Implementing a Longitudinal Adolescent Transition of Care Curriculum: Identifying Comfort and Barriers Among Residents

Abstract

Amid growing recognition of the importance of transitioning adolescents and young adults (AYA) from pediatric- to adult-oriented health care systems, residency programs are being tasked with educating residents on best transition practices. However, consensus on how to approach training residents in transition of care (TOC) is limited. Our academic residency program therefore created and implemented a TOC of AYA curriculum for pediatric residents in an effort to increase provider knowledge and comfort with this topic. Three classes of post-graduate year one (PGY1) pediatric residents participated in this curriculum from 2017-2019 (n=35) and subsequently completed a problem-based learning (PBL) exercise in a primary care clinic with adolescent patients based on core goals in transitioning AYA. Residents completed pre-PBL and post-PBL surveys quantifying provider comfort in several aspects of the transition process. The majority of residents (94%) identified the PBL exercise as being useful, with no significant difference between classes. Eighty-nine percent (n=31) identified 1) earlier introduction of TOC and/or 2) incorporation of TOC discussions during AYA well visits as intended areas of future practice change. Overall provider comfort in transitioning AYA increased significantly from matched pre-PBL to post-PBL surveys (p=0.004). Paired mean differences also showed a significant increase in provider comfort based on several identifiable skillsets in transitioning AYA. This study suggests that a formal curriculum for pediatric residents significantly increases resident comfort in transitioning AYA and encourages change in future clinical practice. Future directions include evaluating the implementation of a formal longitudinal curriculum across several PGY levels and expansion of the curriculum to include internal medicine residents. Standardized curricula on this topic may improve resident comfort on a national level.

Keywords: adolescent and young adults; adolescent medicine; med peds; medical education curriculum; medical resident education; peds; resident clinic; transition of care; transition to adults.