748 - Teaching with Intention: Lessons from a Primary Care Curriculum in Pediatric Resident Continuity Clinics

Publication Number: 3724.748

Jessica Hart, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Priyanka Rao, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Katherine Jordan, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Yumei Yang, Chapel Hill, Chapel Hill, NC, United States; Feng-Chang Lin, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Nicole Chandler, University of North Carolina at Chapel Hill School of Medicine, Greensboro, NC, United States

Background: Education about primary care pediatrics is essential for pediatric residents. However, variability exists in how resident continuity clinics conduct formal education, including the evaluation of faculty-led education. There is a need to better understand the impact that various educational strategies have in the continuity clinic setting.

Objective: Our study aimed to characterize changes in pediatric residents' attitudes toward and comfort working in pediatric continuity clinic one year after the implementation of a formal preceptor-led primary care curriculum, occurring daily in clinic. Prior to its implementation, didactic teaching occurred at the main hospital in a series not focused solely on primary care.

Design/Methods: Pediatric residents at a large academic program were invited to participate in two voluntary, anonymous surveys. Residents were surveyed before the implementation of a dedicated primary care curriculum, using case-based teaching sessions from the Yale Primary Care Pediatrics Curriculum. They were again surveyed one year post-implementation. During this year, education occurred daily, onsite in clinic in small group preceptor-led sessions. Residents were later sent emails with key points and learning materials.

Surveys included 5-point Likert scale questions about perceptions of the teaching environment, including attitudes about working in clinic and intentionality of faculty preceptor teaching. Respondents also rated their comfort level in managing 40 pediatric primary care scenarios from Stuart and Jones' (2009) Continuity Clinic Self-assessment tool. Results were analyzed using Wilcoxon Rank Sum tests and Welch Two Sample t-tests.

Results: Survey response was 71.6% and 58% to the pre- and post-intervention surveys, respectively. There was a significant increase in perception of faculty teaching intentionality after curriculum implementation (3.03 vs 3.31, p < 0.05). There was no significant change in the reported level of enthusiasm for working in clinic. There was also no significant change in reported comfort when looking at the mean score across all 40 primary care scenarios. However, when considering each scenario individually, there were three that had significant improvement in resident reported comfort (Table 1).

Conclusion(s): This single program survey demonstrates that the implementation of a primary care curriculum at the clinic site improves resident perception of preceptor intentionality to teach. Further research could clarify whether curriculum implementation has an impact on objective outcomes related to primary care knowledge acquisition or patient care.

Table 1. Changes in Resident Comfort on Clinical Scenarios Pre- and Post-Curriculum Implementation
* From Continuity Clinic Self-assessment (Stuart and Jones, 2009)
† Residents responded by choosing one option: 1 - not confident at all, 2 - somewhat confident, 3 - fairly confident, 4 - very confident