14. DESIGN AND EVALUATION OF A PEDIATRIC RESIDENT COMPLEX CARE CURRICULUM

Abstract

Background Despite early career physicians’ competence in caring for children with medical complexity (CMC) when acutely ill, residents often do not receive adequate training to care for CMC in the primary care setting. A recent national Delphi study identified 11 curricular gaps in the care of CMC. This study evaluates the design of a curriculum that addresses majority of these gaps. Methods Pediatric residents first watch an orientation video to learn the rotation expectations and complete an anonymous pre-rotation assessment and 4 pre-tests, one for each week's themes. Each week learners receive didactic lectures, conduct ∼ 15 patient visits per week, engage in community-based site visits, and complete writing assignments demonstrating grasp of health literacy and/or evidence-based practice guidelines. Residents complete the rotation with 4 post-tests, a post-hospital rotation assessment, and a reflection. Results The curriculum, guided by Kolb's experiential cycle, was delivered to 28 postgraduate trainees over 3 ½ years of pilot and implementation phases. Complete data were collected for 14 residents/fellows between June 2018 and November 2019. Test scores and trainee self-assessments reveal significant improvement in knowledge (26.3% vs. 99.4%), skills (41.7% vs. 100%), and self-reported behaviors (16.3% vs. 56.6%). Trainees produced 21 reflections describing changes in attitudes, 19 published blogs and 12 health care transition condition fact sheets, 8 health supervision guidelines EHR templates, and 4 portable medical summaries. Reflection statements identified 4 themes demonstrating what residents valued most from the curriculum: 1) coordination of care across disciplines including community-based resources; 2) communication with patients/families that elicits goals and fosters shared decision-making; 3) an empathic and people first approach to care; and 4) advocacy and addressing the social determinants of health. Conclusion A pediatric resident complex care curriculum addressing majority of nationally recommended topics improves trainees’ knowledge, skills, attitudes, and self-reported behaviors.