Care Escalation: Teaching Residents How to Effectively Communicate Patient Care Concerns.

Introduction: Care escalation for patients at risk of deterioration requires that care team members are able to effectively communicate patient care concerns to more senior team members. However, multiple factors inhibit residents from escalating their concerns, which contributes to treatment delays and sentinel events. Methods: We developed and implemented an annual 1- and 2-hour escalation curriculum for senior pediatric residents from the University of Colorado. The curriculum consisted of case presentations (one for the 1-hour or two for the 2-hour session), lecture, large-group discussion, and small-group activities. Faculty and fellows facilitated small groups, in which barriers to care escalation and specific tools for effective escalation were discussed. We administered precurriculum surveys for resident self-reflection and postcurriculum surveys for curriculum evaluation. Results: The curriculum was delivered to 179 residents over 3 years (2016-2018). Surveys were administered during the first 2 years, and 87% of participants completed pre- and postcurriculum surveys. Of all respondents, 88% believed that the curriculum helped them recognize care escalation barriers, and 85% believed that they learned skills for effective escalation. Resident comfort in asking for attending physician help improved from 52% to 95% (p < .001). Analysis of postsurvey open-ended responses indicated that residents valued listening to faculty share their personal experiences of escalating care. Discussion: The development and implementation of a curriculum to improve resident comfort and perceived ability to escalate patient care concerns are feasible and effective. Further work is needed to evaluate the impact of this curriculum in the clinical setting.

School Health: Pediatric Primary Care Curriculum.

Introduction: Pediatric residents encounter issues related to school health (SH) throughout their training, particularly in their continuity clinics, and often serve as liaisons between a patient's medical home and school environment. However, there is currently a paucity of formal education on SH for pediatric residents to prepare them for this role. Methods: We created a 3-hour interactive learning conference that was delivered to four groups of six to eight pediatric residents during their intern year by a multidisciplinary team. Our curriculum focused on understanding the differences between individualized educational plans (IEPs), individualized health plans (IHPs), and 504 plans; the IEP process; and communication with schools. Residents were given pre- and postdidactic surveys, completed reflective writings, and participated in feedback sessions. Results: Twenty-seven pediatric interns completed the curriculum; 85% and 74% had improved knowledge of IEP/504/IHP and SH personnel, respectively. Eighty-five percent reported feeling comfortable with family conversations about accommodations postcurriculum versus 0% precurriculum. The majority of interns found the curriculum to be valuable to their clinic performance. Discussion: Our curriculum offers a unique multidisciplinary approach to teaching and can be easily integrated into other residency programs, even with limited protected didactic time.