Table_3_Targeted Training for Subspecialist Care in Children With Medical Complexity.DOCX

BackgroundChildren with medical complexity (CMC) are prone to medical errors and longer hospital stays, while residents do not feel prepared to provide adequate medical care for this vulnerable population. No educational guidance for the training of future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC exists. We investigated pediatric residents past educational needs and challenges to identify key learning content for future training involving care for CMC.
MethodsThis was a prospective mixed-methods study at a single pediatric tertiary care center. Qualitative semi-structured interviews with residents were conducted, submitted to thematic content analysis, linked to the American Board of Pediatrics (ABP) general pediatrics content outline, and analyzed with importance performance analysis (IPA). Quantitative validation was focused on key themes of pediatric nephrology within the scope of an online survey among pediatric residents and specialists.
ResultsA total of 16 interviews, median duration 69 min [interquartile range IQR 35], were conducted. The 280 listed themes of the ABP general pediatrics content outline were reduced to 165 themes, with 86% (theoretical) knowledge, 12% practical skills, and 2% soft skills. IPA identified 23 knowledge themes to be of high importance where improvement is necessary and deemed fruitful. Quantitative validation among 84 residents and specialists (response rate 55%) of key themes in nephrology yielded high agreement among specialists in pediatric nephrology but low interrater agreement among trainees and “trained” non-nephrologists. The occurrence of themes in the qualitative interviews and their calculated importance in the quantitative survey were highly correlated (tau = 0.57, p = 0.001). Two clusters of high importance for other pediatric specialties emerged together with a contextual cluster of frequent encounters in both in- and outpatient care.
ConclusionRegarding patient safety, this study revealed the heterogeneous aspects and the importance of training future pediatric tertiary care specialists outside their field of expertise involving the multidisciplinary care of CMC. Our results may lay the groundwork for future detailed analysis and development of training boot camps that might be able to aid the improvement of patient safety by decreasing preventable harm by medical errors, especially for vulnerable patient groups, such as CMC in tertiary care pediatrics.

背景 患有复杂医疗状况的儿童（Children with medical complexity, CMC）易出现医疗差错且住院时长更长，而住院医师尚未做好为这一脆弱群体提供充足医疗照护的准备。目前尚无针对儿科专科医师开展其专业领域外的复杂医疗状况儿童多学科照护培训的教育指导方案。本研究旨在调研儿科住院医师既往的教育需求与挑战，以明确未来针对复杂医疗状况儿童照护培训的核心学习内容。
方法 本研究为单中心儿科三级医疗中心开展的前瞻性混合方法研究。对住院医师进行半结构化质性访谈，采用主题内容分析法进行编码分析，将访谈结果与美国儿科学会（American Board of Pediatrics, ABP）普通儿科学内容大纲进行关联，并通过重要性-绩效分析（Importance Performance Analysis, IPA）开展后续分析。定量验证环节聚焦于儿科学肾脏病学核心主题，通过面向儿科住院医师与专科医师的在线调查完成。
结果 共完成16次访谈，中位时长69分钟[四分位距IQR 35]。ABP普通儿科学内容大纲原有的280个主题被精简为165个，其中86%为（理论）知识、12%为实操技能、2%为软技能。IPA识别出23个具备高重要性且亟需改进的知识主题。针对肾脏病学核心主题的定量验证共回收84份住院医师与专科医师问卷（应答率55%），结果显示儿科肾脏病学专科医师间评分一致性较高，但住院医师与「接受过相关培训」的非肾脏病专科医师间的组内评分一致性较低。质性访谈中主题的出现频次与定量调查中计算得到的重要性得分呈显著正相关（tau = 0.57, p = 0.001）。同时还识别出针对其他儿科专科的两组高重要性主题集群，以及一组涵盖门诊与住院环境常见照护场景的情境化主题集群。
结论 本研究围绕患者安全议题，明确了针对儿科三级医疗专科医师开展其专业领域外的复杂医疗状况儿童多学科照护培训的多元维度与重要性。本研究结果可为后续开展详细分析与培训强化训练营的开发奠定基础，此类训练营或可通过减少可预防的医疗差错相关伤害，改善弱势患者群体（如三级儿科医疗体系中的复杂医疗状况儿童）的患者安全。