Social determinants of pediatric residents' injury prevention counseling

Abstract

Background: Social norms imparted by preceptors and the requirements necessary to pass American Board of Pediatrics' examinations are potentially important contributors to physician behavior. Objectives: To explore the relationships between perceived professional norms regarding injury prevention and the injury prevention topics discussed, and counseling strategies employed, by pediatric residents. Designs: A self-administered survey. Setting: All 5 North Carolina pediatric residency programs. Participants: Physicians training in pediatrics or medicine-pediatrics in these programs (N=160, 72% response rate). Main Outcome Measures: Correlation between perceived professional norms and self-reported content of injury prevention counseling and use of behavior change strategies. Results: Although 95% of the pediatric residents reported counseling all or almost all parents with children younger than 1 year about car seat use, only 19% reported counseling this many parents about gun safety. Of the 7 behavior change strategies that residents were asked about, respondents were most likely to report 'showing approval for safe behaviors' to all or almost all parents (78%). Two thirds reported asking all or almost all parents about the safety of their homes. Pediatric residents' reported injury prevention counseling was correlated with their perceived professional norms regarding such counseling for most of the content areas and behavior change strategies. Conclusions: Perceived professional norms regarding injury prevention are related to pediatric residents' counseling. Preceptors should be aware that they transmit professional norms to residents. Also, the American Board of Pediatrics can increase residents' attention to injury prevention by informing them that it will be a topic included in the board examination.