453 - CRISP: A Pediatric Hospital Medicine Curriculum For Family Medicine Residents Using Clinical Reasoning

Poster Number: 453
Publication Number: 453.122

Gayatri B. Madduri, Stanford University School of Medicine, Oakland, CA, United States; Elizabeth L. Torwekar, Randall Children's Hospital at Legacy Emanuel, Portland, OR, United States; Shaban Demirel, Randall Children's Hospital at Legacy Emanuel, Portland, OR, United States; Megan R. Durham, Randall Children's Hospital at Legacy Emanuel/Oregon Health and Science University, Portland, OR, United States; Kimberlee I. Hauff, Swedish Medical Center, Seattle, WA, United States; Rajat Kaul, ProMedica Toledo Children's Hospital, Toledo, OH, United States; Tristan Nichols, Stanford University School of Medicine, Oakland, CA, United States; Noga L.. Ravid, Stanford University School of Medicine, Berkeley, CA, United States; Mason A. Shaner, University of Michigan Medical School, Ann Arbor, MI, United States; Caroline Rassbach, Stanford University, Palo Alto, CA, United States

Background: Family medicine (FM) residents must care for hospitalized children as a residency training requirement. A recent survey of pediatric program directors found that 90% of programs rely on hospitalists to lead FM education on inpatient pediatrics, but only 13% use an FM-specific curriculum. There is a notable curricular gap within pediatric hospital medicine (PHM) for FM residents.

Objective: We created CRISP (Clinical Reasoning Instruction for Students in Pediatrics): a curriculum that uses clinical reasoning (CR) concepts to standardize how pediatric content is taught to FM residents on PHM rotations. We performed a multi-site curriculum evaluation study to assess if CRISP: 1) increases knowledge of four common pediatric chief complaints (CC); 2) is acceptable to learners.

Design/Methods: We designed four 50-minute learning sessions (Table 1) with the same format: organization of the CC with a schema, review of a CR concept, discussion of a case vignette, and direct instruction of illness scripts related to 4-8 differential diagnoses. Pediatric hospitalists implemented CRISP at four community hospitals (CA, OR, WA, OH) with IRB approval/exception during January - June 2022. We analyzed p</span>aired p</span>re-/post-test scores with the Mann-Whitney test, and anonymous learner Likert-scale survey responses with descriptive statistics.

Results: Pre-/post-test scores (Table 2) showed statistically significant increases in learner knowledge for all four learning sessions (*p < 0.05; respiratory distress, pre-test: 72%| post-test: 92%*; abdominal pain, pre-test: 82% | post-test: 96%*; febrile limp, pre-test: 68% | post-test: 81%*; febrile infant, pre-test: 58% | post-test: 73%*). This increase was irrespective of the site where CRISP was delivered. Learners agreed/strongly agreed that CRISP provides a useful way to organize knowledge, develops CR skills, is applicable to clinical practice, and is a preferrable lecture format as compared to traditional lectures (Table 3).

Conclusion(s): CRISP is a highly effective and well-received curriculum that has been studied at four community sites. Pediatric hospitalists may use CRISP to teach FM residents about differential diagnoses frequently encountered in both inpatient and outpatient settings. CR concepts are generalizable across specialties and may be a novel way to structure education at the graduate medical education level for all learners.