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Anticipatory guidance (AG) is essential for all children, especially children with medical complexity (CMC). CMC often rely on medical devices, most commonly gastrostomy tubes, and benefit from proactive AG. However, few curricula have been developed to train residents in providing applicable AG for CMC.

Our objective was to examine the feasibility and impact of an asynchronous online curriculum for residents on providing AG for children with gastrostomy (GT) or gastrojejunostomy (GJ) tubes. Informed by the results of a needs assessment at a large free-standing children’s hospital, we designed and implemented an online asynchronous curriculum for residents using Kolb’s experiential framework.

The four-week course included four modules instructing residents on principles of AG in CMC, GT and GJ basics and troubleshooting. We also included downloadable toolkits with sample smart phrases for documenting exam findings and AG. We assessed knowledge, attitudes, and behaviors related to the curriculum via pre- and post-tests, an anonymous course evaluation, and optional semi-structured interviews. Pre-test and post-test answers were compared using McNemar’s Test, using a test score of 70% to represent adequate knowledge. We used descriptive statistics to assess the results of the course evaluation and thematic content analysis to identify themes from semi-structured interviews.

A total of 102 residents participated in the course; 91 (89.2%) completed the course evaluation and 75 (73.5%) consented to the use of their data in this study (Table 1). The percentage of residents scoring ≥70% on the post-test was significantly higher than on the pre-test (4.7% pre- vs. 96.9% post-, p < 0.001) (Table 2). Residents also reported improved comfort in all assessed activities (comfortable: 34.7%-63.9% pre- vs. 100.0% post-, p < 0.001) (Table 2). The majority agreed or strongly agreed that the course was relevant (86.9%), course objectives were met (88.1%), and time to complete it was reasonable (73.8%). Themes from interviews of 8 residents bolstered these findings: residents perceive barriers in giving AG to CMC and residents learned valuable skills from the curriculum (Table 3).

In conclusion, an online asynchronous curriculum to teach residents how to provide AG for CMC with GT or GJs was feasible, effective, and well received. Future directions include assessing resident documentation of AG in visits with CMC related to GTs to further assess behavior change and the application of knowledge and skills acquired from the curriculum.

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Providing Antiicipatory Guidance For Children With Medical Complexity And Gastrostomy Tubes: Feasibility And Impact Of An Online Curriculum For Residents