Effectiveness of the Adolescent Medicine Rotation in Improving Pediatric Residents Self-Assessed Skill and Confidence Caring for Youth

Effectiveness of a Curriculum for Pediatric Residents to Address Adolescent Nonsuicidal Self-Injury

OBJECTIVE

The present study assessed changes in pediatric resident competence in addressing adolescent nonsuicidal self-injury (NSSI) following a brief, single-session didactic training during the educational unit in adolescent medicine. This study also evaluated knowledge acquisition and retention over time, overall helpfulness of the training, and changes in the perception of how important residents believe that physicians receive training in NSSI.

METHODS

Pediatric residents participated in a single-session NSSI curriculum delivered as part of a monthlong clinical rotation from August 2016 to February 2019. Participants completed pretest, posttest, and 6-month follow-up surveys, and t tests and analyses of variance with post hoc comparisons evaluated changes in variables across the three time points.

RESULTS

One hundred twenty-seven of 162 eligible residents participated (78.4% response rate), and 69 completed the 6-month follow-up (54.3% retention rate). Prior to the NSSI didactic, 107 (85.6%) reported feeling not at all competent or only somewhat competent in responding to patients with a history of NSSI. Residents' self-perceived competence increased significantly (p < .001) from pretest to posttest and was sustained longitudinally. A measure of objective knowledge also showed retention over time. Residents were significantly (p < .001) more likely after the didactic to believe that training in NSSI for physicians is very important compared to before the training.

CONCLUSIONS

Following NSSI training, residents demonstrated increased knowledge and subjective competence in caring for adolescents who self-injure. It is feasible and important to integrate a brief, single-session NSSI curriculum into pediatric residency programs, such as in the adolescent medicine rotation.

Evaluation of One Program's Use of the Society for Adolescent Health and Medicine Resident Curriculum

PURPOSE

The publicly available Society for Adolescent Health and Medicine (SAHM) Resident Curriculum provides resources for blended learning. This report presents a formal evaluation of this blended learning curriculum.

METHODS

We adapted the SAHM curriculum for a required four-week rotation for pediatricians in training. We selected webinars, videos, articles, and Web sites from the SAHM curriculum to complement the local clinical context. We evaluated the effectiveness of our curriculum using resident pre- and post-self-assessments, weekly knowledge quizzes, and a standardized patient encounter.

RESULTS

Resident self-assessment improved in all domains except managing urologic conditions. Residents scored 85% or higher on knowledge quizzes. Standardized patients rated residents a mean of 90.2 out of 100 on adolescent communication and 89.0 out of 100 on parent communication.

CONCLUSIONS

A blended learning curriculum consisting of SAHM online materials and local clinical experiences improved resident self-assessment, knowledge, and communication skills.

Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures

PURPOSE

Results of patient-reported outcome measures (PROMs) are increasingly used to inform healthcare decision-making. Research has shown that response shift can impact PROM results. As part of an international collaboration, our goal is to provide a framework regarding the implications of response shift at the level of patient care (micro), healthcare institute (meso), and healthcare policy (macro).

METHODS

Empirical evidence of response shift that can influence patients' self-reported health and preferences provided the foundation for development of the framework. Measurement validity theory, hermeneutic philosophy, and micro-, meso-, and macro-level healthcare decision-making informed our theoretical analysis.

RESULTS

At the micro-level, patients' self-reported health needs to be interpreted via dialogue with the clinician to avoid misinterpretation of PROM data due to response shift. It is also important to consider the potential impact of response shift on study results, when these are used to support decisions. At the meso-level, individual-level data should be examined for response shift before aggregating PROM data for decision-making related to quality improvement, performance monitoring, and accreditation. At the macro-level, critical reflection on the conceptualization of health is required to know whether response shift needs to be controlled for when PROM data are used to inform healthcare coverage.

CONCLUSION

Given empirical evidence of response shift, there is a critical need for guidelines and knowledge translation to avoid potential misinterpretations of PROM results and consequential biases in decision-making. Our framework with guiding questions provides a structure for developing strategies to address potential impacts of response shift at micro-, meso-, and macro-levels.

Adolescent Depression Curriculum Impact on Pediatric Residents' Knowledge and Confidence to Diagnose and Manage Depression

PURPOSE

Despite the need for pediatricians to diagnose and manage adolescent depression, few pediatric residency curricula exist. This study evaluated the impact of an adolescent depression curriculum on pediatric residents' knowledge and confidence to manage depression.

METHODS

A novel, case-based, adolescent depression curriculum simulating patient-provider continuity was developed and implemented within an adolescent medicine (AM) rotation. The curriculum addressed seven domains critical for diagnosis and management of adolescent depression. Participants were recruited from the pediatric residency at one institution. A survey assessed residents' demographics, prior training, and self-assessed knowledge and confidence within each domain using a retrospective pre-post evaluation. Wilcoxon signed-rank test evaluated changes in knowledge and confidence.

RESULTS

Forty-two of a total 51 residents (82%) completed the curriculum and survey during their AM rotation. Residents reported that within their continuity clinic, 45% (n = 19) had never initiated medication for depression, and 60% (n = 25) did not manage their adolescent patients' depression medications. Comparisons before and after participation in the curriculum, using the retrospective pre-post survey, demonstrated increased self-assessed knowledge (p < .001, for each domain) and confidence (p < .001, for each domain).

CONCLUSIONS

In this study, few residents reported experience initiating medication or managing adolescent depression in the continuity clinic. Residents demonstrated increased self-assessed knowledge and confidence to diagnose and manage adolescent depression after participation in a case-based adolescent depression curriculum simulating patient-provider continuity. Incorporation of training on management of adolescent depression into AM rotation may be a feasible option to standardize training within pediatric residency.