555 - Medically Complex Primer: Improving Intern Comfort when Caring for Children with Medical Complexity

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 555
Publication Number: 555.325

Valerie Schwartz, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Michael D. Fox, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; David Rappaport, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States

Presenting Author(s)

Valerie Schwartz, DO (she/her/hers)

Fellow
NemoursAlfred I. duPont Hospital for Children
Wilmington, Delaware, United States

Background: Pediatricians care for more children with medical complexity (CMC) than ever before. CMC can be defined as children with congenital or acquired disease involving multiple organ systems, who have a severe neurological condition and/or who depend on technology. Many pediatric residents lack comfort in providing the nuanced, multidisciplinary care that these patients require, especially managing their technology needs, and some residents have had no experience with CMC prior to residency.

Objective: To assess changes in intern comfort when caring for CMC through a novel, half-day curriculum during intern orientation.

Design/Methods: Interns participated in a 4-hour, multi-disciplinary led curriculum consisting of 4 didactic sessions, one each dedicated to discussion of cerebral palsy, gastrostomy tubes, tracheostomy tubes, and respiratory clearance. Interns also participated in 2 skills sessions during which they exchanged gastrostomy and tracheostomy tubes on simulation mannequins. Pre- and post-curriculum surveys were completed by all curriculum participants to collect quantitative data on the impact of this curriculum. Several open-ended questions further explored reasons for discomfort when caring for CMC on the pre-curriculum survey.

Results: Twenty-three interns participated in the curriculum. Using a 5-point Likert scale (1=very uncomfortable, 5=very comfortable), interns reported overall comfort when caring for CMC, comfort with each topic of the 4 didactic sessions, and comfort with both simulations. The mean of all topics and skills improved on post-curriculum surveys. When compared via independent-samples median test, scores in overall comfort, all 4 didactic topics and gastrostomy tube exchange showed a statistically significant increase (p value >0.05). Tracheostomy exchange improvement in comfort was not statistically significant. Analysis of open-ended questions revealed 5 themes when interns were asked “what makes you the most uncomfortable when caring for CMC?”: (1) lack of knowledge, (2) lack of experience, (3) fear of causing harm, (4) rare/multisystem disease management, and (5) polypharmacy.

Conclusion(s): This curriculum can help improve intern comfort when caring for CMC before starting clinical rotations, as interns became more comfortable with all topics and one of the two procedures included. Analysis of open-ended questions identified reasons for intern discomfort when caring for CMC, which might allow further targeted educational initiatives going forward. A 6-month post-curriculum survey is in process to determine retention of increased comfort.