Some of the challenges discussed in regard to developing an educational structure in community settings included:

1. Logistics

• Making the case for education
• Legal framework (e.g., affiliation agreements, liability)
• Finances (e.g., GME funding)
• Paperwork burden (e.g., licensing, credentialing)

2. Learning environment

• Complementing clinical work with materials
• Autonomy/supervision balancing
• Developing clinical teachers

The didactic session also reviewed the six steps for curriculum development: general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation/feedback. Each of these was described in further detail with relevant examples.

Groups were broken into small groups based on four learner types: medical students, family medicine residents, pediatric residents, and PHM fellows. Within each group, a “program development matrix” was distributed to assess the support from leadership and logistics within each setting. Each one of these was separated into subgroups such as credentialing, financial support, housing/travel, and preceptor recruitment.

A separate “curriculum development matrix” was used during breakout groups that focused on curriculum development. This matrix was broken into three areas: educational strategies, implementation, and evaluation/feedback. These were further broken down into subgroups such as content, identifying resources, and remediation planning. The group was asked to determine short- and long-term goals with action steps for both of these matrix subgroups.

Key Takeaway

Overall, the session presented a structured way of assessing the educational environment for learners in community settings. It gave tangible tools for sites that wish to develop or improve their current educational framework.

Francisco Alvarez, MD, FAAP, is a pediatric hospitalist and director of the Children’s National Health System Community Hospital Services in Washington, D.C.

Image Credit: Shuttershock.com

Tips on Meeting Needs of Children with a Medical Complexity

Presenters: Mary L. Ehlenbach, MD, FAAP; Megan Z. Cardoso, MD, FAAP, and Christina Kleier, ARNP, PNP

This session at PHM16 was focused on logistical tips on how to build a pediatric complex-care program. Presenters opened with a discussion on how to define children with medical complexity. This involved reviewing different methods, including using research-based aggregation of ICD-10 codes, relying on referral from both families and other providers, and identifying patients by consumption of hospital resources. The presentation continued by highlighting that although medically complex children make up only a small percentage of the overall population of children, they account for about one-third of healthcare spending. Because of advances in technology and medicine, this group of children is growing in numbers. It currently makes up about 10% of all pediatric admissions.

Key Takeaways

1. Children with medical complexity are a growing population on which a large proportion of healthcare resources are utilized. A program dedicated to serving the needs of this population may be helpful in reducing costs and improving the patient and family experience during hospitalizations.

2. When working to initiate a complex-care program:

• Set clear guidelines about which children the program is intended to serve and in what capacity it will function.
• Ensure the team composition is sustainable and meets the needs of the patients.
• Aggregate data about if the program is helping. This may be difficult to quantify since these are mostly qualitative measures.
• Include team members who are nonclinical to aid in improving hospital revenue and highlighting program benefits to the institution.

Margaret Rush, MD, is a hospitalist fellow at Children’s National Medical Center in Washington, D.C.

Image Credit: Shuttershock.com

A Picture Is Worth a Thousand Words

Presenter: Kenneth Roberts, MD

PHM16’s “Visual Diagnosis: Signs and Why They Matter” session was a review of case presentations in which visual clues were vital to establishing a diagnosis. Though much of the content was presented with pictures, the emphasis was placed on the importance of correct diagnosis to avoid both misdiagnoses or overdiagnoses and the potential harm that may result from inappropriate treatment. This may also translate into poor utilization of resources and significant financial burden that can result from the unnecessary hospitalization of a patient.