Letters
P = .004) were confined to children who were born at term gestation and were subjected to at least 1 additional course of antenatal corticosteroids. The effect was not observed in the children born preterm. Further analysis is being undertaken to evaluate the association between antenatal corticosteroid exposure, gestational age at birth, and outcomes. The neurosensory difficulties identified in these children are consistent with the compromised neuronal maturation that has been reported in animal studies after multiple courses of antenatal corticosteroids.2,3 Our findings in children at 5 years of age are indeed a point of concern and reinforce the importance of comprehensive follow-up evaluation in children, adolescents, and adults who were prenatally exposed to corticosteroids, as part of carefully controlled randomized clinical trials. This is critical as subtle difficulties in neurologic as well as cardiovascular and metabolic function may not manifest until later in life.4-6 We fully agree that methods to more accurately identify women at true risk of preterm birth must be a primary focus of research to minimize unnecessary exposure of fetuses/ infants/children to treatments for which the long-term safety has not yet been established. Elizabeth V. Asztalos, MD, MSc Andrew R. Willan, PhD Stephen G. Matthews, PhD Author Affiliations: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada (Asztalos); Program in Child Health Evaluative Sciences, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Willan); Department of Physiology, Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Ontario, Canada (Matthews); Department of Obstetrics and Gynaecology, Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Ontario, Canada (Matthews); Department of Medicine, Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Ontario, Canada (Matthews). Corresponding Author: Elizabeth V. Asztalos, MD, MSc, The Centre for Mother, Infant, and Child Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, M4-230, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada ([email protected]). Conflict of Interest Disclosures: None reported. 1. Asztalos EV, Murphy KE, Willan AR, et al; MACS-5 Collaborative Group. Multiple courses of antenatal corticosteroids for preterm birth study: outcomes in children at 5 years of age (MACS-5). JAMA Pediatr. 2013;167(12):1102-1110. 2. Quinlivan JA, Beazley LD, Evans SF, Newnham JP, Dunlop SA. Retinal maturation is delayed by repeated, but not single, maternal injections of betamethasone in sheep. Eye (Lond). 2000;14(pt 1):93-98. 3. Church MW, Adams BR, Anumba JI, Jackson DA, Kruger ML, Jen KLC. Repeated antenatal corticosteroid treatments adversely affect neural transmission time and auditory thresholds in laboratory rats. Neurotoxicol Teratol. 2012;34(1):196-205.
To the Editor We read with great interest the recently published American Pediatric Society Viewpoint by Walker and Stapleton,1 which points out the increasingly important need to diversify the academic pediatric workforce. As leaders of the Academic Pediatric Association (APA), we strongly agree with this viewpoint. A central goal of the APA is to increase the diversity of future academic pediatricians. However, in response to the comment that “pediatric organizations have not developed national strategies” to address this issue, we want to share with the authors and readers the highly successful efforts of the APA New Century Scholars (NCS) program. The NCS is a national mentorship program aimed at increasing the racial and ethnic diversity of the academic pediatric workforce. NCScholars are underrepresented minority pediatric residents who are interested in pursuing careers in academic pediatrics (particularly within the areas of health disparities, social determinants, cultural competency, and minority child health and development). As part of the 2-year program, each NCScholar is matched with a junior and senior mentor who provide ongoing support to the NCScholar during residency, career planning, the fellowship application process, and onward. Each NCScholar receives membership in the APA and a travel grant to attend the Pediatric Academic Societies meeting where they participate in NCS activities. The program also provides an academic home for these young pediatricians (the APA), as well as a peer network, which is extremely important. Over the past 10 years, 49 residents have participated in the program. To date, more than 65% of scholars have gone on to enter academic careers. Graduates have entered fellowships in a variety of pediatric subspecialties as well as programs such as the Robert Wood Johnson Clinical Scholars program, the White House Health Policy Fellowship program, and the Harvard/Commonwealth Minority Health Policy fellowship program. Many are now faculty members in Departments of Pediatrics. The value of the program to scholars is also demonstrated by the continuing involvement of past scholars in the program; many have become junior mentors to current scholars. This is one concrete way that the APA is working to address the lack of diversity in our academic workforce—by providing multilevel mentorship and networking opportunities to underrepresented pediatric trainees as they develop their postresidency career plans. We encourage the development of other ways to address this issue and appreciate the efforts of Walker and Stapleton in bringing attention to this significant topic.
4. Buss C, Davis EP, Shahbaba B, Pruessner JC, Head K, Sandman CA. Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proc Natl Acad Sci U S A. 2012;109(20):1312-1319.
Darcy A. Thompson, MD, MPH Lee M. Pachter, DO David Keller, MD
5. Davis EP, Sandman CA, Buss C, Wing DA, Head K. Fetal glucocorticoid exposure is associated with preadolescent brain development. Biol Psychiatry. 2013;74(9):647-655.
Author Affiliations: University of Colorado, Aurora (Thompson, Keller); Drexel University College of Medicine, Philadelphia, Pennsylvania (Pachter).
6. Alexander N, Rosenlöcher F, Stalder T, et al. Impact of antenatal synthetic glucocorticoid exposure on endocrine stress reactivity in term-born children. J Clin Endocrinol Metab. 2012;97(10):3538-3544.
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Efforts to Diversify the Academic Pediatric Workforce
Corresponding Author: Darcy A. Thompson, MD, MPH, Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, 12631 E 17th Ave, Room 2605 (Academic Office Bldg), Anschutz Medical Campus, Mail Stop F561, Aurora, CO 80045 ([email protected]).
JAMA Pediatrics April 2014 Volume 168, Number 4
Copyright 2014 American Medical Association. All rights reserved.
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Letters
Conflict of Interest Disclosures: None reported. Funding/Support: Dr Pachter has received grant support to direct the NCS program. Role of the Sponsor: The funder had no role in the preparation, review, or approval of the manuscript or decision to submit the manuscript for publication. 1. Walker LR, Stapleton FB. Pediatric faculty diversity: a new landscape for academic pediatrics in the 21st century. JAMA Pediatr. 2013;167(11):989-990.
In Reply We thank Thompson and colleagues for highlighting the Academic Pediatric Association’s successful New Century Scholars program. We congratulate them on their leadership in this area and the long-term success their program has yielded for those who have participated. We add that the American Association of Pediatric Chairs has also begun leadership initiatives with an emphasis on diverse underrepresented faculty as well. These programs are important in highlighting the need to diversify our faculty and they emphasize the high return on investment. It is, however, important to realize that a na-
tional collaborative agenda to promote and develop a diverse and inclusive workforce in the United States is still missing. Our pediatric organizations must learn from best practices like the New Century Scholars program and work together to visibly and substantively commit to widely adopt strategies to have a workforce that is ready to meet the health care needs of an increasingly diverse pediatric population. Leslie R. Walker, MD F. Bruder Stapleton, MD Author Affiliations: Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle (Walker); Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle (Stapleton). Corresponding Author: Leslie R. Walker, MD, Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, PO Box 5371, M/S CSB 200, Seattle, WA 98145 ([email protected]). Conflict of Interest Disclosures: None reported.
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Copyright 2014 American Medical Association. All rights reserved.
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391
P = .004) were confined to children who were born at term gestation and were subjected to at least 1 additional course of antenatal corticosteroids. The effect was not observed in the children born preterm. Further analysis is being undertaken to evaluate the association between antenatal corticosteroid exposure, gestational age at birth, and outcomes. The neurosensory difficulties identified in these children are consistent with the compromised neuronal maturation that has been reported in animal studies after multiple courses of antenatal corticosteroids.2,3 Our findings in children at 5 years of age are indeed a point of concern and reinforce the importance of comprehensive follow-up evaluation in children, adolescents, and adults who were prenatally exposed to corticosteroids, as part of carefully controlled randomized clinical trials. This is critical as subtle difficulties in neurologic as well as cardiovascular and metabolic function may not manifest until later in life.4-6 We fully agree that methods to more accurately identify women at true risk of preterm birth must be a primary focus of research to minimize unnecessary exposure of fetuses/ infants/children to treatments for which the long-term safety has not yet been established. Elizabeth V. Asztalos, MD, MSc Andrew R. Willan, PhD Stephen G. Matthews, PhD Author Affiliations: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada (Asztalos); Program in Child Health Evaluative Sciences, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Willan); Department of Physiology, Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Ontario, Canada (Matthews); Department of Obstetrics and Gynaecology, Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Ontario, Canada (Matthews); Department of Medicine, Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Ontario, Canada (Matthews). Corresponding Author: Elizabeth V. Asztalos, MD, MSc, The Centre for Mother, Infant, and Child Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, M4-230, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada ([email protected]). Conflict of Interest Disclosures: None reported. 1. Asztalos EV, Murphy KE, Willan AR, et al; MACS-5 Collaborative Group. Multiple courses of antenatal corticosteroids for preterm birth study: outcomes in children at 5 years of age (MACS-5). JAMA Pediatr. 2013;167(12):1102-1110. 2. Quinlivan JA, Beazley LD, Evans SF, Newnham JP, Dunlop SA. Retinal maturation is delayed by repeated, but not single, maternal injections of betamethasone in sheep. Eye (Lond). 2000;14(pt 1):93-98. 3. Church MW, Adams BR, Anumba JI, Jackson DA, Kruger ML, Jen KLC. Repeated antenatal corticosteroid treatments adversely affect neural transmission time and auditory thresholds in laboratory rats. Neurotoxicol Teratol. 2012;34(1):196-205.
To the Editor We read with great interest the recently published American Pediatric Society Viewpoint by Walker and Stapleton,1 which points out the increasingly important need to diversify the academic pediatric workforce. As leaders of the Academic Pediatric Association (APA), we strongly agree with this viewpoint. A central goal of the APA is to increase the diversity of future academic pediatricians. However, in response to the comment that “pediatric organizations have not developed national strategies” to address this issue, we want to share with the authors and readers the highly successful efforts of the APA New Century Scholars (NCS) program. The NCS is a national mentorship program aimed at increasing the racial and ethnic diversity of the academic pediatric workforce. NCScholars are underrepresented minority pediatric residents who are interested in pursuing careers in academic pediatrics (particularly within the areas of health disparities, social determinants, cultural competency, and minority child health and development). As part of the 2-year program, each NCScholar is matched with a junior and senior mentor who provide ongoing support to the NCScholar during residency, career planning, the fellowship application process, and onward. Each NCScholar receives membership in the APA and a travel grant to attend the Pediatric Academic Societies meeting where they participate in NCS activities. The program also provides an academic home for these young pediatricians (the APA), as well as a peer network, which is extremely important. Over the past 10 years, 49 residents have participated in the program. To date, more than 65% of scholars have gone on to enter academic careers. Graduates have entered fellowships in a variety of pediatric subspecialties as well as programs such as the Robert Wood Johnson Clinical Scholars program, the White House Health Policy Fellowship program, and the Harvard/Commonwealth Minority Health Policy fellowship program. Many are now faculty members in Departments of Pediatrics. The value of the program to scholars is also demonstrated by the continuing involvement of past scholars in the program; many have become junior mentors to current scholars. This is one concrete way that the APA is working to address the lack of diversity in our academic workforce—by providing multilevel mentorship and networking opportunities to underrepresented pediatric trainees as they develop their postresidency career plans. We encourage the development of other ways to address this issue and appreciate the efforts of Walker and Stapleton in bringing attention to this significant topic.
4. Buss C, Davis EP, Shahbaba B, Pruessner JC, Head K, Sandman CA. Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proc Natl Acad Sci U S A. 2012;109(20):1312-1319.
Darcy A. Thompson, MD, MPH Lee M. Pachter, DO David Keller, MD
5. Davis EP, Sandman CA, Buss C, Wing DA, Head K. Fetal glucocorticoid exposure is associated with preadolescent brain development. Biol Psychiatry. 2013;74(9):647-655.
Author Affiliations: University of Colorado, Aurora (Thompson, Keller); Drexel University College of Medicine, Philadelphia, Pennsylvania (Pachter).
6. Alexander N, Rosenlöcher F, Stalder T, et al. Impact of antenatal synthetic glucocorticoid exposure on endocrine stress reactivity in term-born children. J Clin Endocrinol Metab. 2012;97(10):3538-3544.
390
Efforts to Diversify the Academic Pediatric Workforce
Corresponding Author: Darcy A. Thompson, MD, MPH, Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, 12631 E 17th Ave, Room 2605 (Academic Office Bldg), Anschutz Medical Campus, Mail Stop F561, Aurora, CO 80045 ([email protected]).
JAMA Pediatrics April 2014 Volume 168, Number 4
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archpedi.jamanetwork.com/ by a Michigan State University User on 06/10/2015
jamapediatrics.com
Letters
Conflict of Interest Disclosures: None reported. Funding/Support: Dr Pachter has received grant support to direct the NCS program. Role of the Sponsor: The funder had no role in the preparation, review, or approval of the manuscript or decision to submit the manuscript for publication. 1. Walker LR, Stapleton FB. Pediatric faculty diversity: a new landscape for academic pediatrics in the 21st century. JAMA Pediatr. 2013;167(11):989-990.
In Reply We thank Thompson and colleagues for highlighting the Academic Pediatric Association’s successful New Century Scholars program. We congratulate them on their leadership in this area and the long-term success their program has yielded for those who have participated. We add that the American Association of Pediatric Chairs has also begun leadership initiatives with an emphasis on diverse underrepresented faculty as well. These programs are important in highlighting the need to diversify our faculty and they emphasize the high return on investment. It is, however, important to realize that a na-
tional collaborative agenda to promote and develop a diverse and inclusive workforce in the United States is still missing. Our pediatric organizations must learn from best practices like the New Century Scholars program and work together to visibly and substantively commit to widely adopt strategies to have a workforce that is ready to meet the health care needs of an increasingly diverse pediatric population. Leslie R. Walker, MD F. Bruder Stapleton, MD Author Affiliations: Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle (Walker); Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle (Stapleton). Corresponding Author: Leslie R. Walker, MD, Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, PO Box 5371, M/S CSB 200, Seattle, WA 98145 ([email protected]). Conflict of Interest Disclosures: None reported.
jamapediatrics.com
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Copyright 2014 American Medical Association. All rights reserved.
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