Patel-Sanchez Namrata, Discepolo Valentina, Asfour Nour, Azzam Ruba K
Department of Pediatric Gastroenterology, Hepatology and Nutrition. University of California, San Francisco, San Francisco (CA), USA.
Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
JPGN Rep. 2022 Aug;3(3):e219. doi: 10.1097/pg9.0000000000000219. Epub 2022 Jun 21.
Non-Alcoholic Fatty Liver Disease (NAFLD) is reported to be the most common chronic pediatric liver disease. Little information is available on the adherence of residents in-training to the published guidelines for the evaluation and management of pediatric NAFLD.The goals of this study are: (i) to assess the consistency of screening and evaluation for NAFLD in obese and overweight children at continuity clinics by upper level residents, and (ii) to determine the residents' extent of training, knowledge, comfort and competence levels in NAFLD care.
An electronic survey developed using REDCap was emailed to accredited Pediatric Residency Programs in the United States. Program directors and coordinators were requested to forward the survey to their upper level pediatric and medicine/pediatrics residents. Statistical analysis of responses (n= 399) was performed.
More than 88% of residents reported to be exposed to obese and overweight children, representing at least 25% of the patients encountered in clinics. Regardless of their training level, they inconsistently screened for (>60%), initiated evaluation of, or provided counseling on NAFLD in these patients, not following the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines. Over 80% of residents perceived to have received inadequate training resulting in insufficient knowledge on NAFLD, which they identified as their biggest barrier (25.7%). There was minimal statistically significant difference in the survey findings between training levels (PGY-2 vs PGY-3/4).
Educational interventions should be implemented by pediatric residency programs to enhance educational core curricula for the early detection and initiation of management of NAFLD, an emerging public health problem.
据报道，非酒精性脂肪性肝病（NAFLD）是最常见的儿童慢性肝病。关于住院医师培训生对已发表的儿童NAFLD评估和管理指南的遵循情况，目前所知甚少。本研究的目标是：（i）评估上级住院医师在连续性诊所对肥胖和超重儿童进行NAFLD筛查和评估的一致性，以及（ii）确定住院医师在NAFLD护理方面的培训程度、知识水平、舒适度和能力水平。
使用REDCap开发的电子调查问卷通过电子邮件发送给美国经认可的儿科住院医师培训项目。要求项目主任和协调员将调查问卷转发给他们的上级儿科和儿科学/儿科学住院医师培训生。对回复（n = 399）进行统计分析。
超过88%的住院医师报告接触过肥胖和超重儿童，这些儿童占诊所接诊患者至少25%。无论其培训水平如何，他们对这些患者进行NAFLD筛查（>60%）、启动评估或提供咨询的情况并不一致，未遵循北美儿科胃肠病学、肝病学和营养学会的指南。超过80%的住院医师认为自己接受的培训不足，导致对NAFLD的知识了解不够，他们将这一点视为最大障碍（25.7%）。不同培训水平（PGY - 2与PGY - 3/4）之间的调查结果在统计学上差异极小。
儿科住院医师培训项目应实施教育干预措施，以加强教育核心课程，用于早期发现和启动对NAFLD这一新兴公共卫生问题的管理。
