1. 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

2. 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

3. 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%

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

5. 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

6. 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

7. 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.”

8. 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

9. The Curriculum

10. 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

11. 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.

12. 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.

13. 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.

14. 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.

15. 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

16. 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

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

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

19. 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

20. 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

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

22. 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

23. “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

24. 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

25. ..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

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

27. 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