P2.043: Pediatric Residents' Perceived Relevance of Caring for CMC to Future Careers

Background: Children with medical complexity (CMC) have multisystem conditions, high medical fragility, functional limitations, and frequent healthcare interactions. Despite frequent encounters with CMC in the healthcare system, pediatric residents’ exposure to clinical training to develop competency in complex care is limited. Prior research shows limitations in pediatric residents’ confidence in care of CMC. However, it is unknown if residents perceive this training to be relevant to their future careers. The aim of this study is to describe (1) residents’ perceptions of the relevance of clinical activities required to care for CMC to their future careers (2) residents’ self-entrustment in these key clinical activities, and (3) associations with duration of training and planned career path.

Methods: This is a cross-sectional survey study including residents (post graduate year (PGY) 1-5) in a moderate-sized pediatric academic residency program. Residents were anonymously surveyed on future career plans, prior experience with CMC before medical training, self-entrustment in key clinical activities in complex care, and perceived relevance to their future careers. Responses from individual participants were analyzed using composite scores for both relevance and confidence for standardization and observing overall trends. Descriptive and univariate comparison statistics were performed.

Results: Of the 110 residents invited, 88 (80%) completed the survey. Participants were distributed across all PGYs (1-5) including categorical pediatrics (73%), peds psychiatry (15%), med peds (6%), pediatric neurology (6%), and genetics (1%). Career plans included subspecialty pediatrics (n=28, 32%) and outpatient general pediatrics (n=24, 27%). Only few participants had prior experience with CMC (n=8, 9%).

The mean composite score for perceived relevance for all residents was 46(±13) (maximum composite score of 70) and decreased as years of training increased (p=0.04). In addition, perceived relevance varied by planned future career (p=0.002).

The mean composite score for confidence for all residents was 33 (±9) (maximum composite score of 70), indicating modest levels of confidence among the participants. Confidence increased as years of training increased, yet did not vary by planned future career. On average, pediatric residents pursuing hospitalist medicine report the highest relevance to future career and lowest confidence in key clinical activities in complex care.

Conclusion: Though pediatric residents report increasing self-entrustment in performing key clinical activities required to care for CMC over the course of training, overall levels of confidence are modest. Additionally, pediatric residents report decreasing perceived relevance of activities required to care for CMC to their future careers as PGY increased. This is concerning for the growing population of CMC who need a well-prepared workforce to care for them. Further research is needed to understand the confidence of community general pediatricians in these key clinical activities, to determine their perceptions of relevance and to assess the impact on access to care for CMC.