Enhancing developmental–behavioral pediatric rotations by teaching residents how to evaluate autism in primary care

Abstract

Most pediatric residency programs do not provide adequate practical experiences for residents in autism-related care, with a specific dearth of training in diagnostic processes. Without this training, residents enter the primary care workforce with uncertainty surrounding implementation of standard-of-care recommendations for children with autism. Our curriculum was designed to improve upon previously passive shadowing experiences within our developmental–behavioral pediatric rotation by integrating hands-on training in within-practice diagnostic identification and care coordination. In addition to multiple web-based learning activities (including a tutorial teaching administration of an interactive assessment tool), residents were required to actively participate in autism evaluations under supervision of an attending provider. Data were collected to assess feasibility of curricular changes as well as increased comfort level across recommended practice behaviors. Regarding feasibility, 95% of residents completed training components and pre-/post-ratings indicated significant increases in comfort in identifying symptoms/risk for autism, providing feedback about diagnostic decision, and effectively connecting families with services. Outcomes suggest feasibility of model and significantly increased resident comfort level across a range of recommended practice behaviors. This project reflects a first step in advancing incorporation of autism training into pediatric residency programs. Lay abstract Most physician preparation programs do not provide enough practical experiences in autism-related care. This is especially true for how to assess for and diagnose autism. Without this training, many pediatricians are not well prepared to implement appropriate care for children with autism and their families. We designed a curriculum to improve training for medical residents that involved explicit hands-on training in diagnostic identification and care coordination for toddlers at risk for autism. We collected data to assess whether our enhanced curriculum led to increased comfort level across recommended practice behaviors. Almost all the residents were able to complete the training within their rotation and our surveys indicated significant increases in residents feeling more comfortable identifying symptoms of autism, providing feedback about diagnostic decisions, and effectively connecting families with services. A significant majority of residents considered it appropriate or very appropriate for children to receive a diagnosis solely from a primary care provider. Our results suggest feasibility of the enhanced model, and this project reflects the first step in advancing incorporation of autism training into pediatric residency programs.

Assessment of the knowledge and awareness of pediatric residents and pediatricians about autism spectrum disorder at a single center in Turkey

“…In the current study, about half of the pediatricians and nearly 20% of the residents knew that the onset of symptoms and findings in early childhood was a diagnostic criterion. These low rates show that a structured, hand-on "child psychiatry" training should be a must in pediatric residency training as well as the undergraduate curriculum to ensure early diagnosis and early intervention for optimal outcome (Hine et al, 2021).…”

The impact of autism-related training programs on physician knowledge, self-efficacy, and practice behavior: A systematic review

“…It is also important to note that most of the training programs, even those that occurred exclusively online, had some live interactive component. The remaining three non-ECHO training programs (1 medium-quality and 2 low-quality) employed a hybrid model consisting of both online and in-person components and were highly variable in duration, ranging from one day to a few months (Carbone et al, 2016; Havercamp et al, 2016; Hine et al, 2021).…”

“…Physician self-efficacy was the second outcome measure assessed in this literature review, and all of the identified studies measuring self-efficacy found significant improvements in the outcome measure following the completion of a specialized autism training program (Table 1). For example, one study found that physicians became more comfortable with identifying the symptoms of ASD, making appropriate diagnoses and referrals, and providing care to autistic children (Hine et al, 2021). Another study found that levels of self-efficacy remained increased six months following the completion of a training program (van ‘t Hof et al, 2021), suggesting that these educational programs are able to have a lasting impact on physicians’ confidence in their ability to provide care to autistic individuals.…”

“…Furthermore, only collecting post-assessment data makes it difficult to accurately assess the impact of the specialized training program. In addition, many of the included studies relied solely on participants’ self-assessment of their knowledge, self-efficacy, or practice behavior (Giachetto et al, 2019; Havercamp et al, 2016; Hine et al, 2021; Mazurek et al, 2019; Pasco et al, 2014; Swanson et al, 2014). In these studies, the lack of an objective assessment to measure the outcomes of interest means that the data are subject to bias from participants’ perceptions and may not be an accurate measure of the program’s impact.…”

Building Capacity for Community Pediatric Autism Diagnosis: A Systemic Review of Physician Training Programs

“…There are also recent feasibility data on incorporating ASD diagnostic assessment into pediatric residency training, which may also enhance community capacity. 30 Furthermore, eligibility for supports and services may depend on including measures (e.g., adaptive skills or other relevant functional domains) that may be less accessible to PCPs than to specialized teams. Mitigating strategies are possible.…”