31. IMPLEMENTING A CLINIC IMMERSION BLOCK BOOSTS INTERN CONFIDENCE AND EARLIER OUTPATIENT CLINICAL EXPERIENCES

Abstract

Background In United States pediatric residency programs, there is a wide range of interpretations of the ACGME requirement to educate residents in community pediatrics and advocacy. Previous iterations of our required month-long intern advocacy rotation included disjointed learning experiences without opportunities for clinical integration. Few programs utilize an integrated curriculum to approach this topic. We sought to integrate early clinical and advocacy experiences to increase their impact. Methods 20 interns participated in a “clinic immersion and advocacy” rotation during block 1 or 2. Interns were scheduled for continuity clinic in the morning (n=20 sessions in 1 month) and experiential community advocacy activities in the afternoon. We utilized Kern's Six Step Approach as a conceptual framework for our intervention. Curriculum was developed using an iterative process; community activities were selected using the AAP's Community Health and Advocacy Milestones Profile (CHAMP). Data was collected from a pre-intervention cohort (class 2021) and compared to our post-intervention cohort (class 2022). Interns completed a survey using visual analog scales to rate their confidence in managing conditions, and in using clinical tools and community resources. They also completed yes/no items verifying whether they had encountered specific types of visits or performed certain skills. The paired t-test was used to assess pre/post intervention confidence measures. Pearson's chi-squared test was used to compare clinic experiences. Significance was assessed at p Results Response rate was 75% (15/20 interns) for the pre- and post-intervention cohorts. Confidence measures were not statistically different between the two groups on 22/23 items. The intervention group rated their confidence in knowledge about community resources significantly higher than the non-intervention group (p=0.008). Clinic experiences were statistically similar between cohorts (1-month vs. 1 year). Discussion This study shows our success in increasing clinical confidence and experiences earlier in intern year as, after 1 month of daily continuity clinic, the post intervention cohort was directly comparable to the pre-intervention cohort after 1 year of weekly continuity clinic. Future directions include whether our curriculum will lead to increased confidence in clinic skills longitudinally, retained confidence in knowledge of community resources, and generalizability to other residency programs.