Peds-Centered

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In this episode, I speak with Dr. Jess Schnell, DO MBA, who transitioned from Pediatric Emergency Medicine and hospital administration to utilization management. We talk about career longevity, deciding to transition away from clinical medicine, and dealing with burnout.

Articles and Resources We Discuss:
Gettel CJ, Courtney DM, Agrawal P, Madsen TE, Rothenberg C, Mills AM, Lall MD, Keim SM, Kraus CK, Ranney ML, Venkatesh AK. Emergency medicine physician workforce attrition differences by age and gender. Acad Emerg Med. 2023 Nov;30(11):1092-1100. doi: 10.1111/acem.14764. Epub 2023 Jun 23. PMID: 37313983; PMCID: PMC10973949.

Chen YW, Orlas C, Kim T, Chang DC, Kelleher CM. Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019. JAMA Netw Open. 2023 Jul 3;6(7):e2323872. doi: 10.1001/jamanetworkopen.2023.23872. Erratum in: JAMA Netw Open. 2023 Sep 5;6(9):e2334513. doi: 10.1001/jamanetworkopen.2023.34513. PMID: 37459094; PMCID: PMC10352856.

COVID Coach App

Psychologytoday.com

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In this episode, I speak with Dr. Allison Messina, an Assistant Professor of Pediatric Infectious Disease in Florida at Johns Hopkins All Children's Hospital. We talk about vector-born illnesses - their presentation and management, and where and when to look out for them. Ranges of many of these illnesses are expanding, both northward from the tropics, and for diseases like Lyme disease, to broadening regions within North America, so many of us will be seeing these illnesses in areas where they weren't previously found. Dr. Messina provides recommendations for us as treating physicians and for those of us planning to travel to areas with illnesses not endemic to where we're living.

We talk about the CDC Yellow Book as a guide for travel medicine and when treating patients who have recently traveled. Here is a link to the website - we both use this regularly and find it really helpful.

https://wwwnc.cdc.gov/travel/page/yellowbook-home

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In this episode, I speak with Dr. Kathy Sumpter, who is Division Chief of Pediatric Endocrinology at Le Bonheur Children's Hospital. We talk about diagnosing diabetes in children and risk-stratifying kids coming in with new-onset diabetes, as well as fluid and insulin management strategies for kids in DKA. Dr. Sumpter specializes in helping kids who struggle to control their diabetes improve their health, and shares insights about her successes and about the future of medical care for diabetes.

Some articles we mention in this episode include:
Kathleen M. Brown, et al, for the Pediatric Emergency Care Applied Research Network Diabetic Ketoacidosis FLUID Study Group; Rehydration Rates and Outcomes in Overweight Children With Diabetic Ketoacidosis. Pediatrics December 2023; 152 (6): e2023062004. 10.1542/peds.2023-062004

Kuppermann N, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378(24):2275-2287. doi:10.1056/NEJMoa1716816

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In this episode I meet with Dr. Jay Pershad from Children's National Hospital in Washington, DC. Dr. Pershad is an expert in high-value care and shares strategies for improving our quality of care to benefit patients, families, and healthcare providers together. A few studies that he mentions are here below for those who are interested in a deeper dive:

Bodenheimer T, Sinsky C. From Triple Aim to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Medicine 2014;12(6):573-576. doi: 10.1370/afm.1713

Foster C, et. al. Emergency Care Connect: Extending Pediatric Emergency Care Expertise to General Emergency Departments Through Telemedicine. Academic Pediatrics 2020;20(5):577-584. https://doi.org/10.1016/j.acap.2020.02.028

Paydar-Darien N, et al. Improving Discharge Safety in a Pediatric Emergency Department. Pediatrics 2022;150(5). 

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April is Child Abuse Awareness Month, so in this episode I am speaking with Dr. Antonia Chiesa, a Child Abuse Medicine Specialist. We discuss sentinel injuries and how to navigate evaluating and reporting these injuries, positive news about the demographics and trends in the US regarding child abuse rates, and the broader conversation about child abuse and child health outside of the acute setting.

I would like to add a clarification here regarding a statement I make in this episode - I talk about the low rates of child abuse in Costa Rica, where I live, and the social protective factors here. This is in reference to child physical abuse, but I did not talk about sex trafficking, including minors, which is rampant in Central America and Costa Rica. We will leave that topic for another conversation.

For a review of the TEN4-FACES Clinical Decision Rule for Sentinel Bruises, this recent article does a great job breaking down sensitivity, specificity, and predictive values:

Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics

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In this episode, I meet with Dr. Chinni Pokala to talk about the assessment and management of hematologic disorders in the acute setting. We discuss how to think about kids presenting with signs and symptoms of new hematologic disorders as well as thrombotic and hemorrhagic risks for kids with established heme/onc diagnoses or other chronic medical conditions.  

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In this episode, I talk with Dr. Alana Arnold about our experiences with pediatric readiness projects in community and urgent care settings, both as partnering with academic pediatric centers and via private consulting. Below, in order, are the seminal paper regarding pediatric readiness in general emergency departments, its associated assessment tool, the Wall Street Journal article about pediatric readiness referenced in this episode, findings from the ImPACTS project, and contact information for Dr. Arnold. 

Gausche-Hill M, Ely M, Schmuhl P, et al. A national assessment of pediatric readiness of emergency departments [published correction appears in JAMA Pediatr. 2015 Aug;169(8):791]. JAMA Pediatr. 2015;169(6):527-534. doi:10.1001/jamapediatrics.2015.138

National Emergency Medical Services for Children Pediatric Readiness Assessment and Scoring Resource Document

https://www.wsj.com/health/healthcare/hospitals-emergency-rooms-cost-childrens-lives-d6c9fc23?reflink=desktopwebshare_permalink

Auerbach MA, Whitfill T, Montgomery E, et al. Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments. Pediatrics. 2023;152(2):e2022060790. doi:10.1542/peds.2022-060790

Dr. Alana Arnold: email:  [email protected]
website: www.linktr.ee/pempal 

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In this episode I meet up with Dr. Dan Park, who is the medical director of the pediatric emergency department at University of North Carolina. We'll be talking about the components of leadership and navigating careers in medicine. We discuss metacognition and cognitive biases, developing our expertise, leadership skills, and resiliency, and how these all interplay. 

Here is Dan's article about cognitive biases that we discussed during this episode:
https://pubmed.ncbi.nlm.nih.gov/24488159/

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In this episode, I'm speaking with Drs. Fred Henretig (Penn) and Carl Baum (Yale) about career transitions and exiting medicine. We discuss the current literature surrounding retirement and attrition in medicine, reasons physicians cite for staying vs going, and strategies for handling major career and life transitions.

Below is the information for a few of the articles mentioned in this podcast:

Henretig F, et. al. PEM Physicians' Perceptions of Colleagues' Clinical Competencies Over Four Age Categories. Pediatrics (2022);149:457.
https://publications.aap.org/pediatrics/article/149/1%20Meeting%20Abstracts%20February%202022/457/186078/PEM-Physicians-Perceptions-of-Colleagues-Clinical

Pizzo PA. Navigating Transitions and Charting New Paths. JAMA (2017);317(16):1625-6.
https://jamanetwork.com/journals/jama/article-abstract/2620092

David Brooks - The New Old Age: https://www.theatlantic.com/culture/archive/2023/08/career-retirement-transition-academic-programs/675085/

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In this episode, I'll be talking with Dr. Matt Harris from Cohen Children's Hospital about medical transport of kids, both in the prehospital and interfacility settings. We will discuss level of skills, training, and equipment available with various teams, factors to consider when choosing transport options, safety and legal concerns, and transport cost.

After recording this episode, Dr. Harris and I were discussing the components of the safety checklist his institution uses for transport of kids with behavioral health emergencies. His team does a huddle prior to transfer and answers these questions:

1. Who participates in huddle (referring doc, EMS clinicians, occasionally tele-psych physician).
2. Was a complete report given?
3. Was the patient aware of the intent to transfer (transparency with patients reduces discord)
4. Type of transfer (voluntary, involuntary, etc)
5. Any concerns from the sending physician?
6. Does the patient appear compliant and willing to transfer?
7. Is crew comfortable transporting the patient as presented?