BACKGROUND Medical students feel they are inadequately trained in caring for patients with developmental disabilities (PWDD) (Troller et al. 2016; Salvador-Carulla et al., 2015). Consequently, PWDD may not receive timely, empathetic care from their future clinicians (Sahin and Akyol, 2010). We developed a preclinical elective, “Developing Skills with Developmental Disabilities” (DSDD), to improve student knowledge, skills, and attitudes toward paediatric PWDD. The first cohorts worked with pre-schoolers; DSDD was effective in improving student confidence working with PWDD (Penner et al. 2017). The current project compared the efficacy of DSDD using a hospital-based day-school for elementary-aged children, to previous cohorts. OBJECTIVES Our goal was to determine if changing the population being observed and the setting in which they are being observed could reproduce improvement in student confidence as seen in past cohorts. DESIGN/METHODS The DSDD module was an elective offered to preclinical medical students for credit. Students were given 6 hours of didactics on child development, assistive technologies, and breaking bad news. Students also participated in 6 clinical hours at the Glenrose Rehabilitation Hospital, where they observed school-aged PWDD in a classroom and interacted with an interdisciplinary team. Students also interviewed children’s families during medical intakes. Students completed pre- and post-elective surveys administered on a 5-point Likert scale. Questions pertained to students’ self-perceived comfort and knowledge regarding PWDD. Scores pre- and post-elective were compared using t-test analysis. This data was compared to data collected from previous cohorts, which used the same survey. RESULTS 24 students registered for DSDD, and 21 surveys were able to be analysed. Statistically significant (p<0.01) increases were present in 9/10 self-reported scores, with the statistically insignificant score pertaining to confidence using positive reinforcement. There was no significant difference in pre- and post-elective score improvement when comparing this cohort with past cohorts, across all scores. The critical components of DSDD were maintained across setting changes with significant (p<0.01) increases in students’ self-reported confidence and knowledge in working with PWDD. CONCLUSION This elective demonstrates effectiveness in different settings and ages. The general structure and principles of this elective may be applied by Paediatricians to improve medical education. Examples include having students attend developmental programmes they might provide support for, using a short set of parent interview questions and/or a child observation to improve developmental teaching, and allocating time for interaction with other allied health professionals to better understand their roles in the management of paediatric PWDD.

PurposeTo characterize high-users (HUs) of inpatient units, obtain insights from their primary care physicians (PCPs) and identify factors that can be modified to reduce resource use. MethodThe study design included retrospective chart reviews of high-user patients and qualitative surveys of their PCPs. HUs were defined as adults with 3 or more admissions to an index tertiary teaching hospital in Edmonton as well as a cumulative length of stay (cLOS) greater than 30 days at any hospital in the province of Alberta, between September 1, 2015 and September 30, 2016. The charts of HUs were reviewed to assess demographics, admitting and consulting services, medical profile, social profile, community supports, and scores on pre-existing risk-stratification tools to identify patient factors that might be characteristic of HUs. Additionally, a survey comprising 12 multiple-choice and 8 short-answer questions was faxed to their PCPs to assess HU attitudes and behaviors and collect recommendations to prevent high use of acute care. ResultsOf 125 HUs (median 62 years old, 5 admissions, cLOS 49 days, 14 emergency department (ED) visits, 10 medications), 74% lived at home, 86% had a PCP, 56% received homecare pre-admission and 34% had at least one critical care admission. HUs accounted for 2474 admissions or ED visits (median 14, IQR 10-22) at all sites in the year studied; 41% of their 1605 ED visits and 21% of their 869 admissions were at other hospitals. Their most prevalent comorbidities were hypertension, depression, and diabetes. 49 responses were received to 114 faxed surveys (43% response rate). Only 14 of 49 responding PCPs suggested interventions to address ED revisits and readmissions; PCPs most frequently cited living conditions and lack of social supports as key causative factors.ConclusionsWe have characterized high-user patients and discussed PCP perspectives and strategies to optimize their healthcare use. Resume ObjetCaractériser les grands utilisateurs (HU) des unités d’hospitalisation, obtenir des informations de leurs médecins de soins primaires (PCP) et identifier les facteurs qui peuvent être modifiés pour réduire l’utilisation des ressources. MéthodeLa conception de l’étude comprenait des examens rétrospectifs de dossiers de patients très utilisateurs et des enquêtes qualitatives sur leurs PPC. Les UH ont été définis comme des adultes ayant été admis à trois reprises ou plus dans un hôpital universitaire tertiaire d’Edmonton et dont la durée de séjour cumulée (DSC) est supérieure à 30 jours dans n’importe quel hôpital de la province de l’Alberta, entre le 1er septembre 2015 et le 30 septembre 2016. Les tableaux des HU ont été examinés afin d’évaluer les données démographiques, les services d’admission et de consultation, le profil médical, le profil social, les soutiens communautaires et les scores des outils de stratification des risques préexistants afin d’identifier les facteurs des patients qui pourraient être caractéristiques des HU. En outre, une enquête comprenant 12 questions à choix multiple et 8 questions à réponse courte a été envoyée par fax à leurs PCP afin d’évaluer les attitudes et les comportements des HU et de recueillir des recommandations pour prévenir un recours élevé aux soins de courte durée. RésultatsSur 125 HU (âge médian 62 ans, 5 admissions, cLOS 49 jours, 14 visites aux urgences, 10 médicaments), 74 % vivaient à domicile, 86 % avaient un PCP, 56 % recevaient des soins à domicile avant leur admission et 34 % avaient au moins une admission en soins intensifs. Les HU ont représenté 2474 admissions ou visites aux urgences (médiane 14, IQR 10-22) dans tous les sites au cours de l’année étudiée ; 41% de leurs 1605 visites aux urgences et 21% de leurs 869 admissions se sont faites dans d’autres hôpitaux. Leurs comorbidités les plus fréquentes étaient l’hypertension, la dépression et le diabète. 49 réponses ont été reçues pour 114 enquêtes envoyées par fax (taux de réponse de 43 %). Seuls 14 des 49 PCP ayant répondu ont suggéré des interventions pour remédier aux problèmes des visites aux urgences et des réadmissions; les PCP ont le plus souvent cité les conditions de vie et le manque de soutien social comme principaux facteurs de causalité. ConclusionsNous avons caractérisé les patients grands utilisateurs et discuté des perspectives et des stratégies de la PCP pour optimiser leur utilisation des soins de santé.

No abstract

Background There is an increasing recognition for medical students to receive more training in caring for patients with developmental disabilities (PWDD). Studies have found that providing training and encounter opportunities with PWDD for medical students improves their attitudes, comfort level, and knowledge. PWDD can have more sensitivity to changes in health than others, highlighting the importance of providing educational opportunities for medical professionals. To mitigate these outcomes, this preclinical 12-hour elective: “Developing Skills for Developmental Disabilities” (DSDD) was developed with the primary learning objective of improving students’ knowledge of and attitudes toward developmental disabilities in pediatrics. Objectives The current study’s objective was to evaluate the consistency of students’ perceived confidence ratings in assessing and managing children presenting with developmental delay or disability, despite changes in workplace educational setting across 5 years. Design/Methods Students received 6 hours of content-specific didactic teachings in addition to the standard second year developmental pediatrics curriculum. Content was provided by a team of developmental pediatricians and physiatrists. Didactic session topics included child development, estimating developmental age, assistive technologies, and breaking bad news, to supplement the 6 hours of clinical experience at a rehabilitation hospital. Students attended medical assessments with the opportunity to conduct a brief interview with the child’s family, observe pediatric PWDD in treatment programs, and interact with interdisciplinary teams. Students were given pre- and post-elective self-assessment surveys administered on a 5-point Likert scale. Questions pertained to students’ self-perceived comfort and knowledge regarding pediatric PWDD. Scores pre- and post-elective were used to calculate relative improvement of participants. Results 120 students enrolled in DSDD, with 94 students meeting elective requirements. On average, 77.2% (SD = 6.2%) of students were female and 81.4% (SD = 12.9%) reported having prior experience with PWDD. Statistically significant (p&lt;0.05) relative improvements were present in 9 of 10 scores for 2 of 5 years and all 10 in the other 3 years. Improved scores involved increases in confidence in interacting with PWDD, taking histories, recommending appropriate resources to families, and estimating developmental age. Conclusion DSDD may support acquisition of clinically relevant skills beyond those learned in the standard curriculum, as students consistently reported improvements in confidence across the same domains over 5 cohort years of this elective. The demonstration of maintained improvement is important because it may be translatable to future clinical practice and have implications towards optimizing outcomes for pediatric PWDD.