Evaluating Curricular Modules in the Care of Children With Medical Complexity: A Mixed-Methods Randomized Controlled Trial

• Published in: Academic pediatrics 2020-03, Vol.20 (2), p.282-289
• Main Authors: Huth, Kathleen, Audcent, Tobey, Long-Gagne, Sara, Sbrocchi, Anne Marie, Weiser, Natalie, Miller, Doug, Arje, Danielle, Stephens, Derek, Major, Nathalie, Issa, Kheirie, Cohen, Eyal, Orkin, Julia
• Format: Article
• Language: English
• Subjects: Adult; Child; Clinical Competence; complex care; Curriculum; Education, Medical, Graduate - methods; Female; Humans; Internship and Residency; Male; Ontario; Patient Care Planning; Patient Simulation; pediatrics; Pediatrics - education; postgraduate medical education; Qualitative Research; Random Allocation; residency education; Self Efficacy; Tracheostomy; Uncertainty; Young Adult
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2019.09.002

Children with medical complexity (CMC) are a growing population, yet training in complex care varies across pediatric residency programs. The purpose of this study was 1) to evaluate the effectiveness of a curriculum for pediatric residents in improving performance in a simulated clinical scenario, and 2) to explore residents’ perceived self-efficacy in caring for CMC. A randomized controlled trial was conducted supplemented by qualitative inquiry. Pediatric residents from 2 residency programs were randomly assigned to participate in interactive modules on: 1) clinical assessment, care planning, and technological dependency or 2) noncomplex care topics. The primary outcome was mean score on an Observed Structured Clinical Examination (OSCE) of tracheostomy care. Semistructured interviews were conducted postintervention and analyzed using qualitative content analysis. Ninety-four eligible residents were randomized. Residents who attended all modules and the OSCE and consented to participate (intervention [n = 20] and control [n=24]) were included in the final analysis. At baseline, few (9%) reported being comfortable caring for CMC. There was no significant difference in mean OSCE score between intervention and control groups (39.0 ± 1.1 vs 38.0 ± 1.0, P = .48). Qualitative analysis revealed 3 emerging themes related to resident self-efficacy: building a system of care, navigating uncertainty, and professional identity formation. A standardized complex care curriculum delivered in a classroom setting did not lead to improved performance in an OSCE station despite increased resident-reported self-efficacy in approaching care for CMC. These findings highlight the need for multidimensional educational interventions and assessments in complex care.