Introduction: The epidemic of adverse childhood experiences (ACEs) has many known health consequences. Robust research has linked ACEs to increased morbidity and mortality. Because of their frequent interaction with children and their families, pediatricians should be educated to recognize ACEs and practice trauma-informed care (TIC). There is a lack of education for pediatric residents on ACEs despite their significance. Our goals were to identify residents' baseline perceived importance, confidence, and frequency of discussion of ACEs, TIC, toxic stress, and resiliency and evaluate the efficacy of an educational module addressing these topics. Methods: A 25-minute self-directed module was created for pediatric residents. The module was accessible online and independently completed by residents during the child advocacy rotation. Pre-and postmodule surveys using a 5-point Likert scale (1 = low, 5 = high) were administered, and median scores of 11 participants who completed both surveys were compared using the Wilcoxon signed rank test. Results: Presurvey results demonstrated that residents were not confident discussing ACEs, TIC, or resiliency (median = 2). Residents reported that it was very important to discuss ACEs, toxic stress, and resiliency with families (median = 5), although they were rarely discussed in clinic (median = 1 or 2). Matched pre/post data showed significant increases in knowledge, confidence, and discussion frequency. Discussion: The results demonstrated a need for ACE education for pediatric residents. The matched survey results showed the module's success in knowledge and behavior change. The module can be adapted to other learners to enhance understanding of ACEs.

SummaryThe use of casemix classifications to assist in the analysis of patient-based information is becoming more widespread and routine in the management of the National Health Service (NHS). This paper details the process of modification of and the results of modifications to Healthcare Resource Groups (HRGs), an in-patient classification tailor-made for the English healthcare system. Clinical expertise and extensive statistical analysis of national data were combined to identify areas of HRGs Version 2 where improvement could be made. The ensuing changes were then reviewed by professional associations and the wider NHS before being incorporated into grouping software. Extensive changes were made to the classification, with significant gains in statistical performance. Analysis shows that the revised groupings perform better on English data than other available systems.

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