464 - Survey Says: There is a Need for Improved Proficiency and Education in Care of Children with Medical Complexity

Publication Number: 464.6569

Christina McClam, The Children's Hospital of Philadelphia, Wynnewood, PA, United States; Ao Tan, Childrens Hospital of Philadelphia, Lansdale, PA, United States; Morgan Congdon, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Rebecca Tenney-Soeiro, Children's Hospital of Philadelphia, Swarthmore, PA, United States

Background: Children with medical complexity (CMC) are a growing population that have high healthcare utilization. Pediatric clinicians will need to be adept at caring for CMC and directing the management of their multisystem diseases. Entrustable professional activities (EPAs) for trainees have been developed for the care of CMC. However, there is limited data about fellow and attending clinicians' comfort and proficiency in this care.

Objective: The complex care education needs assessment’s goal is to identify 1) supervising clinicians’ self-rated comfort and proficiency in the care of CMC 2) the opportunities for continuing education innovations and curriculum development for the care of CMC.

Design/Methods: Pediatric hospital medicine (PHM) fellows and attendings at our institution were included in this study. Using a survey developed by content experts, we assessed training and the frequency of care of CMC, self-rated comfort and proficiency, expertise in specific CMC EPAs, clinicians’ sense of expertise and belongingness in the care of CMC, and interest in future curricula and preferred learning modalities. We used descriptive statistics for quantitative data analysis, as well as the Wilcoxon Signed-Rank Test and Kruskal-Wallis Rank-Sum Test.

Results: Of the 155 clinicians surveyed, 75 (48 %) participated and reported frequent care of CMC (75%: 2-3 times a week or daily). Most reported that all clinicians should be proficient in the care of CMC (93%) though reported that they have lower comfort (83%) and proficiency in the care of CMC (69%), a difference of p < 0.0001. A minority reported CMC expertise (25%). There was a significant increase in comfort and proficiency from complex care compared to general pediatric clinicians (p 0.001, p 0.009).

Almost all agreed with the importance of expanding their knowledge and proficiency in the care of CMC (96%) and most agreed that existing educational opportunities have increased their knowledge in care of CMC (89%). Participants preferred case-based discussions and live didactics as educational modalities (75%, 62%).

Conclusion(s): In a needs assessment of PHM fellows and attendings at our institution, we found a significant gap exists between optimal versus existing self-rated comfort and proficiency in care of CMC for all clinicians, and between clinicians on general pediatric and complex care services. There is a shared interest among this group to improve in the care of CMC and recognition that education is prudent to improve skills. Future curriculum development should prioritize education offerings in the care of CMC to serve the needs of clinicians and trainees.

Self-Identified Knowledge, Comfort, and Sense of Belonging in Care of Children with Medical Complexity


Comparison of Self-Rated Proficiency and Comfort in Care of CMC
We used the Wilcoxon Signed-Rank Test to compare all participant responses to the following pairs of questions:
• Q1: 'I feel that all pediatric clinicians should have proficiency in caring for CMC' vs. Q2: 'I feel that my knowledge and skills are proficient in the care of CMC.'
• Q1: 'I feel that all pediatric clinicians should have proficiency in caring for CMC' vs. Q3: 'I feel comfortable caring for CMC.'

Null Hypothesis for each comparison (Q1 vs. Q2 and Q1 vs. Q3): There is no significant difference in responses between the two questions. Since the p-value for each test is less than 0.05, we reject the null hypothesis, concluding that there is a significant difference in responses between each pair of questions.

The second statistical test used was the Kruskal-Wallis rank-sum test (ANOVA on ranks), appropriate for comparing two unpaired groups that are not normally distributed.

Null Hypothesis: There is no significant difference among the three categories between the Complex Care Clinicians and the Gen Peds Clinicians. Since the p-values for the category "I feel comfortable caring for CMC" and “I feel that my knowledge and skills are proficient in the care of CMC” are less than 0.05, we can conclude that there is a significant difference between the two groups for two categories.

Self-Rated Proficiency in Complex Care Core Content Areas
The core content areas in the care of children with medical complexity in the survey were based on the Entrustable Professional Activities in Complex Care (Huth et al).

Self-Identified Knowledge, Comfort, and Sense of Belonging in Care of Children with Medical Complexity


Comparison of Self-Rated Proficiency and Comfort in Care of CMC
We used the Wilcoxon Signed-Rank Test to compare all participant responses to the following pairs of questions:
• Q1: 'I feel that all pediatric clinicians should have proficiency in caring for CMC' vs. Q2: 'I feel that my knowledge and skills are proficient in the care of CMC.'
• Q1: 'I feel that all pediatric clinicians should have proficiency in caring for CMC' vs. Q3: 'I feel comfortable caring for CMC.'

Null Hypothesis for each comparison (Q1 vs. Q2 and Q1 vs. Q3): There is no significant difference in responses between the two questions. Since the p-value for each test is less than 0.05, we reject the null hypothesis, concluding that there is a significant difference in responses between each pair of questions.

The second statistical test used was the Kruskal-Wallis rank-sum test (ANOVA on ranks), appropriate for comparing two unpaired groups that are not normally distributed.

Null Hypothesis: There is no significant difference among the three categories between the Complex Care Clinicians and the Gen Peds Clinicians. Since the p-values for the category "I feel comfortable caring for CMC" and “I feel that my knowledge and skills are proficient in the care of CMC” are less than 0.05, we can conclude that there is a significant difference between the two groups for two categories.

Self-Rated Proficiency in Complex Care Core Content Areas
The core content areas in the care of children with medical complexity in the survey were based on the Entrustable Professional Activities in Complex Care (Huth et al).