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The Crossover Curriculum
Zadok Sacks, MDChief Resident, 2011-2012
Harvard BWH/CHB Medicine-Pediatrics Resident Program
Background Research has demonstrated that internal medicine
residents (IMRs) are less comfortable caring for adults with childhood-onset chronic diseases (COCDs) than their pediatric counterparts
The transition process may negatively impact the quality of care these patients receive after transferring to adult providers
Medicine-Pediatrics residents gain a unique perspective on differences in COCD management between the adult and pediatric care settings, making them uniquely suited to fill this educational niche
Patel M, O’Hare K, Pediatrics 2010Brousseau DC et al, JAMA 2010
Needs Assessment: BWH IMRs
Program Objectives Increase IMRs’ confidence in managing adult patients
with COCDs
Learn about the transition of young adults from pediatric to adult-centered care
Give IMRs the opportunity to learn from master pediatric educators
Create a unique educational niche for the MP residency program
Curriculum Description Five case-based morning reports and two noontime lectures
have been completed at BWH
All sessions have involved guest pediatric faculty discussants
Discussions typically focus on management issues and highlight the challenges involved in transitioning patients with COCDs
A post-curriculum survey was administered to IMRs after this initial set of sessions was complete. Responses from IMRs who had attended at least one CC session (N=70) were included in the analysis
Results 87% of respondents had no prior training related
to the transitioning of young adults with COCDs
99% of respondents (N=67) stated that hearing from pediatrics subspecialists about these topics enhanced their learning
98% of respondents (N=44) felt that the CC adds to their education
Results
Qualitative Feedback “I feel much more knowledgeable on [inflammatory bowel disease] and [cystic fibrosis] and would feel more comfortable when taking care of adult patients with those diseases.”
“ [I will be] less aggressive with IV fluids in [diabetic ketoacidosis].”
“I will trust a sickle cell patient to tell me what dose of pain meds works for them in a pain crisis.”
“[I will be] more sensitive to [the] transition years.”
Implications Innovative program in which there has been a great deal of
interest from IMRs at our institution
Viewed as a high-yield educational experience with the potential to impact management
Preliminary study involving subjective assessments of change
Plan to add additional topics (e.g. adult congenital heart disease, cerebral palsy, intellectual disability, and genetic disorders) and continue the CC in the future
Can be generalized to any MP residency program and its affiliated IM residency program, and fills an important educational niche
“Children with these diseases are living longer now, and internists have to know how to care for them.”
-- BWH Internal Medicine Resident
Acknowledgements• The Brigham and Women’s Hospital Internal Medicine
Residency Program– Internal Medicine 2011-2012 Chief Residents
• The Boston Combined Residency Program in Pediatrics– Pediatric 2011-2012 Chief Residents
• Niraj Sharma, Colleen Monaghan, and Kitty O’Hare
• Anna Volerman, BWH/CHB Med-Peds 2012-2013 Chief
• Participating Faculty: Amy Sobota, Melissa Putman, Traci Wolbrink, Athos Bousvaros, Ahmet Uluer, Lisa Kenney, Greg Piazza, and Peter Banks
Questions?