Kim Shannon, Mennito Sarah, Wan Lori
Department of Pediatrics, University of California San Diego, San Diego, USA.
Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, USA.
Cureus. 2023 Oct 3;15(10):e46418. doi: 10.7759/cureus.46418. eCollection 2023 Oct.
Lack of consistency in primary care residency training exists in transitions of care (TOC) of adolescents from pediatric to adult medicine, which can lead to conflicting or incomplete training. To fill this gap, we developed a curriculum based on the Got Transition Six Core Elements and piloted it at two bicoastal, academic Medicine-Pediatrics (Med-Peds) residency programs.
The goals of this project are to increase resident TOC knowledge, increase transition discussion comfort and skills, and obtain feedback for curriculum improvement.
Two educational sessions were held at both institutions between 2020-2021. Of 32 potential resident participants, 26 participated in session one and 22 participated in session two. Sessions included a didactic presentation, small group activities, and a guest speaker discussing transitional experience. Electronic pre-session, post-session, and retention surveys evaluated resident knowledge, comfort, and self-reported skills of TOC. A Hybrid Type II design was used with mixed methods to evaluate curriculum effectiveness and implementation.
The first and second sessions had 81% and 68% attendance, respectively. Eighty-four percent completed the pre-session survey, 65% completed the post-session survey, and 68% completed the retention survey. TOC knowledge increased by 19% overall (p<0.001). First-year residents gained the most knowledge and implementation skills. Residents participating in alternating medicine and pediatric clinics gained more knowledge than those in a combined Med-Peds clinic (p=0.001). Comfort increased for both initiating and continuing TOC discussions after the first session. Knowledge retention was not statistically significant.
A standardized TOC curriculum can improve resident knowledge and is easily implemented at multiple institutions. Early-in-training residents and those in alternating medicine and pediatric clinics particularly benefit.
青少年从儿科到成人医学的医疗过渡（TOC）阶段，初级保健住院医师培训缺乏一致性，这可能导致培训相互冲突或不完整。为了填补这一空白，我们基于“顺利过渡六大核心要素”开发了一门课程，并在两个位于东西两岸的学术性内儿科（Med-Peds）住院医师培训项目中进行了试点。
本项目的目标是增加住院医师的TOC知识，提高过渡讨论的舒适度和技能，并获取课程改进的反馈。
2020年至2021年期间，在两个机构都举办了两次教育课程。32名潜在的住院医师参与者中，26人参加了第一次课程，22人参加了第二次课程。课程包括一次理论讲座、小组活动以及一位分享过渡经历的客座演讲者。通过电子课前、课后和留存调查问卷评估住院医师的TOC知识、舒适度和自我报告的技能。采用混合方法的混合II型设计来评估课程的有效性和实施情况。
第一次和第二次课程的出勤率分别为81%和68%。84%的人完成了课前调查，65%的人完成了课后调查，68%的人完成了留存调查。TOC知识总体增加了19%（p<0.001）。一年级住院医师获得的知识和实施技能最多。参加交替的内科和儿科门诊的住院医师比参加综合内儿科门诊的住院医师获得了更多知识（p=0.001）。第一次课程后，启动和继续TOC讨论的舒适度都有所提高。知识留存没有统计学意义。
标准化的TOC课程可以提高住院医师的知识水平，并且易于在多个机构实施。培训初期的住院医师以及参加交替的内科和儿科门诊的住院医师尤其受益。
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