In developmental-behavioral pediatrics, residents are expected to demonstrate competence in developmental screening, behavioral assessment, and anticipatory guidance within the context of family-centered care. This study grew out of this increasing interest in competency-based training practices in resident education. The study, which was presented at the 18th biennial meeting of the International Society for the Study of Behavioural Development in Ghent, Belgium, examined pediatric residents' attitudes and practices related to newborn behavioral assessment and parent teaching.

Methods
Forty-three residents were surveyed, twenty-one of whom (treatment group) had participated in a Newborn Behavioral Observations (NBO) system training course. Pre- and post-training data were collected to examine the impact of the training program on residents' attitudes and practices in the context of their interactions with newborns and their parents. The training program consisted of pediatric resident participation in a one-day workshop that involved didactic and hands-on teaching of the NBO provided by the developers of the tool. Residents completed a pre-training questionnaire focused on their practices and attitudes related to newborn behavioral assessment and their interactions with parents. Following the workshop, teaching faculty-who attended the workshop both during nursery rotations and in the primary clinic-reinforced NBO principles. Residents who participated in training completed a post-training questionnaire 9 months later.

The 17-item Likert scale questionnaire was comprised of 10 practice-related statements (e.g., "In my pediatrics practice I teach parents strategies for calming a fussy baby") and 7 attitude-related statements (e.g., "I feel comfortable talking to parents about their newborn's behavior."). Practice-related statements were divided further into those related to content (e.g., "I talk to parents about newborn state regulation") and those related to interactional style (e.g., "I encourage parents to make observations about their newborn"). The post-training questionnaire also included questions about the frequency and circumstances under which residents used the NBO, as well as barriers to its use in their pediatrics practice.

Results
Comparing pre- and post-training data, significant improvement in residents' practices and attitudes followed CLNBAS training (p <.001). Positive change occurred in both content and interactional components of practice (p<.001). However, only 53% of residents reported that they often or always used the NBO in their practice. Availability of time was the greatest barrier to use of this tool with newborns and parents.

Conclusion
In summary, we found that teaching pediatric residents to use the NBO resulted in positive changes in their assessments of newborn behavior and their interactions with parents of newborns. Residents applied the NBO tool in both nursery and outpatient settings. Time constraints were sighted as the factor which most interfered with residents' use of the tool as a regular component of newborn primary care.

This was originally presented at the 18th biennial meeting of the International Society for the Study of Behavioural Development in Ghent, Belgium

For references and further information please contact: susan.mcquiston@bhs.org