Original Publication
Open Access

Medical Students as Coaches in Transitions of Care for Youth With Special Health Care Needs

Published: August 31, 2015 | 10.15766/mep_2374-8265.10183

Included in this publication:

  • Instructor's Guide.docx
  • Pretest.docx
  • IMRD Project Submission.docx
  • Med Student Coaches.pptx
  • Med Student Reflections.docx
  • Next Steps.pdf
  • Readiness Checklist.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Introduction: On reaching adulthood, youth with special health care needs (YSHCN) face many difficult transitions including transition to adult medical care. In our setting, a population of YSHCN had historically been responsible for establishing their own adult care after graduating from a large pediatric practice. Barriers to effective transition include lack of transportation, intellectual limitations, lack of health insurance, caregiver stress, and inability to advocate for oneself. In addition, adult providers may face a lack of confidence and knowledge to assume care of these patients. In this project, we paired YSHCN with third-year medical students who served as coaches to assist the patients in transition. Methods: Students meet their assigned YSHCN patient in the children’s clinic for the patient’s last appointment there, the exit visit. At that visit the student assists the patient and family in completion of two documents: (1) a validated Transition Readiness Checklist, a simple one-page checklist of tasks which the patient needs to master to achieve independence, and (2) a medical history summary, which indicates what other specialists and services the patient requires. The students then complete a pretest assessing their knowledge of problems and resources pertaining to transitioning YSHCN patients. Then the students attend a brief didactic presentation that outlines the complex needs of this population and the resources available. They were all given a handout with contact information for local services. After the study a posttest is given to assess knowledge gained, and the students submit a reflective essay. Results: All YSHCN patients successfully attended their exit and entrance visit appointments. They or their caregivers completed readiness assessments at both appointments. Some modest goals were achieved. Student pre- and posttests were used to assess their learning of the core material. More importantly, the student essays showed significant gains in their understanding of the importance of fostering and encouraging self-advocacy and independence in this vulnerable population. Discussion: This module gave third-year medical students the opportunity to act as coaches to facilitate the transition of a group of YSHCN who are moving care from a pediatric clinic to a family medicine practice. After implementation, students gained insight into the challenges facing these young people, as evidenced by their reflective narratives. Further, all the patients were successfully established in the Family Medicine Center. However, the additional time requirements for the project made it difficult for the students to be fully engaged.


Educational Objectives

By the end of this module, the facilitator will be able to:

  1. Explain transitions that challenge youth with special health care needs as they reach adulthood.
  2. Describe how medical students can facilitate these transitions.
  3. Demonstrate transformative learning on the part of the students using reflective narratives.

Author Information

  • Nathan Bradford, MD: AnMed Health
  • Brian Mulroy, DO: AnMed Health

Disclosures
None to report.

Funding/Support
None to report.


References

  1. American Academy of Pediatrics. Clinical report—supporting the healthcare transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128(1):182-200. http://dx.doi.org/10.1542/peds.2011-0969
  2. Blum R, Britto M, Rosen D, Sawyer S, Siegel D. (2003). Transition to adult health care for adolescents and young adults with chronic conditions: position paper of the Society for Adolescent Medicine. J Adolesc Health. 2003;33(4):309-311.http://dx.doi.org/10.1016/S1054-139X(03)00208-8
  3. Data Resource Center for Child & Adolescent Health: Child and Adolescent Health Measurement Initiative (CAHMI). 2009-2010 National Survey of Children with Special Health Care Needs: indicator data set. http://www.childhealthdata.org/learn. Accessed May 15, 2014.
  4. Got Transition. GotTransition.org Web site. http://gottransition.org/index.cfm. Published 2014–2015.


Citation

Bradford N, Mulroy B. Medical students as coaches in transitions of care for youth with special health care needs. MedEdPORTAL. 2015;11:10183. https://doi.org/10.15766/mep_2374-8265.10183