Pediatric Hospitalist practice is an evolving career option that combines the excitement and stimulation of high acuity patients without the limitation of sub-specialization in a specific organ system or age group. Hospitalists provide direct patient care, perform procedures, teach, conduct research, but spend too many nights and weekends in the hospital. Hear a panel of experienced pediatric hospitalists frankly discuss their varied career tracks and current employment settings ranging from the traditional academic "ward attending" to private practitioners who cover the Ward, Neonatal ICU, Pediatric ICU, ER, Nursery, and Labor and Delivery without the benefit of housestaff. Significant time will be allowed for questions to find out if a pediatric hospitalist career is in the cards for you or those you advise.

Jack Percelay, Chairperson, AAP Provisional Section on Hospital Care
Michael Ruhlen, Section Head, Pediatrics, National Association of Inpatient Physicians

This seminar will encourage discussion about the omission, withdrawal, or use of treatment for fetuses and newborn infants. The principles of benevolence, non-malfeasance, justice and autonomy will be briefly described and illustrated by; (1) a discussion of the recent Siamese twin case in England and, 2) surrogate decision making. It is hoped that these topics and their presentation will lead to a lively interactive debate.

David K. Stevenson, Harold K. Faber Professor of Pediatrics, Stanford University School of Medicine, Palo Alto, CA

This year’s theme will be “Promoting Adherence to HIV Treatment Recommendations”.  Our Baltimore based programs will present a range of activities we have used to try to support successful adherence.  Other programs are invited to share their efforts—especially if they work!  If you are willing to present in this small group, workshop format, please email Nancy Hutton at nhutton@jhmi.edu.

Little is known about the etiology, treatment, or sequelae of infantile colic. Research has identified potential effects that colic may have on child development, parent-child relationships and family functioning. This year's SIG will describe a multidisciplinary outpatient clinical model of care developed to diagnose and treat infants with crying, sleeping, feeding and associated behavior problems. Pamela C. High, J. E. Twomey, C. F. Z. Boukydis, C. L. Miller-Loncar, V. P. Dalzell & B. M. Lester, all of Brown University School of Medicine, will present "What To Do When Colic Makes You Want To Cry: A Multi-Disciplinary Approach". Their treatment team is comprised of pediatricians, psychologists, and a clinical social worker. Clinical interviews, behavioral questionnaires and 24-hour infant behavior diaries are used to diagnose and to monitor treatment. The clinical approach presented in the workshop illustrates the benefits of integrating psychological and behavioral pediatric services into a single service for infants and their families. The presenters will describe how they examine the infant's crying and its interrelation with feeding, sleep schedules, and parent-infant interactions. An additional emphasis of the presentation is on treating the presenting problems and preventing future behavioral difficulties. Data looking at a possible relationship between maternal depression and colic from a sample of 90 families with infants with excessive crying will be presented. Data on diagnosis, treatment and outcomes from 50 infants recently referred to our clinic will be presented and 6 cases will be used to demonstrate application of this model. An important part of the presentation will be discussion of this technique's use in primary care settings.

Our group has planned a broad-based and provocative set of case presentations for the morning of 4/28/01, starting at 8:30 am. The format for each speaker’s 40 - minute presentation will be 10 minutes for case description, 20 minutes for background information, and 10 minutes for questioning of each speaker.

This SIG supports primary care programs to promote reading aloud and the developmental aspects of literacy, based on the Reach Out and Read (ROR) model. The three-hour meeting will focus on sharing innovations in physician and volunteer training, program organization, fund-raising, and regionalization. Time will be devoted to in-depth discussions of multi-cultural and multi-lingual aspects of literacy intervention, advocacy around literacy, and a review of the SIG's multi-site research project, the Before-and-After-Books-and-Reading (BABAR) study. A separate training session will be offered for programs just getting started. The SIG is coordinated by Perri Klass (BU School of Medicine and Reach Out and Read, Boston) and Robert Needlman (CWRU School of Medicine and DrSpock.com).

We have a busy agenda planned that will focus on the following areas and updates.

1. Pediatric training handbook for Family Practice Residents.

* SIG members have established that there is no widely used resource for the Pediatric component of Family Practice Residency. A handbook developed by the York Hospital Family Practice Residency (the Reilly Handbook) was reviewed. SIG members agreed that this resource would provide a good starting point and several members agreed to work on revisions. Efforts to develop a CD ROM format were also initiated. Our goal is to develop a resource that will have broad based appeal to Family Practice Residency programs across the country.

*Competency based questionnaire

*As an adjunct to the handbook, members felt it would helpful to have coordinated questions to help focus pediatric learning. Several members agreed to contribute questions.

How is pediatric training addressed in Family Practice Residencies?

This question was last addressed in a 1992 article by published by Baldour and Luckman. SIG members felt it would be useful to conduct a similar survey of current Family Practice programs.

*Annual review of Pediatrics Guidelines for Family Practice residents

*New members in particular have found this discussion useful in terms of providing a foundation for pediatric learning objectives.

Competency based education has become a top priority in medical training. It places the emphasis in integrating knowledge, skills and attitudes into the actual performance of the essential tasks of an effective practicing pediatrician. In the field of Community Pediatrics, it has been particularly difficult to define the competencies necessary to become an effective community advocate. Our Community Pediatrics program has achieved a comprehensive competency based approach to training by incorporating Service Learning as the core of the educational experience. Service learning integrally involves the community in the design and implementation of the curriculum. It combines specific learning objectives with community service, evaluation and reflection. With this educational methodology, competencies are defined mutually by members of the community and the academic medical center.

Participants in this workshop will: 1) Develop competency statements in the area of Community Pediatrics, 2) Identify appropriate educational methods to achieve those competencies, with particular emphasis in Service Learning and 3) Explore appropriate methods for evaluating the residents' mastery of the articulated competencies.

D. Meyer, M. McCord, P. Hametz, M. Irigoyen, M. Batista, and V. LeBlanc.

Approaches to the diagnosis, prevention, and treatment of chronic conditions in childhood and adolescence have changed greatly with greater survival of most children, even with severe conditions. Thus, for most children, new issues include preparation for adulthood rather than expectation of early death. Community pediatricians have increasing numbers of children with chronic conditions in their practices and thereby face new challenges in the care of these children and their families. Advances in molecular biology and genetics will lead to more effective ways to identify and treat many conditions. At the same time, children and adolescents face a great rise in new epidemics of chronic conditions, with marked increases in obesity, asthma, Type 2 diabetes, mental health conditions (especially ADHD and depression). This session will examine new advances in the biology of chronic conditions, important changes in epidemiology, consideration of important outcomes for children and adolescents with chronic conditions, and new efforts to improve their pediatric care.

Overview

New Morbidities: Clinical and Social Changes in Childhood Chronic Conditions
James M. Perrin, Mass General Hospital for Children, Harvard Medical School, Boston, MA

Prospects for New Treatments
Alan B. Ezekowitz, Massachusetts General Hospital, Boston, MA

Improving the Care of Children with Chronic Illness
Carole M. Lannon, AAP liaison, National Initiative for Children's Helathcare Quality, University of North Carolina, Chapel Hill, NC

Outcomes of Chronic Conditions: What Should We Measure?
Ruth E. K. Stein, Albert Einstein College of Medicine/Children's Hospital of Montefiore, Bronx, NY

Discussion

The U.S. 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. During the first third of the session, we will present 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 second two-thirds of the session will consist of case discussions and group problem solving. Cases will be provided but attendees will be asked to bring their own cases as well. Several additional experienced obesity specialists will also be present to participate in the case discussions.

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

Over 75,000 children, from 36 countries, have been adopted by U.S. families since 1990. During 1998 alone, almost 16,000 children have been internationally adopted. It is quite likely that the primary care provider will encounter at least one internationally adopted child in his or her practice. While most of these children may appear healthy and well nourished, more than 50% have an undiagnosed medical condition at the time of the initial evaluation in the United States, regardless of age, sex, or country of origin. This workshop is designed to educate and alert the participants to the unique medical needs of these children so that early treatment and intervention is optimized. The workshop will familiarize the primary care provider working with international adoptees and will clarify his or her role in caring for the internationally adopted child. The first part of the workshop will focus on the following topics: 1) review medical records (photos, video) of the child from abroad, 2) travel preparation for parents, 3) post-adoptive medical screening, diagnoses, and treatment of medical conditions, 4) immunizations, 5) assessment of growth, development and nutrition, 6) coordinating care of special-needs children, and 7) guidance on adjustment problems, language delays, preparation for preschool and school, adoption procedures, cultural issues. The second part of the workshop will consist of small group discussions involving several case studies. The workshop team consists of general pediatricians, infectious disease experts, developmentalists, and international adoption clinic directors who provide services to a large number of internationally adopted children and their parents throughout the country. Written materials reviewing workshop concepts and a list of adoption clinics will be distributed.

E. E. Schulte, J. E. Aronson, L. M. H. Albers, S. Blatt; Children's Hospital at Albany Medical College, International Adoption Medical Consultation Services, Mineola, Children's Hospital, Boston, Department of Pediatrics, Syracuse

Medical students have not always had access to information and behavior skills training related to malpractice, and communication skills for difficult situations. Perhaps, as a result, some pediatricians become involved in lawsuits that might have been avoided by using interpersonal skills to enhance the physician-patient relationship. Research suggests that many families file malpractice suits when adverse outcomes are associated with poor physician-patient relationships, physicians' criticism of one another, and unclear communications. This research has led multidisciplinary faculty and risk management staff to develop a 6 hour, small group course for practicing physicians, residents and 4th year medical students taking their 4 week ambulatory pediatrics rotation. The proposed workshop presents a mini version of the course and suggests how it may be adopted elsewhere.

Participants are challenged to: identify patient dissatisfactions that increase risk of suits, communicate effectively in adverse circumstances, relate physician's interpersonal behaviors to patients' perception of quality care and understand risk management's issues and roles. Participants practice with surrogate patients who present 10 cases based on research and actual lawsuits. Scenarios range from a diagnosis of cerebral palsy in which a mother wants to blame her obstetrician to a case of iatrogenic death. The workshop will include a brief lecture, role plays and discussions that focus on: structuring difficult interactions, dealing with patients varied responses to bad news, what to do when you or another physician has erred and principles of risk reduction.

J. Gigante, G. B. Hickson, T. Trotter, J. W. Pichert, Vanderbilt Children's Hospital, Nashville, TN

Many academic general pediatricians, subspecialty pediatricians and community pediatricians serve regularly as attending physicians in the outpatient setting. In this role both teaching of trainees and supervision of patient care occur concurrently in a busy, often fast-paced environment. The goal of this workshop is to provide strategies for physicians to improve the efficiency and effectiveness of their teaching in the outpatient setting. The workshop will be structured as follows: first, participants will identify features of outpatient settings that facilitate good teaching and will delineate potential barriers to effective teaching. Second, we will develop feasible solutions to the barriers. Third, we will identify efficient outpatient teaching strategies that incorporate principles of adult learning. Fourth, we will discuss examples of successful outpatient teaching programs at both our own institution and participants' institutions. Fifth, we will examine and then role-play difficult teaching situations. Finally, we will review the principles and challenges of giving feedback in this setting. Participants will be asked to share their own insights, experiences, and effective outpatient teaching strategies/programs.

P. H. Kaleida; K. Rajakumar; D. L. Bogen. Department of Pediatrics, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA.

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

Introduction: Medical journals increasingly publish clinical 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 and interpret these 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 data sets from studies of common pediatric emergency 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. In the final portion of the workshop, we will discuss how to detect inappropriate/inadequate presentations of multivariate regression, including lack of model diagnostics, unstable models, lack of model validation and co-linearity of variables.

Robert Wright, Jacqueline Grupp-Phelan, Nathan Kuppermann. Divisions of Emergency Medicine, Brown University, Providence RI, University of Cincinnati, Cincinnati OH, University of California-Davis, Davis, CA

Providing pediatric subspecialty care to underserved rural communities has been a long-standing challenge. Several different health care delivery models have addressed this issue, the most common being outreach outpatient clinics with traveling Pediatric subspecialty teams based at tertiary children's centers. This workshop will expose the participant as to how we have utilized telemedicine, live 2 way video linkages, between the rural health care centers and our children's center. We provide 3 types of pediatric patient care: 1) Outpatient subspecialty consultation and follow-up, 2) PICU to rural adult ICU/adult intensivists for critically ill children, 3) Rural emergency rooms to our pediatric emergency room for acutely ill and injured children. Although the model of outpatient consultation is well established, the PICU to Adult ICU is a new model and has many challenges and opportunities that will be discussed. These include acceptance of a rural partner, ability of the PICU to triage and control all patient flow and beneficial relationships derived by supporting appropriate patients to remain in the local community. The rural ER to pediatric emergency room model involves a complex electronic network but is well received in rural communities. A limited discussion of technical details will also be available.

R. J. Dimand, J. P. Marcin, H. J. Kallas, Department of Pediatrics, University of California Davis, Sacramento, CA

The repercussions of violence affect pediatric patients and their families every day. Many residency training programs struggle with how to address this new epidemic. This workshop presents a model of a creative, comprehensive violence assessment and prevention curriculum, encouraging medical educators to explore new teaching methods. We hope to stimulate a lively discussion of educational strategies: didactic presentations, multimedia demonstrations, standardized patient interviews, community resource displays and evaluation methods. Attendees will be trained in case-based role-play scenarios to facilitate learners' communication skills within the patient-physician encounter. The workshop will offer specific didactic outlines and examples of pertinent videotapes and community resource displays as springboards for conversation regarding improvement of resident violence education. The model suggests one evaluation method that reinforces the newly acquired competencies via the creation of learner contracts. Small group discussions will be used to generate new ideas in violence-related curriculum development and evaluation.

Shannon Phillips, Jill Mazurek, Mary Ciccarelli, Marilyn Bull, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN

This 3-hour minicourse will help the primary and subspecialty care providers understand better the changing field of diabetes mellitus: its pathophysiology, epidemiology, and advances in management. The availability of new treatments and devices for the care of patients with Type I diabetes has changed dramatically over the past decade. The rising prevalence of Type 2 diabetes, closely linked to the obesity epidemic, is bringing a formerly "adult" disease into the pediatricians' offices. This minicourse will provide an overview of four pertinent areas, by speakers who are leaders in the field.

Cell Biology of Human Pancreatic Islets
Alberto Hayek, University of California San Diego Medical School, La Jolla, CA

Islet Transplantation in Humans: 2001 and Beyond
R. Paul Robertson, Pacific Northwest Research Institute, Seattle, WA

BREAK

Type 2 Diabetes in Childhood and Adolescence
Francine R. Kaufman, Children's Hospital of Los Angeles, USC School of Medicine, Los Angeles, CA

The Continuity Directors SIG, which was organized by Jan Drutz over 10 years ago, has continued as a very active network for preceptors in resident continuity settings.

We're very pleased that over the years, the group has grown and completed projects that none of us individually could have accomplished. The annual SIG meeting, workshops, directories with clearing house information, newsletters (The Continuity Connection), and research have blossomed by the involvement of countless individuals committed to enhancing resident education. Our group has remained consistently enthusiastic and highly motivated because of all the Continuity Directors' and preceptors' attendance and active participation!

Everyone is welcome to join us for our annual meeting in Baltimore. This provides an opportunity for preceptors and directors to network and learn about current projects and "hot topics" of interest. As usual, we will focus primarily on one interactive discussion interest (selected from suggestions made at our 5/00 meeting) and continue discussion on the Continuity Program evaluation in the RRC accreditation process and curriculum development. Specific agenda information will be available in the spring newsletter and on the APA Web site.

The Special Interest Group on Managed Care is committed to educating medical students, pediatric housestaff and faculty about managed care and its impact on pediatric education, teaching and research. This year's program will focus on several training programs who have developed formal curriculum and clinical experiences highlighting managed care. Representatives from the "Partners in Quality Care" programs funded by the Robert Wood Johnson will be invited to discuss what they have done locally to improve education of students and housestaff in managed care. It should be an interesting and exciting session. All are welcome!!

Functional Foods in the Pediatric Diet

This topic will be presented by Walter Glinsmann, MD Fellow at the Center for Food and Nutrition Policy at Georgetown University.

Functional foods are defined as foods or food components that provide a health benefit beyond basic nutrition. These functional components may range from alpha carotene and fiber to probiotics and prebiotics. Many families are interested and aware of the functional value of foods and seek information from health care providers about their use in pediatrics. This talk will address issues specific to infancy and childhood with discussion of specific topics to follow.

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 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

Two cases of children with asthma will be presented. The group will work through these cases formulating a plan for diagnosis and management. Objectives Include: Recognize warning signs of asthma, determination of asthma, class severity; identification of asthma triggers; familiarity with concepts of pulmonary function testing and peak flow monitoring; understanding of the role of inflammation and anti-inflammatory therapy; recognition and comprehension of potential side effects of medications and the disease patterns, development of asthma action plans using peak flow measurements and formulation of environmental control measures based on history and allergy testing.

Diane Schuller, Penn State College of Medicine, Jay Selcow, AAP Section on Allergy and Immunology

The importance of community-based pediatric training was formally recognized when, in 1996, the Residency Review Committee (RRC) for Pediatrics mandated structured educational experiences in community pediatrics. Under the leadership of late Foundation president pediatrician Anne E. Dyson, the Dyson Foundation, launched a program to stimulate innovation in community pediatrics residency training. The ultimate goal of The Dyson Initiative-Pediatric Training in the Community, which allocates $2.5 million over five years to pediatric residency programs, is to expand the repertoire of residency training to include teaching and experiences in community-based medicine and advocacy.

This workshop will focus on curricular changes that can be implemented to strengthen community-based training. Representatives from Dyson Initiative-funded sites will present innovative curricular enhancements, focusing on those changes that need not require a large monetary investment. They will also discuss the faculty development strategies that accompany curricular change. In the second part of the workshop, Dyson Initiative grantees will present their experience with community collaboration. Practical lessons learned from taking the residency outside the hospital/clinic walls will provide participants with insight into this integral facet of community pediatrics.

M. K. Goyal and J. S. Palfrey, The Dyson Foundation, Millbrook, NY and Dept of General Pediatrics, Children's Hospital, Boston, MA.

The process of designing curriculum begins by identifying specific educational objectives or "competencies" that must be achieved. We will discuss the concept of establishing a "minimal set" of required competencies, and whether that process actually enhances or reduces learner achievement. The steps of curriculum development will be presented, including the process of needs assessment, and the conversion of published educational guidelines (such as those of the APA and COMSEP) to specific, objective, measurable competencies. The development of evaluations appropriate for each competency will also be described. We will then discuss practical considerations regarding implementing, evaluating, and revising the curriculum.

The University of Maryland Pediatric Residency Program is one of the few in the country to have adopted a competency-based curriculum. Excerpts will be presented, along with practical lessons learned from their experience in curriculum development and implementation.

Finally, participants will split into smaller, multidisciplinary Curriculum Development Teams to identify competencies and design a competency-based curriculum focused on a specific clinical topic.

Sponsored by the APA Education Committee.

J. M. Devries and C. Carraccio, Depts. of Pediatrics, Oakwood Healthcare System, Dearborn, MI and Univ. of Maryland Medical Center, Baltimore, MD

Shaken Baby Syndrome is the most common cause of morbidity and mortality in inflicted, abusive head injury; the leading cause of traumatic death in infancy. Recent medical and legal controversies involving high -profile court cases as well the fact that the syndrome is frequently overlooked or misdiagnosed will be focused issues in this workshop. The workshop is designed to guide the physician through the process of diagnostic evaluation, therapeutic intervention, working with a child protection team response that includes medical, psychosocial, law enforcement and legal components, collection of evidence, preparation for court and aspects of expert testimony.

Covered topics will include epidemiology, history taking, physical exam, differential diagnosis, laboratory, radiological and diagnostic testing, crime scene investigation, forensic evidence and the legal response. Factual educational material will be presented with varied audiovisual formats including videotapes of perpetrators as well as demonstrations of the physical dynamics of shaking. The audience will have the opportunity to directly participate through the utilization of role modeling, mock investigation and courtroom trial.

M. Frogel and D. Esernio-Jenssen, Schneider Children's Hospital, New Hyde Park, NY and M. Fisher, Special Victim's Bureau, District Attorney's Office, Queens, NY

Quality training of medical students and residents can be quite demanding and difficult. Issues such as time, resources, curriculum, evaluation and teacher development are important for any educational program. However, the success of such a program is best measured in terms of how well trainees are learning. Effective teaching can only be determined by looking at how well learners change their behavior.

The goal of this workshop is to closely examine how medical students and residents learn in clinical settings. An emphasis will be placed on what constitutes effective learning, rather than effective teaching. Through the use of brainstorming, small group discussion, videotaped vignettes, photograph analysis and role play, participants will actively explore ways in which medical trainees learn. Medical students will participate in this workshop to enhance discussions and simulations. The advantages and disadvantages of rote learning versus meaningful learning will be discussed. Participants will be challenged to find practical solutions to common learning problems and apply these to their own settings.

L. W. Greenberg and R. T. Sarkin, George Washington School of Medicine, Washington, DC and SUNY at Buffalo School of Medicine, Buffalo, NY

Check for information on this SIG on our website at www.aps-spr.org in early 2001.

Check for information on this SIG on our website at www.aps-spr.org in early 2001.

The School and Community Health Special Interest Group will be held on Sunday April 29, 2001 from 2:00 to 5:00 p.m. We will have presentations and discussions on various topics in this area. We will also devote time to planning a SIG long-term project that was discussed at last year's meeting, such as conducting a needs assessment of pediatricians regarding training in school health or creating a resource manual of programs. This promises to be an interesting, productive and interactive session and we welcome all meeting attendees. If you have any questions or suggestions for specific topics, please contact either Elisa Zenni at (904)244-7260 or elisa.zenni@jax.ufl.edu or Beth Edgerton at (202) 884-5000 or eedgerto@rand.org. We look forward to seeing you in Baltimore!

The present standard treatment of AOM in the U.S. is antibiotic, although the literature suggests that many children with AOM will recover with symptom management only. Furthermore, AOM is often over diagnosed due to the difficulty in performing otologic examination in young children. The widespread use of antibiotics has lead to emergence of multidrug-resistant bacteria. Reduction of unnecessary use of antibiotic can be done in 2 major ways: 1) improving accuracy of the diagnosis, and 2) withholding antibiotic in mild cases of AOM. This workshop will make use of modern instruments and ear models to aid participants in making an accurate diagnosis, and differentiating mild from severe cases. The hands-on demonstrations include: a) use of the binocular headlight to facilitate cleaning of the ear canal, b) obtaining and interpreting a tympanogram, c) techniques for successful pneumatic otoscopy in the young child, and d) performing a tympanocentesis. In addition, participants will grade a set of tympanic membrane photographs obtained by high resolution tele-otoscopy, critique our method for distinguishing "mild" from "severe" AOM, and problem-solve management options in AOM cases with an expert facilitator. This interactive learner-oriented workshop can be replicated for students and residents in your own program with the assistance of handout materials to be provided and/or logging onto our AOM website at http://atc.utmb.edu/aom/.

D. McCormick, K. Saeed, T. Chonmaitree, C Baldwin, University of Texas Medical Branch at Galveston, TX

Meta-analyses are becoming increasingly popular as a way to summarize knowledge about clinical questions. Meta-analyses have an air of objectivity; but can their results be trusted at face value?

The goal of this workshop is to help clinicians interpret the findings of published meta-analyses. We will review the purpose of meta-analysis, and emphasize the importance of determining sources of heterogeneity among studies. We will discuss concepts such as publication bias and sensitivity analysis. The workshop will provide an overview of how meta-analyses are performed, focusing at each step on the elements that distinguish a good meta-analysis. The statistical methodology will be reviewed purely on a conceptual level. We will interpret funnel plots, and discuss the meaning of a random effects and fixed effects model. Workshop participants will be given examples of meta-analyses to critique, and will work through sample data analyses that illustrate key concepts. By the end, participants should be comfortable deciding when a meta-analysis is helpful, and when it may lead to false conclusions.

Yvonne W. Wu and Tom B. Newman, University of California, San Francisco, San Francisco, CA

This workshop provides continuity faculty an opportunity to collaborate in the development of core competencies for the continuity experience. Currently the Residency Review Committee (RRC) offers a broad description for continuity but does not address specific competencies or site-specific differences. The RRC is moving towards competency-based requirements in its next revision. Thus, it is timely to consider which competencies should be core for the continuity experience and which are most appropriate to emphasize in specific types of continuity settings (e.g., hospital- based and community sites).

The Continuity Directors' SIG Task Force will present a working draft of competencies for continuity, developed with input from the SIG membership over the year. Attendees will break into subgroups to prioritize these competencies and to select those most appropriate for emphasis in hospital and community-based continuity sites. Teaching and evaluation methods for several key competencies will be explored. Subgroups will bring their recommendations and non-consensus suggestions to the full group for discussion. After the meeting, a summary of recommendations will be sent to attendees and to the APA Education Committee, in order to guide the APA's response to the RRC and to aid in revision of the next APA Educational Guidelines for Residency Training in. General Pediatrics.

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

In education, research is often focused on the determination of progress that students have made toward educational goals. These studies use methodologies which 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.

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 programs, participants will be able to appreciate the uses of quantitative and qualitative studies in medical education.

A. A. 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

Primary care physicians increasingly encounter behavior problems (e.g., noncompliance, sleep problems, and ADHD), but sometimes these problems do not resolve with an exclusive child-symptom centered approach. Furthermore, physicians are encountering interaction-psychosocial problems (e.g., relationship and communication problems, family affective disorders, social-emotional complications of ADHD and learning problems, parent-teen conflict, and parent stresses) that require a family systems approach to assessment and treatment, i.e., viewing the problems and the solutions within the family-social context in which they arise. Most physicians are not trained in family systems-family interviewing techniques, which are needed for these clinical situations.

The goal of this workshop is to teach these techniques. Specifically, attendees will learn basic family systems principles, three models of interviewing techniques, the use of family drawings and genograms, and how to deal with the difficult family.

The workshop will be very interactive. Teaching techniques include case studies, brief didactics, videotapes of family interviews, and extensive handouts. Attendees should bring their own case studies for discussion.

William Coleman, Dept. of Pediatrics, Univ. of North Carolina, Chapel Hill, NC

In the late 1990s, there has been an epidemic of schoolyard shootings. Yet data seem to show that the rate of juvenile violence is decreasing. Why the discrepancy? Can adolescents who are prone to commit violent crimes be identified ahead of time? Why do they commit such crimes. Are we "teaching" our children how to kill? What role do the media play in these crimes?

This workshop will employ an informal approach to answering at least some of these questions, using data, case vignettes, role playing and video clips.

Dr. Strasburger is a nationally known expert on children, adolescents, and the media. Lt. Col. Dave Grossman is an Army Ranger, a West Point Psychology Professor, and a Professor of Military Science who wrote the Pulitzer-Prize-nominated book, On Killing, and the recent book, Stop Teaching Our Kids to Kill. He was a consultant after the Jonesboro, AR, Paducah, KY, Springfield, OR, and Littleton, CO school shooting incidents and testified in the trial of Timothy McVeigh.

Vic Strasburger, M.D., Professor of Pediatrics, Univ. of New Mexico School of Medicine and Lt. Col. Dave Grossman, U.S. Army (Ret.)

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, Undergraduate Medical Education for the 21st Century: A demonstration of curricular innovations to keep pace with a changing health care environment (UME-21). The $7.6 million project began in October 1997 and is administered by the American Association of Colleges of Osteopathic Medicine. UME-21 provides contract funds to eighteen allopathic medical schools to develop, implement and evaluate innovative primary care 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 interdisciplinary teaching and learning 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. At the conclusion of the workshop, common barriers to implementation and effective strategies to address those barriers will be identified.

J. Pascoe, C. Christian, K. Ling-McGeorge, H. Loeser, F. McCurdy, C.A. Olson, S. Rattner, B. Zatelli

Recent guidelines for health supervision include Bright Futures, AAP GHS III, and DSM-pc codes of psychiatric risk. Problems with implementation include: lack of evidence, time required, lack of economic reinforcement, complexity of DSM-pc coding, and lack of training for management, particularly of mental health concerns. Our Child Health and Development Interactive System (CHADIS) facilitates implementation of guidelines using computerized parent questionnaires, e.g., all DSM-pc categories, child strengths, health risks. Computer analysis of responses results in suggested diagnoses with specifically related prompts and guides (e.g., trigger questions, differential diagnoses, potential recommendations, menus of appropriate products and resources such as tutors, etc.) on the electronic medical record worksheet the clinician uses during the visit. The clinician's interaction with the system results in reports (health passport and memory book) for parents. Products and local resources are provided with reviews by experts and without advertising. CHADIS will include validated tools for some aspects of developmental surveillance (e.g., START; Communication Screening System) and for further evaluation of problems (e.g., autism checklists, depression inventories). CHADIS will be free, initially offered to faculty interested in training and collaborative research. We will: demonstrate how CHADIS addresses common problems such as encopresis, sleep problems, ADHD; present data on parent response to CHADIS and pilot prevalence data for DSM-pc; elaborate on its use for collaborative research; and provide an opportunity for joining the network.

Raymond Sturner and Barbara Howard, The Johns Hopkins U School of Med., Baltimore, MD

Despite clinicians' universal intentions to provide excellent care, actual care often falls short. These gaps in care lead to worsened health status, decreased satisfaction, increased costs, and clinician and staff distress. Achieving major enhancements in care requires substantial restructuring of the approach to care and changing office systems to better meet patient, family, and staff needs.

The National Initiative for Children's Healthcare Quality (NICHQ) seeks to eliminate the gap between what is and what can be in health care for all children by raising the will to improve, developing better strategies to accomplish change, and directly assisting practices in their improvement activities. This direct assistance entails measuring current performance, training practice staff about how to achieve change, providing expertise in providing tools and materials to enhance improvement, and supporting change through the formation of "collaborative learning groups." NICHQ, building on the practice guidelines of the American Academy of Pediatrics, has launched a new project to transform care for children with ADHD.

The objective of this workshop is to provide participants with the fundamentals of how to promote change in primary care settings for children so that they better meet the needs of children, families, clinicians, and staff. We will build on the example of ADHD, and give participants the opportunity to plan actual changes they might bring back to their care settings.

C. J. Homer, P. Margolis, P. Heinrich, L. White, J. Perrin. National Initiative for Children's Healthcare Quality, Boston, MA; Chapel Hill, NC; and Seattle, WA; Mass General Hospital for Children, Boston, MA

This session will provide important new mechanistic information about the maternal, placental and fetal influences on certain adult onset diseases. Investigators undertaking studies that are on the cutting edge will provide an overview and share some of their recent experimental results during this session. The first lecture will concentrate on maternal health and its role on adult onset diseases; the second lecture will delineate the role of placental factors; while the third session will detail fetal origins of adult hypertensive disease.

Overview
Sherin U. Devaskar, Mattel Children's Hospital, University of California, Los Angeles, CA

Maternal Health and Its Influence on Adult Onset Diseases
Judith G. Hall, University of British Columbia, Vancouver, Canada

The Placenta Dilemma
Susan Fisher, University of California, San Francisco, CA

Fetal Origins of Adult Hypertension
Susan Bagby, Oregon Health Sciences University, Portland, OR

Discussion

This symposium will provide a broad overview of the state of the pediatric AIDS pandemic. The results of recent trials investigating approaches to prevention and treatment of vertical HIV transmission in the developing world will be discussed. Collaborative approaches and opportunities for partnership in international pediatric AIDS treatment, education, and research will be highlighted.

Overview
Mark W. Kline, Baylor College of Medicine, Houston, TX

Pediatric AIDS: State of the Pandemic
Meg Gwynne Ferris, Baylor College of Medicine, Houston, TX

Approaches to Prevention of Mother-to-Child HIV Transmission in the Developing World
Lynne M. Mofenson, National Institute of Child Health and Human Development, Rockville, MD

Collaborative Approaches to International AIDS Training and Research
Kenneth Bridbord, Fogarty International Center, National Institutes of Health, Bethesda, MD

Models of Partnership in Pediatric AIDS Treatment, Education and Clinical Research: Romania and Botswana
Mark W. Kline, Baylor College of Medicine, Houston, TX

Hormones regulate critical biological functions including neurologic growth, sexual differentiation, and organ maturation, through intricate signaling mechanisms. Pregnant women, infants, and children are increasingly exposed to chemicals in the environment that mimic or block hormones, often at very small doses. Exposure to these endocrine disruptors occurs at home, in the workplace and the community, and even as a consequence of medical care. This session will review the growing evidence of adverse health effects due to exposure to endocrine disruptors and discuss new research efforts that will help fill in the gaps in our knowledge in this area.

Overview
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

The diagnosis and treatment of H. pylori in children is a controversy surrounded with questions of who should be tested, what are the most reliable tests, who should be treated, and what is the preferred therapy. A panel of experts will examine the epidemiology and clinical outcomes of infection, microbial and host factors, and the newly published clinical practice guidelines from the North American Society for Pediatric Gastroenterology and Nutrition.

Overview
Benjamin D. Gold, Associate Professor of Pediatrics and Microbiology, Emory University School of Medicine, Atlanta, GA

Epidemiology and Clinical Outcomes of Infection
John D. Snyder, Professor of Pediatrics, University of California Medical Center, San Francisco, CA

Microbial Genome and Virulence Determinants
Philip M. Sherman, Professor of Paediatrics and Microbiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Host Responses as Determinants of Disease Outcome
Sheila Crowe, Associate Professor of Medicine, University of Texas Medical Branch, Galveston, TX

NASPGN Clinical Practice Guideline Summary and Recommendations
Steven J. Czinn, Director, Division of Pediatric Gastroenterology and Nutrition, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH

1) Ongoing research projects
Descriptions of innovative educational and clinical programs

The second meeting for this group will be held on Monday, April 30 from 9-12 am at the Baltimore PAS meeting. This SIG is designed for those community-based APA physicians involved in academic pursuits such as practice-based research or teaching in a community setting. Items to be covered include the relationship of our group to the APA (faculty development, academic appointments etc.) and the AAP (CATCH, PROS etc.) and how the group can develop a network for better communication about programs (the first newsletter should be published this Fall) including a data-base to allow trainees to access those sites involved in a variety of teaching and research functions. Any questions or suggestions should be addressed to Dr. Emanuel Doyne (doyne0@chmcc.org or 513-636-8043).

The identification and measurement of health care quality for children with chronic conditions is a pressing need shared by clinicians, health plans, consumers and Federal, State and local health agencies. Available methods vary widely in the definition of chronic condition used and cost of administration. The goal of this workshop is to outline alternatives for identifying and measuring quality for children with chronic conditions and an approach that is expected to be used in National health plan monitoring systems (HEDIS) as well as the National Medical Expenditures Panel Survey (MEPS). Two parent survey based and administrative/diagnostic based method for identifying children with chronic conditions will be compared in terms of their appropriateness for alternative applications such as case identification, quality improvement, quality assessment, comparing performance of providers and/or health plans or community health assessment. Results from a 16 sample, multi-State, multi- health plan study testing and comparing these methods will be used as a basis for recommendations. Real life examples of using the identification and measurement tools for prevalence's estimation, case identification, quality improvement and performance comparison will be provided.

C. D. Bethell, D. K. Read, The Foundation for Accountability, P. Newacheck, UCSF Institute for Health Policy Studies, R. E. K. Stein, Albert Einstein College of Medicine, J. Fowler, University of Massachusetts, J. Thompson, Arkansas Children's Hospital

The objective of this workshop will be to introduce strategies to teach pediatric residents about the Healthy Steps approach of developmentally-oriented, primary care. With the support of the Commonwealth Foundation and other funders, we developed an innovative program (presently in 24 practices nationally) called "Healthy Steps" (HS). HS enhances services for young children in primary care through such strategies as teachable moments, promotion of early literacy, parent handouts, and other family supports. To implement HS, we have created an interactive curriculum involving video vignettes of children's behavior and a CD-ROM to help pediatricians better understand and respond to the social, emotional, fine motor, and cognitive development of infants and toddlers. Specifically, the curriculum emphasizes improving observational skills and understanding the meaning of children's behavior and development.

The curriculum and associated videos have been presented to more than 50 faculty of pediatric residency training programs and are presently used in a variety of settings, including pre-clinic primary care conferences or as part of developmental and behavioral pediatrics rotation. This workshop will provide the tools to enhance resident training in developmental and behavioral issues through its innovative, multi-media, interactive approach.

Barry Zuckerman, Steven Parker, Margot Kaplan Sanoff, Marilyn Augustyn. Boston University, Boston MA

The medical home model of care is described as accessible, family-centered, comprehensive, continuous, coordinated, compassionate and culturally-competent. Components include attention to mental health, parent support, education, religious and spiritual support, access to specialists, and finances.

Community pediatrics recognizes economical, educational, environmental, social, political and family forces that impact on child health. Service integration and advocacy are seen as key to the medical model and the practice of community pediatrics. The role of the interdisciplinary team proposes new avenues for effective health care delivery. Translating these concepts into reality as part of program design is challenging. Integrating residency education, program evaluation, and promoting sustainability require a deliberate process. This workshop will address the key components of innovative programs providing improved access to care for children and adolescents. The panelists will review the literature, summarize the experience of the broad-based community partnerships of the Community Access to Child Health Programs (CATCH) and the experience of the recipients of the APA Health Care Delivery Award. The extent to which these models reflect evidence-based practice will be discussed. Specific resources to develop programs will be shared with the workshop participants.

D. Laraque, J. Cox, M. LoFrumento, T. Tonniges, K. Capitulo and the APA Health Care Delivery Committee. Mt Sinai Medical Center, NY; Children's Hospital, Boston; Franklin Pediatrics, NY; American Academy of Pediatrics

Sudden, unexpected death among young athletes is receiving increasing attention by the press and public. This has created a need for physicians working with young athletes to understand the most common causative conditions, and how to respond appropriately.

Participants will understand common causes of sudden cardiac death in young athletes, learn about the natural history and clinical features of hypertrophic cardiomyopathy, and obtain the latest guidelines for athletic participation and information on prevention.

Co-sponsored by the AAP Sections on Sports Medicine and Fitness and Cardiology.

Ronald Feinstein, University of Alabama Birmingham, Reginald Washington, AAP Committee on Sports Medicine and Fitness, Barry I. Maron, Mayo Clinic

Introduction: Practicing evidence-based decision-making (EBDM) is an essential skill for lifelong learning among practicing pediatricians and pediatric residents. The author has developed a set of workshops for general pediatricians designed to help build skills in EBDM and to teach these skills to residents in their clinics.

Goals: As a result of this workshop, participants will be able to 1) translate a clinical scenario into a well-built clinical question; 2) describe basic literature search techniques; 3) critically appraise an article; and 4) describe several tools useful for the daily practice of EBDM. This workshop will be useful for those just learning about EBDM and those want to teach this material to students or residents in their offices.

Format: Following a brief overview of EBDM, the participants will self-select small groups to focus on skills in the practice or teaching of EBDM. Each will have its own facilitator, to ensure that each participant comes away with the skills and comfort to be able to apply this knowledge in their daily practice. Special attention will be given to the newest sources available through the internet to facilitate the practice of EBDM. The session will conclude with discussion of useful pearls for the practice and teaching of EBDM generated by the participants. Participants will receive a workbook with handouts, pediatric case discussions, and teaching materials.

J. G. Frohna, Sheila Gahagan, Kenneth Pituch, Stephen M. Park, Department of Pediatrics, University of Michigan, Ann Arbor, MI

Increasingly, scientific evidence is becoming available that links chronic diseases such as atherosclerosis, neuropsychiatric disorders and certain malignancies with infectious roots. Faculty will expose the fascinating existing information and help put novel findings and theories in perspective.

Are All Diseases Infectious?
Bennett Lorber, Temple University School of Medicine, Philadelphia, PA

Chlamydia pneumoniae and Atherosclerosis: Weighing the Evidence
Thomas C. Quinn, Johns Hopkins University School of Medicine, Baltimore, MD

Epstein-Barr Virus, Lymphoproliferation and Cancer
John L. Sullivan, University of Massachusetts School of Medicine, Worcester, MA

There is a growing body of research examining the prevention of child abuse and neglect. The link between domestic violence and child maltreatment has become increasingly clear, with important implications for pediatricians. Recent studies have demonstrated the potential impact that various strategies could have on the incidence of abuse and neglect. This symposium will present new information regarding the use of home visitors and the role of physicians in identifying and preventing abuse. The presenters will also discuss the need to establish child abuse prevention as a higher priority for funded research and as a major public health concern.

A National Call to Action To End Child Abuse
David Chadwick, Director, Emeritus Center for Child Protection, Children's Hospital, San Diego, CA, Emeritus, Center for Child Protection, Children's Hospital, San Diego, CA

Domestic Violence, Child Maltreatment, and the Pediatrician's Role
Howard Dubowitz, Professor of Pediatrics, Chief, Division of Child Protection, University of Maryland School of Medicine, Baltimore, MD

Building Systems To Improve Preventive Care: Linking Home and Office-based Prevention
Peter A. Margolis, Children's Primary Care Research Group, University of North Carolina School of Medicine, Chapel Hill, NC

Preparing Physicians To Identify and Prevent Abuse
Desmond K. Runyan, Professor and Chair of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC

The Pediatric Environmental Health Special Interest Group is again invites your participation at our annual session at the Spring Pediatric Academic Societies Meeting in Baltimore. Our agenda will include the following:

1. Educational /Training session - Toxic Effects of Herbal Remedies - - Michael Shannon, M.D.
2. Pediatric Environmental Health Training during Pediatric Residency Programs - examples from the field
3. New Ambulatory Pediatric Association Environmental Health Fellowship - a status report
4. Environment Health and the Underserved - collaborative opportunities
5. Research Presentations

SIG Business

The Injury Control Special Interest Group of the APA will hold its annual meeting on Tuesday, May 1st, from 8:45-11:45am in Baltimore, Maryland. A special presentation will be made by Dr. Michael Weitzman from the AAP's Child Health Research Institute concerning new research initiatives within the Institute and how injury control research issues might be addressed. A second presentation on PROS is also tentatively planned. Dr. Mort Wasserman (or another staff member) of the PROS Network, will discuss how PROS works and how it might be utilized to answer clinical questions concerning childhood injuries.

Reports from SIG members on their local activities in injury control will also be discussed. New funding opportunities will also be explored through the pertinent Federal agencies. All are invited to attend the SIG.

This year's Pediatric Telephone Care SIG will focus on resident education in pediatric telephone triage. We will revisit the goals of a resident curriculum in pediatric telephone triage. We will then have several programs present the details of their curriculum for discussion. The session will include the presentation of current tools being used in the evaluation of resident telephone triage education. It is the intent of this session to allow the participants to leave this working session with the goals of a resident curriculum, examples of types of resident training modalities and the means to evaluate the success of resident learning. Anyone interested in presenting their curriculum or resident training ideas should contact Andrew Hertz, M.D. at 216-844-7731 (HertzA@aol.com) or Allison Kempe, M.D. at 303-764-8245 (Kempe.Allison@tchden.org)

The objective of this workshop is to address key issues concerning the use and safety of dietary supplements in infants and children. There is a growing body of evidence that nutrients and other bioactive components of foods play a significant role in health promotion and disease prevention in adults and this information has increased the use of dietary supplements in infants and children. However, little is known about the interaction between the use of many of these supplements and developmental physiology and behavior in children. Such knowledge is critical when evaluating either the justification or safety of this trend. Topics to be addressed at the workshop include: 1) Current usage patterns among infants, children and adolescents; 2) Evidence-based justification for dietary supplement use at various developmental stages; 3) Age-dependent factors influencing bioavailability, pharmacology and safety; 4) Behavioral factors that impact attitudes and beliefs about dietary supplements; 5) Biomarkers for the assessment of efficacy and safety; and, 6) Identification of research needs.

P. M. Coates, D. J. Raiten and M. F. Picciano, Office of Dietary Supplements, National Institutes of Health & Office of Prevention Research and International Programs, National Institutes of Child Health and Human Development, Bethesda, MD

Over the past 25 years, US citizens have adopted mot\re than 200,000 foreign-born children. Annually, Americans adopt more children internationally than citizens of all other countries combined. Recently, there have been major shifts in the sending countries, the characteristics of the children and of the adoptive parents and in the medical and ethical questions faced by pediatricians in working with this special population of children.

Using real life examples of medical records and videotapes, this workshop will give the practitioner hands-on experience in the types of issues and range of problems presented to families at the time they are considering adoption. The most common medical, developmental and behavioral concerns will be addressed in the context of what is the "abstractnorm" for different orphanages and cultures.

The second part of the workshop will focus on the short and long-term follow-up of the children after adoption. Again, using real-life examples, the practitioner will have the opportunity to review some of the major issues facing these children and their parents as they recover from a myriad of social and medical insults.

Jerri Ann Jenista, Departments of Pediatrics and Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI and Provisional Section on Adoption, American Academy of Pediatrics

Type 2 diabetes (DM2) is increasingly a pediatric disease, especially among minority youth. While there is extensive patient educational material available for adults, there is very limited information oriented toward youth. As a consequence, patient and family education for youth with DM2 is often haphazard - with the physician and diabetes educator being forced to select from materials that are behaviorally or intellectually inappropriate. For example, adult education literature focuses on avoiding long-term sequelae, like end stage renal disease; however, adolescents have a limited ability to undertake long-term planning and many have not yet been exposed to the important role of the kidneys.

In the workshop, an overview of contemporary educational material available for DM2 adults and a survey of DM2 materials used by pediatric diabetes specialist will be provided. Then, the participants will evaluate the style and content of 2 contemporary videotapes and 2 chapters from DM2 educational manuals. Finally, a roundtable discussion will be held to identify 8-10 key concepts to be communicated to youth with DM2, the format that would most effectively communicate these (e.g., manuals vs. videotapes) and potential barriers to translating concept into action.

Daniel E. Hale, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX

Assessing adolescents for use of alcohol and drugs presents a major challenge for clinicians in the current primary care environment that emphasizes patient volume. The goal of this workshop is to develop clinical skills in using brief structured assessment tools to assess adolescents for drug or alcohol use. The workshop is intended for pediatric clinicians and pediatric educators.

Participants will learn: (1) To use structured assessment instruments that have been validated for adolescents, and (2) Strategies for interviewing adolescents. This workshop will use a standardized case, The Pinpoint Pupil, along with additional audio-visual materials for skills development. Workshop participants will be invited to discuss the management of an adolescent who is brought to a Pediatricians office because of marijuana use. The CRAFFT mnemonic will be presented. Participants will then watch video tapes of interactions between clinicians and adolescents, and discuss the subtleties of interviewing techniques and their impact on information revealed by the patient. The workshop will conclude with a discussion of how these techniques can be applied in the office and in teaching pediatric residents. Each participant will receive a copy of the complete teaching module, with handouts and references, for use in his or home institution.

S. Levy, B. Vaughan, A. Arneill, J. R. Knight, Department of Pediatrics, Harvard Medical School; Division of General Pediatrics, Children's Hospital, Boston, MA

Each year there are thousands of injuries and deaths in US 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,* J. Gould,* B. Taylor,* J. Fein,# K. Osterhoudt# A.I. duPont Hospital for Children,* Wilmington, DE and Children's Hospital of Philadelphia#, PA

Asset Based Community Development (ABCD), a community building approach promoted by John McKnight and Jody Kretzmann, can be an important skill in community pediatrics. ABCD stresses identifying and mobilizing community assets to improve well-being. CATCH developed an educational curriculum to teach pediatricians the fundamentals of mobilizing communities. The Northern California CATCH Committee and the ABCD Institute presented this curriculum to pediatricians and their community partners with the support of Sierra Health Foundation.

The goals of this workshop are to introduce the CATCH curriculum, present ABCD concepts, and establish a basic framework for community building activities. This workshop includes an overview of the whole CATCH curriculum and presentation of two components: asset mapping and forming partnerships. In asset mapping, participants learn about the potential of associations and how to identify these untapped community resources for improving children's health. The participants then develop strategies to mobilize these community partners for a potential community-based project in the second session. The other components of the curriculum, setting goals and objectives and evaluating results, will be described in the overview.

Arnold Gold, Diane Littlefield, Carol Pandak and Richard Pan; Fremont-Rideout Health Group, Yuba City, CA; Center for Collaborative Planning, Public Health Institute, Sacramento, CA; Dept. of Community Pediatrics, American Academy of Pediatrics, Elk Grove Village, IL; UC Davis, Dept. of Pediatrics, Sacramento, CA.

Despite increasingly prevalent curricula on cultural sensitivity and awareness in medical school, there are no published descriptions of faculty development programs to prepare primary care educators to teach students this material in community settings. This workshop will describe and involve participants in a curriculum developed at the UMASS Community Faculty Development Center that teaches primary care physicians to incorporate cultural competence and patient advocacy into their office-based teaching activities. The curriculum is delivered in 3 modules presented to our community faculty during a faculty development series. Participants will be provided with a concentrated version of our three modules.

Participants will be oriented to the educational planning process (GNOME) developed at our institution. We will discuss how to assess the needs of students with regard to cultural sensitivity, using an interactive format and videotaped examples. Teaching methods that assist with attitudinal objectives including collaborative and facilitative teaching styles, self-reflection and role modeling will all be emphasized. After a short break, 4 specific strategies that facilitate the development culturally competent students will be reviewed: the Patient-Centered Interview; the Social Review of Systems; the LEARN negotiation technique; and use of the community as teacher. Following a large group video demonstration role-play, participants will then break out into small groups. Teaching case vignettes that emphasize needs assessment, attitudinal objectives and teaching skill objectives will be role-played in the small groups, and discussed. Finally, we will reconvene to present workshop evaluation data and discuss ways in which this curriculum could be adapted to their home institution.

D. M. Keller, W. J. Ferguson. Departments of Pediatrics and Family Medicine/Community Health, UMASS Medical School, Worcester MA

The Human Genome Project is impacting every aspect of medicine. Dr. Craig Venter, President of Celera Genomics, one of the chief architects of this venture, will discuss the accomplishments of the human genome project and implications for future impact on health and disease in this special one-hour state of the art lecture.

Sequencing the Human Genome
J. Craig Venter, President, Celera Genomics, Rockville, MD

Supported in part by an educational grant from the Columbus Children's Hospital, Columbus, OH

Previously we have thought that most infections are the circumstance of "bad luck". This session will highlight the exploding information on our innate immunity, subtle defects that cause susceptibility to certain pathogens, and the remarkable mechanisms of microbial pathogenesis.

Toll-like Receptors, Innate Immunity and Responses to Microbial Antigens
Moshe Arditi, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA

Evading Host Defenses: Lessons from Bordetellae
Jeff F. Miller, UCLA School of Medicine, Los Angeles, CA

Recurrent Urinary Tract Infections: Acute or Chronic?
Scott Hultgren, Washington University School of Medicine, St. Louis, MO

Advances in molecular genetics and high through-put analytical chemistry like tandem mass spectrometry (MS/MS) are enabling technologies that permit expanded newborn screening for presymptomic diagnosis of disorders not previously feasible. The prototype genetic disease for which newborn screening is now available is cystic fibrosis. The group of metabolic diseases that can now be diagnosed by MS/MS includes medium chain acyl-CoA dehydrogenase (MCAD) deficiency and related disorders of fatty acid oxidation. This symposium will address the issue of whether these diseases should be added to expanded newborn screening profiles. If so, what is the sensitivity and specificity of the currently available tests? If included in expanded screening programs, who should do the testing and how? What are the implications for genetic counseling? Should any of the new approaches be adapted to preconceptual testing? What important policy issues are created by this new capacity? There is substantial variation among states currently on screening programs. Should there be national guidelines? Who should decide about expanded screening? How will these new tests be paid and by whom?

Overview
James F. Padbury, Women & Infants Hospital of Rhode Island, Brown University, Providence, RI

Newborn Screening for Cystic Fibrosis: An Opportunity To Give Every CF Patient a Healthy Start
Philip M. Farrell, Dean and Alfred Dorrance Daniels Professor on Diseases of Children, University of Wisconsin Medical School, Madison, WI

Tandem Mass Spectrometry and Expanded Newborn Screening
Charles R. Roe, Medical Director, Institute of Metabolic Diseases, Baylor University Medical Center, Dallas, TX

Public Policy Issues in Expanded Newborn Screening
Bradford L. Therrell, Director and Professor, National Newborn Screening and Genetics Resource Center, University of Texas Health Science Center, San Antonio, TX

Discussion

The roles of nature and nurture in shaping behavior are complex and our understanding of them is constantly expanding. Exciting recent findings have given us new perspectives on biologic influences on brain functioning and subsequent behavior. Genetic conditions can be reflected in clearly identifiable behavioral phenotypes. Prenatal exposure to nicotine can have effects that are measurable in adolescence, and low level exposure to environmental toxins are impacting cognitive and behavioral functioning of the current generation. Three outstanding speakers will discuss these advances in our knowledge of neuroscience and their implications for the identification and treatment of a variety of neurodevelopmental conditions.

Overview
Daniel Lee Coury, Children's Hospital, Columbus, OH

Fragile X Syndrome: A Model of Gene-Brain Behavior Relationships
Randi J. Hagerman, University of California at Davis Medical Center, Sacramento, CA

Tobacco, Nicotine and Fetal Brain Damage: The Smoking Gun in ADHD and SIDS
Theodore Slotkin, Duke University Medical Center, Durham, NC

Neurotoxicity of Low-Level Exposure to Pesticides and PCBs
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

The role of experience and the environment in early child development has long been appreciated, but it has been likened to loading software on a computer.  Recent research in neurobiology suggests that early experiences are not only loading software but actually changing the hard wiring of the brain.  Many of the brain’s pathways are in place by three years of age.  What are the implications for this research?  Do these pathways continue to change and evolve with experience? What are the effects of early insults on brain development? This program will focus on the Institute of Medicine Report From "Neurons to Neighborhoods".  The speakers will focus on what is known about the neurobiology of brain development and the implications this research has on child development programs.  The session will highlight how the current knowledge of brain development will impact future research as well as how it may translate into public policy.

A major challenge of daily professional life is keeping abreast of the rapid changes in infectious diseases — pathogens, antimicrobial resistance, therapies and prevention. Four topics are selected because of their timeliness and the importance of new information.

Vaccines: The Good, Bad and Ugly
Jon S. Abramson, Wake Forest University School of Medicine, Winston-Salem NC

Meningococcal Vaccine: Experience and Experiment
Dan M. Granoff, Children's Hospital Oakland Research Institute, Oakland, CA

The MRSA Shows No Mercy
Betsy C. Herold, Mt. Sinai School of Medicine, New York, NY