Scholarship Skills Curriculum 

Training Future Leaders in Academic Pediatrics

The Pediatric Subspecialty Fellows who train at  our hospital will be our legacy to the future as they assume leadership roles in academic pediatrics. The American Board of Pediatrics defines subspecialty fellowship training as preparing trainees to become the academic leaders of the various subspecialties. Thus, Pediatric Subspecialty Fellowships are three years in duration, and fellows must achieve both excellence in clinical care and excellence in the scholarship skills of research methodology and proficiency in teaching.

We train 80 fellows per year in pediatric medical, surgical, pathology, radiology, and anesthesiology subspecialties. Our subspecialty fellowship training programs provide excellent training in clinical care of each subspecialty. Of necessity, this area of training is left to the discretion of each individual program. The Accreditation Council for Graduate Medical Education (ACGME) accredits the majority of our Pediatric Subspecialty Programs. In Spring 2005, the ACGME site visited our programs and every program received continued full accreditation.

Since Pediatric Subspecialty Fellows are being trained to be leaders in academic pediatrics, ACGME has formulated requirements designed to foster academic productivity (scientific research papers, grants, etc.) specifically research methodology and proficiency in teaching requirements. This body of knowledge is common to all fellows, and thus we coordinate the scholarship skills training for fellows under one program which is directed by Thomas Keens, MD and Cheryl Lew, MD.


Core Curriculum Goals

The Core Curriculum on Scholarship Skills is designed to teach first year Pediatric Subspecialty Fellows skills in Research Methodology and in Proficiency in Teaching. At the conclusion of the course the Fellows should have improved their understanding of the basic concepts of research design, implementation, and data analysis, so they can participate in more effective and informative clinical research projects as part of their Fellowship training.  Of equal importance, the knowledge gained should give Fellows enough understanding of statistical and experimental design issues so they may more critically read the medical literature in their area of expertise during their career. In addition, the course will provide training and practice in skills required for proficiency in teaching.

The course runs from September to June, one hour per week on Mondays at noon. The course is taught in a small group interactive format with a minimum of lecture time and a maximum of fellows actually using the skills they have learned. The topics covered in the course are shown in the following table:

Research Methdology Proficiency in Teaching
How to ask a research question Professional academic development
Developing hypotheses Clinical ethics
Study design Research ethics (IRB)
Randomized clinical trials Teaching at the bedside
Conceptual models Case-based learning
Study implementation Preparing an oral presentation
Data analysis: plan and collection Giving feedback to learners
Estimating distribution parameters Dealing with learners in difficulty
Hypothesis testing How to lead a small group
Univariate and miltivariate analysis Curriculum design


Research Methodology Course

In the research methodology portion of the course, short lectures will be presented by a variety of clinical researchers and fellows will work in small groups to complete relevant exercises or problem sets.  Fellows will have the opportunity to immediately apply bio-statistical principles and thus reinforce their learning.


Proficiency in Teaching Course

In the proficiency in teaching portion of the course, fellows work in small groups to develop formal presentations and curriculum design. They practice teaching at the bedside and giving feedback to learners by role playing with psychology interns, who have volunteered to play learners with a variety of problems.


Fellows Forum

As an institution, we are committed to provide the best Subspecialty Fellowship training experience possible. To that end, our Designated Institutional Officer and Vice Chair of Pediatrics, Dr. Robert Adler hosts a semi-annual Fellows Forum. The Forum was created to provide all of the Subspecialty Fellows across the hospital with an opportunity to network and discuss global issues related to fellowship training such as infrastructure, institutional support and suggestions for change. The Forum is held in January and August.  Please check below for the minutes of previous Fellows Forum meetings.

Minutes from previous Fellows Forum meetings:


Course Calendar

 

Date

Topic

Faculty

1

9/14/09

Course Introduction

Keens, T., MD 

2

9/21/09

Learning Portfolios
ACGME Practice Based Learning and Improvement

Objectives
PR IV.5.c.1,2,3, 5 & 9

  1. List strategies for self-reflection & self assessment.
  2. Set learning & improving goals and identify activities to achieve self-identified goals (life long learning)
  3. Incorporate feedback into future practice improvement
  4. Develop and individualized learning plan (e.g. documenting a minimum of 3 personal learning objectives to address identified areas of needed improvement and strategies to achieve the goals)

Resources

C.D. Lew, MD, MSEd

3

9/28/09

Directionality Leadership The Role of a Fellow
ACGME Interpersonal and Communication Skills
PR IV.5.d. 3

  1. Develop skills and habits to work effectively as a member or leader of a health care team or other professional group.
  2. Identify responsibilities of team members
  3. Identify how team members communicate to accomplish responsibilities

C.D. Lew, MD, MSEd

Stages of power and Situational Leadership models.

4

10/05/09

Literature Review
ABP Learning Objectives: C 4
C 4: Using Medical Literature:

  1. Given the need for specific clinical information, identify a clear, structured, searchable clinical question
  2. Identify the study design most likely to yield valid information about the accuracy of a diagnostic test
  3. Identify the study design most likely to yield valid information about the benefits and/or harms of an intervention
  4. Identify the study design most likely to yield valid information about the prognosis of a condition

Emily Brennan, MLIS,
Norris Medical Library

5

10/12/09

Pediatric Board Examination

 

6

10/19/09

Adult Learning:
ABP Learning Objectives: D1

  1. Understand the basic principles of adult learning theory (eg, adult learners are self-directed, goal-oriented, practical; need to feel respected, build on life experiences; learn best when learning is based on an existing framework)
  2. Understand the attributes of an effective learning environment
  3. Understand the importance of “reflective practice” in teaching and learning
  4. Identify strategies that motivate learners 7
  5. Recognize the impact

E. Bogenmann, PhD, EdD

7

10/26/09

Educational Leadership:
ACGME Interpersonal and Communication Skills
PR IV.5.d. 3

  1. Develop skills and habits to work effectively as a member or leader of a health care team or other professional group.
  2. Identify responsibilities of team members
  3. Identify how team members communicate to accomplish responsibilities

E. Bogenmann, PhD, EdD

8

11/02/09

Developing Goals and Objectives
ABP Learning Objectives: D 4

  1. Distinguish between goals and learning objectives
  2. Identify components of well-formulated learning objectives

D. Vanderbilt, MD

9

11/09/09

Curriculum Design I
ABP Learning Objectives: D4
ACGME Program Requirement IV.5.c.10

  1. Understand the role of needs assessment in educational planning
  2. Recognize the strengths and weaknesses of various educational outcome measures (eg, participant satisfaction, acquisition of knowledge and skills, behavioral change, patient outcomes)

C.D. Lew, MD, MSEd

10

11/16/09

Curriculum Design II : Practicum

C.D. Lew, M.D., MSEd

11

11/23/09

Teaching Methods: Clinical Teaching I
ABP Learning Objective: D3
ACGME Program Requirement IV.5.c.10

  1. Understand the strengths and weaknesses of various teaching methods (eg, lecture, small group discussion, bedside teaching, simulation) 
  2. Understand that individuals may learn more effectively with certain teaching methods (eg, reading, hearing, doing) than with others Teaching Methods: Clinical Teaching I

ABP Learning Objective: D3
ACGME Program Requirement IV.5.c.10

  1. Understand the strengths and weaknesses of various teaching methods (eg, lecture, small group discussion, bedside teaching, simulation)
  2. Understand that individuals may learn more effectively with certain teaching methods (eg, reading, hearing, doing) than with others
  3. [Include 6 step- Clinical Preceptor methods]

 

 

 

 

Sheela Rao, MD, Pediatrics

12

11/30/09

Teaching Methods: Clinical Teaching II: Practicum 1 Bedside

Sheela Rao, MD, Pediatrics

13

12/7/09

Teaching Methods: Presentations I
ABP Learning Objectives: D3
ACGME Program Requirement IV.5.c.10

  1. Understand the strengths and weaknesses of various teaching methods (eg, lecture, small group discussion, bedside teaching, simulation)
  2. Understand that individuals may learn more effectively with certain teaching methods (eg, reading, hearing, doing) than with others

 

14

12/14/09

Teaching Methods: Presentation II: Practicum

 

15

12/21/09

Feedback & Evaluation
ABP Learning Objectives: D2
ACGME Program Requirement IV.5.c.;

  1. Distinguish between evaluation and feedback
  2. Understand the strengths and weaknesses of various methods to evaluate learners

Win May

16

1/11/10

Learners in Difficulty I:
ABP Learning Objectives: D2

  1. Identify components of effective feedback
  2. Distinguish between formative and summative feedback

 

17

1/18/10

Learners in Difficulty II: Practicum

 

18

1/25/10

Negotiation or First Job Interview

Sheela Rao, MD

19

2/1/10

Human Subjects Protection & IRB @ CHLA
ABP Learning Objectives: E3, E4 & E5

  1. Understand and apply the three main principles of research ethics articulated in the Belmont Report (ie, respect for persons, beneficence, and justice)
  2. Understand the role of analysis of risks and benefits in the ethical conduct of research
  3. Understand the federal regulatory definitions regarding which activities are considered research
  4. Understand the federal regulatory definitions regarding when research includes the use of human subjects
  5. Understand the federal regulatory definition of minimal risk
  6. Understand the functions of an Institutional Review Board
  7. Understand when an exemption from review by the Institutional Review Board is permissible
  8. Understand the functions of a Data Safety Monitoring Board
  9. Understand the importance of clinical equipoise in research with human subjects
  10. Understand the impact of “therapeutic fallacy” on clinical research with human subjects
  11. Understand the ethical considerations of study design (eg, placebo, harm of intervention, deception, flawed design)

Principles of Consent and Assent

    1. Understand what constitutes informed consent in research
    2. Understand how undue influence can affect obtaining consent for research
    3. Understand how coercion can affect obtaining consent for research
    4. Understand the special ethical considerations related to research utilizing children because of their inability to give informed consent
    5. Distinguish among consent, assent, and permission in research involving children

Vulnerable Populations

  1. Recognize that the definition of “children” is related to the underlying clinical intervention in the jurisdiction in which the child is located rather than a fixed nationwide notion of age
  2. Recognize the types of protections that might be accorded to vulnerable populations (eg, incarcerated individuals, pregnant women, fetuses, children, mentally disabled individuals, educationally or economically disadvantaged individuals)
  3. Understand the concept of minimal risk as it applies to research involving children
  4. Understand the circumstances under which research that involves children and that entails greater than minimal risk may be permissible

Thomas Keens, M.D.
Pulmonology

20

2/8/10

Framing Research Questions Conceptual Models
ABP Learning Objectives

Ellen Iverson, Ph.D., CHOIR

21

2/15/10

Hypothesis Generation – Dependent & Independent Variables
ABP Learning Objectives: A1 & A 3
A 1: Types of Variables

  1. Distinguish types of variables (eg, continuous, categorical, ordinal, nominal)
  2. Understand how the type of variable (eg, continuous, categorical, nominal) affects the choice of statistical test

A 3: Hypothesis

  1. Distinguish the null hypothesis from an alternative hypothesis
  2. Interpret the results of hypothesis testing

Steve Mittelman, M.D., Endocrinology

22

2/22/10

Study Design Types I – Match Research Questions to Research Study Type
ABP Learning Objectives: B1 : Study Types

  1. Distinguish between Phase I, II, III, and IV clinical trials
  2. Recognize a retrospective study
  3. Understand the strengths and limitations of retrospective studies
  4. Recognize a case series
  5. Understand the strengths and limitations of case series

Leo Mascarenhas, Hem / Onc

23

3/1/10

Study Design Types II – Match Research Questions to Research Study Type
ABP Learning Objectives: B1 : Study Types

  1. Recognize a cross-sectional study
  2. Understand the strengths and limitations of cross-sectional studies
  3. Recognize a case-control study
  4. Understand the strengths and limitations of case-control studies
  5. Recognize a longitudinal study
  6. Understand the strengths and limitations of longitudinal studies
  7. Recognize a cohort study
  8. Understand the strengths and limitations of cohort studies
  9. Recognize a randomized-controlled study
  10. Understand the strengths and limitations of randomized-controlled studies
  11. Recognize a before-after study
  12. Understand the strengths and limitations of before-after studies
  13. Recognize a crossover study
  14. Understand the strengths and limitations of crossover studies 4
  15. Recognize an open-label study
  16. Understand the strengths and limitations of open-label studies
  17. Recognize a post-hoc analysis
  18. Understand the strengths and limitations of post-hoc analyses
  19. Recognize a subgroup analysis
  20. Understand the strengths and limitations of subgroup analyses

Leo Mascarenhas, Hem / Onc

24

3/8/10

Assessment of Study Types applied to Clinical Research
ABP Learning Objectives: C 1 Assessment of study design, performance and analysis:

  1. Recognize when appropriate control groups have been selected for a case-control study
  2. Recognize when appropriate control groups have been selected for a cohort study
  3. Recognize the use and limitations of surrogate endpoints
  4. Understand the use of intent-to-treat analysis
  5. Understand how sample size affects the power of a study
  6. Understand how sample size may limit the ability to detect adverse events
  7. Understand how to calculate an adequate sample size for a controlled trial (ie, clinically meaningful difference, variability in measurement, choice of alpha and beta)

 

25

3/15/10

SITE EXAM

 

26

3/22/10

Data: Types of Variables, Distribution, How to know what data do you analyze.
ABP Learning Objectives A2 & C2
A2: Distribution of Data:

  1. Understand how distribution of data affects the choice of statistical test
  2. Differentiate normal from skewed distribution of data
  3. Understand the appropriate use of the mean, median, and mode
  4. Understand the appropriate use of standard deviation
  5. Understand the appropriate use of standard error
C2: Assessment of generalizability
  1. Identify factors that contribute to or jeopardize generalizability
  2. Understand how non-representative samples can bias results
  3. Assess how the data source (eg, diaries, billing data, discharge diagnostic code) may affect study results

 

27

3/29/10

Tests for Numerical Variables: T-test and ANOVA
ABP Learning Objectives: A4

  1. Understand the appropriate use of analysis of variance (ANOVA)
  2. Understand the appropriate use of parametric (eg, t-test, ANOVA) versus non-parametric (eg, Mann-Whitney U, Wilcoxon) statistical tests
  3. Interpret the results of t-tests
  4. Understand the appropriate use of a paired and non-paired t-test
  5. Determine the appropriate use of a 1- versus 2-tailed test of significance
  6. Interpret a p-value 2
  7. Interpret a p-value when multiple comparisons have been made
  8. Interpret a confidence interval

Rima Jubran, MD,
Hem / Onc

28

4/5/10

Tests for Categorical Variables: Chi-Square (p-values)
ABP Learning Objectives: A4

  1. Understand the appropriate use of the chi-square test versus a t-test
  2. Interpret the results of chi-square tests
  3. Interpret a p-value 2
  4. Interpret a p-value when multiple comparisons have been made
  5. Interpret a confidence interval

Rima Jubran, MD,
Hem / Onc

29

4/12/10

Regression
ABP Learning Objectives A6

  1. Identify when to apply regression analysis (eg, linear, logistic)
  2. Interpret a regression analysis (eg, linear, logistic)
  3. Identify when to apply survival analysis (eg, Kaplan-Meier)
  4. Interpret a survival analysis (eg, Kaplan-Meier)

Roby Khemani, M.D.
Critical Care Medicine

30

4/19/10

Bias, Type I & II Errors, Confounding
ABP Learning Objectives: A4 & B2

  1. Identify a type I error
  2. Identify a type II error
  3. Understand how bias affects the validity of results
  4. Understand how confounding affects the validity of results
  5. Identify common strategies in study design to avoid or reduce bias
  6. Identify common strategies in study design to avoid or reduce confounding
  7. Understand how study results may differ between distinct sub-populations (effect modification)

Steve Mittelman, M.D., Endocrinology

31

4/26/10

Odds Ratios and Relative Risk – Causation, incidence and prevalence
ABP Learning Objectives A5, B3, B4 & B5

  1. Differentiate relative risk reduction from absolute risk reduction
  2. Calculate and interpret a relative risk
  3. Calculate and interpret an odds ratio
  4. Interpret a hazard ratio
  5. Understand the uses and limitations of a correlation coefficient
  6. Understand the difference between association and causation
  7. Identify factors that strengthen causal inference in observational studies (eg, temporal sequence, dose response, repetition in a different population, consistency with other studies, biologic plausibility)
  8. Distinguish disease incidence from disease prevalence
  9. Understand factors that affect the rationale for screening for a condition or disease (eg, prevalence, test accuracy, risk-benefit, disease burden, presence of a presymptomatic state)

Barry Markovitz, M.D. Critical Care Medicine

32

5/3/10

Diagnostic Tests
ABP Learning Objectives: A7 & B8

  1. Recognize the importance of an independent “gold standard” in evaluating a diagnostic test
  2. Calculate and interpret sensitivity and specificity
  3. Calculate and interpret positive and negative predictive values
  4. Understand how disease prevalence affects the positive and negative predictive value of a test
  5. Calculate and interpret likelihood ratios
  6. Interpret a receiver operator characteristic curve
  7. Interpret and apply a clinical prediction rule
  1. Understand the strengths and limitations of sensitivity analysis
  2. Interpret the results of sensitivity analysis

 

33

5/10/10

Cost Benefit Analysis
ABP Learning Objectives: B6 & B7

  1. Differentiate cost-benefit from cost-effectiveness analysis
  2. Understand how quality-adjusted life years are used in cost analyses
  3. Understand the multiple perspectives (eg, of an individual, payor, society) that influence interpretation of cost-benefit and cost-effectiveness analyses
  1. Understand the strengths and limitations of decision analyses
  2. Interpret a decision analysis

Alex Chen, M.D., Pediatrics

34

5/17/10

How to Write an Abstract

Ami Shah, M.D.
Bone Marrow Transplant

35

5/24/10

How to Present Data

 

 

5/31/10

Memorial Day Break

36

6/7/10

Saban Poster Session

 

37

6/14/10

Evidence Based Medicine, Systematic Reviews and Meta Analysis.
A8: Systemic reviews and meta analysis

  1. Understand the purpose of a systematic review 
  2. Understand the advantages of adding a meta-analysis to a systematic review
  3. Interpret the results of a meta-analysis
  4. Identify the limitations of a systematic review
  5. Identify the limitations of a meta-analysis