Pediatric Environmental Health | Educational Goals & Objectives

Director: Alan Woolf, MD, MPH, FAACT, FAAP, FACMT
©2019, All Rights Preserved

Educational Goals & Objectives

OVERALL GOALS

The overall goal of the training program in Pediatric Environmental Health at Boston Children’s Hospital is to prepare trainees for a career in academic
pediatric environmental health. This training has two primary components,
training in the management of children with a wide range of environmental health-related concerns and training in research related to pediatric environmental health:

A. To train fellows in pediatric environmental health to be expert in the clinical care of pediatric patients with environment-associated diseases

B. To develop physician leaders for a career in academic medicine through research training and scholarly work in the field.

GENERAL ISSUES

A. Fellows must be grounded in the principles and methods of evidence-based medicine

  1. Should have a general knowledge of the statistical evaluation of
    clinical trials and other types of research study data
  2. Should have the ability to critique published research studies and/or
    manuscripts submitted for publication
  3. Have the ability to manage a difficult clinical problem using the
    primary medical literature
  4. Learn the molecular and epidemiological basis of environmental- associated childhood problems and develop the ability to apply this
    knowledge to the diagnosis and management of patients

B. Develop the knowledge and ability to communicate appropriately with
patients and families

C. Learn the art of being a consultant

D. Become proficient in utilizing community-based resources in the clinical management of patient-centered and community-centered environmental health problems

E. Become competent teachers in patient-based and research settings

F. Understand the principles of research protocols and learn to administer and use them

G. Develop the ability to work effectively with a multi-disciplinary team and lead patient management

H. Become familiar with the principles of quality improvement, patient safety, and the role of the clinician in health services management

DOMAIN: PEH KNOWLEDGE & CLINICAL SKILLS

Goal: Understand the precepts of pediatric and reproductive environmental health
Attain specialized knowledge in toxicology and other content domains pertinent to environmental health issues, using available electronic resources and PEH textbooks, papers, and reviews

Activities

Self-study topics within the curriculum outline

Attend mandatory core, case-based Friday conferences

Attend selected poison control center rounds on M,Tu,W, F

Attend OEM grand rounds at the HSPH on selected Fridays

Attend the Core Metals rounds at the Landmark Center on selected Wednesdays

Audit selected, related coursework at HSPH

Keep personal log of conferences attended, types of PEH problems encountered, and consultations performed

Goal: Confidence in utilizing resources regarding chemicals, radiation, and hazardous materials

Activities

Perform literature searches utilizing Medline, EBSCO, ATSDR and/or EPA resources

Utilize Poisindex, Chemtrec, IRIS, and other electronic resources

Goal: Clinical skills in the assessment of children and pregnant/lactating women with environmental health problems

Opportunities to refine skills in general pediatrics practice and develop new skills in PEH assessment with professionalism

Learn to take a focused environmental history and to analyze appropriately outside medical records and environmental testing results

Conduct an appropriate physical examination for the presenting complaint

Place patient interests and needs above personal concerns or constraints

Demonstrate a consistent level of commitment, responsibility, and accountability to one’s patient care and to scholarly and educational activities

Maintain professional boundaries in one’s professional relationships, with honesty, integrity, humility, and fairness

Demonstrate respect, sensitivity, and responsiveness to gender, age, ethnicity culture, religion, disabilities, and sexual orientation, with compassion and empathy

Communicate effectively with referring providers, patients, and their families

Write/dictate focused, but comprehensive, notes for specialty patient encounters

Understand billing for specialty patient encounters

Appropriately order and evaluate laboratory data, other diagnostic assessments, and radiographic and other imaging studies

Activities

Refine and expand expertise and skills as a clinician in general pediatrics

Take a pediatric environmental health history and perform a comprehensive physical examination

Understand the resources and assistance available through a regional poison control center

Triage knowledgeably public and professional inquiries to the Pediatric Environmental Health Subspecialty Unit (PEHSU)

Understand the context of care and clinical assessment of adolescents and young adults with occupational and environmental medical complaints

DOMAIN: PEH ADVOCACY

Goal: Attain skills and knowledge of child advocacy in pediatric environmental health
Promote justice in the health care system through education, research, and/or advocacy

Be aware of our diverse clinical population and their ethnic, racial, and cultural differences and how these differences impact on the definition of and access to health care, the context of exposures to environmental toxins, and the reality of social justice

Insure fair distribution of health care resources and elimination of health care disparities and prevent the inequity of the burden of childhood exposures to environmental hazards

Activities

Define the different levels of advocacy as they pertain to patients, communities and the legislative process

Take part in regional activities within the context of the ATSDR or EPA

Develop skills in environmental risk assessment and risk communication

Develop a message map

Participate in advocacy in the context of clinical patient care

Become involved in a community-level project or concern, communicating your ideas effectively to a variety of audiences including community-based organizations, legislators, the media, or other key stakeholders

Serve as a community-level advisor or on a community action board, working effectively with community partners/agencies as a member of a multidisciplinary team

Implement and critically evaluate advocacy activities to advance the field in a scholarly fashion

DOMAIN: RESEARCH

Goal: Ability to conceive, carry out, and evaluate medical research
Understand the principles of research design and the analysis & interpretation of results

Define research ethics regarding clinical or animal studies

Outline special protections for children involved in research and the procedures for informed consent

Understand the definitions of conflicts of interest and scientific misconduct and the reporting requirements to the Hospital and/or governmental agencies

Activities:

Attend the 3-day Introduction to Research course for fellows offered by Boston Children’s Hospital (covers basics of research methods, principles of epidemiology, and statistical analysis)

Complete coursework on research ethics (e.g. CITI course) as mandated by the IRB for all investigators at Children’s Hospital

Submit a research proposal first for divisional review, and then to the Hospital-wide IRB

Identify priorities of private or governmental funding agencies and submit a grant proposal of a research idea for funding purposes

Carry out a basic, animal or clinical investigation to completion of data analysis and summarization of results

Understand statistical methods and the use of such software as ACCESS, SAS, SPSS, REDCAP, STATA, Epi*Info in data analyses

Organize data and present research findings at a professional meeting or for a gathering of faculty

Present research at the HPSH ‘works in progress’ seminars

Present research for presentation at the annual national APA PEH fellows’ retreat

Write up at least one case report on a topic in pediatric environmental health for publication

Write at least one grant proposal to be submitted to public or private sources of funding

Write an article that clearly describes and interprets your primary findings, following the conventions of the targeted journal

Write a research abstract for a regional or national meeting

DOMAIN: TEACHING AND SCHOLARSHIP

Goal: Skills in teaching, administration, & academic scholarship
Opportunities to teach, have administrative responsibilities, and perform academic tasks well and with professionalism

Demonstrate a habit of critical thinking, evidence-based decision-making, and continuous quality improvement


Assess one’s own strengths, weaknesses, and knowledge gaps, acquiring needed information and continuously striving to integrate best evidence into one’s daily practices


Develop ability to evaluate others, giving effective feedback on the performance of other trainees, faculty, Hospital services, and the fellowship program

Activities:

In the Fall there is an intensive 3-day Introduction to Clinical Research Course, organized by the Clinical Research Program for fellows and junior faculty at Boston Children’s Hospital. Fellows learn about available research resources as well as techniques for research design and implementation and IRB submissions. Fellows may also take the Catalyst Research course given 2-3 times per year for a week.

Understands the definition of the six core competencies developed by the ACGME and has a plan for self-evaluation for each competency

Run 3-5 meetings efficiently and with feedback from participants

Teach clinical skills in PEH to medical students, nurses, residents and/or other trainees and/or professional groups and receive written and/or verbal feedback on performance

Carry out quality improvement activities to improve patient safety and care, such as the running of an M&M conference

Complete administrative learning tasks (e.g. Hospital policies, fire safety, drug safety) in eLearning modules developed by Children’s Hospital

Identify and evaluate the literature defining best practices and quality assurance in an area of pediatric environmental health

Serve on a Hospital committee or panel (e.g. Hospital’s GME committee, house-staff subcommittee)

Communicate effectively to large and small groups in the role of teacher, investigator, or child advocate

Collaborate with others to demonstrate teamwork

Review a research proposal of another colleague prior to its submission to an IRB

Write a short summary review of a published PEH research paper for inclusion in a professional newsletter

Write a longer review or case report or case series for submission to a professional journal

Perform in a timely, competent, and unbiased manner the peer review of an extramural unpublished manuscript which is being submitted for publication

The fellow is encouraged to develop grant-writing skills and to apply for external funding.

By the middle of the first year, each fellow has begun to design a project to be carried out in years 1 and 2, working closely with their faculty mentor.

Fellows complete the on-line CITI training in research ethics and subject protection to provide them the needed background to be able to conduct clinical research.

YEAR 1 | Pediatric Environmental Health Fellowship Learning Goals and Objectives

DOMAIN: PEH KNOWLEDGE & CLINICAL SKILLS
Complete core curriculum studies
Complete eLearning on-line course on CHB clinical policies
Audit HSPH EH201: Introduction to Environmental Health
Clinical service in one PEHC session per week
Clinical service in two BCH PCC sessions per week plus an additional session/month
Clinical service in four evening OEM sessions at Cambridge Hospital during the 24 months of fellowship
Participate in PEHC in-patient service
Participate in daily PEHSU telephone on-call system
Attend lecture or view videotape on ‘effects of resident fatigue on patient safety’
Attend selected poison control center rounds on M,Tu,W, F
Attend selected OEM grand rounds at the HSPH on selected Fridays
Attend selected Core Metals rounds at the Landmark Center on Wednesdays

DOMAIN: PEH ADVOCACY
Discuss objectives with mentor
Attend community-level meetings, as necessary
Attend periodic Regional EPA/ATSDR/PEHSU meetings

DOMAIN: RESEARCH
Complete “Introduction to Research” course at CHB
Understand the principles of research design and the analysis & interpretation of results
Complete CITI on-line ethics course regarding human subjects
Develop research question with mentor
Complete background literature search on research question
Submit a research proposal to IRB
Submit a small grant funding proposal
Submit a ‘works-in-progress’ abstract to the national PEH fellows’ meeting
Present research at HSPH “works in progress” seminar
Present research at annual APA national PEH fellows retreat

DOMAIN: TEACHING & SCHOLARSHIP
Attend CHB Faculty Development Series
Complete CHB eLearning modules
Participate in monthly journal club
Keep personal log of training activities
Develop lecture on at least 1 topic in PEH
Prepare one manuscript of a case report OR a retrospective series OR a PEH-topic review OR chapter

YEAR 2 | Pediatric Environmental Health Fellowship | Learning Goals & Objectives

DOMAIN: PEH KNOWLEDGE & CLINICAL SKILLS
Self-study PEH topics
Clinical service in one PEHC session per week
Clinical service in two CHB PCC sessions per week and one additional session per month
Participate in PEHC in-patient service
Participate in PEHSU telephone on-call system
Attend selected poison control center rounds on M,Tu,W, F
Attend selected OEM grand rounds at the HSPH on selected Fridays
Attend selected Core Metals rounds at the Landmark Center on Wednesdays

DOMAIN: PEH ADVOCACY
Attend periodic Regional EPA/ATSDR/PEHSU meetings
Develop community-related initiative
Participate as consultant at public/professional meetings as necessary

DOMAIN: RESEARCH
Carry out work plan of research proposal
Submit abstract of research preliminary results to regional or national professional meeting
Present research at HSPH “works in progress” seminar
Present research at annual APA national PEH fellows retreat

DOMAIN: TEACHING & SCHOLARSHIP
Attend BCH Faculty Development Series
Update performance of BCH eLearning modules
Keep personal log of training activities
Develop lectures on at least 2 different topics in PEH
Peer review one IRB research proposal from the Division of General Pediatrics, one abstract from the Division submitted for national presentation, or one publication submitted to a professional journal
Participate in monthly journal club

YEAR 3 | Pediatric Environmental Health Fellowship | Learning Goals & Objectives

DOMAIN: PEH KNOWLEDGE & CLINICAL SKILLS
Self-study PEH topics
Clinical service in one PEHC session per week
Clinical service in one CHB PCC evening session per week
Clinical service in Beverly Hospital satellite
Provide leadership for PEHC in-patient service
Participate in PEHSU telephone on-call system
Attend selected poison control center rounds on M,Tu,W, F
Attend selected OEM grand rounds at the HSPH on selected Fridays
Attend selected Core Metals rounds at the Landmark Center on Wednesdays

DOMAIN: PEH ADVOCACY
Attend periodic Regional EPA/ATSDR/PEHSU meetings
Pursue advocacy collaboration with community agency
Prepare manuscript describing advocacy experience for publication in newsletter or professional publication

DOMAIN: RESEARCH
Carry out work plan of research study
Present research at HSPH “works in progress” seminar
Present research at annual APA national PEH fellows retreat
Submit abstract of research to regional or national professional meeting
Submit original research manuscript for publication

DOMAIN: TEACHING & SCHOLARSHIP
Attend BCH Faculty Development Series
Update performance of BCH eLearning modules
Organize and lead Friday case or M&M conference
Organize and lead monthly journal club
Submit for publication at least one PEH-topic Review or Case Report/Case Series
Serve on a program/division/or hospital panel or committee regarding patient safety or quality improvement
Keep personal log of training activities
Lead at least one session discussing PEH with medical students, residents, or other trainees
Develop and give lectures to local, regional or national audiences on at least 3 PEH topics