Slipped capital femoral epiphysis (SCFE) is a common orthopedic problem that has been associated with hip pain, in primarily obese male children. To

Problem Pediatric residency programs have been tasked to train a workforce of pediatricians with skills in community pediatrics (CP) and advocacy, and knowledge of global child health priorities. Approach In 2009, the University of Washington (UW) Seattle Children's Hospital pediatric residency program developed the Resident Education in Advocacy and Child Health (REACH) program, a combined pathway for global health (GH) and CP training. After participating in a combined curriculum, residents complete a community immersion either in Kisii, Kenya (GH) or rural Washington (CP). This approach provides an efficient use of faculty and administrative resources and delivers a sustainable and ethical strategy for inspiring pediatric residents to address child health problems at a systems level. Outcomes Between 2009 and 2013, the percentage of graduating residents from the UW pediatric residency program who rated GH training as "outstanding/excellent/good" increased from 58.4% to 100%, and the percentage rating community and population health training as "outstanding/excellent/good" increased from 56% to 88.8%. Annual applicant surveys in the period 2011-2014 revealed that the REACH program led a significant percentage of candidates to rank the UW pediatric residency more favorably because of its GH (37%-48%) and CP (55%-74%) training. Next Steps A mixed-methods assessment will evaluate the impact on resident confidence in core areas of community health and advocacy including collaborating with community groups, setting professional career goals, addressing underlying determinants of health during patient encounters, communicating in cross-cultural settings, and advocating for child health. A survey will assess outcomes on graduates' careers.

Although risk factors for progression of chronic kidney disease (CKD) in children are known, we lack a model for predicting the time to end-stage renal

Acute kidney injury (AKI) is associated with adverse outcomes in critically ill adults. In a prospective multinational study, researchers examined the

The University of Washington School of Medicine (UWSOM) has been a leading medical school in training primary care physicians. Yet due to the small number of residency positions in the Pacific Northwest, the 5-state region of Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) has some of the lowest physician-to-population, graduate medical education (GME) positions-to-population ratios in the nation, and has the lowest pediatrician-to-child ratio in the country. The UW Pediatric Alaska Track was designed to increase the number of primary care pediatricians serving rural and underserved populations. The goals are to increase quality and access to health care for children and families throughout the WWAMI region, and to improve the learning environment for residents with a career interest in primary care pediatric practice.

* Abbreviations: ABP — : American Board of Pediatrics SOC — : Scholarship Oversight Committee What is the goal of pediatric subspecialty training, how long should the training period be, and what is the value of a scholarly activity? A committee of the American Board of Pediatrics (ABP) grappled with these and other questions from 2000 to 2003. Previously the ABP supported the view of the Federation of Pediatric Organizations that “the principal goal of fellowship training should be to develop future academic pediatricians”1 and required all applicants for subspecialty certification to have evidence of “meaningful accomplishment in research,” usually a peer-reviewed publication. A number of concerns spawned the 2000 to 2003 ABP review, including subspecialty workforce shortages, decreasing numbers of pediatric physician–scientists, and trends toward nonacademic careers among subspecialty fellowship graduates, concerns that persist today. Based on the committee’s recommendations, in 2004 the ABP issued new fellowship training requirements providing greater curricular flexibility to better prepare subspecialists with varied career aspirations.2 In place of “meaningful accomplishment in research,” the ABP embraced a variety of scholarly activities that could be tailored to individual career goals. Furthermore, fellows were to be mentored by a Scholarship Oversight Committee (SOC) that approved their scholarship work product. Examples of scholarship offered by the ABP included basic, clinical, translational, and health … Address correspondence to F. Bruder Stapleton, MD, Department of Pediatrics, Seattle Children’s Hospital, 4800 Sand Point Way NE, RB2:401, Seattle, WA 98105. E-mail: bruder.stapleton{at}seattlechildrens.org

Infants who survive extreme premature birth are at significant risk for neurodevelopmental impairment. In a multicenter trial, researchers compared mortality and neurodevelopmental outcomes in 1316 extremely premature neonates (born at 24–27 weeks' gestation) who were randomized in the delivery room to receive immediate continuous positive airway pressure …

Prominent forehead hematomas in young children could represent a coagulation disorder. Researchers retrospectively reviewed the medical records of 324

Current research findings for early childhood caries (ECC) disease in the United States point to an urgent need for physicians and dentists to partner and intervene on behalf of children considered most at risk, aged birth to 3 years. ECC disease is multifactorial and multidisciplinary as well as social, behavioral, and most of all, preventable. The estimated annual dental bill in the United States to restore children’s decayed teeth exceeds US$2 billion, making it one of the single most expensive, uncontrolled diseases of childhood. Today, technological, educational, and even philosophical barriers exist making a collaborative, patient centric alliance between medical professionals and dentists challenging. And yet, research findings and real-world working models of joint care point to exactly this type of alliance as pivotal in helping mitigate ECC disease. As well, the cost-benefits to society for early disease discovery and intervention are well documented. This article reviews the current state of affairs in the United States for the ECC disease epidemic, reports barriers prohibiting more urgent development of a nationwide system of allied care, and illuminates current and successful models of joint care already working in different states. Also presented are recent initiative goals set forth in a July 2011 inaugural symposium in Seattle titled, “Physician and Dentist: Together Managing Early Childhood Oral Health.” Symposium speakers, including Institute of Medicine’s (IOM) chair, Dr Fred Rivara, covered ECC-related outcomes from the IOM July 2011 report titled, “Improving Access to Oral Health Care for Vulnerable and Underserved Populations.” As well, Dr Marcia Brand, deputy administrator of the US Health Resources and Services Administration (HRSA) and symposium speaker, expressed HRSA endorsement of a core IOM recommendation that to effectively combat ECC disease in the United States, oral health services can and should be delivered in a variety of settings by a diverse and expanded array of providers, including collaborative and interprofessional teams working across the health care spectrum. Furthermore, Brand appealed for increased efforts to reach children most at risk for developing ECC disease, birth to age 3 years. Methods

Both interleukin 1 and interleukin 6 are implicated in the pathogenesis of juvenile idiopathic arthritis (JIA). In two industry-funded, randomized,

The University of Washington Pediatric Residency Program Experience in Global Health and Community Health and Advocacy embodies essential principles of successful short-term rotations from academic medical centers to resource-limited countries. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Vitamin D supplementation has been associated with protection against development of type 1 diabetes mellitus. U.K. investigators conducted a

Women remain underrepresented in medical leadership positions in the United States in spite of gender equity in medical school enrollment. This underrepresentation exists even in the field of pediatrics, where women constitute more than half of all pediatricians and where the trend toward female predominance is increasing.1Physician Specialty Data: A Chartbook. Association of American Medical Colleges, Washington, DC2006Google Scholar Women represent 66% of pediatric trainees2Women in U.S. Academic Medicine: statistics and medical school benchmarking 2004-2005. Association of American Medical Colleges, Washington, DC2005Google Scholar and 63% of pediatricians taking the American Board of Pediatrics certifying examination for the first time.3Jones Jr, M.D. Stanton B.F. Women in pediatric subspecialties.J Pediatr. 2004; 144: 143-144Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar In spite of their numbers in pediatrics, women are underrepresented in leadership positions both in academic and community pediatric organizations. Women direct only 15 of 140 North American pediatric departments and represent 21% of full professors in pediatrics.2Women in U.S. Academic Medicine: statistics and medical school benchmarking 2004-2005. Association of American Medical Colleges, Washington, DC2005Google Scholar The American Academy of Pediatrics (AAP) also suffers from gender inequity. Currently, 6 of the 14 (43%) of the officers and directors of the AAP are women. But only 6 of 24 (25%) of the 2006 AAP National Conference Planning Group were women, and only one third of faculty listed for that conference were women (33 out of a sample of 103 or every fifth person listed in the conference faculty directory). Within Washington State, the current state chapter of the AAP has only 1 woman officer out of 5, and only 2 of the 9 trustees are women. There has only been 1 woman president in the history of the state chapter. Lack of conditions that promote gender equity in pediatric leadership is found in both academics and community pediatrics. The experience of 1 local center working to change these conditions and lessons learned from this process are shared below. We envision that there will be many such local efforts at the grass roots level, before we see a wave of institutional support to bring about national and societal changes that will eliminate underrepresentation of women in pediatric leadership positions. These culture changes will occur if the younger generation of pediatricians are supported in their expectations for family-friendly careers and see real models of institutional support in their training and in the jobs available to them in both academics and community pediatrics. In an attempt to address these gender disparities in pediatric leadership at a local level, a group of women pediatricians, with strong support from the Chair of Pediatrics at the University of Washington, established the Puget Sound Women’s Pediatric Society (PSWPS) in 2001. An invitation was sent to all women pediatricians, residents, and fellows in the local region inviting them to participate with a questionnaire about their interests, issues, and ideas for programs and speakers. A steering committee was formed from interested pediatricians, with a balance between those in community and academic physicians and included fellow and resident trainees. A mission statement was developed: “To foster and encourage leadership among women in pediatrics in the Puget Sound area and to support their professional and personal development.” The steering committee created a statement of guiding principles that emphasized the importance of uniting women in academics and in community practices, organizational inclusiveness and transparency, promotion of leadership models and roles that fostered a balance between personal and professional lives, and commitment to use of leadership skills to advocate for the health and well-being of children and their families. Activities have included 1 to 2 dinners yearly, with each attended by 40 to 80 women/session and half-day skill-building workshops. The dinners have included time for socializing and networking. Prominent national physician leaders have spoken to the group at the dinners including Dr Joycelyn Elders, former U.S. Surgeon General; Dr Barbara Barlow, former head of pediatric surgery at Harlem Hospital; Dr Iris Litt, Director of the Robert Wood Johnson Fellowship program; Dr Judith Hall, former Chair of Pediatrics at Vancouver BC Children’s Hospital; and Dr Jane Schaller, former Chair of Pediatrics at Tufts and Executive Director of the International Pediatrics Association, the first African American woman Washington State Health Officer, and the first woman athletic director at the University of Washington. These dinner events have focused on the life trajectories of these amazing women leaders and have been both inspirational and intimate, with opportunities for participants to speak from both their hearts and minds. Other events have included panel discussions on child health advocacy and work/life balance with local pediatric leaders. Each year, skill-building and personal development workshops have been held, usually as half-day workshops on Saturday mornings, and each has been attended by 10 to 20 participants. Topics have included negotiating skills for physicians, communication styles, applied meditation, child health advocacy, mastering information overload, and efficient retrieval of electronic information. Participants have affirmed the usefulness of the skills taught in these workshops in both their personal and work lives. Men have been invited to participate, as well as women, and come both as pediatricians interested in the topics and as partners of women physicians. The organization has come to view itself similar to a group such as the League of Women Voters, an organization of women that sponsors events and forums open to both sexes to benefit the entire community. In the case of PSWPS, the goal is to bring more balance into the lives of pediatrics and to develop skills to make them more effective leaders in pediatrics and advocates for child health. Work/life balance and having an opportunity to share equally in child rearing is an issue that is important to men, as well as women. As we have moved into addressing institutional change, male pediatricians, especially those in the academic setting have increasingly lent their support, ideas, and passion to this effort. Funding for activities of the organization was obtained from an initial grant of $10,000 from the Children’s Hospital and Regional Medical Center (CHRMC) and continued by donations from women pediatricians and small grants from supporting individuals and companies. Donated funds go into a “Women’s Leadership Fund” at CHRMC. Events are priced to cover costs and to subsidize participation by residents and fellows. PSWPS operates on a budget of $3000-5000 per year. Over the last year, the Chief Operating Officer of CHRMC agreed to support a part time administrative support person to coordinate this process. Two years ago, our steering committee felt that it was time to move from inspirational talks and skill-building workshops to initiate institutional change that would promote work/life balance in pediatric careers. Important issues, such as the impact of pregnancies during pediatric residency and the continuing lack of on-site quality child care, maternity, paternity, or elder care leave, and flexible work settings in both community and academic settings, among others, were focal points for our discussions. Similar issues were raised by a national task force addressing challenges to women pediatricians.4http://www.ambpeds.org/site/education/education_FPO_newsletter.htm.Google Scholar Successful solutions to these barriers will benefit both men and women and will foster movement of women into positions of leadership. We recognized that changes were needed in both academics and community pediatrics but decided to address the academic setting initially. The leadership of both CHRMC and the Department of Pediatrics in the School of Medicine were concerned about these issues and agreed to approach the issues of family support structures, flexible training and work settings, academic advancement, and midlife career transitions in a proactive and investigative manner. Over the past year, work groups were established with the charge to investigate best institutional practices to support work/life balance in pediatric careers. The work groups addressed (1) family support structures such as on-site child care and parenting and elder care leave, (2) flexible training and work settings to accommodate family and personal needs, (3) academic advancement and promotion issues, and (4) facilitating midlife career transitions into academics by experienced clinicians and researchers at a time in their lives when family responsibilities may be less demanding. The work group investigations culminated in a symposium where these issues were discussed in small interactive groups, and recommendations for institutional change were presented to administrators of the Department of Pediatrics and CHRMC. Dr Bonita Stanton, a major champion of developing women leaders and Chair of Pediatrics at Wayne State University, was invited to be the keynote speaker for this symposium. Her moving presentation promoted a lively discussion with the pediatric community and an open exchange with administrators. The process has unfolded a road map for institutional change to support work/life balance for pediatricians. The leadership of the Department and the hospital are now working with an implementation committee that will actualize and monitor the recommendations that came out of the symposium work groups. See Table for a summary of selected recommendations and measurable action outcomes (available at www.jpeds.com).TableSelected recommendations and measurable action outcomesWork groupRecommendationMeasurable action outcomesFamily support structuresOn-site child careAddition of on-site child care to new research facility and all future new buildingsFlexible training and workClear policies on part-time work and parental leavePolicies written, discussed, and posted on faculty and resident web sitesAcademic advancementIncrease promotion recognition for mentoringEstablish a department of pediatrics faculty mentoring awardFacilitating midlife career transition into academicsFaculty making this transition need extra orientation and supportPeer counseling group set up to mentor/provide guidance to these faculty Open table in a new tab Community pediatricians have now developed a task force that is looking at similar issues as they relate to their own practice settings. They are developing a score card of “family-friendly” practice features that residents and fellows can use as they seek jobs in the community sector. Changing expectations of job-seeking pediatricians will help change what is available in community practices. The community task force also plans to take discussion and sharing of information about “family-friendly” practice features to the annual meeting of the Washington State Academy of Pediatrics to promote statewide awareness of this issue. With the help of the PSWPS and the many committed people who joined this process, institutional change that supports physicians who want and need more balance between their work and personal lives will occur. These changes will allow women to move more easily into positions of leadership in pediatrics both in academics and in national pediatric associations. If change happens at the local level, more rapid changes at the national level will follow. It is anticipated that this process can serve as a model for other institutions and organizations faced with the similar challenges. The authors want to dedicate this commentary to the memory of Gail G. Shapiro, MD, an outstanding pediatric allergist and nationally recognized woman leader in her field who helped establish PSWPS and was an active member of its steering committee until her untimely death during heart surgery in August 2006. References available at www.jpeds.com.

Widespread interest in global health issues is a common characteristic of students and faculty in schools of public health and schools of medicine. Building on strong university-based and community-based programs in global health, the University of Washington has created a unique Department of Global Health that is housed jointly in its School of Public Health and Community Medicine and its School of Medicine. The creation of this department has generated significant enthusiasm throughout the university and the Seattle community as a new paradigm for addressing global health education, research, and service. Placing the new Department of Global Health in two university schools and finding the appropriate niche for the department among the university's many global health initiatives presented challenges, as well as opportunities. This article describes the goals of the department, the process by which it was created, and what it expects to accomplish.