Abstracts

Rationale: The objective of this study was to appraise the current training of Neurology (N), Pediatric (P), and Med-Peds (MP) residents at MedStar Georgetown University Hospital (MGUH) at providing care to patients with epilepsy who are transitioning from pediatric to adult care.Health Care Transitions (HCT) is “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult –oriented health care systems.”¹  Youth with special health care needs (YSHCN) utilize health care services across their lifespan at higher rates than the general population.After nearly a decade of effort, widespread implementation of HCT to YSHCN, including those with epilepsy, has not been fully realized. A national survey revealed that most pediatric practices have failed to fully offer transition-support services to their patients while many adult providers have felt unprepared to care for YSHCN including those with epilepsy. While graduate medical education (GME) in HCT has been identified as an important area of need, there are few studies concerning effective GME models. What has been demonstrated is that when medical providers were exposed to HCT in the context of their residency training, they were more likely to incorporate it into their practices after residency. Methods: An online survey was sent to all 77 residents in Neurology, Pediatrics, and Med-Peds at MGUH distributed through the program directors’ email listservs.The 21-item questionnaire assessed knowledge, confidence, and experience at providing HCT to youth with epilepsy. It comprised of closed-ended questions with nominal and Likert-type response scales, open-ended qualitative questions, and general demographic items. Fisher’s exact test was used to detect group differences between the adult-only providers (Neurology) and the pediatric providers (Pediatrics/Med-Peds). Results: Though majority rated their knowledge of HCT to be very minimal (32%) to minimal (48%), there were more P and MP residents who reported moderate (30.77%) to extensive (7.69%) knowledge of HCT compared to 0% of the N residents. There was a trend that P and MP residents more highly rating their familiarity with transitions resources than N residents. Both groups identified didactic lectures and exposure in continuity clinics as their preferred methods to learn more about HCT.Both groups rated being uncomfortable (52%) or very uncomfortable (24%) at providing primary care to YSHCN with only 1% from both groups reporting  to being very comfortable. In patients with epilepsy, the P/MP group reported to spending time talking privately to the adolescent patient without a guardian present and encouraging health management skills with greater frequency than the N group.Most respondents reported having limited discussions with attendings on HCT though identified training in this area would lead to improved health outcomes for YSHCN. Lack of a structured curriculum and longitudinal clinical experience in HCT were the main barriers. Of those who expressed familiarity with HCT, exposure to online resources was identified as helpful. Conclusions: Training in HCT for YSHCN including youth with epilepsy should be appraised and improved in the Neurology, Pediatric, and Med-Peds residency programs at MGUH. Most respondents identified that training in this area would lead to improved health care outcomes for YSHCN. Residents identified didactic lectures and exposure in continuity clinics as their preferred methods to learn more about HCT in YSHCN. Funding: This study was conducted while the author was a participant in the MedStar Health Teaching Scholar program.