Su-Ting Li - Academia.edu (original) (raw)

Papers by Su-Ting Li

Academic Pediatrics, 2019

External validity was assessed by correlation between mean PNAPE and PDQI-9 scores using Pearson'... more External validity was assessed by correlation between mean PNAPE and PDQI-9 scores using Pearson's coefficient. RESULTS: PNAPE is shown in figure 1. In all, 13 Notes were assessed with an ICC of 0.85. Pearson's r is 0.63 between mean PNAPE and PDQI-9 scores. CONCLUSION: These findings suggest that the PNAPE is a reliable and valid tool for evaluation of resident progress note assessment and plan by expert assessors. Next steps will include use of PNAPE to track note quality over time, provide feedback and to assess notes in other inpatient settings and specialties.

Academic Pediatrics, 2020

Background Assessment using entrustable professional activities (EPAs) is currently under study a... more Background Assessment using entrustable professional activities (EPAs) is currently under study as a joint effort of the American Board of Pediatrics and program director community. However, limited evidence exists for the feasibility of EPA-based assessment in pediatrics. Aim Among pediatric residency programs that implemented EPA-based assessment over 3 academic years (2015-16, 2016-17, 2017-18), determine how often programs were “unable to assess” a resident on a given EPA. Methods 23 programs reported clinical competency committee (CCC) determined EPA supervision level assignments for all residents in their program for a subset of 5-6 of the 17 general pediatrics EPAs biannually (Fall and Spring), except interns who were only assessed at the end of the academic year (Spring). They indicated “unable to assess” whenever applicable. Results Across the 5 data collection cycles, there were 29,643 opportunities to assign an EPA supervision level to 1987 residents from all three post-graduate years. Of these, 4140 assignments (14%) were deemed “unable to assess.” Across all EPAs, this determination was made less often in mid-year reports than year-end reports (p=.005). Post-graduate year 3 (PGY3) residents and PGY2 residents had significantly lower frequencies of “unable to assess” assignments when compared with PGY1 residents (Figure). EPAs with the lowest rates of “unable to assess” included: EPA 4 (patients with acute, common dx) at 0.4%, EPAs 10 (initial resuscitation/stabilization) and 16 (handovers) at 0.9%, EPA 11 (manage information) at 4%, and EPA 13 (practice management) at 5%. EPAs with the highest rates of “unable to assess” included EPA 8 (transition to adult care) at 43%, EPA 17 (procedures) at 27%, EPA 14 (quality improvement) at 20%, and EPAs 12 (make referrals) and 9 (behavioral and mental health) at 14%. Conclusions “Unable to assess” assignments are related to the given EPA, training year, and timing of assessment within the academic year. CCCs may be less likely to assign EPA supervision levels at timepoints viewed as higher stakes, such as transition from one training year to the next. Future work should explore this further and consider the etiology behind high levels of inability to assess some EPAs in particular.

Academic Pediatrics, 2019

Academic Pediatrics, 2018

Teaching and Learning in Medicine, 2007

The Liaison Committee on Medical Education (LCME) recently reinterpreted ED-2, their quantified p... more The Liaison Committee on Medical Education (LCME) recently reinterpreted ED-2, their quantified patient criteria requirement. The purpose is to describe pediatric clerkship directors' response to ED-2. We used a survey of U.S. and Canadian pediatric clerkship directors. Survey response rate was 76% (108/142). The most frequent categories that clerkship directors used to describe quantified patient criteria were age group (77%), organ systems (65%), or symptoms (61%). Computer simulations were the alternative patient experience in 83% of clerkships. Patient logs (90%) and checklists (31%) tracked student completion of ED-2. Thirty-two respondents had an LCME visit since ED-2 was reinterpreted, and 69% reported that LCME had concerns about their clerkships' fulfillment of ED-2. There was no difference in method of ED-2 implementation between schools who were cited by LCME and those who were not. Clerkship directors have used a variety of approaches to specify and monitor quantified patient criteria.

Academic Pediatrics, 2016

MedEdPORTAL Publications, 2015

World journal of critical care medicine, Jan 4, 2015

To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to ... more To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children. We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage (BAL). We found that FFB led to a change in medical management in 28.9% (range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82% (range 45.2%-100%). Infectious organisms were identified in 25.7% (17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1% (ran...

Pediatrics in review / American Academy of Pediatrics, 2013

An 18-year-old girl presents with nighttime fevers to 39°C for 8 days. She complains also of head... more An 18-year-old girl presents with nighttime fevers to 39°C for 8 days. She complains also of headache, myalgia, and rash during the fevers. Eighteen days ago, she removed a tick from her neck after attending a festival in the northeastern United States. One week ago, she presented to her pediatrician with a sore throat and rash. She was hyponatremic (sodium, 129 mEq/dL) and was started on doxycycline for presumed Rocky Mountain spotted fever (RMSF). Her condition has not improved. She admits to multiple unprotected sexual encounters and cocaine abuse. The girl appears weak. Her vital signs include temperature of 38.7°C; heart rate, 84 beats per minute; respiratory rate, 20 breaths per minute; and blood pressure, 113/73 mm Hg. A salmon-colored macular rash is present on her trunk and proximal extremities. She also exhibits dermatographia. There are no mucosal lesions. The liver is enlarged to 2.5 cm beyond the rib margin, and she has right upper quadrant tenderness. Her muscles are tender to deep palpation in all four extremities. She is able to bear weight but refuses to ambulate due to bilateral lower extremity myalgia and arthralgia. A CBC demonstrates a normochromic, normocytic anemia, and leukocytosis with a left shift. ESR and CRP are elevated at 109 mm/hour and 19.8 mg/dL, respectively. A mild transaminitis is present. Ultrasonography reveals a mildly enlarged and echogenic liver. Small pleural and pelvic effusions are present on CT scan. A bone marrow biopsy and a glycosylated ferritin fraction are obtained. A clinical diagnosis is made. An 11-year old Hispanic boy who had poststreptococcal reactive arthritis (PSRA) and rheumatic fever (RF) diagnosed at age 6 years has been symptom-free while taking oral penicillin (PCN). Two months ago, he developed lemon-sized, reddish, painful subcutaneous nodules that were warm to touch on both lower extremities and revealed acute …

Academic Pediatrics, 2015

American Journal of Epidemiology, 2004

Oral rotavirus vaccine was voluntarily withdrawn from the market after studies observed an increa... more Oral rotavirus vaccine was voluntarily withdrawn from the market after studies observed an increased risk of intussusception within 2 weeks after immunization. Concern has been raised that other orally administered vaccines, such as oral poliovirus vaccine (OPV), may also be associated with intussusception. In this 1990-1998 case-control study, the authors examined the association between OPV and intussusception in the Washington State Medicaid population, evaluating receipt of OPV during the month prior to intussusception among 119 cases and 589 controls matched by date of birth. Analysis was conducted via matched conditional logistic regression, controlling for sex. Between 1990 and 1998, 119 children younger than age 2 years had a therapeutic enema, surgical reduction, or hospitalization for intussusception and had been enrolled in Medicaid for at least 1 month prior to their intussusception date. There was no significantly elevated risk of intussusception associated with receipt of OPV; 9.2% (11/119) of cases and 8.5% (50/589) of controls were given OPV 0-28 days prior to the case's intussusception date (odds ratio = 1.1, 95% confidence interval: 0.5, 2.2). However, to address the hypothesis that risk of intussusception is related to receipt of a particular dose of OPV, a larger study would be required.

Pediatrics in review / American Academy of Pediatrics, 2013

The Journal of Pediatrics, 2012

JAMA Network Open

IMPORTANCE Entrustable professional activities (EPAs) are an emerging workplace-based, patientori... more IMPORTANCE Entrustable professional activities (EPAs) are an emerging workplace-based, patientoriented assessment approach with limited empirical evidence. OBJECTIVE To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data.

The Journal of pediatrics, 2018

lthough the importance of educational leaders is emphasized in the program requirements set forth... more lthough the importance of educational leaders is emphasized in the program requirements set forth by the Accreditation Council of Graduate Medical Education, the process for developing those leaders has not been well described. Existing development programs have focused on educational scholarship 1 and project driven curricula 2 in an attempt to provide support for developing the scholarship of medical educators. In response to a lack of formal curricula for developing both educational scholarship and leadership skills in pediatric graduate medical education, the Association of Pediatric Program Directors (APPD) developed a 10-month program entitled Leadership in Educational Academic Development (LEAD) that was designed to "provide training for educators aspiring to develop the knowledge and skills needed to become leaders in medical education." 3 The multifaceted curriculum of APPD LEAD provides facilitated peer-mentorship 4 for developing educational scholarship and emphasizes training in personal professional development, leadership training, and administrative skill development. The program is conducted over 3 sessions, focusing on the individual, their training program, and their interaction with others and is taught in a highly interactive format by the LEAD council, a group of experienced pediatric educators. 3 We undertook this study to assess the change in leadership positions, scholarly productivity, and career development for the participants in the first 3 years of APPD LEAD. We analyzed characteristics of APPD LEAD participants at baseline (program entrance) and 3 years after program completion to describe changes in areas that are important for the professional development of leaders in pediatric medical education: new educational leadership positions; scholarly productivity; and national presence at educational meetings and national committee participation. Methods In this cohort study, we reviewed curricula vitae (CVs) from

Academic pediatrics, Jan 5, 2017

Rigorous medical education research is critical to effectively develop and evaluate the training ... more Rigorous medical education research is critical to effectively develop and evaluate the training we provide our learners. Yet many clinical medical educators lack the training and skills needed to conduct high-quality medical education research. We offer guidance on conducting sound quantitative medical education research. Our aim is to equip readers with the key skills and strategies necessary to conduct successful research projects, highlighting new concepts and controversies in the field. We utilize Glassick's criteria for scholarship as a framework to discuss strategies to ensure that the research question of interest is worthy of further study and how to use existing literature and conceptual frameworks to strengthen a research study. Through discussions of the strengths and limitations of commonly used study designs, we expose the reader to particular nuances of these decisions in medical education research and discuss outcomes generally focused on, as well as strategies f...

Academic Pediatrics, 2019

External validity was assessed by correlation between mean PNAPE and PDQI-9 scores using Pearson'... more External validity was assessed by correlation between mean PNAPE and PDQI-9 scores using Pearson's coefficient. RESULTS: PNAPE is shown in figure 1. In all, 13 Notes were assessed with an ICC of 0.85. Pearson's r is 0.63 between mean PNAPE and PDQI-9 scores. CONCLUSION: These findings suggest that the PNAPE is a reliable and valid tool for evaluation of resident progress note assessment and plan by expert assessors. Next steps will include use of PNAPE to track note quality over time, provide feedback and to assess notes in other inpatient settings and specialties.

Academic Pediatrics, 2020

Background Assessment using entrustable professional activities (EPAs) is currently under study a... more Background Assessment using entrustable professional activities (EPAs) is currently under study as a joint effort of the American Board of Pediatrics and program director community. However, limited evidence exists for the feasibility of EPA-based assessment in pediatrics. Aim Among pediatric residency programs that implemented EPA-based assessment over 3 academic years (2015-16, 2016-17, 2017-18), determine how often programs were “unable to assess” a resident on a given EPA. Methods 23 programs reported clinical competency committee (CCC) determined EPA supervision level assignments for all residents in their program for a subset of 5-6 of the 17 general pediatrics EPAs biannually (Fall and Spring), except interns who were only assessed at the end of the academic year (Spring). They indicated “unable to assess” whenever applicable. Results Across the 5 data collection cycles, there were 29,643 opportunities to assign an EPA supervision level to 1987 residents from all three post-graduate years. Of these, 4140 assignments (14%) were deemed “unable to assess.” Across all EPAs, this determination was made less often in mid-year reports than year-end reports (p=.005). Post-graduate year 3 (PGY3) residents and PGY2 residents had significantly lower frequencies of “unable to assess” assignments when compared with PGY1 residents (Figure). EPAs with the lowest rates of “unable to assess” included: EPA 4 (patients with acute, common dx) at 0.4%, EPAs 10 (initial resuscitation/stabilization) and 16 (handovers) at 0.9%, EPA 11 (manage information) at 4%, and EPA 13 (practice management) at 5%. EPAs with the highest rates of “unable to assess” included EPA 8 (transition to adult care) at 43%, EPA 17 (procedures) at 27%, EPA 14 (quality improvement) at 20%, and EPAs 12 (make referrals) and 9 (behavioral and mental health) at 14%. Conclusions “Unable to assess” assignments are related to the given EPA, training year, and timing of assessment within the academic year. CCCs may be less likely to assign EPA supervision levels at timepoints viewed as higher stakes, such as transition from one training year to the next. Future work should explore this further and consider the etiology behind high levels of inability to assess some EPAs in particular.

Academic Pediatrics, 2019

Academic Pediatrics, 2018

Teaching and Learning in Medicine, 2007

The Liaison Committee on Medical Education (LCME) recently reinterpreted ED-2, their quantified p... more The Liaison Committee on Medical Education (LCME) recently reinterpreted ED-2, their quantified patient criteria requirement. The purpose is to describe pediatric clerkship directors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; response to ED-2. We used a survey of U.S. and Canadian pediatric clerkship directors. Survey response rate was 76% (108/142). The most frequent categories that clerkship directors used to describe quantified patient criteria were age group (77%), organ systems (65%), or symptoms (61%). Computer simulations were the alternative patient experience in 83% of clerkships. Patient logs (90%) and checklists (31%) tracked student completion of ED-2. Thirty-two respondents had an LCME visit since ED-2 was reinterpreted, and 69% reported that LCME had concerns about their clerkships&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; fulfillment of ED-2. There was no difference in method of ED-2 implementation between schools who were cited by LCME and those who were not. Clerkship directors have used a variety of approaches to specify and monitor quantified patient criteria.

Academic Pediatrics, 2016

MedEdPORTAL Publications, 2015

World journal of critical care medicine, Jan 4, 2015

To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to ... more To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children. We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage (BAL). We found that FFB led to a change in medical management in 28.9% (range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82% (range 45.2%-100%). Infectious organisms were identified in 25.7% (17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1% (ran...

Pediatrics in review / American Academy of Pediatrics, 2013

An 18-year-old girl presents with nighttime fevers to 39°C for 8 days. She complains also of head... more An 18-year-old girl presents with nighttime fevers to 39°C for 8 days. She complains also of headache, myalgia, and rash during the fevers. Eighteen days ago, she removed a tick from her neck after attending a festival in the northeastern United States. One week ago, she presented to her pediatrician with a sore throat and rash. She was hyponatremic (sodium, 129 mEq/dL) and was started on doxycycline for presumed Rocky Mountain spotted fever (RMSF). Her condition has not improved. She admits to multiple unprotected sexual encounters and cocaine abuse. The girl appears weak. Her vital signs include temperature of 38.7°C; heart rate, 84 beats per minute; respiratory rate, 20 breaths per minute; and blood pressure, 113/73 mm Hg. A salmon-colored macular rash is present on her trunk and proximal extremities. She also exhibits dermatographia. There are no mucosal lesions. The liver is enlarged to 2.5 cm beyond the rib margin, and she has right upper quadrant tenderness. Her muscles are tender to deep palpation in all four extremities. She is able to bear weight but refuses to ambulate due to bilateral lower extremity myalgia and arthralgia. A CBC demonstrates a normochromic, normocytic anemia, and leukocytosis with a left shift. ESR and CRP are elevated at 109 mm/hour and 19.8 mg/dL, respectively. A mild transaminitis is present. Ultrasonography reveals a mildly enlarged and echogenic liver. Small pleural and pelvic effusions are present on CT scan. A bone marrow biopsy and a glycosylated ferritin fraction are obtained. A clinical diagnosis is made. An 11-year old Hispanic boy who had poststreptococcal reactive arthritis (PSRA) and rheumatic fever (RF) diagnosed at age 6 years has been symptom-free while taking oral penicillin (PCN). Two months ago, he developed lemon-sized, reddish, painful subcutaneous nodules that were warm to touch on both lower extremities and revealed acute …

Academic Pediatrics, 2015

American Journal of Epidemiology, 2004

Oral rotavirus vaccine was voluntarily withdrawn from the market after studies observed an increa... more Oral rotavirus vaccine was voluntarily withdrawn from the market after studies observed an increased risk of intussusception within 2 weeks after immunization. Concern has been raised that other orally administered vaccines, such as oral poliovirus vaccine (OPV), may also be associated with intussusception. In this 1990-1998 case-control study, the authors examined the association between OPV and intussusception in the Washington State Medicaid population, evaluating receipt of OPV during the month prior to intussusception among 119 cases and 589 controls matched by date of birth. Analysis was conducted via matched conditional logistic regression, controlling for sex. Between 1990 and 1998, 119 children younger than age 2 years had a therapeutic enema, surgical reduction, or hospitalization for intussusception and had been enrolled in Medicaid for at least 1 month prior to their intussusception date. There was no significantly elevated risk of intussusception associated with receipt of OPV; 9.2% (11/119) of cases and 8.5% (50/589) of controls were given OPV 0-28 days prior to the case's intussusception date (odds ratio = 1.1, 95% confidence interval: 0.5, 2.2). However, to address the hypothesis that risk of intussusception is related to receipt of a particular dose of OPV, a larger study would be required.

Pediatrics in review / American Academy of Pediatrics, 2013

The Journal of Pediatrics, 2012

JAMA Network Open

IMPORTANCE Entrustable professional activities (EPAs) are an emerging workplace-based, patientori... more IMPORTANCE Entrustable professional activities (EPAs) are an emerging workplace-based, patientoriented assessment approach with limited empirical evidence. OBJECTIVE To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data.

The Journal of pediatrics, 2018

lthough the importance of educational leaders is emphasized in the program requirements set forth... more lthough the importance of educational leaders is emphasized in the program requirements set forth by the Accreditation Council of Graduate Medical Education, the process for developing those leaders has not been well described. Existing development programs have focused on educational scholarship 1 and project driven curricula 2 in an attempt to provide support for developing the scholarship of medical educators. In response to a lack of formal curricula for developing both educational scholarship and leadership skills in pediatric graduate medical education, the Association of Pediatric Program Directors (APPD) developed a 10-month program entitled Leadership in Educational Academic Development (LEAD) that was designed to "provide training for educators aspiring to develop the knowledge and skills needed to become leaders in medical education." 3 The multifaceted curriculum of APPD LEAD provides facilitated peer-mentorship 4 for developing educational scholarship and emphasizes training in personal professional development, leadership training, and administrative skill development. The program is conducted over 3 sessions, focusing on the individual, their training program, and their interaction with others and is taught in a highly interactive format by the LEAD council, a group of experienced pediatric educators. 3 We undertook this study to assess the change in leadership positions, scholarly productivity, and career development for the participants in the first 3 years of APPD LEAD. We analyzed characteristics of APPD LEAD participants at baseline (program entrance) and 3 years after program completion to describe changes in areas that are important for the professional development of leaders in pediatric medical education: new educational leadership positions; scholarly productivity; and national presence at educational meetings and national committee participation. Methods In this cohort study, we reviewed curricula vitae (CVs) from

Academic pediatrics, Jan 5, 2017

Rigorous medical education research is critical to effectively develop and evaluate the training ... more Rigorous medical education research is critical to effectively develop and evaluate the training we provide our learners. Yet many clinical medical educators lack the training and skills needed to conduct high-quality medical education research. We offer guidance on conducting sound quantitative medical education research. Our aim is to equip readers with the key skills and strategies necessary to conduct successful research projects, highlighting new concepts and controversies in the field. We utilize Glassick's criteria for scholarship as a framework to discuss strategies to ensure that the research question of interest is worthy of further study and how to use existing literature and conceptual frameworks to strengthen a research study. Through discussions of the strengths and limitations of commonly used study designs, we expose the reader to particular nuances of these decisions in medical education research and discuss outcomes generally focused on, as well as strategies f...