Implementing a Longitudinal Adolescent Transition of Care Curriculum: Identifying Comfort and Barriers Among Residents

Abstract

Amid growing recognition of the importance of transitioning adolescents and young adults (AYA) from pediatric-to adult-oriented health care systems, residency programs are being tasked with educating residents on best transition practices. However, consensus on how to approach training residents in transition of care (TOC) is limited. Our academic residency program therefore created and implemented a TOC of AYA curriculum for pediatric residents in an effort to increase provider knowledge and comfort with this topic. Three classes of post-graduate year one (PGY1) pediatric residents participated in this curriculum from 2017-2019 (n=35) and subsequently completed a problem-based learning (PBL) exercise in a primary care clinic with adolescent patients based on core goals in transitioning AYA. Residents completed pre-PBL and post-PBL surveys quantifying provider comfort in several aspects of the transition process. The majority of residents (94%) identified the PBL exercise as being useful, with no significant difference between classes. Eighty-nine percent (n=31) identified 1) earlier introduction of TOC and/or 2) incorporation of TOC discussions during AYA well visits as intended areas of future practice change. Overall provider comfort in transitioning AYA increased significantly from matched pre-PBL to post-PBL surveys (p=0.004). Paired mean differences also showed a significant increase in provider comfort based on several identifiable skillsets in transitioning AYA. This study suggests that a formal curriculum for pediatric residents significantly increases resident comfort in transitioning AYA and encourages change in future clinical practice. Future directions include evaluating the implementation of a formal longitudinal curriculum across several PGY levels and expansion of the curriculum to include internal medicine residents. Standardized curricula on this topic may improve resident comfort on a national level.

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

“…Moreover, there is variability in the transition process between institutions and clinics [ 20 - 21 ]. Residency curricula incorporating transition of care knowledge and skills have been shown to be effective at single institutions [ 22 - 25 ]. This study showed that a standardized resident-led transition of care curriculum is effective at two institutions.…”

“…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.…”

Improving the transition from paediatric to adult healthcare: a scoping review on the recommendations of young adults with lived experience

“…The results of this scoping review suggest that care providers must stay up-to-date with transition-related education in order to provide adequate transitional support. Studies interviewing paediatric residents and specialists found that providers experienced low knowledge and comfort levels with transitions from paediatric to adult care due to a gap in the provision of structured curriculum 97 98. This finding is unsurprising given one-third of undergraduate/graduate medical education programmes fail to provide instruction about transition of care 99.…”