131 - Needs assessment for Pediatric Residency curriculum to support the care of patients with Neurodivergent Disorders (NDD) in the Emergency Department

Publication Number: 4128.131

Trek Mizoguchi, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Julia Saykally, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; April Zaat, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States

Background: In the Emergency Department, pediatric residents often receive variable formal teaching regarding physical exam skills given the unpredictable nature of ED workflow. Pediatric patients with Neurodivergent Disorders (NDD) including Autism Spectrum Disorder, Down Syndrome, ADHD, and sensory processing disorders, frequently experience heightened distress in Emergency Departments. Limited resident training and lack of standardized care protocols to address best care practices for patients with NDD may contribute to suboptimal patient experiences and outcomes. A structured needs assessment was conducted to identify current gaps and inform future interventions to improve care delivery for neurodivergent pediatric patients in the ED. This study is part of a larger multidisciplinary QI project to improve overall care in the ED.

Objective: This study aimed to evaluate the need for further skills training among pediatric residents regarding physical exam and history taking skills pertaining to patients with NDD.

Design/Methods: This study is a curriculum development arm of a broader ED QI initiative. Using the Kern curriculum model as a framework, we conducted a needs assessment to understand baseline comfort levels and strategies used by residents caring for children with NDD in clinical settings. Residents at Children’s Hospital of Oakland were surveyed. Topics polled include most challenging physical exam components, and common resources utilized.

Results: We obtained 62 survey responses (71%) from pediatric residents at all levels of training. The majority (47%) responded with a score of 3 on a scale from 1 to 5 to describe level of comfort with NDD patient exams. Exam maneuvers residents reported being the least comfortable performing were oropharynx (79%), ear (68%), and neurologic (61%). The most common strategies used by residents to help with exams were parent, Child Life, or nursing team assistance.

Conclusion(s): Residents identified gaps in education and areas for improvement in resident physical exam training for patients with NDD in the Emergency Department. In response we plan to create a curriculum to disseminate between all trainees rotating through our Emergency Department to better address identified barriers to providing high quality physical exams and patient care.

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