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  1. Article ; Online: Structural Equation Modeling Analysis on Associations of Moral Distress and Dimensions of Organizational Culture in Healthcare: A Cross-Sectional Study of Healthcare Professionals.

    Thomas, Tessy A / Kumar, Shelley / Davis, F Daniel / Boedeker, Peter / Thammasitboon, Satid

    AJOB empirical bioethics

    2024  , Page(s) 1–13

    Abstract: Objective: Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)-perceived psychological safety, ethical climate, ... ...

    Abstract Objective: Moral distress is a complex phenomenon experienced by healthcare professionals. This study examined the relationships between key dimensions of Organizational Culture in Healthcare (OCHC)-perceived psychological safety, ethical climate, patient safety-and healthcare professionals' perception of moral distress.
    Design: Cross-sectional survey.
    Setting: Pediatric and adult critical care medicine, and adult hospital medicine healthcare professionals in the United States.
    Participants: Physicians (
    Main outcome measures: Three dimensions of OCHC were measured using validated questionnaires: Olson's Hospital Ethical Climate Survey, Agency for Healthcare Research and Quality's Patient Safety Culture Survey, and Edmondson's Team Psychological Safety Survey. The perception of moral distress was measured using the Moral Distress Amidst a Pandemic Survey. The hypothesized relationships between various dimensions were tested with structural equation modeling (SEM).
    Results: Adequate model fit was achieved in the SEM: a root-mean-square error of approximation =0.072 (90% CI 0.069 to 0.075), standardized root mean square residual = 0.056, and comparative fit index =0.926. Perceived psychological safety (β= -0.357,
    Conclusions: We used structural equation model to test a theoretical model of multi-dimensional organizational culture and healthcare climate (OCHC) and moral distress.Significant associations were found, supporting mitigating strategies to optimize psychological safety and patient safety culture to address moral distress among healthcare professionals. Future initiatives and studies should account for key dimensions of OCHC with multi-pronged targets to preserve the moral well-being of individuals, teams, and organizations.
    Language English
    Publishing date 2024-01-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2763190-4
    ISSN 2329-4523 ; 2329-4515
    ISSN (online) 2329-4523
    ISSN 2329-4515
    DOI 10.1080/23294515.2023.2297922
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  2. Article ; Online: Impact of COVID-19 on the Sense of Job Security Among Community Pediatric Hospitalists.

    Kim, Tae Yeon / Jackson, Kelsey / Marek, Rachel / Kumar, Shelley / Fromme, H Barrett

    Hospital pediatrics

    2023  Volume 13, Issue 5, Page(s) 443–450

    Abstract: Objectives: The coronavirus disease 2019 (COVID-19) pandemic offers a prime opportunity to examine the ability of community pediatric hospital medicine programs to respond to external stressors. This study aims to characterize the impact of the COVID-19 ...

    Abstract Objectives: The coronavirus disease 2019 (COVID-19) pandemic offers a prime opportunity to examine the ability of community pediatric hospital medicine programs to respond to external stressors. This study aims to characterize the impact of the COVID-19 pandemic on compensation and furlough among community pediatric hospitalists, as well as self-reported sense of job security.
    Methods: This study was part of a larger quantitative project investigating community pediatric hospitalists' career motivators. The survey was drafted through an iterative process by the authors. It was disseminated via e-mail to a convenience sample of community pediatric hospitalists obtained through direct contact with community pediatric hospital medicine programs. Data were collected on changes in compensation and furlough because of COVID-19, as well as worry about job security measured as self-reported worry about one's job being permanently terminated on a 5-point Likert scale.
    Results: Data were collected from 31 hospitals across the United States with 126 completed surveys. Because of COVID-19, many community pediatric hospitalists experienced reduced base pay and benefits and a minority experienced furlough. Nearly two-thirds (64%) reported some worry about job security. Initial base pay reduction, working in suburban areas compared with rural areas, and affiliation with a university-based center or free-standing children's hospital were significantly associated with greater worry about job security.
    Conclusions: The initial response to the COVID-19 pandemic resulted in changes in compensation and furlough for some community pediatric hospitalists and many expressed concerns about job security. Future studies should identify protective factors for community pediatric hospitalists' job security.
    MeSH term(s) Humans ; Child ; United States/epidemiology ; Hospitalists ; Pandemics ; Job Satisfaction ; COVID-19/epidemiology ; Surveys and Questionnaires
    Language English
    Publishing date 2023-03-22
    Publishing country United States
    Document type Journal Article
    ISSN 2154-1671
    ISSN (online) 2154-1671
    DOI 10.1542/hpeds.2022-006898
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  3. Article ; Online: Virtual Deliberate Practice Module for Tracheostomy Change Training: An Application of Educational Design Research.

    Benjamin, Jennifer Christina / Flores, Saul / Jain, Parag / Kumar, Shelley / Thammasitboon, Satid

    ATS scholar

    2022  Volume 3, Issue 1, Page(s) 135–143

    Abstract: Background: The pandemic poses challenges for in-person procedural skills training. We developed a virtual module for teaching hands-on tracheostomy skills.: Objective: To develop and evaluate a virtual module prototype grounded in deliberate ... ...

    Abstract Background: The pandemic poses challenges for in-person procedural skills training. We developed a virtual module for teaching hands-on tracheostomy skills.
    Objective: To develop and evaluate a virtual module prototype grounded in deliberate practice using tracheostomy change as an example.
    Methods: After identifying desirable features of a virtual module by surveying stakeholders, we designed a prototype using VoiceThread, a multimedia-based collaborative learning platform. We created an asynchronous module accessible to learners for repeated skill practice and for video upload of individual performance on a tracheostomy task trainer using personal devices. This virtual module provided a four-step coaching (demonstration, deconstruction, formulation, and performance) to practice tracheostomy change. Two instructors reviewed the learners' performance videos, providing timely feedback for further refinement of skills.
    Results: Sixty-four residents completed the module, System Usability Scale, and self-efficacy survey. All residents rated the module, with a mean System Usability Scale score of 68.6 ± 18.4 (maximum score of 100). Two independent instructors rated performance videos using a 12-item checklist with mean interobserver agreement of 88.1% (standard deviation, 9.7) and mean performance checklist score (
    Conclusion: We developed an asynchronous deliberate practice module on a virtual platform using tracheostomy change as an example. Residents evaluated the module favorably using system usability and learner self-efficacy surveys with improvement of skills.
    Language English
    Publishing date 2022-03-11
    Publishing country United States
    Document type Journal Article
    ISSN 2690-7097
    ISSN (online) 2690-7097
    DOI 10.34197/ats-scholar.2021-0110OC
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  4. Article ; Online: Epidemiology and variability in management of acute mastoiditis in children.

    Edwards, Stephen / Kumar, Shelley / Lee, Soyoon / Pali, Beth L / Marek, Rachel L / Dutta, Ankhi

    American journal of otolaryngology

    2022  Volume 43, Issue 5, Page(s) 103520

    Abstract: Background: To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship.: Methods: We conducted a retrospective observational study of children aged >6 months to ≤ ... ...

    Abstract Background: To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship.
    Methods: We conducted a retrospective observational study of children aged >6 months to ≤18 years of age admitted to a tertiary care hospital with AM over an 8-year period (2011-2019). Electronic medical records were reviewed to collect data.
    Results: A total of 129 patients met inclusion criteria for AM during this time period. Eighty-one (63 %) were males with 110 (81 %) White and 67 (52 %) non-Hispanic. The median age at presentation was 6.4 years (3-10.1 years). Ear protrusion was associated with reduced odds of having AM with intracranial extension (ICE) (OR 0.307, 95 % CI = 0.107-0.883) whereas presence of headaches and/or neck pain increased the odds of having AM with ICE (OR = 3.96, 95%CI 1.29-12.1). The most common etiologies were Streptococcus pyogenes (n = 23, 19.2 %), Pseudomonas aeruginosa (n = 20, 17 %), and Streptococcus pneumoniae (n = 15, 12.5 %). Empiric antibiotic selection and duration of therapy was highly variable. The most common empiric antibiotic used was intravenous vancomycin with a third generation cephalosporin (n = 45, 34.8 %). Majority completed course (n = 92; 73 %) with an oral antibiotic. Shorter (≤10 and ≤14 days) versus longer courses (>10 and >14 days) did not affect readmission rates for AM without ICE.
    Conclusion: There is high variability of treatment of AM in children. Broad spectrum antibiotics, especially vancomycin were used most frequently despite low rates of Methicillin Resistant Staphylococcus aureus. The use of antibiotic stewardship is essential for judicious antibiotic use.
    MeSH term(s) Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Cephalosporins ; Child ; Female ; Humans ; Infant ; Male ; Mastoiditis/complications ; Mastoiditis/drug therapy ; Mastoiditis/epidemiology ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Vancomycin
    Chemical Substances Anti-Bacterial Agents ; Cephalosporins ; Vancomycin (6Q205EH1VU)
    Language English
    Publishing date 2022-06-06
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 604541-8
    ISSN 1532-818X ; 0196-0709
    ISSN (online) 1532-818X
    ISSN 0196-0709
    DOI 10.1016/j.amjoto.2022.103520
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    Zs.A 1637: Show issues Location:
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  5. Article ; Online: Development and Validation of a Theory-Informed Group Learning Environment Assessment Tool for Graduate Medical Education Programs.

    Welch, Cristina E / Carbajal, Melissa M / Kumar, Shelley / Thammasitboon, Satid

    Journal of graduate medical education

    2020  Volume 12, Issue 4, Page(s) 447–454

    Abstract: Background: Recent studies showed that psychological safety is important to resident perception of the work environment, and improved psychological safety improves resident satisfaction survey scores. However, there is no evidence in medical education ... ...

    Abstract Background: Recent studies showed that psychological safety is important to resident perception of the work environment, and improved psychological safety improves resident satisfaction survey scores. However, there is no evidence in medical education literature specifically addressing relationships between psychological safety and learning behaviors or its impact on learning outcomes.
    Objective: We developed and gathered validity evidence for a group learning environment assessment tool using Edmondson's Teaming Theory and Webb's Depth of Knowledge model as a theoretical framework.
    Methods: In 2018, investigators developed the preliminary tool. The authors administered the resulting survey to neonatology faculty and trainees at Baylor College of Medicine morning report sessions and collected validity evidence (content, response process, and internal structure) to describe the instrument's psychometric properties.
    Results: Between December 2018 and July 2019, 450 surveys were administered, and 393 completed surveys were collected (87% response rate). Exploratory factor analysis and confirmatory factor analysis testing the 3-factor measurement model of the 15-item tool showed acceptable fit of the hypothesized model with standardized root mean square residual = 0.034, root mean square error approximation = 0.088, and comparative fit index = 0.987. Standardized path coefficients ranged from 0.66 to 0.97. Almost all absolute standardized residual correlations were less than 0.10. Cronbach's alpha scores showed internal consistency of the constructs. There was a high correlation among the constructs.
    Conclusions: Validity evidence suggests the developed group learning assessment tool is a reliable instrument to assess psychological safety, learning behaviors, and learning outcomes during group learning sessions such as morning report.
    MeSH term(s) Education, Medical, Graduate/methods ; Faculty, Medical/psychology ; Humans ; Internship and Residency/methods ; Learning ; Neonatology/education ; Physicians/psychology ; Power, Psychological ; Psychometrics ; Texas
    Language English
    Publishing date 2020-08-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2578612-X
    ISSN 1949-8357 ; 1949-8357
    ISSN (online) 1949-8357
    ISSN 1949-8357
    DOI 10.4300/JGME-D-19-00748.1
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  6. Article ; Online: No Faculty Required: Use of a Health Literacy Low Inference Self-Assessment Measure to Promote Behavior Change.

    Gupta, Aditi / Wood, Margaret / Kumar, Shelley / Misra, Sanghamitra / Turner, Teri

    Academic pediatrics

    2020  Volume 20, Issue 5, Page(s) 712–720

    Abstract: Objective: To determine if use of a health literacy low-inference, self-assessment measure (LISAM), promoted behavior change as measured by increased use of health literacy communication skills (HLCS).: Methods: The LISAM is a tool used by educators ... ...

    Abstract Objective: To determine if use of a health literacy low-inference, self-assessment measure (LISAM), promoted behavior change as measured by increased use of health literacy communication skills (HLCS).
    Methods: The LISAM is a tool used by educators to self-assess their performances after giving a lecture. The tool is low inference because it self-assesses behaviors that are specific, with little room for subjectivity. Forty-four third-year medical students self-assessed HLCS using a LISAM modified to include health literacy communication skills (LISAM-HLCS).  Self-assessment followed participation in an audio recorded, standardized patient encounter and again after listening to the recording.  Students also created 3 written goals for improvement.  This session was repeated 1 week later.
    Results: At Session 2, 71.4% of students met at least 2 of their 3 self-created objectives. The 3 most commonly created objectives were using teach-back, asking more open ended questions, and obtaining patient input into the management plan. Use of the LISAM increased HLCS use at Session 2 versus Session 1 as assessed by both students and study investigators (P < .05).
    Conclusions: Without faculty present, students met and adjusted objectives, catalyzing changes in HLCS. The LISAM-HLCS has the potential to empower students to improve communication skills and to reduce dependence on faculty observations.
    MeSH term(s) Communication ; Faculty ; Health Literacy ; Humans ; Self-Assessment ; Students, Medical
    Language English
    Publishing date 2020-02-19
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2483385-X
    ISSN 1876-2867 ; 1876-2859
    ISSN (online) 1876-2867
    ISSN 1876-2859
    DOI 10.1016/j.acap.2020.02.019
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    Zs.A 5914: Show issues Location:
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  7. Article ; Online: COVID-19 and Moral Distress: A Pediatric Critical Care Survey.

    Thomas, Tessy A / Davis, F Daniel / Kumar, Shelley / Thammasitboon, Satid / Rushton, Cynda H

    American journal of critical care : an official publication, American Association of Critical-Care Nurses

    2021  Volume 30, Issue 6, Page(s) e80–e98

    Abstract: Background: Moral distress adversely affects the delivery of high-quality patient care and places health care professionals at risk for burnout, moral injury, and the loss of professional integrity.: Objectives: To investigate whether pediatric ... ...

    Abstract Background: Moral distress adversely affects the delivery of high-quality patient care and places health care professionals at risk for burnout, moral injury, and the loss of professional integrity.
    Objectives: To investigate whether pediatric critical care professionals are experiencing moral distress during the COVID-19 pandemic and, if so, for what reasons.
    Methods: An exploratory survey of pediatric critical care professionals was conducted via the Pediatric Acute Lung Injury and Sepsis Investigators Network from April to May 2020. The survey was derived from a framework integrating contemporary literature on moral distress, moral resilience, and expert consensus. Integration of descriptive statistics for quantitative data and thematic analysis for qualitative data yielded mixed insights.
    Results: Overall, 85.8% of survey respondents reported moral distress. Nurses reported higher degrees of moral distress than other professional groups. Inducers of moral distress were related to challenges to professional integrity and lack of organizational support. Five themes were identified: (1) psychological safety, (2) expectations of leadership, (3) connectedness through a moral community, (4) professional identity challenges, and (5) professional versus social responsibility. Most respondents were confident in their ability to reason through ethical dilemmas (76.0%) and think clearly when confronting an ethical challenge even when pressured (78.9%).
    Conclusions: During the COVID-19 pandemic, pediatric critical care professionals are experiencing moral distress due to various factors that challenge their professional integrity. Despite these challenges, they also exhibit attributes of moral resilience. Organizations have opportunities to cultivate a psychologically safe and healthy work environment to mitigate anticipatory, present, and lingering moral distress.
    MeSH term(s) Burnout, Professional ; COVID-19/epidemiology ; COVID-19/psychology ; Child ; Critical Care ; Humans ; Morals ; Pandemics/prevention & control ; SARS-CoV-2 ; Stress, Psychological/epidemiology ; Surveys and Questionnaires
    Language English
    Publishing date 2021-08-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1130987-8
    ISSN 1937-710X ; 1062-3264
    ISSN (online) 1937-710X
    ISSN 1062-3264
    DOI 10.4037/ajcc2021999
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  8. Article ; Online: If You Build It, Will They Come? An Analysis of Candidate Attitudes Toward A New Residency Program.

    Barajaz, Michelle / Denniston, Sarah / Kumar, Shelley / Wolfe, Adam

    MedEdPublish (2016)

    2018  Volume 7, Page(s) 245

    Abstract: This article was migrated. The article was marked as recommended. ...

    Abstract This article was migrated. The article was marked as recommended.
    Language English
    Publishing date 2018-11-05
    Publishing country Scotland
    Document type Journal Article
    ISSN 2312-7996
    ISSN (online) 2312-7996
    DOI 10.15694/mep.2018.0000245.1
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  9. Article: Lessons and Insights From the Implementation of the Cohort Model for a PICU: A Case Study Research.

    Ninemire, Margaret R / Petrescu, Matei / Musick, Matthew A / Shekerdemian, Lara S / Kumar, Shelley / Dinh, Julie / Thammasitboon, Satid

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

    2022  Volume 23, Issue 10, Page(s) e456–e464

    Abstract: Objectives: The subspecialty cohort model allows for creation of smaller diagnosis pools, enabling concentration of expertise and collaboration. Given unknown effects of this model on team dynamics in a PICU, we examined how the cohort-model ... ...

    Abstract Objectives: The subspecialty cohort model allows for creation of smaller diagnosis pools, enabling concentration of expertise and collaboration. Given unknown effects of this model on team dynamics in a PICU, we examined how the cohort-model implementation was perceived by our providers and how this organizational change affected the work environment.
    Design: Case study research approach consisting of surveys, operational observations, and semistructured interviews. A descriptive survey was derived from an integrated conceptual framework (i.e., teamwork and psychologic safety). Sensitized by the framework and quantitative survey data, we conducted a thematic analysis from field notes and interview data.
    Setting: A quaternary-care, children's hospital with a 31-bed PICU.
    Subjects: PICU providers and nurses and subspecialists.
    Intervention: Implementation of the subspecialty cohort model.
    Measurements and main results: A total of 308 and 269 responses from pre- and postcohort surveys, respectively, were analyzed. Overall, 76% of physicians and 74% of nurses viewed the cohort model favorably. Three themes emerged: community-from disruption to redistribution, transforming identity-expert or generalist, and expansive learning from focused practice. The findings provided insights, informed by a theory of "Community of Practice," as lessons learned and ways to enhance the cohort model.
    Conclusions: Our transition to a cohort PICU model offers lessons on impacts of PICU model changes on communities and teams. These theory-informed insights and implications can guide others undergoing similar transitions.
    MeSH term(s) Child ; Cohort Studies ; Humans ; Intensive Care Units, Pediatric ; Surveys and Questionnaires ; Workplace
    Language English
    Publishing date 2022-06-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2052349-X
    ISSN 1947-3893 ; 1529-7535
    ISSN (online) 1947-3893
    ISSN 1529-7535
    DOI 10.1097/PCC.0000000000003018
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  10. Article: Call Me Maybe… A Simulation Based Curriculum for Telephone Triage Education in a Pediatric Residency.

    Blumberg, Joel S / Barajaz, Michelle / Roberts, Danielle / Clary, Cody / Kumar, Shelley

    Frontiers in pediatrics

    2020  Volume 8, Page(s) 283

    Abstract: Pediatrician communication with caregivers by phone has traditionally made a significant impact on patient care but remains a source of medical liability. Despite its importance, few publications exist regarding the education of pediatric residents on ... ...

    Abstract Pediatrician communication with caregivers by phone has traditionally made a significant impact on patient care but remains a source of medical liability. Despite its importance, few publications exist regarding the education of pediatric residents on telephone triage. Our study involved the development of an educational curriculum aimed at expanding the pediatric resident skill set in telephone triage. Our method of curriculum development is based on Kolb's experiential learning theory. We utilized a combination of resource familiarization, didactic education, and simulation in the building of knowledge through reflection upon concrete experience, generalization of knowledge gained, and application of this new knowledge. We developed a 30-min PowerPoint presentation in which instructors reviewed the basic tenets of telephone triage. In the pilot study, residents were divided into two groups-a didactic-first group and a simulation-first group. Their performance was monitored during two scripted, symptom based "parent" phone call simulations. The didactic-first group received the PowerPoint didactic prior to the simulation, and the simulation-first group received the didactic after the simulation. A comparison of resident evaluations by faculty and self-documented confidence level revealed statistically significant higher evaluation scores in the didactic-first group, and an overall improvement in resident confidence with telephone triage. We conclude that this educational curriculum may improve pediatric resident performance in telephone triage.
    Language English
    Publishing date 2020-06-23
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2711999-3
    ISSN 2296-2360
    ISSN 2296-2360
    DOI 10.3389/fped.2020.00283
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