Pediatric resident attitudes toward caring for children with severe disabilities

The Impact of Caring for Children With Severe Neurological Impairment on Clinicians

Clinicians face many challenges in caring for children with severe neurological impairment (SNI). This study aimed to understand expert clinician perspectives on the personal impact of caring for children with SNI to highlight the challenges and potential solutions by underscoring the aspects of care that can be sustaining. Twenty-five clinicians participated including physicians (n = 8, 32%), social workers (n = 5, 20%), nurses/nurse practitioners (n = 5, 20%), case managers (n = 3, 12%), developmental therapists (n = 2, 8%), and other psychosocial clinicians (n = 2, 8%). Clinicians represented a variety of specialties including complex care/hospitalists (n = 10, 19%), palliative care (n = 7, 13%), and critical care (n = 6, 12%). Thematic content analysis revealed 3 major themes: (1) worries and challenges; (2) positive impact from being present; and (3) personal growth and meaning-making. Many clinicians described the ways listening, examining biases, learning about family perspectives, and normalizing the need for emotional processing helped them to understand their patients, families, and themselves more deeply.

Attitude and willingness of pediatric dentists regarding dental care for children with developmental and intellectual disabilities

AIM

Children with developmental and/or intellectual disabilities (DD/ID) are considered to be at greater risk of developing dental disease and are more likely to have unmet dental needs than other children. The purpose of this study was to determine the attitude and willingness of pediatric dentists and residents to provide dental care for children with DD/ID.

METHODS

Two surveys were created and emailed via SurveyMonkey^® to pediatric dentists and post-doctoral student members of the American Academy of Pediatric Dentistry.

RESULTS

Five hundred and seventy-four pediatric dentists (9%) and 143 pediatric dentistry residents (13%) responded. Ninety-nine percent of the practicing pediatric dentists do provide dental care for children with DD/ID. Ninety-six percent of the practitioners are confident/very confident in treating these children with nonpharmacological methods, while 86% are confident/very confident with pharmacological methods. Among the residents, 99% are willing to provide dental care to children with DD/ID after they graduate. Eighty-six percent of the residents are confident/very confident in treating these children with nonpharmacological methods, while 70% are confident/very confident with pharmacological methods.

CONCLUSION

Pediatric dentist and resident respondents to the survey were overwhelmingly willing to provide dental care for patients with DD/ID and are confident with pharmacological and nonpharmacological treatment modalities.

Outcomes of a randomized controlled educational intervention to train pediatric residents on caring for children with special health care needs

OBJECTIVE

To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE).

METHODS

Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction.

RESULTS

Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction.

CONCLUSION

SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease.

Challenges and potential solutions to educating learners about pediatric complex care

OBJECTIVE

To identify existing challenges and potential strategies for providing complex care training to future pediatricians from a national group of educators.

METHODS

Data were collected from pediatric educators involved in complex care at the Pediatric Educational Excellence Across the Continuum national meeting. Participants completed an anonymous 15-item survey adapted from the Association of American Medical Colleges (AAMC) Best Practices for Better Care initiative and participated in a focus group to understand the challenges and potential solutions to pediatric complex care education. Data were analyzed using grounded theory.

RESULTS

Of the 15 participants, 9 (60%) were in educational leadership positions. All participants provided care to children with medical complexity (CMC), although 80% (n = 12) reported no formal training. Thematic analysis revealed learners' challenges in 2 domains: 1) a lack of ownership for the patient because of decreased continuity, decision-making authority, and autonomy, as a result of the multitude of care providers and parents' distrust; and 2) a sense of being overwhelmed as a result of lack of preparedness and disruptions in work flow. Participants suggested 3 mitigating strategies: being candid about the difficulties of complex care, discussing the social mandate to care for CMC, and cultivating humility among learners.

CONCLUSIONS

Residency education must prepare pediatricians to care for all children, regardless of disease. Training in complex care involves redefining the physician's role so that they are better equipped to participate in collaboration, empathy and advocacy with CMC. This study is the first to identify specific challenges and offer potential solutions to help establish training guidelines.