Early Literacy Research Library (ELRL) - Article

Training Pediatric Residents in Literacy Promotion: Residency Directors’ Perspectives

Kinney, J.E., Jimenez, M.E., Morrow, L.M., Pai, S. (2020) Training Pediatric Residents in Literacy Promotion: Residency Directors’ Perspectives. Teaching and Learning in Medicine, 32(1), 45–52.,

Access: Institutional Access

Publication year


study description

Qualitative, semistructured interview study.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Medical Providers , Medical Trainees

Exposures, Outcomes, Other

Implementation and Evaluation , Medical Training/Education


We sought to understand how literacy promotion training is currently implemented in pediatric residency programs from the perspective of program directors.


Reach Out and Read (ROR) training.

outcomes evaluated

Experiences and perspectives around literacy promotion training.


Pediatric residency programs in New Jersey.


We conducted semi structured interviews with all 9 residency program directors in 1 state. We analyzed data iteratively coding transcripts using an immersion/crystallization approach to identify themes.

sample size

n=9 (interviews); n=11 (participants)


Crabtree and Miller process for thematic analysis to identify themes regarding residency program director’s beliefs regarding implementation and barriers to literacy promotion education.


Measure of Training Implementation: semi-structured interview guide:

    • Would you describe for me how your program balances priorities in educating pediatric residents?
    • Would you take me through how your program incorporates training on child development?
    • The AAP releases several policy statements and clinical guidelines regarding child development. What role do these policy statements play in resident education? 
    • Would you describe for me how your residency program trains residents with regards to literacy promotion?
    • From your experience, would you tell me about the barriers faced in educating residents about literacy promotion?
    • From your experience, what are successful ways to implement training on literacy promotion into a residency program?
    • Is there anything else you would like to add?


We achieved saturation after 9 interviews with 11 participants. We identified 3 major themes: (a) Residency programs rely on an existing primary-care-based literacy promotion intervention (Reach Out and Read) and the resident continuity clinic for literacy promotion training; (b) program directors encourage early and repeated exposure to facilitate literacy promotion education; and (c) service obligations, content specifications, and pressure on faculty create competing time demands that function as key barriers to literacy promotion training.


Residency program directors used an existing, widely used intervention and the infrastructure provided by continuity clinics to facilitate training on literacy promotion, a relatively new pediatric care standard. Additional work is needed to overcome the barriers identified by program directors.


Our work is subject to certain limitations. First, interviews were limited to residency programs in one state, so our findings may not transfer to all settings. Although most of the program directors in our sample practiced in a primary care setting like a national sample of pediatric residency program directors in another recently published study, our sample differed in that most participants were male and oversaw relatively smaller programs. Second, responses may be subject to social desirability bias. Third, we did not confirm the extent to which programs participated in literacy promotion education or program directors’ familiarity with ROR training materials using objective measures or observation. Further, the present study did not assess the extent to which pediatric residency programs adhere to the ROR training regimen or model. One of the most important indicators of quality for ROR and for literacy promotion more broadly is that it should not be reduced to book distribution. As the AAP recommendation is based on the power of the primary care relationship and the opportunity for specific developmentally appropriate guidance, the same facets should be present to ensure adequate resident training. We would therefore expect that high fidelity to the ROR model would be correlated with pediatric residents’ proficiency and success in promoting literacy among patients and their families. Fourth, we did not explore this topic with pediatric residents directly. Future studies might consider incorporating observation, quantitative measures, and interviews with pediatric residents. Additional work may also seek to study training practices and how they relate to resident educational outcomes, as well as the extent to which resident learning impacts patient outcomes.