participants the tools/framework necessary to construct and lead their own effective workshops. Facilitators of this workshop are from a variety of institutions and are participants in the APA National Pediatric Faculty Development Scholars Program. We will draw from our participation in this program, our previous experience with this workshop and current literature to review concepts of adult learning theory and techniques for working with small groups. Through participatory and interactive segments, the group will address how to conduct a needs assessment of the target audience and use the results to plan an effective workshop. Techniques for effective communication, stimulating audience participation and interaction, and evaluation will be demonstrated and practiced. During interactive breakout sessions, participants can choose to focus on the logistics of new workshop development or on refining their previously developed workshops. A listing of faculty development scholars by region will be provided to facilitate further networking and long-range access to workshop development expertise.

E. Zenni, J. Andrake, L. Pasquinelli, J. Christner, S. Wong and T. Shope, Department of Pediatrics, University of Florida Health Science Center, Jacksonville, FL

While integrated health care systems where patient care is intensely managed are becoming more common, young physicians are not being taught how to provide high quality health care within these systems. Therefore, the Health Resources and Services Administration (HRSA) has funded a national medical education program (1997–2002), Undergraduate Medical Education for the 21st Century (UME-21). It is administered by the American Association of Colleges of Osteopathic Medicine. UME-21 funds 18 allopathic medical schools to develop, implement, and evaluate innovative educational strategies in the clinical years of medical school. The goal of the curricular innovations is to provide future physicians with the knowledge, skills, values and attitudes necessary to provide high quality, population-based, cost-effective medical care to their patients within integrated health care systems. This project aims to foster effective primary care teaching in ambulatory and community-based settings.

The main goal of this workshop is to identify challenges and opportunities that arise when medical schools collaborate with integrated health systems (including managed care organizations) to effect curricular change in the clinical years of medical school. Project evaluation data will be presented. At the conclusion of the workshop, common barriers to implementation and effective strategies to address those barriers will be identified.

J. Pascoe, C. Christian, T. Kelly, L. Lane, K. Ling-McGeorge, A. Olson, C. Olson, American Association of Colleges of Osteopathic Medicine

Recent advances in cell and molecular biology have revolutionized our understanding of the molecular mechanisms underlying human disease. Subspecialty training in pediatrics requires a comprehensive understanding of the molecular methodologies involved in the current diagnosis and treatment of human disease as well as the future design of therapeutic interventions. This workshop is designed to provide the pediatric physician in training with an overview of some basic molecular principles relevant to understanding normal gene expression as well as aberrant gene expression resulting in human disease. Workshop modules will focus on participant identification of several common laboratory methodologies for DNA cloning, analyses of gene regulation and expression, and histological tissue analyses. Upon completion of this workshop, participants will be able to (a) describe three fundamental steps of gene cloning and analysis, (b) define two processes that regulate transcriptional control of gene expression, (c) identify two methods for analysis of gene expression in vitro and (d) identify two histological techniques for the subcellular localization of gene expression products in vivo.

Patricia L. Ramsay, Assistant Professor of Pediatrics, Departments of Perinatal-Neonatal Medicine and Cellular and Molecular Biology, Baylor College of Medicine, Houston, TX

Lawyers have become an essential part of the multidisciplinary healthcare team that low-income communities rely on to protect the health of their children. No longer is a doctor’s letter enough. Poor families navigating the bureaucratic barriers to government benefits such as food stamps or subsidized housing need both a doctor and a lawyer by their side. The goal of this workshop is to underline the importance of making local social resource networks more accessible to the patient population, while simultaneously teaching health care providers how to do so. The workshop will:

• Teach pediatricians and other health care providers about the basics of legal advocacy by providing them with the necessary tools and resources to proactively address the social issues that affect children’s health and wellness.

• Introduce pediatricians to Advocacy Code Cards, on which are listed reference numbers of social service agencies in Boston, a sample letter a doctor could use to advocate for a patient, as well as general advocacy tips.

• Emphasize the unique ability of medical–legal collaborations located within pediatric clinics to comprehensively care for children’s health. Participants will learn methods to establish liaisons between legal services and pediatric offices. Case examples will be used to demonstrate the usefulness of medical and collaboration from an on-site legal service program to provide families more holistic care.

B. Zuckerman, MD, M. Sandel, MD, E. Lawton, Esq., Boston Medical Center, Boston, MA

Quality improvement activities are intended to close the gap between desired evidence-based structures and processes of health care and what is actually delivered. The Agency for Healthcare Research and Quality (AHRQ) continues to encourage and support rigorous research so that quality improvement efforts can themselves be evidence-based. In this workshop, AHRQ awardees will explain how they successfully applied for grants for quality improvement research, and how they are conducting quality improvement research in real world settings. The grantees will discuss the theoretical and conceptual QI frameworks that informed their approaches, the interventions they designed and implemented, the tools they used and developed, the practicalities of collaborations with health systems and the barriers and opportunities they encountered, including IRB issues. The workshop will include substantial opportunities to address participants' questions about individual research projects and the overall QI theme.

D. M. Dougherty and M. Miller (co-chairs), Agency for Healthcare Research and Quality, Rockville, MD; Charles Irwin, MD, University of California-San Francisco; MaryAnn Shafer, MD, University of California-San Francisco, and two other awardees of AHRQ quality improvement grants.

Physicians are frequently asked to shoulder administrative responsibilities in addition to their more traditional clinical and teaching duties. Balancing these new responsibilities can be a challenge. Often time does not permit formal preparation and training for these duties. This workshop provides a "hands-on" practical overview of basic skills needed for effective administrative leadership.

Using an interactive format, the workshop will begin with a general approach to administration looking at fiscal, personnel and quality improvement issues. Participants will review standard financial reports such as program profit/loss (P&Ls) and budget vs. actual variance reports. Participants will discuss how to use the information from these basic reports to manage a budget or cost center. After developing familiarity with fiscal issues, participants will discuss human resource issues such as job descriptions and evaluations. Finally the value of a quality improvement (QI) process will be discussed.

At the conclusion of the workshop, participants will have used real-life examples to gain experience that is applicable to their own program and which will help them review standard reports and manage a budget, recruit and retain staff and participate in QI efforts.

A. P. Giardino, The Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, Philadelphia, PA

Objective: To enable clinicians to evaluate and interpret results of studies which utilize multivariate regression analytic techniques.

Introduction: Medical journals increasingly publish observational studies which utilize complex statistical analyses. Because treatment and prevention recommendations may be founded on such studies, clinicians need to understand the basic principles of multivariate regression to appropriately evaluate their results.

Course: This workshop will utilize a case-based teaching approach to illustrate how multivariate regression techniques work, when they are appropriate and how they are interpreted. The participant will understand how to evaluate and interpret studies which use multivariate analytic models. Minimal computer and math skills are necessary. We will begin by defining confounding in an example study and how it is distinguished from bias. Next we will define/calculate crude odds ratios and confidence intervals using datasets from studies of common pediatric diagnoses as examples. We will then explain and demonstrate the results from the same datasets using logistic regression to adjust for confounding. This case-based approach will be repeated using an example of simple linear and multiple linear regression.

R. O. Wright, J. Grupp-Phelan, N. Kuppermann, Divisions of Emergency Medicine, Brown University, Providence RI, University of Cincinnati, Cincinnati, OH, University of California-Davis, Davis, CA