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Minding the Gap — Individually and Collectively

Tuesday, March 3, 2020 - 11:15

Anyone who has stepped onto a train, subway, or airplane has noticed the space between the platform and the transport. In the London Underground, prominent signs warn subway passengers to “Mind the Gap.” Pediatricians face gaps, too — in their own knowledge and medical practice. But through their commitment to continuous learning and improvement, these dedicated physicians also strive to “mind the gap.”

Certification activities can help.

A major goal of the American Board of Pediatrics (ABP) is to help identify and fill gaps faced by pediatric trainees, faculty, practitioners, programs, and the profession as a whole. Over the past few years, the ABP has made significant changes to better reflect the needs of pediatricians and their patients and to support efforts to share best practices and medical innovations that are relevant today. The ABP is committed to continuous improvement.

This issue of the annual report focuses on ways the ABP is helping mind the gap in pediatric practice on numerous levels.

University of Colorado first-year resident Dr. Grace Huh (left) consults with Megan Louderman, postdoctoral fellow in Colorado’s Irving Harris Program in Child Development and Infant Mental Health.

ARE THERE GAPS IN TRAINING? The ABP works with numerous organizations, including the Association of Pediatric Program Directors (APPD), the Accreditation Council for Graduate Medical Education (ACGME), and the Council of Pediatric Subspecialties (CoPS), to identify them. Are the requirements of residency and fellowship programs adequately preparing trainees to practice without supervision? In 2018, in collaboration with the National Academies of Sciences, Engineering, and Medicine (NASEM), the ABP Foundation sponsored a two-day meeting about “Preparing Future Pediatricians to Meet the Behavioral and Mental Health Needs of Children.” Since that meeting, many of the pediatric training programs who were represented have planned and/or implemented new strategies to fill this gap. Several other stories in this report talk about how programs are identifying areas where trainees lack confidence and/or competence and how these efforts are helping strengthen training.

DO INDIVIDUAL PEDIATRICIANS HAVE GAPS IN THEIR KNOWLEDGE? Advances in medical care grow exponentially every year. New diseases and conditions are discovered. Others, like measles, re-emerge or develop resistance to treatment. It’s nearly impossible to keep up with everything. One way the ABP can help is through MOCA-Peds, the ABP’s online nonproctored assessment platform. It allows individual pediatricians to identify gaps in knowledge each time they answer questions (up to 20 per quarter). Participants find out immediately whether their answer was correct and are provided with a rationale and supporting references that offer a learning opportunity. Surveys of MOCA-Peds pilot participants (2017 and 2018) show that many appreciate these learning opportunities, and over 78% say they have made a change or plan to change some aspect of their practice because of something they learned through MOCA-Peds.

WHAT ABOUT GAPS IN PEDIATRICIANS’ CARE? Often quality improvement (QI) activities can help fill those. The many approaches pediatricians develop to measure and improve their practice standards and processes inspire others to make similar changes and share best practices. One example is the Children’s Health Alliance of Wisconsin’s “shared plan of care” QI project, designed to help advance family-centered care coordination. Another is the work of the New Jersey Pediatric Psychiatry Collaborative in creating a statewide mental health care program to address the gap between patients’ needs and the shortage of child and adolescent psychiatrists.

ARE THERE GAPS FACED BY THE WHOLE PROFESSION? The ABP also partners with many groups, including the American Academy of Pediatrics (AAP), to consider what those gaps might be and how to fill them. For example, the ABP, the AAP, and many other groups have identified gaps in pediatric mental health care. Some are in access to care, while others are in pediatricians’ confidence in recognizing mental health conditions and then treating and/or referring patients.

Routinely, the ABP reaches out to pediatricians and subspecialists to determine what topics ABP exams should cover. Every five or six years, for General Pediatrics and for each of the subspecialties, the ABP recruits a special practice-analysis panel of 10 to 12 pediatricians in active practice who identify the knowledge areas that are required to care for patients. Then, the ABP sends (via online survey) the list of knowledge areas to all pediatricians certified in the appropriate area to rate each area based on how frequently the knowledge is required in their practice and what harm could occur if the knowlege is lacking. This way, all pediatricians can contribute to keeping exams relevant to practice.

Drs. Clifton Lee, Doug Carlson, Jennifer O’Toole, Vineeta Mittal, and Neha Shah discuss safe and effective care in the field of pediatric hospital medicine during a Pediatric Hospital Medicine Subboard meeting.Periodically, pediatricians see gaps encompassing an emerging field and ask for new certifications. The newest is Pediatric Hospital Medicine. The first certifying exam for this subspecialty was administered in November.

Each year, the ABP shares data on the pediatric workforce across the United States at www.abp.org/content/data-and-workforce. The data show where there are gaps in access to general pediatric and pediatric subspecialty care, among other demographics.

Certification is recognition of the commitment of pediatricians and pediatric subspecialists to continuous learning and improvement to meet the highest standards of care — from residency to retirement. The ABP aspires to support and nurture a lifetime of learning, practice improvement, and adherence to high standards of care.

Together, we can see the gaps and ensure that no one — physician or patient — falls through them.


Top photo: University of Colorado first-year resident Dr. Grace Huh (left) consults with Megan Louderman, postdoctoral fellow in Colorado’s Irving Harris Program in Child Development and Infant Mental Health.
 
Bottom photo: Drs. Clifton Lee, Doug Carlson, Jennifer O’Toole, Vineeta Mittal, and Neha Shah discuss safe and effective care in the field of pediatric hospital medicine during a Pediatric Hospital Medicine Subboard meeting.