Practice management training for pediatric residents

Article Abstract:

Just as pediatric residents (physicians who are undertaking a three-year training in pediatrics) are taught special techniques such as the use of mechanical ventilators, they need to be taught how to run a pediatric practice. Using this reasoning, and following guidelines established by the American Academy of Pediatrics, a program to improve the familiarity of pediatric residents with aspects of pediatric practice was integrated into their education. The program consisted of six standard lectures on topics such as insurance, selection of accountants, location and types of practices, and personnel management. The most important part of the program was the rotation among five types of pediatric practices, including two small groups, a large primary-care group, an HMO (health maintenance organization), and a subspecialty practice. Within these rotations, residents met with physicians, business managers, and office staff. Incoming first-year residents (PL-1) and third-year residents (PL-3) who participated in the program were surveyed regarding their attitudes about pediatric practices. PL-3 residents were significantly more confident in their competence in office management, choosing a practice location, and choosing office staff and design, along with management aspects such as appointment, billing, computer systems, and deciding on fee schedules. PL-3 residents were also significantly more confident in telephone management and establishing office laboratories. Attitudes toward choice of type of practice based on attitudes regarding business aspects and the call schedule (time spent being available to patients) was also different between PL-1 and PL-3 residents. In comparison to previous groups of residents, more PL-3 residents trained in the program intended to be general pediatricians rather than specialist pediatricians. However, whether this intention represented a significant change could not be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Economic aspects, Practice, Training, Pediatrics, Medical practice, Pediatricians

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Pediatric acquired immunodeficiency syndrome: barriers to recognizing the role of child sexual abuse

Article Abstract:

The AIDS virus can be transmitted to children through sexual abuse, but this problem has not been adequately addressed. The possibility of HIV infection is not always considered in sexually abused children, and conversely, sexual abuse is not always considered as a possible cause of HIV infection in children. HIV testing may not be considered for a sexually abused child due to lack of risk-factor information about the perpetrator. Legal considerations, such as consent requirements, may also prevent HIV testing. HIV-infected children may not be evaluated for sexual abuse for several reasons. Vertical transmission from the mother may be assumed if the child is very young. Transmission by consensual sex may be assumed if the child is a teenager. Sexual abuse has not been officially included as a risk factor for HIV infection. Policies need to be developed to increase awareness of the risk of HIV infection due to sexual abuse. Also, protocols should be established for HIV testing of sexually abused children and for evaluating HIV-positive children for possible sexual abuse.

AIDS (Disease) in children, Pediatric AIDS (Disease)

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Words too terrible to hear: sexual transmission of human immunodeficiency virus to children

Article Abstract:

Sexually abused children may be at risk for HIV infection. This possibility has been largely ignored for many reasons. It is difficult to elicit information from both abused children and suspected perpetrators. Also, legal requirements for consent sometimes prevent HIV testing of abused children and suspects. The social stigma of both child sexual abuse and infection with the AIDS virus also contributes to reluctance to study the problem. Denial of this problem must be overcome, and research should be done to discover the prevalence of sexual transmission of HIV in abused children so that protocols for screening can be developed.

Editorial

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