DEIA Curriculum: Pediatrics

Suggested Rotations: Outpatient Pediatrics PGY-1, PGY-2, PGY-3

Objective #1: Find the Early Intervention referral form for your state. Make sure you know how to complete it and submit it.

Resources:

• IDEA Act: What you need to know The Individuals With Disabilities Education Act (IDEA) for Children With Special Educational Needs | Pediatrics (30 min read)

Applications and Questions:

• Research how to refer a child 4-5 year old (i.e. too old for Early Intervention but not yet in school) for evaluation and services in your area. What is the process? What handout/resources does your clinic have to help guide parents through the process?

• Explain IDEA (Individual with Disabilities) Act and why it is relevant to our patients; guide the families of preschool age children for evaluation and services

Objective #2A: Describe IEPs and 504s, and list 5 common reasons kids might qualify for them.

Objective #2B: List ways to support families of children with disabilities.

Resources:

• Family Physician's Role Curtin MJ, et al. Specific Learning Disabilities: The Family Physician’s Role. AAFP 2019;199(10).
  (12 minute read)
• A personal story Elder N. Almost 9: A personal essay on parenting, aniridia, and being a doctor. J Am B Fam Med 2007;20(6):606-607. (4 min read)
• Sample IEP requests: Requesting an Initial Evaluation for Special Education Services | Center for Parent Information and Resources (3 min read)
• Government Programs for Children with Disabilities | Special Needs Alliance (4 min read)
• How Does a Child with Special Needs Affect the Family? (broachschool.com) (3 min read)

Applications and Questions:

• Ask every family of pediatric patients that you see whether the child has an IEP or 504. If they do, ask what accommodations their IEP or 504 provides. This way you will begin to familiarize yourself with the resources available.
• Think about what might be helpful in a 504 for a child with ADHD. 
• Who in your clinic might help you support children with learning differences? (social work, care navigator, team nurse, community health worker,etc)

Objective #3: Identify and utilize at least one standardized tool for universal screening of social determinants of health. 

Resources:

• Child Health Disparities: What Can a Clinician Do? Read here: this article (10 min read)
• Examples of SDoH questionnaires:
  
  • AAFP SDoH screening tool—website has several brief resources/screening tools

Applications and Questions:

• Use a SDoH screener with the family of a pediatric patient in the clinic. Did it improve your care for the child? What were some challenges?

Objective #4: Explain the “school to prison pipeline” in communities of color and the PCPs role in de-pathologizing normative developmental behavior to schools.

Resources:

• Who is Most Affected by the School-to-Prison Pipeline (3 min table)
  
• Recognizing the Role of Health Care Providers in Dismantling the Trauma-to-Prison Pipeline | Pediatrics (5 min read)
• “Why I never diagnose Oppositional Defiant Disorder as a child psychiatrist” Dr. Kali Hobson Link to watch: ODD as racist (5 min video)

Applications and Questions:

• Consider how you might speak to a school aged or adolescent child who is struggling with behavioral issues and/or has been diagnosed with ODD. What can you do to highlight the child’s strengths? What might you tell the family about the limitations of an ODD diagnosis?
• Might this concept be relevant to other diagnoses?

Suggested Rotation: Outpatient Pediatrics PGY-1 and PGY-2

Objective 1A: Demonstrate the ability to communicate confidentially, and with sensitivity and respect with the LGBTQIA+ patient and the patient's identified family.

Objective 1B: Identify three unique health concerns of LGBTQIA+ youth.

Resources:

National LGBTQIA+ Health Center:

• Affirming Care for Transgender and gender-diverse children and adolescents (free webinar, but need to register to access, CME credit available)
• Health Care for LGBTQIA+ youth (free webinar, but need to register to access, CME credit available)

Applications and Questions:

• Consider how your clinic and/or hospital could be made more affirming for LGBTQIA+ youth and their families. What is your system already doing? What could be better?

Suggested Rotations: Outpatient PGY-1, PGY-2, and PGY-3

Objective 1A: Describe three key reasons why it is important for clinicians to engage and support families of gender diverse youth.

Objective 1B: Provide LGBTQIA+ youth and their families with affirming resources

Resources for Patients:

• The Trevor Project: Supports LGTBQIA+ youth mental health
• PFLAG: Resources for friends and family to support LGBTQIA+
• The Family Acceptance program website: http://familyproject.sfsu.edu/

Other Resources:

• Extra resource full of resources on caring for LGBTQIA+ patients includes definitions, sample patient questionnaires, learning objectives and activities, and enough resources to create a full LGBTQIA+ health rotation: https://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint289D_LGBT.pdf (12-min read)

Applications and questions:
Explore the resources for patients—when might you guide a patient or family to each of these resources?

Suggested Rotations: PGY-1, PGY-2, PGY-3

Objective: Residents will demonstrate counseling on normal language development and perception of language development for bilingual children. 

Resources:

• Language Growth in English Monolingual and Spanish-English Bilingual Children from 2.5 to 5 Years - PMC (15-min read)
• Moving From Language Access to Justice - de Beaumont Foundation (5-min read)

Applications and Questions:

• How would you counsel a parent who worries that their child’s language development will lag if they continue to speak to them in a language other than English?
  
• Why is using a child as an interpreter considered unethical?

Suggested Rotations: PGY-1, PGY-2, PGY-3

Objective: List three of the unique needs of children in foster care. 

Resources:

• Caring for Children in Foster Care American Academy of Family Physician (5 min read) 

Applications and Questions:

• Imagine that you are the clinician for a child in the foster care system. What might you do differently with that child’s care?

Suggested Rotations: Outpatient PGY-1, PGY-2, PGY-3

Objective 1A: Define vaccine equity.

Objective 1B: Describe strategies to address vaccine hesitancy in communities that have historically been abused by the medical system.

Resources:

• Addressing Vaccine Hesitancy in BIPOC Communities (10 min read, NEJM)
• From Roast Dinners to Seatbelts: Metaphors to Address Covid-19 Vaccine Hesitancy – by Elena Semino (3 min read)

Applications and Questions:

• What can you do to help work toward vaccine equity in your community?
  
• How might you improve trust in vaccines in your patient counseling? 
  
• Have you heard good stories or metaphors that might be useful?

Suggested Rotations: Inpatient Pediatrics PGY-1, PGY-2, PGY-3; Pediatrics ER

Objective 1A: Analyze the impact of racial health disparities that affect children admitted to the hospital. 

Objective 1B: List three ways to decrease racial health disparities related to hospitalizations of children.

Resources:

• Health Disparities in the Hospitalized Child (15 min read)
• Our Biases Begin With a Name (3 min read)

Applications and Questions:

• Reflect on a time when you heard medical professionals joking about a patient name or other attribute. How would you handle it if you encounter this situation in the future? How can we balance the need for humor/levity with respecting our patients and confronting biases?
• Reflect on the article about Khabir Rasaan. Staff interpreted a Black mother’s tears as aggressive. Have you seen distress in a person of color interpreted as aggression? 
• What is “tone policing?” How might you respond if you see this occur?

Suggested Rotations: Inpatient Pediatrics PGY-1, PGY-2, PGY-3, Pediatrics ER

Objective: Identify the impact of ACEs in the way that patients and families interact with the medical system

Resources:

• Nadine Burke Harris: How childhood trauma affects health across a lifetime | TED Talk (15 min video)

Applications and Questions:

• Reflect on a case in which ACEs might have impacted a patient or family interaction on inpatient pediatrics and how you might use a trauma informed approach to improve interactions or outcomes in a similar case in the future.

Suggested Rotations: Inpatient PGY-1, PGY-2, PGY3, Pediatrics ER

Objective: Define the concept of false equivalency and explain how it applies to race-based calculators in medicine. 

Resources:

• Eliminating Race-Based Medicine | Pediatrics | American Academy of Pediatrics (aap.org)
  (10-minute read)

Applications and Questions:

• Does your organization use any race-based calculators in pediatrics?

Suggested Rotations: Inpatient Pediatrics PGY-1, PGY-2, PGY-3; OB-GYN PGY-1, PGY-2, PGY-3; Newborn Nursery

Objective: Describe your institution’s protocol for newborn drug screening

Resources:

• Infant Race Affects Application of Clinical Guidelines When Screening for Drugs of Abuse in Newborns | Pediatrics | American Academy of Pediatrics

Applications and Answers:

• What is your institution's protocol for newborn drug screening? How might this policy be susceptible to bias?

Suggested Rotations: Inpatient Pediatric PGY-1, PGY-2, PGY-3; Pediatric ER

Objective 1: Identify the importance of pain control in sickle cell anemia and how bias undermines proper medical care.

Resources:

• Racism and Discrimination in Sickle Cell (changeforscd.com)

• Patient stories about sickle cell disease: These Sisters With Sickle Cell Had Devastating, and Preventable, Strokes - The New York Times (10-min read)

Objective 2: Recognize unconscious bias in themselves in pain management in ER

• Racial and Ethnic Differences in Emergency Department Pain Management of Children With Fractures | Pediatrics | American Academy of Pediatrics (aap.org)
• Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites by Hoffman et al.

Applications and Questions:

• Our culture is rife with false beliefs about biological differences between Black patients and White patients, particularly in the realm of pain. Look at table one in the article by Hoffman et al. Reflect on which of these biases you have observed?