Most pediatric residency programs do not provide adequate practical experiences for residents in autism-related care, with a specific dearth of training in diagnostic processes. Without this training, residents enter the primary care workforce with uncertainty surrounding implementation of standard-of-care recommendations for children with autism. Our curriculum was designed to improve upon previously passive shadowing experiences within our developmental–behavioral pediatric rotation by integrating hands-on training in within-practice diagnostic identification and care coordination. In addition to multiple web-based learning activities (including a tutorial teaching administration of an interactive assessment tool), residents were required to actively participate in autism evaluations under supervision of an attending provider. Data were collected to assess feasibility of curricular changes as well as increased comfort level across recommended practice behaviors. Regarding feasibility, 95% of residents completed training components and pre-/post-ratings indicated significant increases in comfort in identifying symptoms/risk for autism, providing feedback about diagnostic decision, and effectively connecting families with services. Outcomes suggest feasibility of model and significantly increased resident comfort level across a range of recommended practice behaviors. This project reflects a first step in advancing incorporation of autism training into pediatric residency programs.

Lay abstract

Most physician preparation programs do not provide enough practical experiences in autism-related care. This is especially true for how to assess for and diagnose autism. Without this training, many pediatricians are not well prepared to implement appropriate care for children with autism and their families. We designed a curriculum to improve training for medical residents that involved explicit hands-on training in diagnostic identification and care coordination for toddlers at risk for autism. We collected data to assess whether our enhanced curriculum led to increased comfort level across recommended practice behaviors. Almost all the residents were able to complete the training within their rotation and our surveys indicated significant increases in residents feeling more comfortable identifying symptoms of autism, providing feedback about diagnostic decisions, and effectively connecting families with services. A significant majority of residents considered it appropriate or very appropriate for children to receive a diagnosis solely from a primary care provider. Our results suggest feasibility of the enhanced model, and this project reflects the first step in advancing incorporation of autism training into pediatric residency programs.

中文翻译：

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通过教居民如何评估初级保健中的自闭症来加强发育-行为儿科轮换

大多数儿科住院医师项目没有为自闭症相关护理的住院医师提供足够的实践经验，尤其缺乏诊断过程的培训。如果没有这种培训，住院医师进入初级保健工作队伍时，对自闭症儿童标准护理建议的实施存在不确定性。我们的课程旨在通过整合实践内诊断识别和护理协调方面的实践培训，改进我们的发育行为儿科轮换中以前的被动阴影体验。除了多项基于网络的学习活动（包括交互式评估工具的辅导教学管理）外，居民还必须在主治提供者的监督下积极参与自闭症评估。收集数据以评估课程更改的可行性以及在推荐的实践行为中增加的舒适度。在可行性方面，95% 的居民完成了培训部分，并且预/后评级表明在识别自闭症症状/风险、提供有关诊断决策的反馈以及有效地将家庭与服务联系起来方面的舒适度显着提高。结果表明模型的可行性，并在一系列推荐的实践行为中显着提高了居民的舒适度。该项目反映了将自闭症培训纳入儿科住院医师计划的第一步。95% 的居民完成了培训内容，并且预/后评级表明在识别自闭症症状/风险、提供有关诊断决策的反馈以及有效地将家庭与服务联系起来方面的舒适度显着提高。结果表明模型的可行性，并在一系列推荐的实践行为中显着提高了居民的舒适度。该项目反映了将自闭症培训纳入儿科住院医师计划的第一步。95% 的居民完成了培训内容，并且预/后评级表明在识别自闭症症状/风险、提供有关诊断决策的反馈以及有效地将家庭与服务联系起来方面的舒适度显着提高。结果表明模型的可行性，并在一系列推荐的实践行为中显着提高了居民的舒适度。该项目反映了将自闭症培训纳入儿科住院医师计划的第一步。

抽象

大多数医师准备计划都没有提供足够的自闭症相关护理实践经验。对于如何评估和诊断自闭症尤其如此。如果没有这种培训，许多儿科医生就没有做好充分准备为自闭症儿童及其家人实施适当的护理。我们设计了一个课程来改善对住院医师的培训，其中包括对有自闭症风险的幼儿进行诊断识别和护理协调的明确实践培训。我们收集数据来评估我们的强化课程是否会提高推荐练习行为的舒适度。几乎所有居民都能够在轮换期间完成培训，我们的调查表明，居民对识别自闭症症状感到更自在的情况显着增加，提供有关诊断决策的反馈，并有效地将家庭与服务联系起来。绝大多数居民认为儿童仅从初级保健提供者那里接受诊断是适当或非常适当的。我们的结果表明增强模型的可行性，该项目反映了将自闭症培训纳入儿科住院医师计划的第一步。