<p><strong>BACKGROUND AND OBJECTIVE: </strong>Education of residents in academic medical centers occurs as part of clinical care, but little is known about the relationship between clinical workload and educational experiences among pediatric residents. The goal of this study was to assess residents' perceptions of learning on inpatient services at a children's hospital in relation to perceived workload and actual patient census.</p>

<p><strong>METHODS: </strong>This was a prospective cohort study of pediatric residents at 1 urban academic children's hospital. Surveys on educational experience were administered weekly to residents on 12 inpatient units from October 2010 to June 2011. Daily peak medical inpatient census data were collected, and Pearson correlations were performed.</p>

<p><strong>RESULTS: </strong>Mean weekly response rate was 25%. Perceived workload was correlated with weekly peak of patient census for interns (r = 0.66; P= .00) and senior residents (r = 0.73; P = .00). Many aspects of perceived learning were negatively correlated with perceived workload among interns and residents in "acute care" units. Activities beyond direct patient care (eg, attending conferences, independent reading) revealed more negative correlation than educational experience during rounds. Among seniors, scores of aspects of perceived learning did not correlate with workload.</p>

<p><strong>CONCLUSIONS: </strong>The study found mostly negative associations between high perceived workload and perceived learning, especially for interns. Results suggest varied impact of workload on perceived learning by training year. Although patient care is essential for resident education, higher workload may adversely affect learning opportunities for pediatric trainees. More research is needed to identify if generalizable thresholds of patient census and/or clinical workload cause declines in perceived or real education.</p>

<p><strong>OBJECTIVE: </strong>To describe variation across selected US children's hospitals in screening for occult fractures in children &lt;2 years old diagnosed with physical abuse and in infants &lt;1 year old who have injuries associated with a high likelihood of physical abuse.</p>

<p><strong>METHODS: </strong>We performed a retrospective study of children &lt;2 years old with a diagnosis of physical abuse and infants &lt;1 year old with non-motor vehicle crash-associated traumatic brain injuries or femur fractures admitted to 40 hospitals within the Pediatric Hospital Information System database from January 1, 1999, to December 31, 2009. We examined variation among the hospitals in the performance of screening for occult fractures as defined by receipt of skeletal survey or radionuclide bone scan. Marginal standardization implemented with logistic regression analysis was used to examine hospital variation after adjusting for patient demographic characteristics, injury severity, and year of admission.</p>

<p><strong>RESULTS: </strong>Screening for occult fractures was performed in 83% of the 10,170 children &lt;2 years old with a diagnosis of physical abuse, 68% of the 9942 infants who had a traumatic brain injury, and 77% of the 2975 infants who had femur fractures. After adjustment for patient characteristics, injury severity, and year of admission, hospitals varied significantly in use of screening for occult fractures in all 3 groups of children.</p>

<p><strong>CONCLUSIONS: </strong>The observed variation in screening for occult fractures in young victims of physical abuse and infants who have injuries associated with a high likelihood of abuse underscores opportunities to improve the quality of care provided to this vulnerable population.</p>

<p><strong>OBJECTIVE: </strong>To examine the relationship between local macroeconomic indicators and physical abuse admission rates to pediatric hospitals over time.</p>

<p><strong>METHODS: </strong>Retrospective study of children admitted to 38 hospitals in the Pediatric Hospital Information System database. Hospital data were linked to unemployment, mortgage delinquency, and foreclosure data for the associated metropolitan statistical areas. Primary outcomes were admission rates for (1) physical abuse in children &lt;6 years old, (2) non-birth, non-motor vehicle crash-related traumatic brain injury (TBI) in infants &lt;1 year old (which carry high risk for abuse), and (3) all-cause injuries. Poisson fixed-effects regression estimated trends in admission rates and associations between those rates and trends in unemployment, mortgage delinquency, and foreclosure.</p>

<p><strong>RESULTS: </strong>Between 2000 and 2009, rates of physical abuse and high-risk TBI admissions increased by 0.79% and 3.1% per year, respectively (P ≤ .02), whereas all-cause injury rates declined by 0.80% per year (P &lt; .001). Abuse and high-risk TBI admission rates were associated with the current mortgage delinquency rate and with the change in delinquency and foreclosure rates from the previous year (P ≤ .03). Neither abuse nor high-risk TBI rates were associated with the current unemployment rate. The all-cause injury rate was negatively associated with unemployment, delinquency, and foreclosure rates (P ≤ .007).</p>

<p><strong>CONCLUSIONS: </strong>Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends.</p>