O3211: Pediatric resident participation in primary care autism evaluations: an assessment of resident confidence in autism care after a novel training opportunity

Background: Autism spectrum disorder (ASD) has a prevalence of 1 in 36 children and evidence shows that earlier diagnosis and intervention benefit patient outcomes. Long wait time to be evaluated by an autism specialist often delays diagnosis. The AAP urges primary care providers (PCPs) to conduct autism screening; however, PCPs report a lack of confidence in providing ASD-related care, thereby increasing the need for PCP education. Efforts to expose pediatric residents to hands-on training with patients result in greater educational benefits compared to standard developmental/behavior curricula and case-based didactic training. This study evaluates resident confidence in autism care after implementation of a novel training intervention intended to increase resident competency in caring for autistic children.

Methods: A primary care autism evaluation pathway was created in a resident continuity clinic. Residents participating in autism evaluations were provided enhanced didactic information about autism including components of autism assessments, use of a specific assessment tool, neurodiversity, and access to a video library with autism resources. Residents then led an autism assessment visit with the support of an attending physician with autism training. A survey was created to assess residents’ confidence in autism-related care before and after the didactic education and patient encounters. Residents reported their confidence using a 5-point Likert Scale. The primary outcomes were confidence in the ability to recognize ASD symptoms, use standardized ASD screening tools, gather clinical information using DSM-5 criteria, use standardized assessment tools, make an ASD diagnosis, and recommend treatment. After 5 months, additional survey questions were added to address resident understanding of neurodiversity, use of a strength-based approach, providing treatment recommendations, and recommending resources. Pre- and post-encounter survey data was compared using Mann-Whitney U tests.

Results: Twenty-three physician-patient encounters were included in this study, and data collection spanned 12 months. Eighteen (78%) residents completed both a pre- and post-encounter survey. Resident responses to all questions demonstrated a trend from disagree/strongly disagree in the pre-evaluation toward agree/strongly agree in the post-evaluation. Residents reported increased confidence in their ability to recognize ASD symptoms (p < 0.05), use standardized ASD screening tools (p < 0.05), gather clinical information from caregivers (p=0.001), use standardized tools to complete an ASD assessment (p < 0.05), and diagnose and discuss ASD with caregivers (p < 0.05). No significant differences were noted in the questions about neurodiversity, likely due to low participant number.

Conclusion: Implementing an enhanced resident training intervention which involves a combination of didactics and participation in an ASD assessment increases pediatric residents’ confidence in providing ASD-related care. This has the potential to improve ASD training in pediatric residents, which may be an important strategy to improve autism care in primary care clinics.