A Pediatric Resident Advocacy in Complex Care Curriculum

• DOI: 10.15766/mep_2374-8265.11358
• Publication Date: 2023-10-24T04:00:14Z
• Authors: Ruchi Kaushik
• Keywords: Medicine (General); Adolescent; 4. Education; Complex Care; Original Publication; Internship and Residency; Advocacy; Problem-Based Learning; Pediatrics; L; Child Advocacy; 3. Good health; Education; R5-920; Resident Education; Humans; Curriculum; Child; Delivery of Health Care

OPEN ACCESSOctober 24, 2023A Pediatric Resident Advocacy in Complex Care Curriculum Ruchi Kaushik, MD, MEd, MPH https://orcid.org/0000-0002-6769-2801 Medical Director of Education and Research Palliative Physician, Imagine Pediatrics E-mail Address: [email protected] Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.11358 SectionsAboutPDF ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: Children youth with special health care needs (CYSHCN) are a special, vulnerable population. medical complexity (CMC) represent smaller, medically fragile sliver (6%) the US child Several professional pediatric entities direct (or require) educators to instruct residents advocacy for all children, explicitly including CYSHCN/CMC populations. While many existing curricula address education, gap remains specifically designed aid learners CYSHCN/CMC. Methods: Using Kolb's experiential learning cycle as framework, we delivered comprehensive outpatient complex curriculum, several didactic video lectures (total: 60:04 minutes, median: 6:25 minutes) site visits devoted topics CMC, one portion 4-week elective rotation. Residents completed pre- posttests knowledge postsurveys self-assess attitudes, comfort, behavior; viewed lectures; engaged visits. Reflective statements captured attitudes regarding CMC. Results: Between July 2016 June 2020, 47 trainees rotation; data were available 30 trainees. demonstrated statistically significant improvement (p < .001), well improved diversity sensitivity, comfort advocating CMC postrotation. Qualitative comments showed overwhelmingly positive learner reaction. Discussion: This which can be offered stand-alone resource or supplement incorporates teaching methods addresses competency education. Educational Objectives Upon completion will able to: 1.Discuss social determinants adverse childhood experiences their impact on outcomes.2.Mindfully approach children families incorporating sensitivity person-first language.3.Locate describe community-based providers nonmedical resources advocate medical, developmental, socioemotional, behavioral CMC.4.Relate current education policies that affect daily outcomes these apply them when Introduction deemed population1 constitute 13%-18% children/youth US.2 an even smaller population,3 have chronic requiring extensive coordination, considered fragile.4 Because account approximately 40% spending,3 engaging clinical, community, systems/legislative is often vital securing services they need access optimize care.5 The Accreditation Council Graduate core competencies,6 American Board entrustable activities (EPAs),6 Academy Community Training Initiative Core Curricular Health Milestones,1 recently published EPAs7 residency programs design deliver high-quality effective curricula. require not only foundational discussion (SDOH) but also depth skills affording treating respect dignity (clinical level), supporting living through family engagement collaboration within communities (community applying payor policy (systems/legislative level).7 Moreover, emerging pediatricians must strong grasp critical role intersectionality outcomes.7 Although broad resident MedEdPORTAL,8,9 aimed at addressing population unique needs. With mind, and/or supplementary curriculum would prepare levels. Methods Setting Baylor College Medicine–Children's Hospital San Antonio (BCM-CHofSA) Clinic serves 225 complexity. Eligibility criteria include dependence upon least medical/technological device (including 75% feeding tubes, 20% tracheostomy tube, 26% dependent invasive noninvasive mechanical ventilation) referrals two subspecialists. Approximately two-thirds patients receiving private-duty nursing services. Participants BCM-CHofSA began delivering comprehensive, 4-week, rotation PGY 2-PGY 4 hospital medicine fellows) 1 2019. Design Implementation We utilizing adaptation theory.10 selected conceptual framework believed pairing instructional material opportunities observe engage homes thriving greatly enrich guides concrete experience (feeling), reflective observation (watching), conceptualization (thinking), active experimentation (doing). Details design, prerotation preparation, components, evaluation, already MedEdPORTAL.11 Briefly, originally divided into four weeklong blocks, each week theme themes. Themes curricular priorities,12 educational objectives devised theme. For individual theme, created arranged pretests, sessions, visits, posttests. Primarily clinical themes presented our previous publications,11,13 while instruction following processes implementation Educators encouraged review facilitator's guide (Appendix A) delivery details. Rotation pretests presurveys distributed syllabus checklist B) via email prior start date. C) surveys skills, behavior D) beginning Didactic either narrated animated lecture face-to-face presentation E: Policy, Appendix F: Medicare Medicaid, G: Title V, H: SSI, I: Medicaid Waivers, J: ACEs Today's SDOH, K: Diversity Sensitivity; total time: minutes; range: 2:04-24:30 minutes); subsequently C). Posttest results any questions later discussed clarification. references included final slide, literature. secured explicit permission from Powtoon create publish lectures. Experiential Learners visited sites serving CYSHCN goal was introduce organizations whom could collaborate Learner Assessment Evaluation assessed using Pre- postrotation learners’ caring Following subsequent inpatient rotation, invited complete survey. evaluation finishing Data Analysis Descriptive statistics frequencies used display differences knowledge, self-assessed behavior, data. posttest compared unpaired t tests. A consent letter attached orientation email, given opportunity opt out deidentified collection (but procedures) approved Medicine Institutional Review Board. No financial incentives provided participation. Results Forty-one six fellows between 2020. trainees; 105 102 posttests, demonstrating gain (37%, SD = 26%, vs. 85%, 23%, p .001). In total, 29 15 analysis behaviors, attitudes. Survey items, median Likert-scale scores, percentage selecting scores 5 displayed Table 1. refer MedEdPORTAL publication data.11 brief description qualitative featured 2; gleaned written narrative reflections undergone thematic separate publication.14 Postrotation Self-Assessment Skills, Attitudes, BehaviorTable Behavior 2. Comments Complexity CurriculumTable Discussion Here, present effectively When previously resources,11,13 combined eight 11 EPAs.7 (Kirkpatrick level 2) change 3) CMC; demonstrate reaction 1).15 opted part encourage adapt videos own program structures. Initiative's Training1 list populations milestone, community directors may choose rotational longitudinal materials. Alternatively, transitioned X+Y scheduling model, incorporated alone Y week. Delivering relies so heavily local prove challenging. invite Snowball ASSET Mapping detailed publication.11 state chapters excellent legislative CYSHCN. example, volunteered Texas Society Resident, Fellow, Student Day preceptor accompanied capitol building Austin, Texas, funding early intervention increases self-assessment limited low postsurvey response rates (50%). suspect capturing responses weeks after (and during protected time rotation) resulted fewer surveys. As result, objectively assess behavior. Future benefit rotation—allowing postsurvey—and use assessment tool directly observing because midsize elective, findings generalizable similar among similarly opting such That said, who variety career trajectories representative numerous generalist subspecialty fields (general pediatrics, medicine, newborn neonatal/perinatal care, hematology/oncology, palliative emergency gastroenterology, infectious disease, abuse, psychiatry, dermatology). summary, supports majority EPAs. includes materials, tools, tools. adaptable other users allow incorporate it structure. References1. Milestones Profile (CHAMP). Pediatrics. Updated September 27, 2021. Accessed 18, 2023. https://www.aap.org/en/advocacy/community-health-and-advocacy/teach-community-health-and-advocacy/community-health-and-advocacy-milestones-profile-champGoogle Scholar2. National Children's Interactive Query. Resource Center Child & Adolescent Health. https://www.childhealthdata.org/Google Scholar3. Bergman DA, Keller D, Kuo DZ, et al. Costs management program. 2020;145(4):e20192401. https://doi.org/10.1542/peds.2019-2401Medline, Scholar4. Cohen E, Agrawal R, complexity: research initiatives. 2011;127(3):529–538. https://doi.org/10.1542/peds.2010-0910Medline, Scholar5. Quini Kaushik R. Is managed better care? effects Hosp Pediatr. 2020;10(8):709–711. https://doi.org/10.1542/hpeds.2020-0046Medline, Scholar6. ACGME Program Requirements Education; 2022. https://www.acgme.org/globalassets/pfassets/programrequirements/320_pediatrics_2022_tcc.pdfGoogle Scholar7. Huth K, Henry Fabersunne CC, multistakeholder development care. Acad 2022;22(2):184–189. https://doi.org/10.1016/j.acap.2021.09.014Medline, Scholar8. Hoffman BD, Rose J, Best project planning tool: practical advocacy. MedEdPORTAL. 2017;13:10630. https://doi.org/10.15766/mep_2374-8265.10630Medline, Scholar9. Majeed A, Newton H, Mahesan Vazifedan T, Ramirez D. Advancing advocacy: pediatrics 2020;16:10882. https://doi.org/10.15766/mep_2374-8265.10882Medline, Scholar10. Zackoff MW, Real FJ, Abramson EL, Li STT, Klein Gusic ME. Enhancing scholarship frameworks: challenge roadmap educators. 2019;19(2):135–141. https://doi.org/10.1016/j.acap.2018.08.003Medline, Scholar11. curriculum. 2023;19:11319. https://doi.org/10.15766/mep_2374-8265.11319Medline, Scholar12. Newman L, Glader L. 17 top priorities national Delphi study. Paediatr 2019;24(suppl 2):e7–e8. https://doi.org/10.1093/pch/pxz066.016Medline, Scholar13. Niebuhr V. transition 2022;18:11239. https://doi.org/10.15766/mep_2374-8265.11239Medline, Scholar14. Kothinti Battistelli Impact multifaceted fellows. J. Published online 28, http://complexcarejournal.org/2022/07/28/impact-of-a-multifaceted-complex-care-rotation-on-pediatric-residents-and-hospital-medicine-fellowsGoogle Scholar15. Kirkpatrick WK. An New World Model. Partners; http://www.kirkpatrickpartners.com/wp-content/uploads/2021/11/Introduction-to-the-Kirkpatrick-New-World-Model.pdfGoogle ScholarPDF download Sign up latest publications Add your below APPENDICESReferencesRelatedDetailsAppendices Facilitators Guide.docx Syllabus Checklist.docx Posttests.docx Surveys.docx Policy.mp4 Medicaid.mp4 V.mp4 SSI.mp4 Waivers.mp4 Todays SDOH.pptx Sensitivity.mp4 All appendices peer reviewed integral parts Original Publication. Download CitationKaushik Curriculum. 2023;19:11358. Related Comprehensive Outpatient Transition Copyright Permissions© 2023 Kaushik. open-access under terms Creative Commons Attribution-NonCommercial license.KeywordsPediatricsResident EducationAdvocacyComplex CareDisclosures None report. Funding/Support Ethical Approval project. tabs.loading