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

Abstract

Background Pediatric 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. Objective Using 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. Methods We 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). Results All 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). Conclusions Using 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.

Keywords: adolescent and young adult; curriculum; health care transition; internal medicine & pediatrics; young adult.

Figure 1. Self-assessment transition goals which were reported by program directors and trainees.

YSHCN: youth with special health care needs; YYA: youth and young adults

Figure 2. Program Directors’ vs. Trainees’ Self-Assessment of Confidence on Transition Goals

Program Directors (n = 19); Trainees (n = 193). Goal 1- Knowledge and skills of the issues around the transition from pediatric to adult care for youth with special health care needs. Goal 2- Understanding the development and psychosocial aspects of transitioning to adulthood for youth with special health care needs. Goal 3- Understanding how youth with special health care needs and their families are impacted by insurance policies and social services as they age from childhood to adulthood. Goal 4- Understanding and addressing the educational and vocational needs of youth and young adult with special health care needs. Goal 5- Applying knowledge of health care systems to practice environment and beyond, to improve patient care and policies for youth and young adults with special health care needs.