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?