AAP SPROUT Tele-Inpatient ECHO Registration Survey

Registration

Thank you for your interest in the American Academy of Pediatrics SPROUT Tele-inpatient ECHO. This project is supported by the National Institutes of Health through the University of North Carolina Chapel Hill.

Project ECHO® (Extension for Community Healthcare Outcomes) is an innovative hub and spoke program, designed to create knowledge networks by connecting health care providers with an expert team through a tele- mentoring program using brief lectures and case‐based presentations. These networks have been shown to increase capacity for health care providers to identify, treat, and manage patient care. Using basic, widely available teleconferencing technology, clinical management tools, and case‐based learning, health care providers develop knowledge and self‐efficacy on techniques for management of care and quality improvement.

The AAP SPROUT Tele-inpatient ECHO will serve as a forum for pediatricians, hospitalists, and other professionals that provide medical care to children in a hospital setting to increase knowledge, skills and self-efficacy regarding effective strategies and best practices related to telehealth in the hospital setting. The ECHO sessions will take place from September 2023 - March 2024. The one hour educational ECHO session will include a facilitated conversation by a faculty member during the 6-month program for discussion and expert recommendations.

This ECHO will meet monthly at 11:00 am – 12:00 pm CT / 12:00 – 1:00pm ET on the following dates: September 13, October 11, November 15, December 13, January 10, February 14 for a total of 6 sessions.

All ECHO sessions occur virtually using Zoom video conference technology. Participants are expected to join using video as this makes for a more interactive and impactful session. Only the lecture presentations are recorded for both synchronous and asynchronous observations.

Registration will be accepted on a rolling basis with first come, first served. For questions, contact Robinn Yu at ryu@aap.org.

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* 1. Please enter your name, email address, and phone number below (all fields require an answer; please write NA if it does not apply to you):

Name:

Credentials:

Email address:

Phone number:

Chapter affiliation:

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* 2. Are you a member of the American Academy of Pediatrics?

Yes

If yes, please include your AAP ID:

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* 3. What is your gender?

Male

Female

Non-binary

Prefer not to answer

Prefer to self-describe:

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* 4. Which of the following best describes your ethnic group? Please check all that apply.

American Indian or Alaska Native

Asian or Asian American

Black or African American

Native Hawaiian or Other Pacific Islander

Middle Eastern or North African

White/Caucasian

I prefer not to answer

Another option not listed here (please specify):

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* 5. Do you consider yourself Hispanic/Latinx?

Yes

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* 6. Which of the following best describes your training?

Physician (MD, DO)

Nurse practitioner

Physician assistant

Registered nurse (RN)

Medical Assistant

Public health professional

Healthcare administrator

Social services and other counseling

Licensed practical nurse (LPN)

Non-clinical support staff

Community Health Worker

Health Educator

Patient Navigator

Public Health Aide

Community Health Practitioner

Other (please specify)

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* 7. If you selected Physician (MD, DO), select all that apply

Resident/Fellow

Early Career

Retired

Primary Care

Subspecialist

Pediatric Surgeon

Hospitalist/Neonatologist

Other (please specify)

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* 8. Please indicate the number of years in practice/profession:

<5 years

6-10 years

11-15 years

>15 years