The use of handheld computers in medicine has grown dramatically. This session is intended for those who have a handheld computer (Palm or Pocket PC), or are considering purchasing one, but who have not yet learned how to use it. The goal of the session is to help the beginner achieve a working familiarity with handheld computing such that they will leave the session ready, able and eager to use their own device in their daily life and clinical practice. Ideally, all participants should bring their own handheld. The session will include an overview of the devices and their desktop software; mastery of the basic (built-in) functions: datebook/calendar, address book, memo pad, to-do lists; and add-on applications: where to find them, how to install them and what applications are available specific to clinical pediatrics. Participants should be familiar with the use of personal computers and the Internet, but no prior knowledge of handheld computing is assumed.

Introductions and Overview of Mini Course

Lecture (with Audience Participation)—PDA Basics, Hardware and Software, the Palm OS and Its Functions

Palm OS Functions, Continued; PPC OS

Medical and Pediatric Applications for the PDA
 

This 6-hour mini course is intended for faculty who teach and do research on pediatric environmental health problems. We will use an evidence-based approach and focus on research that is needed to clarify unresolved issues. The challenges and controversies in the field of pediatric environmental health will be presented, and there will be time to discuss prevention strategies for the clinic and the community. The participants will develop and share ideas to use in teaching, research and practice. (There is a separate workshop for Chief Residents on May 4, 2003.)

Content of this session is similar to session 6200 An Introduction to Children's Environmental Health

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. 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.
 

The U.S. 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 spectrum of the world’s 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.
 

Background: Observational research studies have become increasingly complex. The results of observational research studies can be driven by properties other than chance or causation. While these factors may drive the p values of the results, they also change the appropriate interpretation.

Workshop Methods: In the first half of this workshop, we will formally define confounding, effect modification, restriction vs. heterogeneity of exposure, intermediate variables, selection bias and differential vs. nondifferential information bias. In the second half, we will use a case-based approach to illustrate examples of studies in which the results are driven by these factors and compare differences in the appropriate interpretation in the presence and absence of these factors. Minimal math skills will be needed, however, familiarity with basic concepts of study design and data analysis (case control vs. cohort study, interpretation of Ors, etc.) is recommended. We will specifically illustrate examples of effect modification vs. confounding, intermediate variables vs. confounding, selection bias, underpowered studies, and the role of measurement error in determining effect estimates.
 

To improve child health outcomes, pediatricians will need to expand their expertise to include population-based knowledge and skills. Collaboration with local health departments and public health practitioners can provide assets and resources to pediatricians to support them in these efforts. This workshop will: (a) establish a framework for linking pediatrics and public health on the local level; (b) identify and demonstrate the inventory, relevance and use of public health resources to child advocacy, clinical pediatrics and population-based child health; and (c) develop approaches for practitioners and pediatric educators that integrate pediatrics and public health to improve child health. Healthy People 2010 and Community Oriented Primary Care will be used to provide context to the discussion.

After an introductory didactic presentation, participants will be engaged in an interactive case study and scenario development process to demonstrate and generate potential strategies to improve child health. This will include: access to data relevant to clinical practice and child advocacy, introduction of population-based practices into clinical practice and the application of the principles and practice of public health to common health issues affecting children, e.g., asthma, obesity, diabetes, infant mortality, substance use. Names of local health officials in communities and a set of relevant websites will be provided.
 

The Special Interest Group on Literacy Development in Primary Care provides information, support and networking for clinicians interested either in research or implementation projects related to pediatric early literacy interventions. The SIG provides an important ongoing opportunity for reviewing research in progress, coordinating research ideas, enhancing provider training on early literacy guidance and evaluation related to the REACH OUT AND READ (ROR) model of pediatric literacy intervention. This year, in addition to general research update, we will spend some time on the topic of using the book as an assessment tool in the exam room. We invite participants to join that discussion by bringing examples of techniques for including books in developmental assessment or by discussing any research on using books as part of developmental screening. The session will also include a brief presentation on language development in young children.
 

Based upon our SIG meeting discussion, a number of newborn nursery topics will be addressed. A response by our group B streptococcous work group, headed by John Olsson, to the CDC guidelines will challenge us to prevention in our nurseries of sepsis and concepts for studies. We will discuss jaundice guidelines, screening, treatment and breastfeeding. Hypoglycemia detection and treatment will be surveyed and presented. Current screening with meconium and treatment of substance-exposed infants will be described. We will explore pain control in nurseries and circumcision.

During the session, Latha Chandran will distribute and discuss the results of the survey of our members needs and current practices. We will update our E-mail lists for our members and discuss new teaching ideas.
 

The Nutrition Special Interest Group of the Ambulatory Pediatric Association is currently preparing A Teacher’s Guide to Pediatric Clinical Nutrition.

The first part is "Pediatric Nutrition Notes." Dr. Karp wrote these in 1993 as an in-house project requested by Dr. Laurence Finberg for use by medical students at SUNY-Downstate. Since that time, the notes have been distributed to 3rd year medical students and residents. Pediatric Nutrition Notes provide essential vocabulary and knowledge of pediatric nutrition. The Notes were written at the level of medical student education. The cases that follow make the complete Teacher’s Guide a vehicle for resident and faculty education.

The second part of "A Teacher’s Guide to Pediatric Clinical Nutrition" is the subject of the current project. The main component of the second part of the Teacher’s Guide is a set of 21 case studies, prepared by authors within the SIG with editing by the editorial committee. These authors are leaders in the field of teaching nutrition. The case studies will draw on material presented in Pediatric Nutrition Notes and other sources for students and residents to use in clinical settings. The clinical settings will provide an opportunity to describe the influence of metabolism and thus nutrition, on the course, outcome and possible treatments of the children.

At Downstate, Dr. Karp is currently conducting a pilot study of the Teacher’s Guide using chapters already drafted. He plans on presenting a complete rough draft of the Teacher’s Guide to the Special Interest Group at the 2003 Pediatric Academic Meetings (APS-SPR-APA). Dr. Karp and colleagues estimate completing the Teacher’s Guide by May 2004.
 

Dear Colleagues,

We’re actively considering suggestions and ideas for the agenda as well as looking for persons interested in the "Cig SIG Debate" (see below). If you excelled in argument in high school and would like to take this on, or have other thoughts/feedback about the 2nd Cig SIG meeting, please contact Dana Best (dbbest@cnmc.org) or Deb Moss (mossd@pitt.edu). We look forward to seeing you in Seattle!

2003 Meeting Preliminary Agenda

• Introductions – Who’s who, who’s doing what, what projects are working, what projects aren’t
• Presentation – "The Top Pediatric Tobacco Articles in 2002"
• Break – Meet and mingle
• Debate: Current Pediatric Tobacco Controversies, on a topic such as "Access Laws Do/Don’t Work"
• Discussion on APA Tobacco Policy
• Miscellaneous Items
• Adjourn
   

The primary objective of this mini course is to convey the array of issues intrinsic to caring for older adolescents and young adults with chronic, life threatening disease. For several reasons, cancer provides an ideal paradigm for this adolescent/young adult challenge.

1. The spectrum of disease is broader for cancer at many levels of biological organization than it is for any other disease. Virtually all organ systems and organs may be diseased in patients with cancer, whether due to the disease or its treatment. The affected organs include CNS, hematopoeitic, cardiovascular, hepatic, renal, endocrine, musculoskeletal, immune, pulmonary, gastrointestinal, cutaneous, ocular, otic and oral tissues.
2. The affected levels of biological organization include molecular, cellular, tissue, organ, organ system, connective, and psychological. The latter is particularly challenging among adolescents with cancer.
3. The clinical and translational research programs in oncology are among the most organized medical enterprises at the national and tertiary center level in all of medicine, with the cooperative infrastructure that has supported this success among the most successful in the history of science. The advances among children with cancer have been among the most dramatic in the history of medicine.
4. Despite the organizational achievements, there is emerging evidence that patients with cancer in this age group have been ignored relative to the scientific and clinical focus that has been successfully applied to younger and older patients with malignant disease.

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.
 

The goal of this interactive workshop is for participants to improve their teaching skills as they strive for teaching excellence. The characteristics of outstanding teachers will be defined and applied to a variety of different teaching scenarios. Several teaching methods used by expert instructors will be presented and discussed. Opportunity for practice will be provided. Participants will be challenged to apply what they have learned to their own teaching settings.
 

There are many new technologies to help the primary care pediatrician more accurately diagnose genetic disorders. These newer diagnostic tests and their interpretation require a close working relationship between the pediatrician and the clinical geneticist. Approaches to the diagnosis, management, and discussion of the psychosocial, legal and ethical issues of genetics, from screening, to giving bad news, to helping families understand and cope with the impact of genetic diseases within a family context, have always been challenges for the general pediatrician. This session will examine the information needed from the clinical assessment of the child in relationship to the family context that increases the likelihood that the pediatrician is dealing with a possible genetic issue. Newer diagnostic genetic technologies will be reviewed. Exploration of the history, including the family pedigree, aspects of the physical exam that alert the pediatrician to a possible genetic problem, the referral process to a clinical geneticist and the legal, ethical and psychosocial issues that should be addressed with the individual or family member before the referral to the geneticist will be presented. The collaborative process between the patient/family, the pediatrician and geneticist will be examined.

The field of medicine is replete with examples of ways that handheld computers may be used to educate, organize and inform clinicians. There are also examples of how researchers may benefit from this technology. During this more advanced session, we will discuss some of these uses of handheld computers. We will provide examples of software in a variety of domains and discuss their historical, current and future use. We also will demonstrate some future technology and discuss its implications. At the conclusion of this session, participants will have increased familiarity with state-of-the-art applications, techniques to install them and the future of handheld computers and wireless networking.

Introductions and Overview of Mini Course

Lecture with Audience Participation: The Top 10 Novel Uses of PDAs in Health Care

Exercises and Demonstrations
 

With the recent technologic advances to treat spasticity, the care of children with motor disorders has changed dramatically. The physician now has new choices in oral medications, as well as the ability to offer the patients possibilities such as botulinum toxin, intrathecal baclofen and selective dorsal rhizotomy. This course will offer an overview of the current thought on spasticity and related movement disorders, as well as an update on the new treatment modalities and their efficacy. The pivotal role of the pediatrician in the comprehensive management plan will be discussed. Didactic information, case studies and video presentations will be utilized.

Tobacco, marijuana and alcohol have long been recognized as the "gateway drugs" or the drugs adolescents first begin to abuse. Each drug has inherent dangers, one of which is they can serve as stepping stones to abuse of other drugs. This session will review current issues involved with each of these three drugs—issues that involve the pediatric researcher and clinician as well as society itself. The first hour will be devoted to tobacco, the second to marijuana and the final to alcohol. Questions and answers will be encouraged from the audience.

Cultural competence in medical practice implies the effective interaction of the cultures of patients and providers. However, medical training programs often focus solely on the culture of patients, assuming that providers maintain value neutral systems. This cultural competency curriculum is located at two urban hospitals affiliated with Columbia University and is unique in that it incorporates self-reflection regarding personal cultural backgrounds as well as a critical understanding of medical culture. Training spans all three years of residency and focuses on: community asset mapping and language skills development; provider and patient cultures; and cross cultural communication. Rather than utilizing passive didactic methods, this curriculum uses multiple innovative teaching methodologies such as: resident-initiated projects, interactive workshops, discussions of films, reading of narrative texts, service learning and home visits. Learning occurs both in the traditional clinical setting and at community-based organizations. Pediatrics and public health faculty, as well as partners from community-based organizations, are vital in teaching. Residents from various cultural backgrounds and two culturally disparate hospitals participate in the curriculum. Self-reflective exercises allow residents to document, share and learn from these activities. This educational workshop will be a "training of trainers" session on cultural competency that will demonstrate effective training methodologies and allow participants to share strategies to create their own curricula. The session will be led by faculty members, community partners and pediatric residents.
 

Pediatricians are often asked to evaluate children for sexual abuse, yet deciding when, where, how and by whom the evaluation should be done are problematic given the rapidly changing interpretation of physical findings and testing and the paucity of data regarding the optimal provision of health services for this population.

This workshop will address the multiple decisions facing the primary pediatrician in sexual abuse evaluation by using an interactive, case-based approach and clinical decision analysis in a 60–90-minute workshop session. Participants will receive a brief introduction to the literature regarding triaging sexual abuse cases based on child age, gender and recency of contact and will be updated regarding interview techniques, interpretations of findings and medical and legal outcomes.

Using predictive values for outcomes based on timing, behaviors, disclosure and physical findings, participants will then select and evaluate the effects of their various choices at each clinical decision point (triage, type of evaluation, testing, referral) in 4–6 test cases. Clinical decision analysis will be used to optimize health and legal outcomes based on the participants’ choices. Potential strategies for health services for child sexual abuse will be reviewed with participants based on locally available resources.
 

This session will provide an overview of the Healthcare Cost and Utilization Project (HCUP)—a family of databases and tools maintained by the Agency for Healthcare Research and Quality (AHRQ)—and will include presentations by child health services researchers of their projects utilizing one of HCUP’s databases, the Kid’s Inpatient Database (KID). The KID is a unique and powerful database of hospital inpatient stays for children age 0–18 years. The KID was specifically designed to permit researchers to study a broad range of conditions and procedures related to child health issues. Researchers and policymakers can use the KID to identify, track and analyze national trends in health care utilization, access, charges, quality and outcomes. The KID contains approximately 1.9 million hospital discharges for children and includes a sample of pediatric discharges from over 2,500 U.S. hospitals. Since the KID has a large sample size it can be used for analyses of both common and rare conditions such as congenital anomalies, uncommon treatments and organ transplantation. Users will receive detailed packets of information about KID products. Research studies on congenital birth defects, hypoplastic left heart syndrome, adolescent depression and others will be used to illustrate application of the KID data and tools.
 

Pediatricians are in a unique position to identify and advocate for children's health care needs. To do so, pediatricians need to understand the psychosocial, economic and cultural forces that affect the health of their patients. Community-based training provides residents with the opportunity to gain firsthand knowledge and experience of these forces and, importantly, gives them the basis from which to identify and mobilize community resources to enhance health outcomes. The goals of this workshop are to 1) improve the participant's knowledge of innovative community-based curricula and 2) discuss strategies for successful implementation of these experiences. Using an interactive format, representatives from The Initiative's programs will discuss components of their advocacy and community-based curricula. Participants will be encouraged to share their experiences of similar efforts. Specific community pediatrics' competencies will be described in conjunction with training efforts designed to achieve them. Workshop participants will divide into small groups to discuss implementation of community pediatrics block rotations, longitudinal residents' projects and cultural competence experiences. At the closing, participants will review and reflect on key issues raised during this session.
 

Family physicians provide care for a significant number of infants, children and adolescents. Many pediatricians have chosen faculty positions aligned with Family Practice Residencies, and these pediatricians are responsible for the oversite of pediatric training. Pediatricians thrust into this position find that you can’t follow the same roadmap used for training pediatric residents. If you do, it is likely that you’ll spend too much time talking about too little; the residents might be bored; and the residents might not gain an appreciation of the appropriate scope of pediatric care for a family practitioner. Plus, each program seems to have its own set of roadblocks. This SIG’s goal is to provide mentoring, guidance and feedback to pediatricians who have embarked on this career choice.
 

1. Career Development of Minority Faculty - This discussion will be a complement to the information given in the Minority Faculty Development Workshop. We will discuss, in more detail, some of the "intangible" factors that impact on the success of minority faculty members. In addition, we will address the various career paths available to faculty and how minority faculty can identify which path is appropriate for them.
2. Recruitment and Retention of Minority Faculty in Academic Careers: We will discuss ways in which institutions can successfully attract and retain minority faculty members.
3. Mentoring Minority Faculty to Success: Ideas about how residents, fellows and junior faculty can find appropriate and effective mentors will be discussed. In addition, we will talk about how to effectively use mentors and how mentors can better serve the needs of minority faculty.

Both junior and senior faculty panelists have been invited to discuss each topic. This will be an interactive session. We hope these topics will generate a productive and thought-provoking discussion. If successful, we hope to generate a proposal for an initiative on Pediatric Workforce Diversity for submission to the Ambulatory Pediatric Association leadership.
 

This 6-hour mini course is intended for faculty who teach and do research on pediatric environmental health problems. We will use an evidence-based approach and focus on research that is needed to clarify unresolved issues. The challenges and controversies in the field of pediatric environmental health will be presented, and there will be time to discuss prevention strategies for the clinic and the community. The participants will develop and share ideas to use in teaching, research and practice. (There is a separate workshop for Chief Residents on May 4, 2003.)

Content of this session is similar to session 6200 An Introduction to Children's Environmental Health

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.
 

The period of adolescence encompasses dramatic changes, both physical and emotional. Taking care of these youth requires not only patience, compassion and flexibility but also knowledge of the biologic, psychological and cultural transformations. Adolescents aged 11–21 years made 61.8 million visits to physicians in 1994 and continue to see their primary care providers for continuity health care. There is a terrific opportunity for preventive health interviewing in these visits. In this workshop, the participants will become familiar with GAPS and Bright Future Guidelines for the adolescent visit, as well as effective coding and billing procedures. There will also be a panel of adolescents who will talk about how they want to be interviewed and provide insight into positive and negative experiences that they have had during their health visits.
 

Clinician-educators are those physicians whose career activities combine patient care and teaching and whose scholarly activities promote excellence in medical education. With this interactive workshop, it is expected that participants will learn a practical approach to their career development and will:

1. have a better understanding of the motivations, career plans and challenges of clinician-educators;
2. be able to develop a career ‘map’ for junior clinician-educators;
3. learn how a mentoring program can help the clinician-educator plan and develop his/her career, including suggestions on how mentors and ‘mentees’ can contribute to enhancing professional academic skills;
4. be able to identify faculty development needs and participate in useful and effective faculty development activities, having a better understanding of specific faculty development activities and the evidence for the effectiveness of these activities; and
5. have a better understanding of the evaluation of teachers and how these evaluations are used for faculty development and promotion and will learn guidelines for developing an effective Teaching Dossier.

This workshop will be of interest to both junior faculty with an interest in developing their academic careers as clinician-educators and to administrators responsible for supporting junior faculty in the areas of teaching and education.
 

This interactive session will provide the attendee with basic information on publication of a manuscript, as derived from the perspective of an editor. Issues (with data provided when possible) to be discussed are:

A. View From the Inside

1. Characters involved
2. Manuscript flow
3. Peer review process
4. Working with the author

B. View From the Outside

1. How to choose the right journal for your paper
2. How to prepare the cover letter
3. How to prepare the abstract
4. How to prepare the body of the manuscript
5. How to prepare the references

C. Conflict of Interest and Ethics
 

With their numbers continuing to grow at an alarming rate, health care needs of the more than 500,000 children in foster care often remain unmet. Children in foster care suffer from inordinately high rates of acute and chronic illnesses, lack of preventive health care, mental illness and developmental delays. Inefficient child welfare agencies, inadequate health care funding and a dearth of qualified health care and mental health care professionals willing to treat this population of children compound the problems.

The 21st century heralds a paradigm shift in medical education with a focus turned to competence and outcomes. The Accreditation Council for Graduate Medical Education (ACGME) is spearheading a competency-based system of graduate medical education coincident with the American Board of Pediatrics’ (ABP) initiative to transition from periodic "recertification" to "maintenance of certification." Our greatest challenge as educators lies in developing tools to evaluate competence during training and to equip all trainees with the skills necessary to achieve quality continuous professional development in order to maintain their certification in pediatrics.

The overarching goal of this workshop is to explore the value of using technology as a tool for promoting self-assessment and lifelong learning in continuous professional development. We will demonstrate how physicians can use an innovative web-centered tool to document competence in practice-based learning and improvement. Participants will discover how to create and manage a personal list of educational needs based on their professional experiences, develop individualized learning plans to address these needs and then document the impact of learning on their practice.

The outcome of implementing this web-based technology will be the ability to demonstrate competence of our trainees in the domain of practice-based learning and improvement to the ACGME and the preparation of tomorrow’s physicians to demonstrate evidence of continuous professional development in maintaining their certification.
 

What should you do when parents want you to continue burdensome treatments, which you think are futile? What should you do when parents want you to stop intensive care treatment, the continuation of which you think is in the best interests of the child? Who ought to make decisions for the not yet competent? Is it the parents, the doctors, the ethics committee, society or some other disinterested third party? The goal of this seminar is to consider the complexity of these difficult decisions, looking at factual and evaluative considerations. Through interactive case discussion we will identify the problems and potential pitfalls in decision-making for the pediatric population.
 

5:15pm–7:15pm
Poster Session I
Original Science Abstracts – Poster Session

• Historical Perspectives
• Underserved Populations
• Clinical Issues
• Children with Special Health Care Needs
• Breast Feeding/Well Child
   

Dr. Rivara's area of research for the past two decades has been injury control and prevention. He will discuss his thoughts on keys to success for academic pediatricians, including role of mentors, focus of one's research career and tips for successful publishing.

Frederick P. Rivara, University of Washington, Seattle, WA, Editor, Archives of Pediatrics and Adolescent Medicine
 

The purpose of this symposium is to describe the benefits to pediatricians of collaborating with public health specialists and to offer examples of some effective collaborations. Speakers will identify resources available to pediatricians who want to engage in public health efforts.

This program will give a "pediatric perspective" to smallpox bioterrorism preparedness planning efforts now under way within federal, state and local public health agencies. It will include a review of smallpox epidemiology, clinical disease, smallpox (vaccinia) vaccine and lessons learned from the WHO Smallpox Eradication Program. The nature of the current threat and responses to that threat will be discussed.

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 workshop will provide participants with such strategies that will in turn aid in the recruitment, faculty development and retention of receptors. 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.
 

American Indians and Alaska Natives (AI/AN) represent the smallest ethnic group in the United States. Large disparities exist between child health status indicators in this population and the rest of the U.S. population. The AI/AN population is also unique in that tribally enrolled AI/AN members have access to a unique healthcare system sponsored by the federal Indian Health Service (IHS). Increasingly, the IHS is turning over control of Indian health care to tribal health entities, thereby encouraging autonomy and self-determination. A consequence of this transfer of responsibility, IHS is providing fewer centralized administrative and consultative services to independent tribes. As a result, tribes will become increasingly reliant on alternative sources of assistance. Potentially rewarding new opportunities exist for pediatricians from universities and pediatric organizations to provide clinical and public health consultation to these newly independent tribes and their regional consortia. This workshop is aimed at clinician-teachers and investigators interested in developing closer ties to tribes and urban Indian organizations in their area. The following topics will be discussed during the session: 1. The evolution and devolution of the IHS: a contextual history of health services for AI/AN’s (didactic); 2. community-based participatory research in Indian communities: tribal expectations (panel discussion); 3. creating and optimizing educational opportunities for medical students and residents in AI/AN health sites (panel discussion). 4. advocacy for Native American health: how can we help? (interactive presentation).
 

The use of psychopharmacologic agents in children and adolescents has increased significantly over the past decade. Clinicians are becoming more involved in using these various medications, and this trend will continue in the future. What is the evidence-based medicine (EBM) for these medications as they apply to children and adolescents? This mini course will review the current research as applied to antidepressants, stimulants, mood stabilizers and antipsychotics. Applications to mental disorders in children and adolescents will be discussed. Questions from the audience will be encouraged.

Since 1989 New York State has had regulations that specifically prescribe resident work hours. Now, legislation that restricts resident work hours is being considered in many states and on the national level. In addition, the ACGME has instituted new regulations to take effect in July 2003. Clearly such regulations will have an impact on the structure of most residency training programs. The goals of this workshop are to explain the regulations and learn ways to accommodate to the regulations—not only meeting the work hour limits but how to continue to incorporate teaching in the lives of the residents. The presenters are all experienced New York residency directors who have taken different approaches to meeting the 405 regulations. After an introduction reviewing the regulations the presenters will explain some specific methods that have been successfully used, including creative scheduling, night float systems, and the incorporation of additional providers. The attendees will then break into small groups to work on the challenge of meeting the regulations in their own programs, facilitated by the presenters. The session will end with each small-group sharing their ideas. This workshop is intended for anyone involved in residency training. The presenters have no conflicts of interest to declare.
 

Approximately 60% of families have concerns about children’s development and behavior, yet almost half do not share these concerns spontaneously, suggesting that they need to be actively elicited. While many concerns lack significance in terms of serious clinical diagnoses, they provide opportunities for parent support, an important intervention that may lead to improved outcomes. Best results are likely to be achieved by deploying a systems approach through which community agency involvement is well coordinated with health professionals. Working within a systems approach and collaborating with non-medical professionals present many challenges for pediatricians.

In this workshop, participants will be introduced to new models of working with families focusing on eliciting parent concerns. These models use a broader approach than the dichotomous pass/fail limitations of basic screening tests. A parent elicitation tool (PPDS) is a vehicle for parent support and a platform for communication and family/agency collaboration. Participants will also engage in an interactive community mapping exercise for improved collaboration with non-medical providers. Finally, the workshop will address organizational issues important to successful practice change. Drawing upon a model with demonstrated effectiveness, participants will work in small groups as they undertake a step-by-step planning exercise applying change principles to guide practice change in their own settings.
 

Objectives: 1) increase and promote skill acquisition on cultural competency among health care providers, 2) increase understanding of cultural values and health beliefs/practices among a culturally diverse populations. Participants will be given a brief introductory quiz to assess their previous experience on the subject. An ethnicity/cultural awareness exercise will follow. Video clips of case scenarios highlighting cultural issues and health practices, which may become important during a well-child visit, will be shown. Information on cultural education/training issues, culture-specific terminologies, common pitfalls for cultural bias/misunderstandings and practical ways to improve cultural sensitivity/proficiency will be offered. Demographic characteristics of the U.S. populations, guidelines for using interpreters and culture-bound syndromes will be reviewed. Participants will then divide into three stations to gain exposure to three featured cultures: Islamic, African-American and Hispanic. They will experience culture-specific items and participate in role-playing. The three groups will meet again for a panel discussion and problem-solving exercises. In conclusion, participants will summarize the propositions to employ the culturally specific therapies.
 

Previously offered and well received at PAS. The BaFa BaFa simulation will: (1) provide an immersion experience in the challenges and rewards of cross-cultural interaction, (2) highlight the importance to medicine of such qualities as self-awareness; willingness to try to "see through others' eyes" when differences in values and expectations make interaction or understanding difficult and the capacity to act upon these in formulating workable action plans; and (3) provide facilitator training to participants. Format: Participants divide into two fictitious cultures, moving into separate locations to learn the basic values and behavioral norms of their new cultures. Following a brief enculturation period, the groups exchange teams of visitors who interact in their host cultures and attempt to describe to their co-culturists their experiences and interpretations of the "others." When all players have had a chance to visit, the groups reunite in a final hour plenary to debrief and discuss their experiences, insights and impressions. Plenary includes practical and logistical information to facilitate importation of BaFa BaFa to participants' home institutions. Both entertaining and insight-producing, this unique exercise is readily adaptable to a variety of medical educational purposes and settings. *Note: The simulation cannot accommodate late arrivals once enculturation stage has begun (about 15 minutes p start).
 

The Institute of Medicine has challenged health care leaders to redesign health care systems to achieve care that is more patient centered, timely, efficient, effective, equitable and safe (in "Crossing the Quality Chasm: A New Health System for the 21st Century"). Dramatic improvements in patient care, in alignment with the IOM challenge can be made with innovative clinical models. At the Open Access Workshop at the 2002 PAS meeting, the basics of the Open Access concept were presented. Improvements include increased access to care and productivity, optimal utilization, decreased urgent care visits and improved preventative health care outcomes. At this session, participants will understand the Open/Advanced Access model applications. Lessons learned from the Institute for Healthcare Improvement (IHI) National Initiatives, along with Mayo Clinic experience in primary care and specialty care areas, will be shared. Implementation in primary care and specialty clinics, as well as academic settings, will be reviewed. The format for the session will be highly interactive with the understanding that many pediatricians already have substantial understanding and experience with the Open/Advanced Access model of care.
 

The Women in Medicine SIG will focus on the topic of part-time employment, with participation by women who have and do work part-time. The group will also discuss what the current research agenda is, vis a vis women in pediatrics, including the pediatric workforce and pediatric subspecialties.