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Are Graduating Pediatric Residents Trained and Prepared to Utilize Medical Home Principles?

Mary Pat Frintner, MSPH1, Dana Bright, MSW, LSW1, Michelle Esquivel, MPH1, Janet Serwint, MD2, Renee Turchi, MD, MPH3, Aditee Narayan, MD, MPH4. 1American Academy of Pediatrics, Elk Grove Village, IL, United States; 2Johns Hopkins University, Baltimore, MD, United States; 3St. Christopher's Hospital for Children and Drexel University School of Public Health, Philadelphia, PA, United States and 4Duke University Medical Center, Durham, NC, United States.​

Presented at the 2015 Pediatric Academic Societies Annual Meeting.

Background: A family-centered medical home is recommended for all children. Little information is available to gauge residents' preparedness to operationalize medical home principles in practice. ​

Objective: Examine resident training and perceived preparedness on medical home principles.

Methods: National, random sample of graduating pediatric residents surveyed in 2014 (n=1,000; response=58%).  Chi-square analyzed formal training on 5 medical home principles and desire for more training and self-perceived preparedness.

Results: Most residents (72%) perceived themselves to be very/fairly knowledgeable about medical home principles. While most reported receiving training on medical home principles, 30% reported no formal training on eliciting family feedback. Residents with and without formal training desired more training [table1]. Most residents (69-83%) who received training on the principles rated their preparation as very good/excellent. Approximately half with no formal training rated their preparation on the principles as excellent/very good. For all 5 medical home principles, receipt of training was linked to perceived preparedness and inversely related to desire for more training, p<.001.

Most residents agreed they have communication skills to lead comprehensive care planning (89%) and are adequately prepared to work with other clinicians using team-based approaches to provide care (97%).

Medical Home Principle (n=580)

Formal training

% Yes

Wish for more formal training

% Yes ​

​Self-perceived preparedness

% Very good/excellent

  Residents with trainingResidents without trainingResidents with trainingResidents without training
Involve patients/families in family-centered rounds8510458343
Involve patients/families in health care decisions8014428355
Communicate effectively with families from diverse backgrounds7621537350
Incorporate families' cultural backgrounds into medical decision making7222617348
Elicit patient/family concerns and feedback7018516946

 

Conclusion: Graduating residents report confidence in their ability to communicate and involve families and use family-centered/team-based approaches in patient care. Most report training on caring for diverse families but among those who do not, more than half want more training. Future work might assess the accuracy of residents' perceptions regarding skills in medical home delivery.  

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