Introduction: We designed this curriculum to address our pediatric residents’ learning needs related to caring for the growing population of children with special health care needs (CSHCNs). Although trainees regularly encounter CSHCNs in various clinical settings, they have not historically received focused instruction on the multidisciplinary needs of CSHCNs or how to address them as the primary care provider (i.e., medical home). Due to the fundamental nature and broad applicability of the content taught in this curriculum, we feel it is most appropriate for the intern year. Methods: This curriculum is composed of three segments. The first segment consists of a list of suggested self-directed learning activities for trainees that will introduce them to the concepts of the medical home and CSHCNs, and important issues related to their care. The second segment exposes residents to a variety of resources—medical and nonmedical—that their CSHCN patients will be utilizing as part of their multidisciplinary plan of care, through experiential learning activities and site visits. Residents are provided with worksheets to complete for each of their site visits. These worksheets address issues including the processes for accessing community resources, methods of communication between primary care providers and subspecialists, comorbidities and other challenges commonly faced by patients in each of the subspecialty populations, and the psychosocial needs and obstacles for families of CSHCNs. The final segment of the curriculum includes reflective learning and content review activities. Results: Prior to the rotation, 72% of interns reported understanding the definition of a CSHCN, but only 48% reported understanding the concept of a medical home, and 60% reported understanding a CSHCN's impact on the family. After completing the rotation, 100% of residents reported understanding these three concepts. One-hundred percent of interns reporting they are comfortable working with other health care providers to care for CSHCNs (up from 64% pre-rotation); 94% felt comfortable advocating for CSHCNs (up from 52%); 89% felt confident assessing the functional needs of CSHCNs (up from 8%); 94% felt confident assisting the family of these patients (up from 8%); and 89% felt confident providing a medical home for CSHCNs (up from 0%). Discussion: Our ultimate goal is to instruct our learners on how to create effective medical homes for their patients. The information and principles taught in this curriculum must ultimately be practiced by the trainee with CSHCNs he/she encounters in the primary care setting. During residency training, practice of these skills can occur in the continuity clinic setting, provided the organizational resources and invested faculty mentors are in place.
- Describe the concepts of chronic illness and children with special health care needs (CSHCN).
- Explain the concept of the medical home and its components, and develop a conceptual framework of how to develop a medical home for patients within one’s own clinic practice.
- Recognize the impact of chronic illness on a patient and his/her family and surrounding community, and thus understand and encourage patient- and family-centered care in their own practice.
- List the tools primary care physicians can use to coordinate care of CSHCNs in their own practice.
- Articulate how private, public, and community resources can be used to meet the multidisciplinary needs of CSHCNs and their families.
- Effectively communicate with families, other health care providers, and nonmedical providers of CSHCNs.
- Describe palliative care resources and how to coordinate care for terminally ill children.
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Stancil JM, Albertini LW. Evaluation of a Curriculum for Pediatric Residents on Caring for Children with Special Health Care Needs. Poster presented at: Pediatric Academic Societies Annual Meeting; May 2, 2010; Vancouver, British Columbia, Canada.
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