No fewer than 10 alumni of the Robert Wood Johnson Foundation Clinical Scholars, Physician Faculty Scholars and Generalist Physician Faculty Scholars programs authored articles in the December 2010 issue of Pediatrics, the official journal of the American Academy of Pediatrics. Their topics range from the varying prescription rates of antibiotics by doctors at children’s hospitals to the impact of a 1910 report on women in the pediatrics profession.
Maria T. Britto, M.D., M.P.H, an alumna of the Clinical Scholars® program (1993-1995) and the Generalist Physician Faculty Scholars program (2000-2003) and Gail B. Slap, M.D., M.S., an alumna of the Clinical Scholars program (1980-1982), collaborated with Tanya L. Tivorsak, M.D., on an article reporting on research into adolescents’ preferences for privacy in the health care setting. They conducted focus groups and concluded that maintaining privacy about information was a top priority for adolescents. They further observed that while younger adolescents are wary of disclosing information to health care providers, older adolescents are more concerned about disclosure of information to parents. This research was funded, in part, by a Generalist Physician Faculty Scholars program grant to Britto from the Robert Wood Johnson Foundation (RWJF).
Seizures among Children
Dimitri A. Christakis, M.D., Ph.D., an alumnus of both the Clinical Scholars program (1996-1998) and the Physician Faculty Scholars program (1999-2004), co-authored an article reporting on research into seizures among children—specifically, the causes of seizures and the risk of recurrence. Christakis and colleagues conducted a longitudinal study tracking 117 children from their first seizure through any subsequent recurrences. They found that children with non-febrile seizures—those that are unaccompanied by a fever—were more likely to have acute gastroenteritis, and that such children had a low rate of seizure recurrence.
David C. Grossman, M.D., M.P.H., an alumnus of the Clinical Scholars program (1988-1990), is among a group of authors who examined the validity of the Patient Health Questionnaire-9 Item (PHQ-9) as a screening tool for depression among adolescents. They studied data on 442 youth and concluded that the “brief nature and ease of scoring of this instrument make this tool an excellent choice for providers and researchers seeking to implement depression-screening in primary care settings.”
Frederick P. Rivara, M.D., M.P.H., an alumnus of the Clinical Scholars program (1978-1980), co-authored a paper that looks at the effect of hospitals’ status as pediatric cardiac specialty centers and their neonatal level of care. The researchers examined the 90-day mortality rates for infants at such hospitals in Washington State, conducting a retrospective study of data on infants with ductal-dependent congenital heart disease, and found no significant difference in mortality rates for children born at hospitals with such specialty centers.
Regionalization of Health Care
In a “review article,” Brendan Carr, M.D., M.S., an alumnus of the Clinical Scholars program (2006-2008), and colleagues assess the state of the literature on the “regionalization” of health care for children—the development of a structured system of care that directs patients to facilities with “optimal capabilities for a given type of illness or injury.” The article observes that, in the case of pediatrics, such regionalization has been undertaken in the areas of neonatal intensive care and pediatric trauma care. The authors conclude that more research with stronger study designs is needed to improve the understanding of the effectiveness of regionalization.
Use of Antibiotics in Children
Chris Feudtner, M.D., Ph.D., M.P.H., an alumnus of the Clinical Scholars program (1998-2000), and colleagues conducted a retrospective study of the significant variation among children’s hospitals in their use of antibiotics. They found that hospitals “vary substantially in their use of antibiotics to a degree unexplained by patient- or hospital-level factors typically associated with the need for antibiotic therapy.” They concluded that the variation suggested “an opportunity to improve the use of these drugs.”
Jill Halterman, M.D., M.P.H., an alumna of the RWJF Generalist Physician Faculty Scholars program (1999-2002), joined in an article reporting on research into prescription patterns and how they relate to the nonmedical use of prescription drugs. They concluded that “Controlled medications are prescribed at a considerable proportion of visits from adolescents and young adults, and prescribing rates have nearly doubled since 1994. This trend and its relationship to misuse of medications warrants further study.”
Medical Education and Women
Shari L. Barkin, M.D., M.S.H.S., an alumna of both the Clinical Scholars program (1994-1996) and the Physician Faculty Scholars program (2000-2003), and Elena Fuentes-Afflick, M.D., M.P.H., an alumna of the Generalist Physician Faculty Scholars program (1998-2003) and a member of the National Advisory Committee of the Clinical Scholars program, collaborated on a paper about Abraham Flexner’s groundbreaking 1910 report on medical education in the United States and its impact on women in the medical profession. The 100-year-old report led to a greater reliance on mainstream science in medical education, but the authors describe an unintended consequence: By steering the profession toward an educational model that “favored the laboratory over the bedside” and the “physician as researcher over the physician as practitioner,” the report helped lead to a 60-year “near elimination” of women from the physician workforce. Before the report, the authors write, female physicians had a significant presence, despite the reluctance of all-male medical institutions to admit them. The Flexner report led to a transformation in medical education, one effect of which, they write, was that funds dried up for many of the institutions that admitted women, Blacks, and working class students.