The Crossover Curriculum

1. The Crossover Curriculum Zadok Sacks, MD Chief Resident, 2011-2012 Harvard BWH/CHB Medicine-Pediatrics Resident Program

2. 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 2010 Brousseau DC et al, JAMA 2010

3. Needs Assessment: BWH IMRs

4. 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

5. 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

6. 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

7. Results

8. 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.”

9. 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

10. “Children with these diseases are living longer now, and internists have to know how to care for them.” -- BWH Internal Medicine Resident

11. 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, AhmetUluer, Lisa Kenney, Greg Piazza, and Peter Banks

12. Questions?