Caring for Children With Chronic Health Care Needs: An Introductory Curriculum for Pediatric Residents

Abstract

Abstract Introduction We designed this curriculum to address our pediatric residents' learning needs related to caring for the growing population of children with special health care needs (CSHCNs). Although trainees regularly encounter CSHCNs in various clinical settings, they have not historically received focused instruction on the multidisciplinary needs of CSHCNs or how to address them as the primary care provider (i.e., medical home). Due to the fundamental nature and broad applicability of the content taught in this curriculum, we feel it is most appropriate for the intern year. Methods This curriculum is composed of three segments. The first segment consists of a list of suggested self-directed learning activities for trainees that will introduce them to the concepts of the medical home and CSHCNs, and important issues related to their care. The second segment exposes residents to a variety of resources—medical and nonmedical—that their CSHCN patients will be utilizing as part of their multidisciplinary plan of care, through experiential learning activities and site visits. Residents are provided with worksheets to complete for each of their site visits. These worksheets address issues including the processes for accessing community resources, methods of communication between primary care providers and subspecialists, comorbidities and other challenges commonly faced by patients in each of the subspecialty populations, and the psychosocial needs and obstacles for families of CSHCNs. The final segment of the curriculum includes reflective learning and content review activities. Results Prior to the rotation, 72% of interns reported understanding the definition of a CSHCN, but only 48% reported understanding the concept of a medical home, and 60% reported understanding a CSHCN's impact on the family. After completing the rotation, 100% of residents reported understanding these three concepts. One-hundred percent of interns reporting they are comfortable working with other health care providers to care for CSHCNs (up from 64% pre-rotation); 94% felt comfortable advocating for CSHCNs (up from 52%); 89% felt confident assessing the functional needs of CSHCNs (up from 8%); 94% felt confident assisting the family of these patients (up from 8%); and 89% felt confident providing a medical home for CSHCNs (up from 0%). Discussion Our ultimate goal is to instruct our learners on how to create effective medical homes for their patients. The information and principles taught in this curriculum must ultimately be practiced by the trainee with CSHCNs he/she encounters in the primary care setting. During residency training, practice of these skills can occur in the continuity clinic setting, provided the organizational resources and invested faculty mentors are in place.

Keywords

• Chronic Illness
• Children
• Special Needs