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Children’s National Fetal Medicine Institute hosts 2nd annual International Symposium on the Fetal Brain


The Children’s National Health System Fetal Medicine Institute hosted the 2nd annual International Symposium on the Fetal Brain in August 2017 in Washington, D.C.

Speakers at this year’s symposium focused on the following four areas:

  • Brain Development in an Unsupportive In Utero Environment – Diagnosis and Consequences
  • Supporting Brain Development in the Ex Utero Fetus: How Far Are We From Optimal?
  • Genomic and Epigenomic Mechanisms Underlying Differences in Brain Development
  • The Emergence of Consciousness and Pain Sensation

Adré J. du Plessis, M.B.Ch.B., M.P.H., Director of the Fetal Medicine Institute and Division Chief of Fetal and Transitional Medicine hosted the conference. In his opening remarks Dr. du Plessis noted “Our goal has been to gather together a diverse group from across the spectrum of disciplines focused on the well-being of the fetal brain and to engage all disciplines together.”

Diana-Bianchi-at-ISFB

Diana Bianchi, MD gives her keynote presentation on non-invasive fetal testing at the second annual International Symposium on the Fetal Brain.

Invited, internationally renowned speakers presented on diverse topics, including Diana Bianchi, Director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development who spoke on the “Non-Invasive Fetal Testing Beyond Karyotype: What’s in it for the Fetal Brain?”

A new component to the symposium was the clinically-focused breakfast breakout sessions, created based on feedback from attendees of the 2016 Symposium. Sessions covered varied topics such as “Fetal Ultrasound: the Cornerstone of Fetal Neurodiagnosis,” “The Essentials of Neurogenetic Testing,” “Developing a Transitional Fetal-Neonatal Program” and “Using MRI to Advance Fetal Neurodiagnosis.”

The conference started with an exciting discussion by Alistair Gunn, M.B.Ch.B., Head of the Department of Physiology at the University of Auckland. His presentation “Fetal Heart Rate: What It Does and Does Not Tell Us” explored the considerable body of evidence that essentially all decelerations are mediated by chemoreflex responses to repeated hypoxia and that the parasympathetic autonomic nervous system is the critical regulator of both fetal heart rate and heart rate variation in labor.

Following a voting process from the symposium’s external speakers, the inaugural Andrea Poretti Abstract Award was presented to Katherine Ottolini for her poster titled: Breastmilk Feeds Improve Brain Microstructural Development in Very Premature Infants.

For more information about the sessions and speakers at the 2017 Symposium, please visit our website.

Promoting diversity and inclusion in pediatric academic medicine

Mary Ottolini

Mary Ottolini, M.D., M.P.H., ME.d., highlighted the Academic Pediatric Association’s efforts to promote more diversity and inclusion within pediatric academic medicine.

Data from the Association of American Medical Colleges on faculty promotion show a very low percentage of diverse assistant professors being promoted to associate professors, and a low percentage of diverse associate professors rising through the ranks to become full professors within academic medicine. Mary Ottolini, M.D., M.P.H., ME.d., vice chair for Medical Education at Children’s National Health System, professor of pediatrics at George Washington University School of Medicine and president of the Academic Pediatric Association (APA) addressed this problem at the recent Pediatric Academic Societies annual meeting. In her presentation, “APA approach to diversity-inclusion,” Dr. Ottolini explained various APA initiatives in place to assist underrepresented minority (URM) residents, fellows and junior faculty to advance academically in pediatric medicine.

The APA’s core value and strategic goal for diversity and inclusion is to increase diversity and engagement of its membership. To execute this initiative, New Century Scholars was created in 2004 as a national mentorship program to increase racial and ethnic diversity of academic pediatric medicine. The two-year program collaborates with the American Pediatric Society and utilizes junior and senior mentors to provide support to our URM residents with a special interest in health disparities, social determinants of health, cultural competency and minority child health and development.

Dr. Ottolini believes, “it’s important for our URM faculty to have early, strong mentorship that provides an idea of what it takes to be academically successful, by networking and collaborating with others.” She went on to say, “By forming these collaborations, they can transform an idea into a project that will be published, which strengthens their ability to achieve promotions.”

Research Academic Pediatrics Initiative on Diversity (RAPID), is another APA national program working to recruit, retain, and provide career development for diverse junior faculty in general academic pediatrics that are pursuing careers in the National Institute of Diabetes and Digestive and Kidney Diseases mission areas. RAPID targets applicants who are members of an underrepresented minority group and are disabled or from a socially, culturally, economically or educationally disadvantaged background.

“Diversity and inclusion is an issue that is important for patients and the field of academic pediatrics because we need to have a physician workforce that resembles the patient population that we are entrusted to take care of,” Dr. Ottolini says.

Dr. Ottolini also explained APA’s current special interest groups were put in place to bring awareness to the role of race in the practice of medicine, and to provide resources by which members can support the healthy development and optimal care for U.S. youth of color. The ultimate goal is to develop strategies for increasing diversity and retention among academic medical faculty across the United States, and develop best practices for caring for youth of color in the primary care setting.

The presentation concluded with a question-and-answer session and further discussion from the audience. Since her presentation, Dr. Ottolini has received offers from other doctors and national organizations to fund these initiatives.

e-learning

Gamifying e-learning for medical education

e-learning

Computer-based learning simulations and training modules hold the promise to create “virtual patients,” enhancing opportunities for real-time learning and evaluation in medical education.

Today’s e-learning platforms are often static, one-way programs or web pages that ask passive users to read text or watch a video on screen. However, the emerging generation of e-learning features dynamic visualizations and interactions that immerse the user in real-time settings. Military pilots and vehicle operators, for example, still log hours in traditional ways, such as hands-on simulation and flight time, but now also sit in front of a computer and practice tackling unique scenarios designed to challenge and improve their real-time decision making under pressure.

In medical education, computer-based learning simulations and training modules have the promise to create “virtual patients,” giving trainees and physicians the opportunity for real-time evaluation and application of evidence-based care models. Mary Ottolini, M.D., M.P.H., M.Ed., vice chair of medical education and designated institutional official, and Jeff Sestokas, M.Ed., director of the E-Learning Center, are at the forefront of developing these types of training modules for a wide variety of users with variable experience and specialty/sub-specialty expertise in pediatric medicine.

Instructional technologists, multimedia developers and members of the Children’s Academy of Pediatric Educators (CAPE) – some of the nation’s best pediatric clinicians and medical educators – all work collaboratively to design programs that achieve specific educational goals. Each platform resides in a responsive template, making it accessible on a variety of devices and highly customizable to the needs of specific learners. A multitude of online communication and educational tactics are available to enhance learning, including live and archived lectures, forums, blogs, wikis, documents, training modules, virtual simulations, quizzes, podcasts and videoconferencing. Within each platform, individual educators have the ability to customize learning experiences even further, selecting specific modules and specialty content.

“We’re taking these tools to people where they are, and delivering the content in ways that really embrace how this latest generation of trainees receives and processes information,” says Sestokas.

Designed for Children’s National and sites around the country, the majority of the 25 plus platforms and portals created so far focus on what Children’s experts know best – the unique challenges and needs of pediatric patients and their families.

Mary Ottolini

Mary Ottolini, M.D., M.P.H., M.Ed.

For example, clinical scenarios encompass more than simple clinical evaluation and diagnosis. The learning module BEARScalpel teaches surgical residents with limited prior exposure to pediatric care how to address common communication challenges that arise when interacting with pediatric patients and their families. Maybe the “digital” family has a language barrier or a child is in more grave condition than it appears and the trainee has to decide when and how to escalate the issue to an attending physician.

Another module asks participants to diagnose a three-dimensional nonverbal “digital” infant, based on visual and audio cues such as type of cry, skin tone and overall responsiveness.

This type of case-driven learning is relatively new in the universe of electronic medical education, but is showing early promise to improve students’ analytical thinking and problem solving skills.

“There is a lot of medical e-learning available,” Sestokas adds. “But not much e-learning is case-based. That’s something we’re doing that few others do, even in adult-focused medical education.”

A recently published study measured the success of one platform at achieving its educational goals. Participants had higher satisfaction, reported higher impact on knowledge and demonstrated higher scores on metrics assessing behavior change in a virtual environment when compared to the traditional format of reading. The results suggest that interactive modules are not only a preferred method of content delivery but also more likely to improve resident performance. This assessment was made possible by sophisticated tracking systems built into each platform. The data collection provides a steady stream of intelligence about user interaction with presentation format and content, and the material’s contribution to learning goals.

“These systems augment the long standing medical education practices of hands-on simulation and bedside patient care rotations, to allow us to expose trainees and physicians to more scenarios, more complications, and more challenging decisions. We know that the value of a trainee’s education is based on the quality of the cases they are exposed to,” says Dr. Ottolini. “Our goal is to equip these trainees with tools to care for pediatric patients in the future, but to also improve their ability to care for patients today, while they continue to learn.”

As a result of this innovative work, Children’s National is one of seven institutions, and the only children’s hospital, selected to receive an Accreditation Council for Graduate Medical Education (ACGME) Innovation Award that will develop next generation of learning resources for faculty and trainees around the country.

“We have the opportunity to ensure that we are doing the best possible job of training and continuously developing pediatric experts in a field that is rapidly changing and adapting,” concludes Dr. Ottolini. “The best way to do this is to develop flexible training systems that engage users, establish a habit of lifelong learning, and instill a desire for clinical care improvement.”

 


One patient-focused module creates a virtual grocery store to help patients
and families with celiac disease learn how to identify gluten-free food.

Breastfeeding Mom

Breast milk helps white matter in preemies

Breastfeeding Mom

Critical white matter structures in the brains of babies born prematurely at low birth weight develop more robustly when their mothers breast-feed them, compared with preemies fed formula.

Breast-feeding offers a slew of benefits to infants, including protection against common childhood infections and potentially reducing the risk of chronic health conditions such as asthma, obesity and type 2 diabetes. These benefits are especially important for infants born prematurely, or before 37 weeks gestation – a condition that affects 1 in 10 babies born in the United States, according to the Centers for Disease Control and Prevention. Prematurely born infants are particularly vulnerable to infections and other health problems.

Along with the challenges premature infants face, there is a heightened risk for neurodevelopmental disabilities that often do not fully emerge until the children enter school. A new study by Children’s National Health System researchers shows that breast-feeding might help with this problem. The findings, presented at the 2017 annual meeting of the Pediatric Academic Societies, show that critical white matter structures in the brains of babies born so early that they weigh less than 1,500 grams develop more robustly when their mothers breast-feed them, compared with preemie peers who are fed formula.

The Children’s National research team used sophisticated imaging tools to examine brain development in very low birth weight preemies, who weighed about 3 pounds at birth.

They enrolled 37 babies who were no more than 32 weeks gestational age at birth and were admitted to Children’s neonatal intensive care unit within the first 48 hours of life. Twenty-two of the preemies received formula specifically designed to meet the nutritional needs of infants born preterm, while 15 infants were fed breast milk. The researchers leveraged diffusion tensor imaging – which measures organization of the developing white matter of the brain – and 3-D volumetric magnetic resonance imaging (MRI) to calculate brain volume by region, structure and tissue type, such as cortical gray matter, white matter, deep gray matter and cerebellum.

“We did not find significant differences in the global and regional brain volumes when we conducted MRIs at 40 weeks gestation in both groups of prematurely born infants,” says Catherine Limperopoulos, Ph.D., director of the Developing Brain Research Laboratory and senior author of the paper. “There are striking differences in white matter microstructural organization, however, with greater fractional anisotropy in the left posterior limb of internal capsule and middle cerebellar peduncle, and lower mean diffusivity in the superior cerebellar peduncle.”

White matter lies under the gray matter cortex, makes up about half of the brain’s volume, and is a critical player in human development as well as in neurological disorders. The increased white matter microstructural organization in the cerebral and cerebellar white matter suggests more robust fiber tracts and microarchitecture of the developing white matter which may predict better neurologic outcomes in preterm infants. These critical structures that begin to form in the womb are used for the rest of the person’s life when, for instance, they attempt to master a new skill.

“Previous research has linked early breast milk feeding with increased volumetric brain growth and improved cognitive and behavioral outcomes,” she says. “These very vulnerable preemies already experience a high incidence rate of neurocognitive dysfunction – even if they do not have detectable structural brain injury. Providing them with breast milk early in life holds the potential to lessen those risks.”

The American Academy of Pediatrics endorses breast-feeding because it lowers infants’ chances of suffering from ear infections and diarrhea in the near term and decreases their risks of being obese as children. Limperopoulos says additional studies are needed in a larger group of patients as well as longer-term follow up as growing infants babble, scamper and color to gauge whether there are differences in motor skills, cognition and writing ability between the two groups.

Mary Ottolini receives COMSEP Achievement Award

Mary Ottolini

Mary Ottolini, M.D., M.P.H., M.Ed., vice chair of medical education at Children’s National Health System and professor of pediatrics at The George Washington University, recently received the Council on Medical Student Education in Pediatrics (COMSEP) Achievement Award during the group’s annual meeting in Portland, Oregon. This prestigious award is given to a current or former COMSEP member who has made major contributions to the organization and its members.

Since joining the organization in 2000, Dr. Ottolini has become a leader in the COMSEP Education Technology task force, a mentor to medical students, a teacher in clinical settings and an education innovator. Currently, Dr. Ottolini’s work with COMSEP is focused on overturning a Centers for Medicare & Medicaid Services regulation that bars medical students from documenting in the medical record, which interferes with their progress to becoming physicians. She continues to uphold the educational mission of Children’s National in caring for children by training the pediatric experts of tomorrow.