Implementation and faculty perception of outpatient medical student workplace-based assessments.

BACKGROUND: There is growing interest in use of entrustable professional activity (EPA)-grounded workplace-based assessments (WBAs) to assess medical students through direct observation in the clinical setting. However, there has been very little reflection on how these tools are received by the faculty using them to deliver feedback. Faculty acceptance of WBAs is fundamentally important to sustained utilisation in the clinical setting, and understanding faculty perceptions of the WBA as an adjunct for giving targeted feedback is necessary to guide future faculty development in this area. APPROACH: Use of a formative EPA-grounded WBA was implemented in the ambulatory setting during the paediatrics clerkship following performance-driven training and frame-of-reference training with faculty. Surveys and semi-structured interviews with faculty members explored how faculty perceived the tool and its impact on feedback delivery. EVALUATION: Faculty reported providing more specific, task-oriented feedback following implementation of the WBA, as well as greater timeliness of feedback and greater satisfaction with opportunities to provide feedback, although these later two findings did not reach significance. Themes from the interviews reflected the benefits of WBAs, persistent barriers to the provision of feedback and suggestions for improvement of the WBA. IMPLICATIONS: EPA-grounded WBAs are feasible to implement in the outpatient primary care setting and improve feedback delivery around core EPAs. The WBAs positively impacted the way faculty conceptualise feedback and provide learners with more actionable, behaviour-based feedback. Findings will inform modifications to the WBA and future faculty development and training to allow for sustainable WBA utilisation in the core clerkship.

Prioritizing Health Literacy Educational Objectives for Pediatric Residents - A Delphi Study.

OBJECTIVE: Children of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum. METHODS: Our Delphi panel participated in 3 rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential. RESULTS: Thirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After 3 survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies. CONCLUSIONS: A panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.

Using a Modified Delphi Methodology to Identify Essential Telemedicine Skills for Pediatric Residents.

OBJECTIVE: Telemedicine use in pediatrics increased during the coronavirus disease-2019 (COVID-19) pandemic. Despite rapid uptake by pediatric residency programs, consensus on essential telemedicine skills for pediatric residents is lacking. We used a modified Delphi methodology to identify essential telemedicine skills and behaviors for pediatric residents. METHODS: A focused literature search was performed to identify items for review by pediatric telemedicine experts. A modified Delphi methodology consisting of iterative rounds of anonymous surveys was conducted until consensus for each item was reached. Consensus was defined as >80% of experts identifying a topic as "very important." All items were mapped to one of the Accreditation Council for Graduate Medical Education (ACGME) core competencies. RESULTS: Seventeen pediatric telemedicine skills and behaviors achieved a consensus of "very important." Most items mapped to the ACGME core competency domains of interpersonal and communication skills and professionalism. CONCLUSIONS: There was a high degree of agreement among pediatric telemedicine experts on the importance of 17 telemedicine skills and behaviors for pediatric trainees. These skills can inform pediatric telemedicine curricula and provide validity evidence for pediatric telemedicine assessment tools.

A Pediatric Resident Curriculum for the Use of Health Literacy Communication Tools.

BACKGROUND: Despite evidence that use of evidence-based communication tools (EBCT) with a universal precautions approach improves health outcomes, medical trainees report inadequate skills training. OBJECTIVE: We developed, implemented, and evaluated a novel, interactive curriculum featuring a 30-minute, single-session didactic with video content, facilitated case-based discussions and preceptor modeling to improve use of EBCT among pediatric residents. A direct observation (DO) skills checklist was developed for preceptors to evaluate resident use of EBCT. METHODS: Shortly after implementation of the curriculum, residents completed a survey assessing self-reported frequency of EBCT use both pre- and post-intervention. DOs were conducted 2 to 3 weeks after the didactic was completed and scores were compared among residents who participated in the curriculum and those who did not. A longitudinal 6-month follow-up survey was also distributed to assess changes over time. KEY RESULTS: Forty-seven of 78 (60%) of residents completed the survey and 45 of 60 (75%) of the eligible residents participated in the DO. There was significant change in self-reported use of all but one EBCT after participation in the curriculum. Residents reported sustained increased frequency of use of all communication tools except for Teach Back, Show Back, and explanation of return precautions in the 6 months following the curriculum. Notably, there was no significant difference in resident scores in the DO among residents who participated in the didactic session and those who did not. CONCLUSIONS: This novel interactive curriculum addresses ACGME (Accreditation Council for Graduate Medical Education) core competencies and fulfills a needed gap in resident curricula for health literacy-related skills training. Findings suggest a small, positive affect on frequency of self-reported use of health literacy EBCT. However, our findings demonstrate a lack of parallel improvement in resident performance during DO. Future curricula may require certain modifications, as well as reinforcement at regular intervals. [HLRP: Health Literacy Research and Practice. 2022;6(2):e121-e127.] Plain Language Summary: Use of evidence-based communication tools, such as presenting information in small chunks and avoiding complex medical terms among pediatric trainees, is limited. This study describes a new and interactive health literacy curriculum, with emphasis on preceptor modeling and DO to improve use of evidence-based communication tools among residents. After participation in the curriculum, residents report greater use of evidence-based communication tools. However, results from DO of residents did not demonstrate similar improvements.

Mental Health in the Medical Home: A Longitudinal Curriculum for Pediatric Residents on Behavioral and Mental Health Care.

Introduction: Currently, a pediatric mental and behavioral health crisis exists, driven by increasing stressors among children coupled with a paucity of psychiatric providers who treat children. Pediatric primary care providers can play a critical role in filling this gap, yet trainees feel uncomfortable screening for, identifying, and managing mental and behavioral health conditions among their patients. Thus, expanding training for pediatricians in this domain is critical. Methods: We created a longitudinal integrated mental and behavioral health curriculum for pediatric residents at NewYork-Presbyterian/Columbia University Irving Medical Center with a logic model contextualizing outpatient pediatric care as a framework for the development and planned evaluation. We devised a comprehensive set of materials, with presentations on topics including attention deficit hyperactivity disorder and anxiety disorders. Workflows and escalation pathways promoting collaboration among interdisciplinary providers were implemented. We evaluated residents' and faculty members' participation in the curriculum and their perception of curricular gaps. Results: Approximately 155 pediatric residents participated in the curriculum from 2017 to 2021, reflecting robust curricular exposure. Few residents and no preceptors perceived mental and behavioral health as a curricular gap. Discussion: Our curriculum is feasible and can be adapted to a variety of educational settings. Its use of a logic model for development, implementation, and ongoing evaluation grounds the curriculum in educational theory and can address curricular gaps. The framework can be adapted to suit the needs of other institutions' educational and practice settings and equip pediatric trainees with the skills to promote patient mental health and well-being.

Design and implementation of an interactive, competency-based pilot pediatric telemedicine curriculum.

During the height of the COVID-19 pandemic, telemedicine visits surged to increase access and maintain continuity of care, while reducing transmission of disease. However, few curricula exist for training residents on how to care for patients via telemedicine, especially in pediatrics. We aimed to create and evaluate an interactive, competency-based pilot curriculum, to meet the urgent need to train residents in telemedicine. The curriculum was developed in 2020 and includes a didactic, cased-based discussions, and direct observation exercise. A model for precepting residents, adhering to new ACGME guidelines, was also created to further engage residents in telemedicine in the outpatient general pediatrics settings. To evaluate the curriculum, we assessed feasibility of a direct observation to provide feedback and we conducted pre and post surveys to assess for changes in residents' self-reported skills in performing telemedicine visits following implementation of the curriculum. 16 residents participated in the curriculum and 15 completed both the pre and post surveys (93%). Residents' self-reported efficacy in performing key components of telemedicine visits, including completion of telemedicine visit (p = 0.023), initiation of visits (p = 0.01), and documentation (p = 0.001) all improved significantly following implementation. Residents' perception of patient satisfaction with telemedicine and personal perception of ease of use of the telemedicine system increased, though neither were statistically significant. Uptake of the direct observation exercise was nearly universal, with all but one resident having a direct observation completed during their ambulatory month. This novel, interactive telemedicine pilot curriculum for residents addresses ACGME competencies and provides residents with a toolkit for engaging in telemedicine.

Transition-to-residency: pilot innovative, online case-based curriculum for medical students preparing for pediatric internships.

Background: There is increasing recognition in medical education that greater emphasis must be placed on preparing graduating medical students for their new roles as interns. Few publications in the literature have described transition-to-residency curricula specifically for students interested in pediatrics or pediatric-related fieldsApproach: We developed novel online pediatric cases, embedded within an innovative, hybrid transition-to-residency course, to address high yield, multi-disciplinary topics within the context of several of the AAMC's identified Entrustable Professional ActivitiesEvaluation: The pilot cases were evaluated over two academic years (2018, 2019) at a single academic medical center as part of routine student course evaluation (N = 18/35) with the 2019 evaluation containing additional retrospective pre-post survey questions (N = 9/18) assessing self-reported changes in knowledge. Almost all students were very satisfied or satisfied with the modules overall (94%), the quality of the resources provided (100%), and the structure and clarity of the presentation of the material (100%). Among the students who completed the retrospective pre-post survey after participation in the online modules, significant self-reported improvements were noted in writing orders to the pediatrics floor (Z = -2.07, p = 0.04), providing anticipatory guidance (Z = -2.0,p = 0.046), formulating a differential diagnosis for common pediatric conditions (Z = -2.24, P = 0.03), and preparedness for managing common pediatric floor emergencies (Z = -2.33, P = 0.02).Reflection: We demonstrated feasibility of implementation of an interactive, online case-based curriculum, medical student satisfaction with content and delivery, and increased self-reported knowledge after completion of the pilot pediatric cases on the online, asynchronous learning platform.

Impact of a Community Health Worker Program to Support Caregivers of Children With Special Health Care Needs and Address Social Determinants of Health.

Few studies have evaluated the effects of a community health worker (CHW) intervention on social determinants and caregiver distress. This study assesses the impact of a CHW program for caregivers of children with special health care needs (CSHCN) on these factors in addition to confidence in self-management. A retrospective, pre-post analysis was conducted for those who completed a CHW program. Caregivers reported high levels of distress, low educational attainment, linguistic isolation, positive depression screens, and food and housing issues at baseline. On completion of the program, there was significant improvement in caregiver distress scores (P < .001) and in understanding of their children's diagnoses (P < .001). Furthermore, the number of caregivers reporting food or housing issues was significantly reduced (P < .01 and P < .01, respectively). This study demonstrates the feasibility and potential effects of a CHW intervention for CSHCN and highlights the need for a large-scale controlled trial to further evaluate impact.