Development of an office-based curriculum of common pediatric primary care skills for residents.

OBJECTIVE: Basic primary care skills-such as injections and hearing screening-are commonly absent from residency curricula, yet competence in these skills is required by residency accrediting organizations. To meet this need at our program, an office-based curriculum of common pediatric primary care skills was developed and piloted in a resident continuity practice.

DESCRIPTION: Based on a needs assessment, an eight-unit curriculum was developed to teach residents basic ambulatory primary care skills. The program was designed as a skills supplement to existing primary care curricula and includes hearing screening, vision screening, developmental screening, injections, venipuncture, urinalysis, in-office rapid testing, and analysis of skin scrapings. Each unit lasted one month, using a "skill of the month" format during continuity clinic. During the month, residents received instruction and demonstration, practiced the skill, and tested to document competence. A pilot of the unit "Intramuscular, Subcutaneous, and Intradermal Injections," was conducted at the Pediatric Primary Care Center of Cincinnati Children's Hospital with 26 pediatrics residents. Fourteen residents participated in the pilot prior to testing and a comparison group of 12 was tested without the pilot experience. The pilot occurred over two weeks. The first week, a 20-minute training session was held at the beginning of continuity clinic to discuss a procedure checklist for injections and allow residents to practice with a mannequin. Throughout the remainder of the continuity clinic during the pilot, residents administered injections to their patients, following the procedure checklist and under supervision by medical assistants. At the conclusion of the second week, residents were evaluated with a written test and a practicum. The 12 residents in the control group were tested identically.

DISCUSSION: This pilot demonstrated that it is feasible to teach primary care skills to residents in the office setting. In our pilot, the test group performed 61% better on a written test and 64% better on a practical test when compared with the control group (p <.0001). Residents who participated in the pilot felt the methods used were appropriate and effective and that the skills taught were important. Additionally, they found the pilot did not interfere with the operation of the continuity clinic. The procedure checklist proved to be an effective and simple method of instructing a psychomotor skill. Conducting the educational sessions at the beginning of clinic was difficult due to interruptions and tardiness. While other methods, such as noon conferences, may also be effective, instruction in the actual clinical setting appeared to better demonstrate the importance, practicality, and relevance of the skill. The residents were more enthusiastic during this office-based curriculum than a typical resident conference. We conclude that this model is an effective and practical method to teach primary care skills in a clinical setting. Our success with the pilot unit has been encouraging, and we plan to develop and test the remaining units of the curriculum.