P2.O297: Preparing for life after residency: Does primary care come with a manual?

Purpose/Objectives: In recent years, pediatric residents report feeling less prepared for starting their careers. The American Academy of Pediatrics Annual Survey of Graduating Residents showed a decrease in perceived preparedness for primary care practice, declining from 69% in 2015 to 42% in 2022. Currently, the Accreditation Council for Graduate Medical Education requires pediatric residents to complete a minimum of thirty-six half-day sessions per year of longitudinal outpatient experience. This longitudinal experience allows for continuity within a medical home strengthening the doctor-patient relationship as well as the relationships among colleagues. The educational environment within this longitudinal outpatient experience fosters a safe space where residents are encouraged to take an active role in their education. Aligned with national survey data, our residency program perceives a lack of preparedness for a career in primary care. We propose that the development of a curriculum, grounded in a learners’ needs assessment with emphasis on evidence-based teaching strategies can improve this perception, as well as academic performance.

Design/Methods: Our study aims to identify the strengths and weaknesses of our current continuity clinic curriculum, utilize perceived knowledge gaps of our residents and the results of the in-training examinations to guide curricula using teaching strategies that optimize retention and understanding of pediatric primary care using Kern’s Six Steps of Curriculum Development and quality improvement measures we describe one institution’s experience in engaging learners in the creation and implementation of a continuity clinic curriculum.

Results: We conducted a pilot trial of the continuity clinic curriculum using attitudinal data as measured via an electronic anonymous Likert scale survey. Twenty-eight out of thirty-five residents responded to the pre-implementation survey (80%). Residents reported perceived preparedness for a career in primary care and licensing examinations to be 55%. The pre-implementation survey revealed that didactic sessions were conducted 48% of the time. Residents rated their understanding of the learning objectives at 42% with full comprehension of topics at 50%. The residents reported a 42% overall satisfaction of the didactic sessions.

The initial PDSA cycle involved systematic changes in the structure and curriculum, with the first cycle focused on increasing the percentage of sessions performed monitored with session trackers. The percentage of sessions performed increased to 92.8% over a 3-month period Ongoing PDSA cycles involve standardization of objectives and teaching materials and increasing the interactive nature of sessions. The results of a post-implementation survey will be collected in early Fall 2024

Conclusion/Discussion: We believe a standardized primary care curriculum developed with the input from learners will lead to increased compliance with assigned educational modules, improvement in the in-training examinations, and perceived resident preparedness for a career in primary care.