A Comprehensive Outpatient Pediatric Resident Complex Care Curriculum

Pediatric resident training typically prepares learners to care for children with medical complexity (CMC) when acutely ill; however, residents often do not receive formal primary care training for this population. We designed a curriculum to improve pediatric resident knowledge, skills, and behavior when providing a medical home for CMC.

Guided by Kolb's experiential cycle, we designed and offered a complex care curriculum as a block elective to pediatric residents and pediatric hospital medicine fellows. Participating trainees completed a prerotation assessment to establish baseline skills and self-reported behaviors (SRB) and four pretests to document baseline knowledge and skills. Residents viewed online didactic lectures weekly. During four half-day patient care sessions per week, faculty reviewed documented assessments and plans. Additionally, trainees attended community-based site visits to appreciate the socioenvironmental perspective of CMC families. Trainees completed posttests and a postrotation assessment of skills and SRB.

Between July 2016 and June 2021, 47 trainees participated in the rotation, with data available for 35 trainees. Residents demonstrated significant improvement in knowledge (p < .001), self-assessed skills (average Likert-scale rating prerotation = 2.5 vs. postrotation = 4.2), and SRB (average Likert-scale rating prerotation = 2.3 vs. postrotation = 2.8) based on test scores and trainees' postrotation self-assessments. Learner evaluations of the rotation site visits (15 out of 35, 43%) and video lectures (eight out of 17, 47%) demonstrated overwhelmingly positive reaction.

This comprehensive outpatient complex care curriculum addressing seven of 11 nationally recommended topics demonstrated improvement in trainees' knowledge, skills, and behaviors.