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Background: Pediatric residents typically only interact with patients and families in healthcare settings which limits the opportunity to fully understand the patient and family experience. Encounters with children with medical complexity (CMC) that only relate to illness or health monitoring can anchor residents to false preconceptions and limit their ability to practice patient- and family-centered care (PFCC). The core principles of PFCC include acknowledging patient and family expertise and strengths, encouraging their input, and appreciating the value of their observations and perceptions.

Objective: To explore how a home visit program with patients and families serving as faculty could instill the principles of PFCC in pediatric residents.

Design/Methods: This mixed methods study used grounded theory to qualitatively analyze 10 years of retrospective data from resident reflections facilitated by parents on staff following a non-medical home visit with a CMC. Transformative and social learning theories were used to structure the output into 6 themes: frame of reference, observations, realizations, disorienting dilemmas, reflections and discourse, and shifts in their world view.

Results: The 132 reflection sessions were analyzed using a 90-word code book to capture 11,194 codes in 3,741 excerpts. Responses early in the reflection sessions most often were more factual statements representing their prior attitudes and experiences, literal observations from the home visit, and discovery of new knowledge. By the end of the sessions the excerpts represented challenges to their preconceptions, shifts in their frames of reference, and comments about how this experience will alter or impact their future practice (Table 1). The most common codes reflected the PFCC principles including “normalcy,” “family centered care,” and “medicine beyond the bedside.”

Conclusion(s): Immersion experiences solidify or alter resident frames of reference; however, a facilitated group debrief may deepen the learning opportunity and lead to a variety of realizations that promote broader reflections and discourse. Parent facilitated reflection sessions following a non-medical home visit instilled concepts that are difficult to teach within clinical settings.

Presented at the 2021 PAS Virtual Conference



Pediatric Resident Reflections from a Non-Medical Home Visit of a Child with Medical Complexity

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