Future perspectives of transgender youth and their caregivers may be shaped by knowledge of discrimination and adverse mental health among transgender adults. Qualitative data from the Trans Youth Family Study were used to examine how transgender and gender nonconforming (TGN) youth and their caregivers imagine the youth's future. A community-based sample of 16 families (16 TGN youth, ages 7-18 years, and 29 caregivers) was recruited from two regions in the United States. Participants completed in-person qualitative interviews and surveys. Interview transcripts were analyzed using grounded theory methodology for coding procedures. Analyses yielded 104 higher order themes across 45 interviews, with eight prominent themes: comparing experiences with others, gender affirming hormones, gender affirming surgery, gender norms, questioning whether the youth is really transgender, expectations for romantic relationships, uncertainty about the future, and worries about physical and emotional safety. A conceptual model of future perspectives in TGN youth and caregivers is presented and clinical implications are discussed.

Coronavirus disease 2019 and pediatrics residency training: before 2020, it was difficult to imagine a public health crisis that could so immediately bring critical aspects of health care and society to a grinding halt. Yet slightly more than a year into the pandemic, we are still seeing significant disruptions in health care and society due to the pandemic. In this issue of Hospital Pediatrics, Geanacopoulos et al 1 evaluated the impacts of the COVID-19 pandemic on pediatric residents in the emergency department, ICU step-down unit, and hospitalist settings in one training program. The authors determined that residents provided care for fewer patients on their emergency department and hospitalist services, worked fewer shifts, and had decreased exposure to common respiratory and gastrointestinal diagnoses. Although residency programs often rely heavily on experiential learning while also integrating didactic learning, during the pandemic many programs had to shift their focus within education by creating alternate experiences, such as the virtual curriculum this program created.Programs across all specialties are now reevaluating how they assess clinical competency and how they will achieve educational goals for trainees required of a residency program. [2][3][4][5][6][7] As pediatric residency leaders, we must balance the need to graduate residents on time with fulfilling our mission to provide a comprehensive training experience. The pandemic has created more questions around clinical competency than answers. We thus ask: How has the pandemic affected pediatric residents' clinical competency? In what areas can programs augment residency education to assure graduates are ready to practice without supervision? If we decide residents working fewer shifts and caring for fewer patients are still competent doctors, how does this impact the future of medical education? If we decide residents working fewer shifts and caring for fewer patients are less competent doctors, how should we address this problem for current residents? Our pediatrics community will need to evaluate competency ratings for trainees during the pandemic and determine if additional educational supports may be indicated.

IntroductionPhysicians have increasingly used social media platforms to review new research, expand networks, and communicate. However, few studies have evaluated how the integration of social media into residency programs affects training. This is relevant during the COVID-19 pandemic, with a shift towards virtual formats for medical education, community building, and recruitment. ObjectiveThe objective of this study was to evaluate how the integration of social media platforms, including Slack, Twitter, and Instagram, influences education, social connectedness, and recruitment within a residency program. MethodsIn 2020, pediatric residents at one institution were encouraged to create personal Twitter and Instagram accounts if they did not already have one and follow the residency program's Twitter and Instagram accounts. Residents were also encouraged to enroll in a private Slack network within the residency program. We surveyed residents in May and June 2020 (pre-intervention) and March 2021 (post-intervention). Analytics from the residency program's social media accounts and Slack were recorded. Data were analyzed using a mixed-methods approach. ResultsResponse rates from residents regarding the impact of social media interventions on education, connectedness, and recruitment were 98% (100/102) pre-intervention and 74.5% (76/102) post-intervention. During the study period from May 2020 to March 2021, chief resident posts on the residency program's Twitter and Instagram accounts garnered 447,467 and 151,341 impressions, respectively. Posts with the highest average impressions were those related to advocacy. After the intervention, residents reported increased connectedness to residents in other classes and increased usage of their personal Twitter and Slack accounts for learning and education. Residents rated the program's Instagram account as a useful recruitment tool. Feasibility of posting was assessed by the number of posts by chief residents during the study period (Twitter n=806, Instagram n=67). There were no costs. ConclusionOur data shows that social media in residency is feasible, cost-effective, and valuable for education, connectedness, and recruitment. We outlined specific ways social media was feasible and useful in these domains.