Hillary A Franke

Interests

Teaching

Pediatric critical careIntegrative medicine

Courses

Scholarly Contributions

Journals/Publications

• Reed, S., Kemper, K. J., Schwartz, A., Batra, M., Staples, B. B., Serwint, J. R., McClafferty, H., Schubert, C. J., Wilson, P. M., Rakowsky, A., Chase, M., & Mahan, J. D. (2022). Variability of Burnout and Stress Measures in Pediatric Residents: An Exploratory Single-Center Study From the Pediatric Resident Burnout-Resilience Study Consortium. Journal of evidence-based integrative medicine, 23, 2515690X18804779.
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  Residency is a high-risk period for physician burnout. We aimed to determine the short-term stability of factors associated with burnout, application of these data to previous conceptual models, and the relationship of these factors over 3 months. Physician wellness questionnaire results were analyzed at 2 time points 3 months apart. Associations among variables within and across time points were analyzed. Logistic regression was used to predict burnout and compassionate care. A total of 74% of residents completed surveys. Over 3 months, burnout ( P = .005) and empathy ( P = .04) worsened. The most significant cross-sectional relationship was between stress and emotional exhaustion (time 1 r = 0.61, time 2 r = 0.68). Resilience was predictive of increased compassionate care and decreased burnout ( P < .05). Mindfulness was predictive of decreased burnout ( P < .05). Mitigating stress and fostering mindfulness and resilience longitudinally may be key areas of focus for improved wellness in pediatric residents. Larger studies are needed to better develop targeted wellness interventions.
• Dundon, K. M., Powell, W. T., Wilder, J. L., King, B., Schwartz, A., McPhillips, H., Best, J. A., & , A. L. (2021). Parenthood and Parental Leave Decisions in Pediatric Residency. Pediatrics, 148(4).
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  The demands of residency training may impact trainees' decision to have children. We examined characteristics of pediatric residents' decisions regarding childbearing, determinants of resident parental leave, and associations with well-being.
• Kemper, K. J., Schwartz, A., & , P. R. (2021). Bullying, Discrimination, Sexual Harassment, and Physical Violence: Common and Associated With Burnout in Pediatric Residents. Academic pediatrics, 20(7), 991-997.
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  Many pediatric residents suffer from burnout. We aimed to describe the prevalence, source, and epidemiology of bullying, discrimination, harassment, and physical violence, and the relationship between these experiences and burnout.
• Lauden, S. M., Wilson, P. M., Faust, M. M., Webber, S., Schwartz, A., Mahan, J. D., Batra, M., Schubert, C. J., & , P. R. (2021). Global Health Experiences, Well-Being, and Burnout: Findings From a National Longitudinal Study. Academic pediatrics, 20(8), 1192-1197.
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  Describe the demographics of pediatric and internal medicine/pediatric residents participating in global health (GH) experiences and examine relationships between GH involvement and self-perceived burnout, resilience, mindfulness, empathy, and spirituality.
• Webber, S., Sklansky, D. J., Schwartz, A., Mahan, J. D., Kemper, K. J., Batra, M., & Babal, J. C. (2021). Faculty and Peer Support During Pediatric Residency: Association With Performance Outcomes, Race, and Gender.. Academic pediatrics, 21(2), 366-374. doi:10.1016/j.acap.2020.08.009
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  To examine the association of resident perception of colleague and faculty support with performance, as measured by milestones-based competency scores, exploring associations between race and gender and perception of support and milestone scoring..Resident satisfaction was measured using an annual survey of residents at 49 pediatric residency programs in 2016, 2017, and 2018. Satisfaction with colleague and faculty support was measured using Likert scale survey questions. Pediatric Milestone Competency scores were obtained from the Association of Pediatric Program Directors' Longitudinal Educational Assessment Research Network. Analysis included linear fixed-effects models to examine the relationship between support satisfaction, race, gender, and spring milestone scores..Over 60% of eligible residents responded to the survey. The majority of residents were satisfied with colleague and faculty support, with those identifying as Asian or underrepresented in medicine (URM) reporting lower rates of satisfaction than White peers. Residents satisfied with colleague support had higher milestone scores compared to those with a neutral degree of satisfaction. Residents reporting dissatisfaction with colleague and faculty support had lower milestone scores in most competency domains. Residents identifying as URM had lower milestone scores than White residents, which was partially mediated by lower rates of support satisfaction..Resident satisfaction with colleague and faculty support correlates with milestone performance. In particular, dissatisfied residents have lower scores than those who are neutral or satisfied. Racial inequities in resident milestone scores may be partially driven by lower rates of support satisfaction among underrepresented residents.
• Wilson, P. M., Staples, B. B., Serwint, J. R., Schwartz, A., Schubert, C. J., Mahan, J. D., Kemper, K. J., Burke, A. E., & Batra, M. (2021). Burnout and Association With Resident Performance as Assessed by Pediatric Milestones: An Exploratory Study.. Academic pediatrics, 21(2), 358-365. doi:10.1016/j.acap.2020.08.006
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  Prior work demonstrating that burnout is associated with decreased performance in medical trainees has relied on self-report and/or single-site studies. We explored the relationship between burnout status and Milestones-based scores in pediatric residents nationally..In April to June 2016, we confidentially surveyed residents using the Maslach Burnout Inventory. Separately, programs submitted resident Milestones scores in June 2016. We examined the relationship between burnout and performance as assessed by Milestones scores for each domain of competence. We performed multivariate analysis to determine which components of burnout (depersonalization [DP], emotional exhaustion, and lack of personal accomplishment [PA]) were most impactful..About 1494 of 2368 (63%) residents at 32 programs completed the Maslach Burnout Inventory and had Milestones scores submitted. Residents who scored positive for burnout scored lower in all Milestones domains. Subgroup analysis demonstrated that this association was only significant (P < .05) in the post-graduate year 1 (PGY1) categorical pediatric cohort. In the PGY1 residents (n = 442), those positive for burnout had lower Milestones scores in patient care (PC) (2.78 vs 2.98), systems-based practice (2.69 vs 2.87), practice-based learning and improvement (2.77 vs 2.93), professionalism (3.09 vs 3.24), and interpersonal and communication skills (2.95 vs 3.12), but not medical knowledge. Multivariate analysis demonstrated that, in PGY1 residents, lower PC score was associated with lower PA and higher DP..Burnout is associated with decreased Milestones performance for pediatric PGY1 residents. DP and low PA were associated with lower PC scores in PGY1 residents. Future research should address whether strategies to mitigate burnout improve PGY1 performance.
• Kemper, K. J., Schwartz, A., Wilson, P. M., Mahan, J. D., Schubert, C. J., Staples, B. B., McClafferty, H., Serwint, J. R., Batra, M., & , P. R. (2020). Burnout in Pediatric Residents: Three Years of National Survey Data. Pediatrics, 145(1).
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  We aimed to describe the national epidemiology of burnout in pediatric residents.
• Staples, B. B., Burke, A. E., Batra, M., Kemper, K. J., Schwartz, A., Wilson, P. M., Schubert, C. J., Mahan, J. D., Serwint, J. R., & , P. R. (2020). Burnout and Association With Resident Performance as Assessed by Pediatric Milestones: An Exploratory Study. Academic pediatrics.
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  Prior work demonstrating that burnout is associated with decreased performance in medical trainees has relied on self-report and/or single-site studies. We explored the relationship between burnout status and Milestones-based scores in pediatric residents nationally.
• Webber, S., Schwartz, A., Kemper, K. J., Batra, M., Mahan, J. D., Babal, J. C., Sklansky, D. J., & , P. R. (2020). Faculty and Peer Support During Pediatric Residency: Association With Performance Outcomes, Race, and Gender. Academic pediatrics.
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  To examine the association of resident perception of colleague and faculty support with performance, as measured by milestones-based competency scores, exploring associations between race and gender and perception of support and milestone scoring.
• Kemper, K. J., McClafferty, H., Wilson, P. M., Serwint, J. R., Batra, M., Mahan, J. D., Schubert, C. J., Staples, B. B., & Schwartz, A. (2019). Do Mindfulness and Self-Compassion Predict Burnout in Pediatric Residents?. Academic medicine : journal of the Association of American Medical Colleges, 94(6), 876-884.
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  Burnout symptoms are common among health professionals. Gaps remain in understanding both the stability of burnout and compassion over time and relationships among burnout, self-compassion, stress, and mindfulness in pediatric residents.
• Kemper, K. J., Wilson, P. M., Schwartz, A., Mahan, J. D., Batra, M., Staples, B. B., McClafferty, H., Schubert, C. J., & Serwint, J. R. (2019). Burnout in Pediatric Residents: Comparing Brief Screening Questions to the Maslach Burnout Inventory. Academic pediatrics, 19(3), 251-255.
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  Measuring burnout symptoms is important, but the Maslach Burnout Inventory (MBI) has 22 items. This project compared 3 single-item measures with the MBI and other factors related to burnout.
• Placzek, E., Patel, P. G., Manzo, R. B., Kurland, Y., Hollinger, J., Haughey, B., & Franke, H. A. (2018). Wellness, For Residents - By Residents. Pediatrics, 142, 98-98. doi:10.1542/peds.142.1_meetingabstract.98
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  Background: Managing stress during residency training, be it mental, physical, or spiritual, requires a holistic approach. [1] Resident wellness is imperative for effectively managing stress successfully and preventing burnout. [2] Physician burnout during residency, is often reported higher than sixty percent. [3] Establishing an environment of wellness for residents is important. For such an endeavor to be successful and sustainable, resident participation, buy-in, and faculty support is required. [4] Objective: A self-identified group of residents spanning all years of training organized a resident-led wellness committee. The committee goals were to …
• Cramer, N., Elliott, S. P., Shwaish, N., Cramer, N., Shwaish, N., Elliott, S. P., Franke, H. A., Franke, H. A., Seserinac, J., Seserinac, J., Cramton, R., & Cramton, R. (2017). A QI Project to Improve Resident Satisfaction and Participation in Pediatric Board Examination Review. Academic Pediatrics, 17(5), e14-e15.
• Wilson, P. M., Kemper, K. J., Schubert, C. J., Batra, M., Staples, B. B., Serwint, J. R., McClafferty, H., Mahan, J. D., & , P. R. (2017). National Landscape of Interventions to Improve Pediatric Resident Wellness and Reduce Burnout. Academic pediatrics, 17(8), 801-804.
• Franke, H. A. (2014). Toxic Stress: Effects, Prevention and Treatment. Children (Basel, Switzerland), 1(3), 390-402.
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  Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP) Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus.
• Franke, H. A., Theodorou, A. A., Erstad, B. L., Romero, A., & Hennings, S. (2010). A Comparison of Automated Infusion Device Technology to Prevent Medication Errors in Pediatric and Adult Intensive Care Unit Patients. Hospital Pharmacy. doi:10.1310/hpj4506-464
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  Objective To compare possible differences in the proportion of medication errors associated with high-risk medications that were avoided by the use of automated infusion device (AID) technology in pediatric and adult intensive care unit (ICU) patients. A secondary purpose was to investigate the number of serious adverse drug events (ADEs) identified by root-cause analyses (RCA). Method The study included pediatric and adult patients receiving high-risk medications by continuous infusion in an academic medical center with mixed medical-surgical ICUs. A retrospective evaluation of 1 year's data collected prospectively in an AID database was used to compare the proportion of medication errors avoided based on reprogramming events (2.5 times limit as a low threshold) and overrides (10 times limit as high). Information obtained from RCAs was used to compare the proportion of serious ADEs that occurred during the 5-year periods before and after AID implementation. Results The pediatric population was 1.68 times (95% confidence interval [CI], 1.18 to 2.38) more likely to require a reprogramming event than the adult acute care population for all high-risk medications combined. Significantly more reprogramming events occurred in the pediatric patients with potassium (relative risk [RR], 2.77; 95% CI, 1.15 to 6.68) and insulin (RR, 2.73; 95% CI, 1.15 to 6.45) infusions. Additionally, there were more overrides in the pediatric compared to the adult population for the high-risk medications (RR, 1.82; 95% CI, 1.32 to 2.53). The number of serious adverse or sentinel events as identified in RCAs decreased from six before (four deemed preventable by AID technology) to three (zero preventable) after AID implementation. Conclusions This study demonstrates that AID technology when properly used leads to reductions in medication errors and possibly serious ADEs in critically ill patients receiving high-risk medications. The technology appears to be particularly beneficial in pediatric patients with weight-based dosing strategies. However, the potential for clinicians to override the alerts remains a concern.
• Franke, H. A., Theodorou, A. A., Erstad, B. L., Romero, A., & Hennings, S. (2010). Original Article A Comparison of Automated Infusion Device Technology to Prevent Medication Errors in Pediatric and Adult Intensive Care Unit Patients. Hospital Pharmacy.
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  Objective: To compare possible differences in the proportion of medication errors associated with high-risk medications that were avoided by the use of automated infusion device (AID) technology in pediatric and adult intensive care unit (ICU) patients. A secondary purpose was to investigate the number of serious adverse drug events (ADEs) identified by root-cause analyses (RCA). Method: The study included pediatric and adult patients receiving high-risk medications by continuous infusion in an academic medical center with mixed medical-surgical ICUs. A retrospective evaluation of 1 year’s data collected prospectively in an AID database was used to compare the proportion of medication errors avoided based on reprogramming events (2.5 times limit as a low threshold) and overrides (10 times limit as high). Information obtained from RCAs was used to compare the proportion of serious ADEs that occurred during the 5-year periods before and after AID implementation. Results: The pediatric population was 1.68 times (95% confidence interval [CI], 1.18 to 2.38) more likely to require a reprogramming event than the adult acute care population for all high-risk medications combined. Significantly more reprogramming events occurred in the pediatric patients with potassium (relative risk [RR], 2.77; 95% CI, 1.15 to 6.68) and insulin (RR, 2.73; 95% CI, 1.15 to 6.45) infusions. Additionally, there were more overrides in the pediatric compared to the adult population for the high-risk medications (RR, 1.82; 95% CI, 1.32 to 2.53). The number of serious adverse or sentinel events as identified in RCAs decreased from six before (four deemed preventable by AID technology) to three (zero preventable) after AID implementation. Conclusions: This study demonstrates that AID technology when properly used leads to reductions in medication errors and possibly serious ADEs in critically ill patients receiving high-risk medications. The technology appears to be particularly beneficial in pediatric patients with weightbased dosing strategies. However, the potential for clinicians to override the alerts remains a concern. Key Words—infusion pumps, intensive care units, medication error, pediatrics
• Hiller, K., Jarrod, M. M., Franke, H. A., Degan, J., Boyer, L. V., & Fox, F. M. (2010). Scorpion antivenom administered by alternative infusions. Annals of emergency medicine, 56(3), 309-10.
• Theodorou, A. A., Romero, A., Hennings, S., Franke, H. A., & Erstad, B. L. (2010). A Comparison of Automated Infusion Device Technology to Prevent Medication Errors in Pediatric and Adult Intensive Care Unit Patients. Hospital Pharmacy, 45(6), 464-471. doi:10.1310/hpj4506-464
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  ObjectiveTo compare possible differences in the proportion of medication errors associated with high-risk medications that were avoided by the use of automated infusion device (AID) technology in p...
• Franke, H. A., Woods, D. M., & Holl, J. L. (2009). High-alert medications in the pediatric intensive care unit. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 10(1), 85-90.
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  To identify pediatric intensive care unit (PICU) clinicians' perceptions of high-alert medications and to develop a PICU-specific, high-alert medications list. We hypothesize that a PICU-specific list will include medications not identified on the Institute for Safe Medications Practices list and that the high-alert medications identified will differ by PICU clinician type (physicians, nurses, pharmacists).
• Woods, D. M., Holl, J. L., & Franke, H. A. (2006). HIGH-ALERT MEDICATIONS IN THE PICU.: 447. Critical Care Medicine, 34, A125. doi:10.1097/00003246-200612002-00428

Presentations

• Smith, K., Clemens, C., Banerjee, M., & Franke, H. A. (2019, WInter). Can We Do It? Feasibility Study of “Blinding” Program Directors to USMLE Step 1 Exam Scores Before Inviting Applicants to Interview. National Residency Matching Program, Transition to Residency Conference. Sedona, Arizona: National Residency Matching Program.
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  Smith K, Clemens C, Banerjee M, Franke, H. Can We Do It? Feasibility Study of “Blinding” Program Directors to USMLE Step 1 Exam Scores Before Inviting Applicants to Interview. National Residency Matching Program, Transition to Residency Conference, October 5, 2019.

Poster Presentations

• Julie, F., Stephany, C., Louise, M., Conner, K., & Franke, H. A. (2018, June/Summer). Parental Understanding of Health Information: The Need for a Smartphone Application.. Pediatrics in the Red Rocks Conference. Sedona, Arizona: Arizona Chapter of the American Academy of Pediatrics.
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  Furmick J, Chiacchio S, Malburg L, Kelley C, Franke HA. Parental Understanding of Health Information: The Need for a Smartphone Application. Arizona Chapter of the American Academy of Pediatrics, Pediatrics in the Red Rocks Conference, June 29, 2018.
• Cramton, R., Seserinac, J., Franke, H. A., Zahedieh, S., Cramer, N., & Elliott, S. P. (2017, April). ‘Practice Makes Perfect’: A Study Comparing Clustered Vs. Daily Flashcard Review and Medical Knowledge Retention. APPD Spring Meeting. Anaheim, CA: Association of Pediatric Program Directors.
• Franke, H. A., Elliott, S. P., & McClafferty, H. H. (2017, April). Approach to Implementation of a Residency Wellness Series.. APPD Spring Meeting. Anaheim, CA: Association of Pediatric Program Directors.
• Haughey, B., Rachel, M., Yonatan, K., Jennifer, H., Priti, P., Liz, P., & Franke, H. A. (2017, September/Winter). Wellness, For Residents By Residents.. American Academy of Pediatrics National Conference and Exhibition. Chicago, IL: American Academy of Pediatrics.
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  Haughey, B, Manzo, R, Kurland, Y, Hollinger, J, Patel, P, Placzek, L, Franke, HA. Wellness, For Residents By Residents. Accepted at American Academy of Pediatrics National Conference and Exhibition, September 2017.
• Stout, J., Johnson, D., Cramton, R., Franke, H. A., & Shehab, K. W. (2020, March/Spring). Procedural Simulation Increases Knowledge and Comfort in Pediatric Residents. Association of Pediatric Program Directors Annual Meeting. San Diego, CA: Association of Pediatric Program Directors.