Targeted Training for Subspecialist Care in Children With Medical Complexity

Frontiers in Pediatrics

article

Fabian Eibensteiner¹  Valentin Ritschl³  Isabella Valent¹  Rebecca Michaela Schaup¹  Axana Hellmann¹  Lukas Kaltenegger¹  Lisa Daniel-Fischer¹  Krystell Oviedo Flores⁷  Stefan Brandstaetter¹  Tanja Stamm³  Eva Schaden²  Christoph Aufricht¹  Michael Boehm¹ 

[1] Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna;Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna;Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna;Ludwig Boltzmann Institute for Arthritis and Rehabilitation;Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna;Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna;Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna;Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna

关键词: nephrology;    medical education;    training;    medical complexity;    children with medical complexity (CMC);    residency;    patient safety;    children with chronic disease;   

DOI  :  10.3389/fped.2022.851033

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Children with medical complexity (CMC) are prone to medical errors and longer hospital stays, while residents do not feel prepared to provide adequate medical care for this vulnerable population. No educational guidance for the training of future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC exists. We investigated pediatric residents past educational needs and challenges to identify key learning content for future training involving care for CMC. Methods This was a prospective mixed-methods study at a single pediatric tertiary care center. Qualitative semi-structured interviews with residents were conducted, submitted to thematic content analysis, linked to the American Board of Pediatrics (ABP) general pediatrics content outline, and analyzed with importance performance analysis (IPA). Quantitative validation was focused on key themes of pediatric nephrology within the scope of an online survey among pediatric residents and specialists. Results A total of 16 interviews, median duration 69 min [interquartile range IQR 35], were conducted. The 280 listed themes of the ABP general pediatrics content outline were reduced to 165 themes, with 86% (theoretical) knowledge, 12% practical skills, and 2% soft skills. IPA identified 23 knowledge themes to be of high importance where improvement is necessary and deemed fruitful. Quantitative validation among 84 residents and specialists (response rate 55%) of key themes in nephrology yielded high agreement among specialists in pediatric nephrology but low interrater agreement among trainees and “trained” non-nephrologists. The occurrence of themes in the qualitative interviews and their calculated importance in the quantitative survey were highly correlated (tau = 0.57, p = 0.001). Two clusters of high importance for other pediatric specialties emerged together with a contextual cluster of frequent encounters in both in- and outpatient care. Conclusion Regarding patient safety, this study revealed the heterogeneous aspects and the importance of training future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC. Our results may lay the groundwork for future detailed analysis and development of training boot camps that might be able to aid the improvement of patient safety by decreasing preventable harm by medical errors, especially for vulnerable patient groups, such as CMC in tertiary care pediatrics.

【 授权许可】

CC BY