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 seminar will provide clinically oriented pediatricians with basic epidemiologic and analytic tools needed for the planning, design, and preliminary analysis of a clinical research project. Seminar attendees and leaders will work together to develop a research strategy that includes the development of an appropriate research hypothesis, the selection of proper outcome measures, and the type of data that should be collected. We will then undertake a preliminary organization and analysis of hypothetical data. Brief didactic interludes woven into the seminar will focus on commonly used statistical terms such as relative risks, confidence intervals, and p-values.

Kenneth C. Schoendorf, Chief, Infant and Child Health Studies, National Center for Health Statistics, CDC, Hyattsville, MD
William G. Adams, Division of General Pediatrics, Boston University School of Medicine, Boston, MA

Reviewing articles for peer-reviewed journals combines many skills, including knowledge of the area of investigation, methodology, epidemiology, statistics and the scientific context of the research being reviewed. Judging one’s peers and colleagues is difficult and represents an important aspect of the scientific method. Unfortunately, there is little "formal" teaching of this activity.

In this workshop we will review the process of peer review and discuss those areas that reviewers are usually asked to comment on, including: importance and originality; validity of data; clarity of manuscript; importance for readers; and assignment of priority. Samples of checklists that some journals provide for reviewers will be distributed and discussed. Participants will be asked to review a brief manuscript and formulate their opinions during the workshop. The manuscript and reviews will then be discussed. Finally, sample reviews will be distributed and participants will be asked to assess how helpful the review would be for both the editors as well as the authors. Areas that are most subjective, such as importance for practitioners and scientists and assigning priority will be discussed, with particular attention paid to each participant’s own biases.

There is little formal instruction in the peer-review process – an important aspect of academic medicine. This workshop should help faculties who are beginning to be peer-reviewers.

Howard Bauchner, Professor of Pediatrics and Public Health, Boston University School of Medicine, Boston, MA
Patricia Shiono, The David and Lucile Packard Foundation, Los Altos, CA

Patient safety and quality of care continue to loom large in our patients’ and public leaders’ views about health care. Despite widespread interest in providing safe and excellent care by clinicians, many are uncertain how to respond. This course will provide both a framework for thinking about safety and quality and up-to-date information about major initiatives affecting pediatric care. Course content will specifically include updates on government initiatives about patient safety, a national project to reduce errors in hospitals, an improvement project building on comparative data from neonatal intensive care units, and the current status of efforts at quality measurement for health care accountability.

Overview
Charles J. Homer, National Initiative for Children's Healthcare Quality, Boston, MA

Collaborative Quality Improvement for Neonatal Intensive Care
Jeffrey D. Horbar, Vermont Oxford Network, Burlington, VT

Medication Safety in Children's Hospitals
Carol Haraden, Institute for Healthcare Improvement, Boston, MA

The Child and Adolescent Health Measurement Initiative
David Bergman, Lucile Packard Children's Hospital, Palo Alto, CA

Federal Role in Safety and Quality
Lisa Simpson, Agency for Healthcare Research and Quality, Rockville, MD

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).

The focus of this group is on advancing the recognition, assessment, and management of pain in children. The orientation of the SIG is not on how to manage pain but on the development of strategies that will promote change in health care institutions and individual practice patterns. Presentations may concern the management of pain in specific age groups (e.g. infancy), specific settings (e.g. ambulatory, ED, NICU), specific populations (e.g. developmentally disabled), individuals with specific pain problems (sickle cell, cancer, RSD, headache) or on strategies to promote changes in institution or individual attitudes and practice. The SIG will allow a forum for discussion and sharing of ideas with the goal of reducing pain in pediatric practice.

The Serving the Underserved (STUS) SIG meeting will build on the momentum of last year's meeting and will include:

Research/program evaluation in the STUS arena. We will highlight several successful STUS community-based projects with a special emphasis on successful program evaluation. Presenters will highlight lessons learned and academic areas to be advanced in this area. Discussants will review related resources including the AAP Center for Child Health Research and the PROS Network.

STUS curriculum development. There has been a lot of progress with the STUS SIG web-based curriculum over the last year. We will discuss this project and other curriculum development advances in the STUS field.

Community and the underserved. We will follow up last year's program with a discussion of the progress being made in improving care and education in the community. Discussants from the Dyson Initiative and CATCH will be included.

Legislative update. We will review the status of key federal and state legislative efforts regarding health services for underserved pediatric/adolescent populations.

Come and join us as we work to improve health services and STUS related teaching for underserved pediatric and adolescent populations.

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.

As the clinical venues and topics continue to evolve in pediatric education, faculty are being asked to revise or develop new curricula. Unfortunately, the medical education literature provides little guidance in the specific steps required to develop educationally sound clerkships and rotations. In this workshop, participants will learn a validated model for developing medical curricula. The model has been successfully used with faculty development fellows at Michigan State University for the past decade. At the end of this workshop, participants will be able to: 1) develop curricula using the model, and 2) explain the political and communication issues involved in getting curricula adopted.

The workshop format will include a simulated curriculum development task, brief presentations of essential concepts, and small group activities with feedback. Participants will be provided with an extensive take-home curriculum development manual.

Anne Armstrong-Coben, Columbia University, New York, NY; and William A. Anderson, Michigan State University, East Lansing, MI

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.

Thomas B. Newman, Professor, University of California, San Francisco, CA
Yvonne Wu, Clinical Instructor, University of California, San Francisco, CA

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

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

Thomas A. Hazinski, Professor of Pediatrics, Associate Chair for Academic Affairs, Vanderbilt University Medical Center, Nashville, TN

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

Thomas R. Welch, Louise M. Williams Professor of Pediatrics, Children's Hospital Medical Center, Cincinnati, OH
William F. Balistreri
Stephen R. Daniels, Professor of Pediatrics and Environmental Health, Children's Hospital Medical Center, Cincinnati, OH
Alan H. Jobe, Professor of Pediatrics, Children's Hospital Medical Center, Cincinnati, OH

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

Carol D. Berkowitz, Professor, Harbor/UCLA Medical Center, Torrance, CA
Philip Pizzo, Harvard Medical School, Children's Hospital, Boston, MA

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

Norman Siegel, Professor of Pediatrics and Medicine, Interim Chair and Physician-in-Chief, Department of Pediatrics, Yale University School of Medicine, Yale-New Haven Children's Hospital, New Haven, CT

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

Dimitri A. Christakis, Assistant Professor Pediatrics, Co-director of Child Health Institute, University of Washington, Seattle, WA

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

Thomas G. DeWitt, Professor and Director, Division of General and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, OH

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

Richard C. (Mort) Wasserman, Professor of Pediatrics, University of Vermont College of Medicine, Burlington, VT
Roger F. Soll, Professor of Pediatrics, University of Vermont College of Medicine, Burlington, VT

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

Phyllis A. Dennery, Associate Professor and Associate Division Chief, Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA

Susan B. Shurin, Professor of Pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, OH

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

This minicourse will highlight new technologies in genetics and genomics that build on the mapping and sequencing of human and model organism genomes to define the function of genes and their clinical importance in normal health and disease.

Genetic Analysis of Hematopoiesis and Cancer
Leonard I. Zon, Howard Hughes Medical Institute, Children's Hospital, Boston, MA

Genetic Polymorphisms for Linkage and Association Studies
Aravinda Chakravarti, Johns Hopkins University School of Medicine, Baltimore, MD

Gene Expression: Expression Profiling and Microarray Technology
Jeffrey M. Trent, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD

Workshops are a popular and versatile method of teaching adults. From teaching a procedure to teaching how to teach, from local departmental retreats to national meetings, from precepting students to working to develop the skills of colleagues, workshops are widely used in medical education. This workshop will give participants the tools/framework necessary to construct and lead their own effective workshops. Facilitators of this workshop are from a variety of institutions and are participants in the APA national Pediatric Faculty Development Scholars Program, a project to develop regional faculty development training expertise. We will draw from our experiences in this program and the literature on education to review concepts of adult learning theory and techniques for working with small groups. Through participatory and interactive segments, the group will address how to conduct a needs assessment of the target audience and use the results to plan an effective workshop. Techniques for effective communication, use of audio-visual supplements, and evaluation will be covered. Various techniques for role-playing and audience participation and interaction will be demonstrated. Breakout sessions will allow participants to practice some of the skills that are taught. Participants will receive a listing of national Pediatric Faculty Development Scholars by region to facilitate further networking and long-range access to workshop development expertise.

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

As we entered the molecular genetics era, the hope had been that correlation of mutations with clinical course would permit accurate prediction of prognosis with future patients. However, as increasing information has been accumulated, what has emerged has been the recognition that clinical variability among individuals with identical mutations is the rule, not the exception. We will explore mechanisms for clinical variability, including protein activity, thresholds, modifier genes, and system complexity.

Complexity of Single Gene Disorders
Edward R. B. McCabe, University of California School of Medicine, Los Angeles, CA

Even PKU Is Not a Simple Mendelian Disorder
Charles R. Scriver, McGill University, Montreal, PQ, Canada

Genetic Heterogeneity in CF
Garry R. Cutting, Johns Hopkins University, Institute of Genetic Medicine, Baltimore, MD

Muscle Diseases as Models of Complexity
Georgirene D. Vladutiu, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Children's Hospital, Buffalo, NY

Much attention has been given to advances in molecular biology, the genome project, immunobiology and rational drug design based on sound scientific discoveries. While there has been much excitement generated by such areas, an often expressed concern is "Where's the beef?" This session will attempt to describe several examples of how advances in laboratory science are now being translated into more effective treatments for diseases that have evaded more conventional therapeutic approaches.

Overview

AML as a Model for Novel Cancer Therapeutics
Robert J. Arceci, Director, Pediatric Oncology, Johns Hopkins Oncology Center, Baltimore, MD

Nonmyeloablative Transplants and Novel Conditioning Approaches
Stella M. Davies, University of Minnesota, Minneapolis, MN

New Therapeutic Approaches for Sickle Cell Disease
James F. Casella, Johns Hopkins School of Medicine, Baltimore, MD

Steroid-resistant nephrotic syndrome is one of the most common forms of primary nephrotic syndrome in childhood. Recent genetic and molecular studies indicate that the podocyte plays a central role in the pathogenesis of this disorder. This symposium will address recent advances in our understanding of the development, cell biology, and pathology of the glomerular podocyte. The recent identification of NPHS2, the gene encoding the glomerular protein podocin, and its role in autosomal recessive steroid-resistant nephrotic syndrome will be discussed. Finally, new strategies for therapeutic intervention in steroid-resistant nephrotic syndrome will be described.

Development of the Glomerular Capillary Wall
Dale R. Abrahamson, University of Kansas Medical Center, Kansas City, KS

Cell Biology and Pathology of Podocytes
Peter Mundel, Albert Einstein College of Medicine, Bronx, NY

The Genetic Basis of Steroid-Resistant Nephrotic Syndrome
Corinne Antignac, INSERM, Paris, France

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

This session will provide an introduction to HCUP, a family of databases and tools maintained by the Agency for Healthcare Research and Quality (AHRQ). The objectives of HCUP are to provide data and tools for research on use of health care services in the U.S. HCUP is a partnership among states, industry, and the federal government; currently 26 states contribute data to the project. HCUP includes uniformly formatted administrative databases including state inpatient data, a nationwide sample of inpatient data, a children's inpatient dataset, and ambulatory surgery data. HCUP data provide many advantages for research: (1) all payers including uninsured, (2) all stays within participating institutions, (3) permit state-level analyses, (4) large sample sizes permit studies of subgroups (e.g., minorities, rare diseases or procedures), and (5) charge data.

Recent innovations in dissemination make these data even more accessible. HCUP also includes software and Internet tools to better use these databases, for example, HCUPnet (interactive web-based query tool for HCUP data), free software (HCUP Quality Indicators, performance measures), and clinical groupers (Clinical Classification Software). HCUP has been infrequently used for pediatric research, but recent advances - the Children's Nationwide Inpatient Sample and the Child and Adolescent Clinical Classification Software - will make the databases and tools even more useful to study children's health care issues. Examples of research studies using HCUP data and tools will be used to illustrate applications.

A. Elixhauser, C. Steiner, J. Thompson, Agency for Healthcare Research and Quality, Rockville MD and University of Arkansas for Medical Sciences, Little Rock, AR

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

An OSCE is a clinical performance evaluation tool designed to appraise student behaviors or skills in a variety of areas. OSCEs can provide powerful formative and summative feedback to both students and curricula. Unfortunately, an OSCE can be quite labor intensive and expensive to set up and operate.

The objective of this workshop will be to design OSCE stations that minimize the use of scarce labor and financial resources yet still effectively measure student performance. Participants will review different methodologies, costs associated with each, and the National Core Curriculum in Pediatrics. Using a combination of inexpensive "low tech" and "high tech" props, participants will design OSCE stations to measure specified student skills and competencies. By the conclusion of the workshop, the participant should be familiar with how to create and implement a low-cost 10-15 station OSCE designed primarily to give students formative feedback.

W. V. Raszka and P. B. Patterson, Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT and The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME

Children are a vulnerable class of research subjects because they lack the developmental, intellectual and legal capacity to provide informed consent. Research information is given to parents who are asked to make a decision regarding participation based on their perception of what is in the best interest of their child and society at large. We propose to conduct a workshop for new investigators that will accomplish the following goals: (1) Workshop participants will be able to present the essential elements of informed consent to parents in both written and verbal format. (2) Participants will be able to discuss research involvement with children in a manner appropriate for the child's age, maturity and psychological state. (3) Participants will be able to evaluate the appropriateness of involving adolescents in research with/without parental permission. These goals will be accomplished using a combination of didactic and interactive methods. Case studies consisting of background information, case vignettes, discussion questions and references will be used to explore ethical principles and federal regulations guiding the consent process. Sample consent documents, and videotapes of investigators interacting with parents and potential subjects will be reviewed and critiqued by workshop participants for content, style and effectiveness of communication. The workshop evaluation will consist of pre and post-test questions designed to allow the participant to directly assess their knowledge and skill acquisition.

K. L. Meert, G. Deisinger and E. R. Stinson, Department of Pediatrics, and Office of Research and Graduate Studies, Wayne State University, Detroit, MI.

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

Poster session on current general pediatric residency and faculty development grant activities funded under section 747 of the public health service act

This poster session will:

1. Highlight the uniqueness of these grant activities as well as their contributions in shaping graduate medical education for the nation;

2. Provide a forum for project directors to discuss their activities, challenges and innovations directly with other project directors and colleagues interested in medical education, with the possibility for replication in other programs;

3. Provide an opportunity for initiating networks and collaborative activities with other grantees and participants at the annual meeting and;

4. Provide an opportunity to showcase measurable outcomes from residency and faculty development programs.

This symposium will address a topic of considerable public debate, especially as it relates to research involving human subjects, among these clinical trials using children as subjects, and research involving gene therapy. A recent two-day meeting at NIH was devoted to this subject and it is likely that there will be new and more explicit guidelines promulgated by HHS. The symposium will address these issues from the perspective of academic pediatrics and pediatric research, in particular with regard to the impact on education at both the undergraduate and graduate levels and the availability of appropriate tests and therapies for children. The role of professional societies, such as the sponsoring members of the PAS meeting, will be examined. The symposium is planned to allow at least 30 minutes of interactive discussion between the members of the panel and the audience.

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

The Division Directors in General Pediatrics SIG addresses all issues pertaining to Sections of General Pediatrics, including section and clinic management, patient care issues, finances, educational responsibilities and clinical research.

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 session focuses on the developmental biology of hematopoiesis, utilizing the zebrafish as a genetic model. The focus of research over the next few years, described in this session, will be to understand stem cell biology, particularly focusing on the induction and self-renewal of the hematopoietic stem cell. Through the analysis of these newly derived mutant genes and cell biology, the hope is to develop a better understanding of stem cell plasticity. The fields of stem cell biology and cancer biology are likely to merge as we understand more about cell differentiation and proliferation during development.

Overview
Jeffrey M. Lipton, Schneider Children's Hospital, New Hyde Park, NY

Hematopoietic Stem Cell Development in Zebrafish
Leonard I. Zon, Howard Hughes Medical Institute, Children's Hospital, Boston, MA

Advances in Stem Cell Biology
Ron McKay, National Institutes of Health, Bethesda, MD

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

It has long been hypothesized that tumor expansion is dependent on the growth of new blood vessels. Recently, a new understanding of the molecular mechanisms of vascular development and growth has been achieved and has suggested new targets for cancer treatment. This program will clarify the role of novel growth factors in vascular development and tumor growth and review the novel strategies currently being developed to interfere with tumor growth.

Cellular Interactions During Vascular Development
Patricia A. D'Amore, Schepens Eye Research Institute, Harvard Medical School, Boston, MA

Angiopoietins and the Regulation of Vascular Growth
Jocelyn Holash, Regeneron Pharmaceuticals, Tarrytown, NY

Tumor Angiogenesis at the Cellular Level
Lance Munn, Massachusetts General Hospital, Boston, MA

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

Evidence of Endocrine Disruption: Lessons from Wildlife
Louis Guillette, University of Florida, Gainesville, FL, University of Florida, Gainesville, FL

NHANES: A Rich Source of National Pediatric and Adolescent Exposure Data
Elaine Gunter, NHANES Laboratory, Centers for Disease Control & Prevention, Atlanta, GA

Biomarkers in Endocrine Disruptor Research
Cynthia F. Bearer, Case Western Reserve University, Cleveland, OH

Discussion

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 Women in Medicine Special Interest Group will have presentations dealing with the experiences of minority women: the past, the present and the future, lessons for us all. There will be personal presentations highlighting barriers as well as opportunities. The SIG will hear about efforts aimed at increasing minority recruitment.

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 participation of children in research is a double-edged sword. Children are vulnerable and need protection, yet their participation is critical to ensure improvements in the medical care of this same population. The fundamental question is how to balance the need for protection and access in a manner that is ethically sound and yet pragmatically feasible.

In this workshop, we will look at various recent publications in pediatric journals and present several vignettes to explore ethical and policy issues regarding the participation of children as human subjects. Through the scenarios, we will discuss such issues as: 1) the questions raised by the need to balance access versus protection; 2) the potential impact on this balance of the new NIH and FDA policies that went into affect in the late 1990s; 3) ethical issues regarding consent to participation (e.g., should adolescents be able to consent to research without parental participation?); and 4) ethical issues in research design (e.g. when are placebos morally justifiable?). For each vignette and journal article, the workshop leaders will then present where there is and is not consensus between bioethicists.

L. F. Ross, J. D. Lantos, G. Koren, S. Leikin, University of Chicago, Chicago IL (LFR, JDL), University of Toronto, Toronto Canada (GK), Office of Human Protection Research, Department of Health and Human Services, Washington, DC (SL--probable).

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

Studies from New York, Colorado and Utah, and Australia have demonstrated a high rate of adverse events in the inpatient setting related to medical error, in particular one-in-five related to medication error. A recent Institute of Medicine report stressed the importance of improving systems to reduce preventable adverse drug events in health care. CHAI is a collaborative of thirteen pediatric hospitals that have successfully improved their medication systems to reduce preventable adverse drug events. CHAI representatives will use a complement of short lectures and work sessions to introduce a conceptual framework for assessing medication systems and a model for improvement that will lead to successful change and reductions in preventable adverse drug events. The workshop will emphasize a non-punitive and systems-oriented approach to quality improvement. Participants will be expected to bring a pre-workshop assessment of their medication systems and will identify and work on a specific medication-related problem during the course of the workshop.

Institutional teams, in contrast to individuals, will be given priority admittance to the workshop.

G. Takata, C. Taketomo, and W. Mason (Childrens Hospital Los Angeles, Los Angeles, CA), L. Brodsky and M. Cimino (Children's Hospital Buffalo, Buffalo, NY), and M. Kirschbaum (Child Health Corporation of America, Shawnee Mission, KS), representing the Child Health Accountability Initiative (CHAI)

As pediatricians are called upon to manage more complex clinical and administrative information, educators of residents should respond by providing relevant curricula in medical informatics (MI).

In this workshop, participants will relate their experiences with two different but long-standing MI electives for pediatric house officers. The workshop leaders will demonstrate templates, reading lists, web-based course administration, syllabi, and curricula used to facilitate MI experiences. Curricular content areas for these rotations include basic information technology literacy, the Internet, accessing medical literature, evidence-based medicine, practice management systems, hospital information systems, decision support, and health services research. The workshop includes an orientation to educational guidelines, a tutorial on web-based course administration, and strategies for integrating the experience into the residency program. Participants should have some familiarity with information technology but not necessarily special expertise in MI. Participants who desire to create an elective experience as described in this workshop should need no special resources other than internet access and as little as four hours a month to devote to supervising the residents. Participants will also be able to take away evaluation tools for pre-test and course evaluation purposes.

S. Andrew Spooner, University of Tennessee at Memphis, Memphis, TN, and Raymond G. Duncan, Cedars-Sinai Medical Center, Los Angeles, CA

Quality improvement activities are intended to close the gap between desired evidence-based structures and processes of health care and what is actually delivered. The Federal Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research) continues to encourage and support rigorous research so that quality improvement efforts can themselves be evidence-based. In this workshop, AHRQ awardees will explain how they successfully applied for grants for quality improvement research, and how they are conducting quality improvement research in real world settings. The grantees will discuss the theoretical and conceptual QI frameworks that informed their approaches, the interventions they designed and implemented, the tools they used and developed, the importance of collaborations with health systems, the real world barriers and opportunities they encountered, and how they handled IRB requirements. Panelists' projects concern jaundice (Palmer, funded in 1998): timely delivery of surfactant to high-risk neonates (Horbar, funded in 1999); and pediatric asthma (project(s) to be funded in 2000). The workshop will include substantial opportunities to address participants' questions about individual research projects and the overall QI theme.

D. M. Dougherty and M. Miller (co-chairs), Agency for Healthcare Research and Quality, Rockville, MD; R. Heather Palmer, Harvard University; Jeffrey D. Horbar, M.D., University of Vermont College of Medicine; other awardees of AHRQ quality improvement grants.

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

This workshop will enable participants to begin using public use files from the Medical Expenditure Panel Survey (MEPS), a large national study of health care use and expenditures, health status, access to care and insurance. The design of the survey will be reviewed and examples of past uses of the survey for pediatric research will be discussed to demonstrate the potential uses of the MEPS for children's health care issues and policy interventions. Participants will become familiar with the content of public use files, including person-level files, condition files, and event files, such as ambulatory care, hospital, emergency room, and prescribed medication files. The workshop will also cover the basics of setting up an analytic file for research from public use files and the use of appropriate software. Time will be allotted for questions. This workshop is designed for health services researchers who have a background or interest in using national surveys. Some familiarity with statistical software (SAS, SPSS, etc.) would be helpful. Analysts whose primary interest is in local area analysis or clinical research would not benefit from this workshop.

N. A. Krauss, R. M. Weinick, and J. S. Banthin Center for Cost and Financing Studies, Agency for Healthcare Quality and Research, Rockville, MD USA

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

Co-Chairs: Ben Gitterman MD and Jimmy Roberts MD

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 HSR SIG will sponsor a session on implementing quality improvement research, including research in patient safety for children. The session will be moderated by Larry Kleinman (Lehigh Valley Hospital) and facilitated by senior staff from the Agency for Healthcare Research and Quality (AHRQ). Quality improvement activities are intended to close the gap between desired evidence-based structures and processes of health care and what is actually delivered. The Federal Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research) continues to encourage and support rigorous research so that quality improvement efforts can themselves be evidence-based. In this session, senior AHRQ staff will explain their quality improvement initiatives and how applicants have responded with projects ranging from neonatal intensive care improvements to chlamydia screening for young women. There will be discussion of theoretical and conceptual QI frameworks, interventions, tools, the nature of collaborations with health systems, real world barriers and opportunities, and IRB requirements.

Patient safety is promoted through the development of clinically appropriate plans for patient care and the successful implementation of those plans as intended.  Patient safety research may investigate human and/or system factors that promote appropriate medical decision making and the successful delivery of clinical services.

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

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

In an interactive format, workshop participants will practice the technique by observing live medical students and simulated patients. We will also model the BSO method by giving participants feedback on their skills. We will also discuss our experience with using the BSO in different settings (inpatient and outpatient) and for the assessment of the competencies of different learners (students and residents).

Ken Pituch, Jonathan Fliegel and Katherine Layton, University of Michigan Medical School, Ann Arbor, MI

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

Academic health centers require new methods to develop physician compensation packages that encourage physician accountability for individual clinical productivity as well as contribution to the academic success of the institution. Often, educational responsibilities - teaching of residents and students - are not addressed in compensation programs, resulting in diminished physician effort and a perception that teaching is not valued.

This workshop will focus on the tools needed for creation and implementation of a productivity-based compensation program in an academic health center. Measures of physician productivity, including collections, visit numbers, and relative value units (RVUs) will be discussed and evaluated. Participants will have the opportunity to review, analyze and critique two years of experience with a field-tested program.

At the conclusion of the workshop, participants will be able to: 1) define performance responsibilities and expectations for faculty, 2) establish a market-based productivity benchmark using national norms, 3) define educational efforts in terms of work RVUs, 4) link salary to performance, 5) implement work RVU as measure of productivity, and 6) establish a regular checks and balance system for accurate recording of performance activity.

Margie Andreae, Gary L. Freed, Div. of General Pediatrics, Univ. of MI, Ann Arbor, MI

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

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

Trauma is the leading cause of death in children and severe traumatic brain injury is a key contributor to this mortality and important morbidity. This session will focus on novel developments in our understanding of the mechanisms of secondary damage that evolve during the acute phase after injury and novel therapeutic approaches to this important condition-including therapies targeting brain swelling and delayed neuronal death. Finally, reorganization of the injured brain and potential therapeutic implications in the subacute/chronic phase will also be discussed.

Key Mechanisms of Secondary Damage After Traumatic Brain Injury in Infants and Children
Patrick M. Kochanek, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA

Secondary Cerebral Swelling and the Use of Hypertonic Saline
Bradley Peterson, Children's Hospital and Health Center, San Diego, CA

Understanding and Targeting Neuronal Death
Robert S.B. Clark, Children's Hospital of Pittsburgh, Pittsburgh, PA

Reorganization of the Injured Brain: Therapeutic Implications
Harvey Levin, Baylor College of Medicine, Houston, 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.

Overview
Barry S. Zuckerman, Boston University School of Medicine, Boston, MA

The Critical Period Viewpoint and a More Complete View of the Effects of Experience on the Brain
William Greenough, University of Illinois College of Medicine, Chicago, IL

Early Biologic Insults on Brain Development
Betsy Lozoff, University of Michigan, Ann Arbor, MI

Neurons to Neighborhood: Translating the Science to Policy and Program
Deborah Phillips, Georgetown University, Washington, DC

Discussion

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