Introduction of a Longitudinal Curriculum In the Primary Care of NICU Graduates For Family Medicine Residents J. Claude Gauthier, M.D., F.A.A.P. Assistant Program Director Pediatric and Predoctoral Education Southwest Georgia Family Medicine Residency Program Phoebe Putney Memorial Hospital Albany, Georgia First try at curriculum development Process vs. content

Objectives Present a curriculum in the primary care of NICU grads for family medicine residents Describe the background, implementation, and plans for evaluation of this curriculum Provide an interim critique outlining the successes and challenges encountered thus far

Introduction Family physicians provide care for a significant number of children “Usual provider” for 1/3 of children 1/5 of MD visits by children Preterm birthrate rate is consistently rising 1994: 11% 2004: 12.5%

Introduction Thus, family physicians will likely be called upon to manage increasing numbers of NICU grads Especially true in rural areas

Preterm Birth Georgia, 2001-2004 Average Preterm is less than 37 completed weeks gestation. Source: National Center for Health Statistics, final natality data. Retrieved April 19, 2007, from www.marchofdimes.com/peristats.

The Perfect (Curriculum Development) Storm The need exists The resources exist Regional Perinatal Center NICU with developmental follow up clinic Interest from neonatologists Personal interest in primary care of NICU grads

The Perfect Storm The motivation exists Pediatric Academic Societies announces the Educational Scholars Program “…to assist pediatric educators in developing themselves as productive, advancing and fulfilled faculty members and to increase the quality, status and visibility of pediatric educators in academia.” “…targets present or future faculty in academic pediatrics who wish to build their skills in educational scholarship.”

The Perfect Storm Educational Scholars Program Competitive entry LOR Mentor statement Project proposal 60 applications, 30 accepted 10% of participants working in FM settings Increasing cooperation/collaboration Presenting at Peds in FM SIG next week

The Curriculum

Goal Develop and implement an educational experience that will be successful in teaching participating family medicine residents the knowledge, skills, and attitudes necessary to competently care for the NICU graduate

Objectives Patient care After participating in the curriculum, residents will be able to develop and implement a management plan for the NICU graduate which will adequately address the well child care issues typical medical issues typical developmental issues typical social and environmental issues seen in this patient population.

Objectives Medical knowledge After participating in the curriculum, residents will have a sufficient knowledge base to be able to effectively provide primary care for the NICU graduate.

Objectives Interpersonal and communication skills After participating in the curriculum, residents will be able to initiate and maintain a therapeutic relationship with the parents of ex-preemies.

Objectives Systems-based practice After participating in the curriculum, residents will effectively partner with other health care providers often needed in the care of ex-preemies to assess, coordinate, and improve health care.

Methods/Learning Activities: Experiential Residents paired during each PGY-1 and PGY-2 pediatrics rotation with 1-2 recently-born preemies (<31 weeks EGA) Resident follows baby while in NICU Observe acute and convalescent stages Form therapeutic alliance with parents Participate in discharge planning Residents provide ongoing primary care follow-up in clinic after discharge from NICU

Methods/Learning Activities: Experiential Residents participate in Regional Perinatal Center Developmental Follow-up Clinic during PGY-1 and PGY-2 pediatrics rotation Neonatologist Nutritionist Occupational and physical therapists Nurse

Methods/Learning Activities: Self-directed Residents provided with suggested reading list

Methods/Learning Activities: Didactic Formal resident noon conference lecture on follow-up of NICU grads presented biennially

Learner Assessment Based on results of: Repeated periodically Structured chart reviews Management plan based on case scenario Multiple choice question test Resident self assessment Patient surveys Repeated periodically Feedback given

Program Evaluation: Formative Based on: Resident success in establishing and maintaining relationship with preemies/parents NICU After discharge Resident attendance in Developmental Follow-up Clinic Resident attendance at noon conference lecture

Program Evaluation: Formative Resident completion of applicable assessment tools Control (non-participating) resident completion of applicable assessment tools

Program Evaluation: Summative Based on: Participating residents achieving passing grade on all assessment instruments Participating residents showing greater improvement in competency than control residents Curriculum introduced with intern cohort of July, 2006 Residents of previous cohorts to serve as controls

“Results” Remember: this is an “in-progress” presentation Implemented with intern class of July, 2006 3 year longitudinal curriculum 2/6 interns have completed PGY-1 pediatrics rotation

The Good… Addresses an increasing societal need Spans continuum of care Emphasizes medical home concept Knowledge, skills, and attitudes developed applicable to care of other children with complex health needs Program evaluation involves a control group Quasi-research design

..the Bad… Curriculum was more resource-driven than needs-driven No learner perceived needs assessment performed Small numbers Assessment tools not validated Program evaluation not discussed with research design experts prior to implementation

…and the Ugly Complex administration and follow-up Long duration Program evaluation will involve complex analyses

What I’ve Learned Curriculum development is hard Buy-in from participants makes thing much easier Go with previously validated and standardized assessment tools Be careful when submitting applications-they just might be accepted