P3.284: Mission NEC: Navigating the effects of social health determinants and care settings on Military Pediatrics

Background: HealthyPeople 2030 defines Social Determinants of Health (SDOH) as conditions in the environments where people are born, live, learn, work, and age. Healthcare access and quality is a key SDOH domain, impacting morbidity and mortality in necrotizing enterocolitis (NEC). Factors such as healthcare access, primary care availability, insurance coverage, and health literacy influence NEC outcomes. A novel educational approach, “Choose Your Own Adventure” (CYOA), fosters learner autonomy and diverse discussions. Our objective was to investigate the impact of healthcare access and quality on NEC outcomes in the NICU using CYOA as an interactive learning technique.

Methods: Using the C.I.R.C.L.E method (Choose, Identify, Research, Create, Lead, Equip), five learning objectives were developed: (1) Summarize how healthcare access affects outcomes, (2) Identify aspects of healthcare quality impacting management, (3) Understand NICU level capabilities, (4) Recognize long-term NEC complications, and (5) Utilize an Ostomy Care Action Plan. Objectives 1 and 2 were assessed via pre/post-curriculum surveys, while objectives 3-5 were evaluated through real-time group discussions.
A total of 31 participants (4 medical students, 15 pediatric residents, 5 fellows, and 7 faculty) were divided into three groups with mixed training levels. A 90-minute session utilized a PowerPoint-supported CYOA framework, allowing learners to navigate NEC management in rural, semi-rural, and urban NICU settings. Facilitators conducted literature reviews on NEC, healthcare access, and quality.

Results: Preliminary data from 20 trainees and faculty indicated discrepancies in comfort levels with SDOH education, measured on a Likert scale (1-5). Post-curriculum assessments are pending final data collection in March 2025. During the session, groups researched NICU capabilities, discussed long-term NEC complications, and reviewed an Ostomy Care Action Plan, which was verified by a pediatric gastroenterologist and distributed to attendees. The CYOA model facilitated engagement with real-world challenges in NEC care across different healthcare settings.

Conclusion: Pre-curricular assessments revealed gaps between resident-perceived SDOH education frequency and faculty comfort in teaching SDOH concepts. Post-curriculum assessments will determine whether this gap decreased. This study supports CYOA as an effective, replicable educational tool to enhance understanding of healthcare disparities in NEC management. By integrating interactive learning, this module equips trainees with practical knowledge to better serve patients facing healthcare access and quality challenges.