Teaching Residents to Provide High-Value Care: Evaluation of Cost-Conscious Care Curriculums in Pediatric Residencies

ACADEMIC PEDIATRICS October-November, residents who received patient/guardian CATs were randomized to review their scores with either their coach or via email only. Pre-intervention and post-intervention mean scores were compared with paired t-tests. Qualitative data were also gathered regarding how residents valued the feedback and process by which it was reviewed. RESULTS: 75/82 (91%) pediatrics residents completed the preintervention self-assessment, and all 82 (100%) completed the post. 27 residents both received CAT evaluations from patients/ guardians and completed the pre/post self-assessments. For the residents who reviewed their reports with their faculty coach (n¼14), the self-assessment score increased from 3.64 on the pre-intervention self-assessment to 3.81 on the post-intervention self-assessment (p¼0.17). For the residents who received their reports through an email only (n¼13), scores stayed the same at 3.74 vs. 3.72 (p¼0.92). Comments reflected the positive value that residents placed on being able to discuss the feedback with their coach. CONCLUSION: Review of patient feedback with a faculty coach increases resident confidence in communication skills, compared to when feedback is reported via email-only. The addition of a faculty coach may be helpful in improving residents’ communication skills. 24. HOW WELL DO RESIDENTS COMMUNICATE WITH PATIENTS? Tyrone Chan, MD, Rebecca Blankenburg, MD, Caroline Rassbach, MD, Stanford/Lucile Packard Children’s Hospital, Palo Alto, CA BACKGROUND: The ACGME requires programs to assess residents’ communication skills. The Communication Assessment Tool (CAT) is a validated measure of physicians’ communication with patients, but it has not yet been published in pediatrics. OBJECTIVE: To implement the Communication Assessment Tool to compare residents’ self-assessments with patient/guardian assessment of residents’ communication skills. METHODS: Cross-sectional IRB-exempt study at Lucile Packard Children’s Hospital. In June 2014, a modified CAT with 14 5-point Likert-scale items was distributed to all pediatric residents to self-assess their communication skills. In July-September 2014, 2 non-MD teams administered CATs by iPad or paper to admitted patients/guardians on designated units. A mean summary score for the patient/guardian CATs and the resident self-assessments was calculated for each resident and class. Patient/ guardian summary scores and resident self-assessment summary scores were compared with an unpaired t-test. Summary scores of each resident class were compared with one-way ANOVA. Difference between highest and lowest scoring self-assessment items was evaluated with a paired t-test. RESULTS: 75/82 (91%) pediatrics residents completed the selfassessment. Patients/guardians completed 98 CATs on 28 residents. 27 of these residents completed self-assessments. Self-assessment scores were lower than patient/guardian scores (mean difference¼0.88, p<0.0001). Summary scores for self-assessments and patient/guardian assessments increased with year of training, but this was not statistically significant. For the self-assessment, the highest-scoring item (“Treating . . . with respect”) and lowestscoring item (“Spending the right amount of time . . .”) were significantly different (mean difference¼1.14, p<0.0001). Patient/guardian CATs had no significant variation between mean item scores. CONCLUSION: Pediatric residents underestimate their communication skills when compared to responses of patients/guardians. Furthermore, residents feel they excel at treating patients/

ABSTRACTS

e9

guardians with respect and need improvement with spending the right amount of time with them. 25. TEACHING RESIDENTS TO PROVIDE HIGH-VALUE CARE: EVALUATION OF COST-CONSCIOUS CARE CURRICULUMS IN PEDIATRIC RESIDENCIES Michael Tchou, MD, Elizabeth Burgener, MD, Alice Hensley, MD, Rebecca Blankenburg, MD, Stanford University, Palo Alto, CA BACKGROUND: Expenditure on healthcare in the US is increasing at an unsustainable pace, and there has been a call to action to incorporate education on resource stewardship into medical training; however, there is little emphasis on cost and value in most residency curricula. OBJECTIVE: To describe the current national landscape of curricula on high-value, cost-conscious medicine (HVCCM) in pediatric residencies, identify the potential factors that may interfere with a pediatric resident’s ability to perform HVCCM, and determine which educational modalities would be preferred as a means to teach pediatric residents to perform HVCCM. METHODS: IRB-exempt, anonymous, web based survey of pediatric chief residents and pediatric program directors at all pediatric residency programs, with one response per role per program (n¼199 programs). RESULTS: We received responses from pediatric chief residents (CR) at 72/199 (36%) programs in 32 different states and pediatric program directors (PD) at 83/199 (42%) programs in 35 states. 12% of CR and 10% of PD reported to have a formal curriculum on HVCCM. Program directors perceived that a lack of cost transparency as the biggest barrier to residents performance of HVCCM, whereas chief residents identified attendings having a final say in treatment decisions. A majority of respondents (83%) agree that their program needs such a curriculum and 89% PD and 92% of CR stated that they would use a curriculum if it were available. Both CR and PD preferred a curriculum with case based discussion in a morning report or noon conference setting (82% and 79%, respectively). CONCLUSION: The majority of pediatric residency programs responding to this survey do not have a formal curriculum on HVCCM. There is a strong need and desire nationally for HVCCM curriculum in pediatrics, particularly in a case-based discussion format. 26. PEDIATRIC RESIDENT EXPERIENCE WITH FAMILY CENTERED ROUNDS IN A MULTI-SITE TRAINING PROGRAM Laura J. Hagemeyer, MD, Adam Foss, MD, Judy Wiltse, MD, Abby J. Montague, MD, University of Minnesota Pediatric Residency Program, Minneapolis, MN BACKGROUND: Family centered rounds (FCR) have been described as a positive addition to patient care. Some concerns about implementing FCR include decreased teaching time, decreased resident autonomy, and increased presenter interruptions. Multiple studies have shown that both direct teaching and observational learning increase during FCR as well as increased feedback for learners. We will demonstrate the resident experience with medical decision making and teaching on FCR in our multi-site program. METHODS: We conducted a prospective, observational study of FCR at four local hospitals. Rounds were observed at each institution using a standardized form to assess time on rounds, participants, time spent teaching, resident decisions, presentation