A Multi-Institutional Collaborative To Assess the Knowledge and Skills of Medicine-Pediatrics Residents in Health Care Transition

Abstract

BackgroundPediatric to adult health care transition (HCT) is an essential process in the care of youth with special health care needs (YSHCN). Many internal medicine-pediatrics (med-peds) residency programs have developed curricula to teach transition knowledge and skills for the care of YSHCN. ObjectiveUsing a national med-peds program director quality improvement collaborative to improve transition curriculum, we aim to identify curricular content areas of improvement by describing baseline trainee knowledge and skills taught through existing transition curricula in med-peds programs. MethodsWe analyzed data collected during the 2018-2019 national med-peds program director quality improvement collaborative to improve transition curriculum. Program directors assessed their programs, and trainees assessed themselves on five transition goals by completing a Likert-scale questionnaire. In addition, trainees received an objective assessment of their knowledge through a multiple-choice questionnaire (MCQ). ResultsAll 19 programs in the collaborative, and 193 of 316 trainees from these programs, completed the questionnaires. Most programs were based at academic centers (68%) and provided transition training via didactics (63%) and/or subspecialty rotations (58%). More programs had high confidence (95%) than trainees (58%) in goal 1 (knowledge and skills of the issues around transition), whereas more trainees had high confidence (60%) than programs (47%) in goal 2 (understanding the developmental and psychosocial aspects of transition). Programs and trainees self-assessed lower in goals related to health insurance, educational and vocational needs, and application of health care system knowledge to the practice environment (goals 3, 4, and 5, respectively). ConclusionsUsing the assessments of the program directors and resident trainees, we identified subject areas for improvement of transition curricula, including health insurance and the application of health care system knowledge to the practice environment.

Piloting a Transition of Care Curriculum at Two Bi-coastal Medicine-Pediatrics Residency Programs

“…TOC guidance for providers, parents, and young adults have been available [ 17 - 19 ]. However, these resources are generally utilized post-residency and have not been consistently incorporated into residency curricula.…”

“…It is possible that residents in alternating clinics are less likely to have supervising faculty familiar with transition of care processes, therefore baseline knowledge prior to this curriculum was lower, allowing for greater knowledge gain. Most curricula and studies focus on patients with special healthcare needs [ 8 , 12 , 20 - 21 , 23 , 26 ], occur at single institutions/clinics [ 23 , 25 , 27 - 28 ], or evaluate transition goals for resident education as opposed to implementation [ 17 , 29 - 30 ]. This pilot curriculum executes transition education for residents caring for patients with and without special health care needs in the outpatient setting and to our knowledge, is the first resident-level transition curriculum conducted at multiple institutions.…”

Sex Differences in Biological Systems and the Conundrum of Menopause: Potential Commonalities in Post-Menopausal Disease Mechanisms

“…For example, those with osteoporosis are treated by endocrinologists, whereas those with heart and cardiovascular system disorders are treated by cardiologists, osteoarthritis is in the purview of orthopedic surgeons and rheumatologists, obesity in that of internal medicine or family practice experts, menopause in the purview of endocrinologists and gerontologists and dementia that of neurologists. Furthermore, individuals are also segregated by life stage, with children and adolescents the focus of pediatricians and the elderly by a variety of specialists depending on any comorbidities, and there can be challenges associated with such age transitions [139,140]. Therefore, there is an associated limitation with this paradigm to focus on the target tissue that is directly associated with the symptoms, rather than look for any commonalities.…”