Design and Evaluation of a Pediatric Resident Health Care Transition Curriculum

• DOI: 10.15766/mep_2374-8265.11239
• Publication Date: 2022-04-01T04:00:07Z
• Authors: Ruchi Kaushik; Virginia Niebuhr
• Keywords: Graduate medical education

OPEN ACCESSApril 1, 2022Design and Evaluation of a Pediatric Resident Health Care Transition Curriculum Ruchi Kaushik, MD, MPH, Virginia Niebuhr, PhD MPH https://orcid.org/0000-0002-6769-2801 Associate Professor, Department Pediatrics, Baylor College Medicine The Children's Hospital San Antonio E-mail Address: [email protected] Google Scholar More articles by this author , Clinical University Texas Medical Branch School Medicine/UTMB https://doi.org/10.15766/mep_2374-8265.11239 SectionsAboutPDF ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: In 2011, the American Academy Pediatrics developed consensus statement urging physicians who provide care to youth with special health needs acquire knowledge skills facilitate well-timed transitions adult-oriented care. However, minority these receive services necessary make appropriate transitions. Two potential barriers supporting well-planned are minimal provider training gaps in medical records. Methods: We designed an adaptable transition (HCT) curriculum combinings asynchronous didactic modules synchronous portable summary (PMS) critique exercise improve resident knowledge, skills, behavior. Residents completed pre- posttests assess prior after viewing animated video modules. attempted create PMS, received feedback instruction on how well-written then reattempted activity. evaluated both PMS following delivery curriculum. Results: Over 21 months, 20 pediatric residents hospital medicine fellows during elective complex block rotation. Pre- revealed statistically significant (p < .001) improvement knowledge. Learners included average 46% 18 recommended elements before 98% .001). Evaluations demonstrated overwhelmingly positive learner responses. Discussion: Our HCT improves residents' behavior processes addresses gap graduate education. Educational Objectives By end activity, learners will be able to: 1.Recognize current state US numerous aspects consider when planning seamless HCTs.2.Enumerate steps process.3.Implement process.4.Support (YSHCN) self-management process.5.Identify local community-based resources that support HCTs YSHCN their families.6.Apply established guidelines development summaries within electronic record. Introduction care.1 there is evidence mere 40% care.2 effective include parent/caregiver concerns for youth's ability self-manage,3 adult providers' lack comfort managing conditions,3 limited sharing relevant records information between providers,4 inadequate practices emerging pediatricians.5 Self-management adults associated improved outcomes patient experience, evidence-based best models inform exist chronic conditions.6 These same may not as common making pediatric-to-adult transition. study describing mothers' experiences transitioning type 1 diabetes mellitus, Ness colleagues heightened concern college compared families without concluded increasing preparedness would serve decrease stress.7 2018, Lozano Houtrow outlined among young adults, including address modifiable influences at individual, family, community, system levels.6 Gaps support, however, remain.8 often contribute patients transferring into Portable (PMSs) concise documents detailing prevent disruptions care4 guide patients/families providers establishing new relationships YSHCN.9,10 Adult accepting have expressed need first outpatient visit.11–13 Nevertheless, sample 181 primary pediatricians, although 92% identified whom they sent patients, only 57% created PMS.14 Incorporating education has proven challenging. One cohort staff pediatricians highly rated importance specific (4.3 5-point Likert scale) professed level low (2.6 scale), yet 4% participants had formal residency.5 This translated locally. conducted assessment March 2018 Medicine-The (BCM-CHofSA), academic, freestanding children's hospital. were interested learning about identifying HCT, becoming proficient policy families, creating PMSs. previously published curriculum15 utilizes case-based strategy over three 75- 120-minute sessions learners' self-reported engaging practices. can much-needed initial introduction roles various professionals remains assessing behaviors. Another resource provides case discussion 15-year-old Crohn's disease care,16 but step-by-step process implementing or developing included. Finally, Bradford Mulroy foster transformation students coaches gained through reflection.17 Although reflective narratives illustrate benefits educational product does protected time learners, which result diminished engagement. aim our project was design behaviors YSHCN. Before such could implemented, needed systematic process; thus, step implement clear Primary Complex Clinics using tools available GotTransition platform, federally funded national center HCT.18 collaborating technology team incorporate autopopulation (GotTransition core element 1), tracking monitoring dot phrase 2), uploading readiness 3), creation 4). With place, we develop teach skills. did 5 6. Mapping curricular illustrated Table 1. Curricular Elements Core ElementsTable believed utilizing diverse teaching methods, allowing consume materials reflect upon them, applying newly learned real optimal strategies learning. Additionally, aimed achieve behavioral (i.e., Kirkpatrick 319). Consequently, integrated afforded view modules, assessed directly clinical setting. philosophy aligned Kolb's experiential cycle cognitive apprenticeship frameworks (Figure). Both asserted expertise content modeling, coaching, practical application, reflection, exploration. allow them approach similar situations complexity sequencing. Figure. Application Abbreviations: transition; summary. Methods Target Setting target BCM-CHofSA. embedded 4-week rotation, occurred Clinic. clinic housed Clinic served approximately 200 children/youth depending least one medical/technological device needing specialty from two subspecialists). Of those complex, diagnoses, 68% private duty nursing services, 76% feeding tube (nasogastric, gastrostomy, gastrojejunostomy), 20% tracheostomy tube, 27% dependent invasive noninvasive mechanical ventilation, 6% central venous access. Knowledge prerotation test baseline (Appendix A), delivered survey software. Modules viewed five asynchronously. •Part 1: B).•Part 2: Team C).•Part 3: Your Clinic's Process D).•Part 4: Patient/Family-Centered Approach E).•Part 5: PMSs Transfer F). Parts 2, 4, (under 6 minutes length) narrated videos Powtoon Part 3 PowerPoint presentation. A facilitator G) also assist educators implementation part 3. postrotation After all H), During patient, Word document. asked write searching internet tips reading other rotation director critiqued each resident's inclusion list compiled GotTransition.18 critiquing director's use. Following critique, face-to-face session elements, review demonstrate provided exercise. second template reviewed attempt gave resident. frequency data attempts collected tabulated spreadsheet. exercise, Likert-scale surveys (1 = all, extremely) evaluate (Appendices I J, 1). Surveys REDCap, email. scores presented means standard deviations. sets checked deviations normality, differences points paired t tests. Statistical significance set p .05. Results Between October 2019 June 2021, (19 fellows) All attested having writing PMS. Knowledge: Prerotation/Postrotation Test Nineteen tests analysis. (One complete either pretest posttest, posttest.) showed gain (58%, SD 0.12, vs. 94%, 0.06; .00001; 2). Behavior: Critique Exercise postcritique (Two submit attempt.) eight (46%, 0.10) 17 (98%, 0.04) illustrating .00001) change (Kirkpatrick 3). Available analysis 16 module evaluations 12 evaluations. selected responses 4 evaluation questions (effective, enjoyable, format appropriate, ideal, likely change). Thematic noted reactions 2 2. Content Analysis Resident/Fellow Perceptions CurriculumTable On evaluations, 33% respondents reported confidence (Likert-scale 5) 25% completing director. (100%) compose remaining (format Discussion goal adapting nationally resources. implemented safe particularly YSHCN, application processes. well-received incorporating methods. executing processes, well formulating while championing self-advocacy. offer recommendations programs adopting participated duties morning only, afternoon. believe integral Indeed, designating afternoon completion activities proved valuable, emphasized fact almost strengths nature flexibility watch schedules permitted. Moreover, found portion effective, engaging, ideal material. For residency no encourage identify venues might used. Because relevance translates populations, integrating rotations where care, adolescent advocacy community health, developmental-behavioral pediatrics, any number rotations. presentation, here editable format, allows individualize it own institution-specific Also, choose present synchronously. system. synchronous, interactive inspired likelihood future Again, allotted formulate PMSs, consequently, submitted review. limitation (a practitioners transfer care) (how clinic's completion). is, far, more challenging US,20 organizations primarily pediatric, hospital, therefore within-system groups accept patients. Educators robust enough advised presentation institutions process, delivering prove brief descriptions experience initiating process. quite positively, comments reflected opted participate. required instructional material vary. because posttest rates response rates, appreciate components general pediatrics across subspecialties. immediately curriculum, followed longitudinally whether employ practice. That sustained retention evidenced recommending methods assessment, initiation conversation, faced patients/families. topics addressed As continue deliver better its long-term impact retesting 6–12 months 2) reviewing summary, focus outcome actually concepts includes materials, tools, tools. users individual context systems' References1. Cooley WC, Sagerman PJ; Family Physicians, Transitions Report Authoring Group. Supporting adolescence adulthood home. Pediatrics. 2011;128(1):182–200. https://doi.org/10.1542/peds.2011-0969Medline, Scholar2. National Survey Children Special Needs: NS-CSHCN 2009/10—outcome #6. Child Adolescent Measurement Initiative, Data Resource Center Health. Accessed November 10, 2019. http://www.childhealthdata.org/browse/survey/results?q=1616&r=1&r2=45Google Scholar3. O'Sullivan-Oliveira Fernandes SM, Borges LF, Fishman LN. care: perceptions discipline role. Pediatr Nurs. 2014;40(3):113–120.Medline, Scholar4. Wirth B, Kuznetsov A. Shared Plan Care: Tool Support Youth Needs Their Families. Home Implementation; 2016. January 30, 2022. https://medicalhomeinfo.aap.org/tools-resources/Documents/Shared%20Plan%20of%20Care2.pdfGoogle Scholar5. Weeks M, Cole Flake E, Roy D. satisfaction medically Mil Med. 2018;183(11-12):e676–e679. https://doi.org/10.1093/milmed/usy057Medline, Scholar6. P, children adolescents conditions. 2018;141(suppl 3):S233–S241. https://doi.org/10.1542/peds.2017-1284HMedline, Scholar7. MM, Saylor Selekman J. Maternal college. Diabetes Educ. 2018;44(2):178–187. https://doi.org/10.1177/0145721718759980Medline, Scholar8. Varty Popejoy LL. disease. West J Nurs Res. 2020;42(7):554–566. https://doi.org/10.1177/0193945919875470Medline, Scholar9. Spain PD, Oeffinger KC, Candela McCabe Ma X, Tonorezos ES. Response treatment plan survivors cancer. Oncol Pract. 2012;8(3):196–202. https://doi.org/10.1200/JOP.2011.000345Medline, Scholar10. Chouteau WA, Allen SR. Implementation 2019;48:35–41. https://doi.org/10.1016/j.pedn.2019.05.012Medline, Scholar11. McLaughlin SE, Diener-West Indurkhya A, Rubin H, Heckmann R, Boyle MP. Improving cystic fibrosis lessons 2008;121(5):e1160–e1166. https://doi.org/10.1542/peds.2007-2217Medline, Scholar12. Garvey Telo GH, Needleman JS, Forbes Finkelstein JA, Laffel LM. diabetes: perspectives endocrinologists U.S.Diabetes Care. 2016;39(2):190–197. https://doi.org/10.2337/dc15-1775Medline, Scholar13. Dale CM, King Amin et al. Canadian ventilator-assisted family caregivers: qualitative interview study. Paediatr 2017;22(5):277–281. https://doi.org/10.1093/pch/pxx079Medline, Scholar14. Davidson Chhabra Cohen HW, Lechuga C, Diaz Racine Pediatricians practices, New York State. Clin (Phila). 2015;54(11):1051–1058. https://doi.org/10.1177/0009922815573940Medline, Scholar15. Gooding O'Reilly Weitzman Burke Goncalves Pitts S. Transitioning Bryan: MedEdPORTAL. 2015;11:10226. https://doi.org/10.15766/mep_2374-8265.10226Google Scholar16. L. But Tommy likes here: moving medicine. 2012;8:9190. https://doi.org/10.15766/mep_2374-8265.9190Google Scholar17. N, B. needs. 2015;11:10183. https://doi.org/10.15766/mep_2374-8265.10183Google Scholar18. GotTransition. February 17, https://www.gottransition.orgGoogle Scholar19. Macdougall CF. Evaluation—the context. Arch Dis Educ Pract Ed. 2010;95(1):28–32. https://doi.org/10.1136/adc.2008.142240Medline, Scholar20. White PH, WC; Group; 2018;142(5):e20182587. https://doi.org/10.1542/peds.2018-2587Medline, Sign up latest publications MedEdPORTAL Add your email below APPENDICESReferencesRelatedDetailsAppendices Prerotation Test.docx 1.mp4 2.mp4 3.pptx 4.mp4 5.mp4 Facilitator Guide.docx Postrotation Didactic Module Evaluation.docx Summary appendices peer parts Original Publication. Download CitationKaushik Niebuhr V. Design Curriculum. 2022;18:11239. Copyright & Permissions© 2022 Kaushik Niebuhr. open-access publication distributed under terms Creative Commons Attribution license.KeywordsPediatricsChildren ComplexityHealth TransitionAcknowledgmentsWe like acknowledge thank Dr. Kitty O'Hare, Rita Nathawad, Emily Goodwin providing suggestions Alexis Wood statistical support.Disclosures None report. Funding/Support Ethical Approval Institutional Review Board approved project. PDF DownloadLoading ...