Research in Pediatric EducationAsthma Treatment Decisions by Pediatric Residents Do Not Consistently Conform to Guidelines or Improve With Level of Training
Section snippets
Procedures
A cross-sectional survey of pediatric residents was conducted between May 2008 and July 2008. Participation was limited to those who were residents at the time the study started (May 2008). An e-mail with a Web-based link to an online survey was sent to prospective residents whose continuity clinic practices were enrolled in the CORNET. Completion of the survey served as consent to participate in the study. Survey responses were anonymous. Institutional review board approval was obtained from
Respondent Characteristics
Of the 568 surveys sent to pediatric residents in the 10 participating programs, we received 367 complete responses (overall 65% response rate). Three hundred twenty-seven (89%) were categorical pediatric residents, and 40 (11%) respondents were internal medicine–pediatric residents. Year in training was unrelated to demographic and practice characteristics except for self-rated asthma experience (Table 2), where PGY1 residents were less likely than PGY2 or PGY3+ residents to report moderate or
Discussion
In this vignette-based survey of a national sample of pediatric residents, we observed the following: 1) a majority of residents recommended treatment in accordance with asthma guidelines for 2 of the 4 guideline-based vignettes (97% stepping up treatment for mild persistent symptoms; 52% stepping down treatment for well-controlled symptoms); 2) a majority of residents recommended treatment for only 1 of 3 focus group based (nonguideline) indicators of asthma morbidity (60% stepping up for
Conclusions
The findings from this study demonstrate that pediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. Additionally, there were no meaningful differences in the outpatient asthma management between residents of different years in training. Future efforts should be focused on developing strategies to facilitate pediatric residence adherence to management strategies that conform to national guideline recommendations and to adaptation of
Acknowledgments
We appreciate the efforts of our site coinvestigators: Baystate Medical Center: Matthew Sadof, MD; Children's Memorial Hospital, Northwestern University: Sandra M. Sanguino, MD, MPH; DeVos Children's Hospital: William Stratbucker, MD; College/Westchester: Theresa Hetzler, MD; North Carolina Children's Hospital: Michael Steiner, MD; University of Texas at Houston: Michelle S. Barratt, MD, MPH, and Lisa de Ybarrondo, MD; University of Texas Health Sciences at San Antonio: Pamela Wood, MD;
References (14)
- et al.
Racial and ethnic disparities in asthma medication usage and health-care utilization. Data From the National Asthma Survey
Chest
(2009) - et al.
Preventive asthma care delivery in the primary care office: missed opportunities for children with persistent asthma symptoms
Acad Pediatr
(2013) - et al.
Using unannounced standardized patients to assess residents’ competency in asthma severity classification
Ambul Pediatr
(2008) - et al.
Barriers pediatricians face when using asthma practice guidelines
Arch Pediatr Adolesc Med
(2000) - et al.
Reasons for pediatrician nonadherence to asthma guidelines
Arch Pediatr Adolesc Med
(2001) - et al.
How do perceptions of asthma control and severity relate to indicators of asthma status and treatment recommendations by pediatricians?
Pediatr Allergy Immunol Pulmonol
(2012) - et al.
Patient factors used by pediatricians to assign asthma treatment
Pediatrics
(2008)
Cited by (3)
Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs
2020, Foot and Ankle SurgeryCitation Excerpt :Similar studies have been done in various medical subspecialties to identify shortfalls that require further effort in educating residents. Okelo et al. conducted a web-based survey in 369 pediatric residents focusing on asthma management [19]. No difference was found between residents by years in training.
The authors declare that they have no conflict of interest.