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DEVELOPMENTAL-BEHAVIORAL PEDIATRICS (DBP) IN PRIMARY CARE CURRICULUM

By: Abubakr Elbashier, MD.

Supervisor: Dr Michael Msall.

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Background

  • Nearly 25% of children and adolescents having a developmental, learning, behavioral, or emotional problem. Impacting over 20,000,000 US children.
  • There is a workforce shortage of specialists to care for this population {1}
    • Only 706 physicians in US are maintaining active certification in DBP.
    • Child and adolescent psychiatrists (CAPs) outnumber DBP nationally 10-fold.
    • Current behavioral health insurance plans limit access.
  • Due to the scarcity of DBP providers, pediatricians are often asked to diagnose and manage common DBP related conditions (e.g. autism, ADHD… etc).
  • Yet, pediatricians report feeling unqualified to care for DBP related conditions because of limited experiences and training.
  • Pediatric residents also report feel underprepared to handle Developmental & Behavioral Pediatrics (DBP) concerns in their continuity clinics.

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{1} Defining DBP – Carol C. Weitzman et al. Pediatrics (2022) 149 (4): e2021054771. https://doi.org/10.1542/peds.2021-054771

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Aim

  • To increase resident exposure to common DBP disorder in primary care and to initiate evaluation and knowledge of developmental, educational and behavioral resources for management.
  • To strengthen the interaction between the DBP team and residents at the University of Chicago medicine, with the hopes of attracting them into careers in primary care and/or DBP.

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Method

  • IRB exemption was given because the human subjects were residents and there was minimal risk to them
  • Conducted an online needs assessment of pediatric residents at the University of Chicago medicine (n=56)
  • 16 items about the confidence of DBP topics in their primary care clinics, and future interest.
  • A unique 4 letter & number identifier was used to keep the participants identity anonymous to those conducting the study.
  • Response rate 86%
  • The needs assessment was designed, tested, and conducted via RedCap
  • The program R-studio was used in the survey analysis

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Needs Assessment

  • Almost three quarters of the 56 pediatric residents have completed a DBP rotation.

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Highest confidence to diagnose ADHD

By year of training

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Next steps

  • 3 curriculum modules planned
  • Autism, ADHD, and behavioral concerns
  • Pre and post-assessment for each module to assess knowledge acquisition.

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Take home messages

  • There is a mismatch in residents’ belief between the importance of DBP issues and the confidence they have in managing DBP issues.
  • The only way to increase interest in DBP, is an increase in exposure.

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Special thanks to our team ☺

  • Dr Lolita Alkureishi - University of Chicago
  • Dr Colleen Rusciolelli - University of Chicago
  • Dr Sarah Safdar - University of Chicago
  • Ashley Andrade - University of Chicago
  • Dr Anjali Rao - University of Wisconsin
  • Dr Katie Kastner - University of Wisconsin

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References

  • Defining DBP – Carol C. Weitzman et al. Pediatrics (2022) 149 (4): e2021054771. https://doi.org/10.1542/peds.2021-054771
  • Ending Developmental-Behavioral Pediatrics Faculty Requirement for Pediatric Residency Programs-Desperate Times Do Not Justify Desperate Actions - Tanya E Froehlich et al. 2023 Oct 1;177(10):999-1000. doi: 10.1001/jamapediatrics.2023.2829.
  • Schonhaut L, Maturana A, Cepeda O, et al. Predictive validity of developmental screening questionnaires for identifying children with later cognitive or educational difficulties: a systematic review. Front Pediatr 2021;9:698549.
  • Cairney DG, Kazmi A, Delahunty L, et al. The predictive value�of universal preschool developmental assessment in identifying children with later educational difficulties: a systematic review. PLoS One 2021;16:e0247299

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