CRISP: An Inpatient Pediatric Curriculum for Family Medicine Residents Using Clinical Reasoning and Illness Scripts
Gayatri B. Madduri,
Elizabeth L. Torwekar,
Shaban Demirel,
Megan Durham,
Kimberlee I. Hauff,
Rajat Kaul,
Tristan Nichols,
Noga L. Ravid,
Mason A. Shaner,
Caroline E. Rassbach
Affiliations
Gayatri B. Madduri
Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Family Medicine Inpatient Pediatrics Rotation Director, John Muir Medical Center
Elizabeth L. Torwekar
GME Director of Pediatric Education and Pediatric Hospitalist, Department of Pediatrics, Randall Children's Hospital, Legacy Health
Shaban Demirel
Vice President of Research, Legacy Research Institute, and Director of Clinical Research, Legacy Health
Megan Durham
Clinical Instructor, Department of Pediatrics, Randall Children's Hospital, Legacy Health
Kimberlee I. Hauff
Associate Professor, Department of Family Medicine, University of Washington; Family Medicine Inpatient Pediatrics Rotation Director, Swedish Medical Center
Rajat Kaul
Associate Professor, Division of Hospital Medicine, Department of Pediatrics, Ebeid Children's Hospital; Pediatric Clerkship Director, University of Toledo College of Medicine and Life Sciences
Tristan Nichols
Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Family Medicine Inpatient Pediatrics Rotation Director, John Muir Medical Center
Noga L. Ravid
Assistant Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine; Chair, Department of Pediatrics, John Muir Medical Center
Mason A. Shaner
Third-Year Medical Student, University of Michigan Medical School
Caroline E. Rassbach
Professor, Division of Pediatric Hospital Medicine, Department of Pediatrics, and Program Director, Pediatrics Residency and Pediatrics-Anesthesiology Residency, Stanford University School of Medicine
Introduction Clinical reasoning enables safe patient care and is an important competency in medical education but can be challenging to teach. Illness scripts facilitate clinical reasoning but have not been used to create pediatric curricula. Methods We created CRISP (Clinical Reasoning with Illness Scripts in Pediatrics), a curriculum comprising four 1-hour learning sessions that deliberately incorporated clinical reasoning concepts and illness scripts to organize how four common chief complaints were taught to family medicine residents on inpatient pediatric rotations. We performed a multisite curriculum evaluation project over 6 months with family medicine residents at four institutions to assess whether the use of clinical reasoning concepts to structure CRISP was feasible and acceptable for learners and instructors and whether the use of illness scripts increased knowledge of four common pediatric chief complaints. Results For all learning sessions, family medicine residents and pediatric hospitalists agreed that CRISP's format was preferable to traditional didactic lectures. Pre-/posttest scores showed statistically significant increases in family medicine resident knowledge (respiratory distress [n = 42]: pretest, 72%, posttest, 92%; abdominal pain [n = 44]: pretest, 82%, posttest, 96%; acute febrile limp [n = 44]: pretest, 68%, posttest, 81%; well-appearing febrile infant [n = 42]: pretest, 58%, posttest, 73%; ps < .05). Discussion By using clinical reasoning concepts and illness script comparison to structure a pediatric curriculum, CRISP represents a novel instructional approach that can be used by pediatric hospitalists to increase family medicine resident knowledge about diagnoses associated with common pediatric chief complaints.
