As more and more youth with special health care needs survive to adulthood, successful transition to adult oriented health care systems has become increasingly important. Despite this, few educational programs exist to teach pediatric trainees to become effective in transitioning their patients or to foster good communication and collaboration between pediatricians and their adult counterparts. This single-center trial aimed to integrate pediatrics, medicine-pediatrics, and internal medicine trainees into an inter-disciplinary transitions clinic for youth ages 16-26 with chronic medical illnesses, neurodevelopmental disorders, and serious mental health conditions. Residents were grouped into dyads (pediatrics and internal medicine provider) and conducted transition assessments under the supervision of attending physicians. Residents also underwent didactic training; each resident participated in 1-4 sessions over the course of a month-long rotation. Residents were evaluated using pre-intervention and post-intervention electronic surveys with the goal of assessing resident comfort in speaking with patients and other providers about transition; 54% of those eligible completed both surveys. All trainees reported statistically significant improvement in preparedness for communicating with adult or pediatrics providers respectively. Additionally, all trainees reported statistically significant improvements in counseling families and preparing young adults for transition or receiving young adults into care respectively.

This innovative educational model allowed pediatrics and internal medicine trainees to work together to learn about transitioning a growing patient population into adult oriented systems. Results showed modest but significant improvements in resident comfort with transitions, including the ability to effectively communicate with providers across the divide and with youth and families regarding this challenging issue. However, the study was limited by relatively small sample sizes and low response rate to post-intervention survey. Additionally, further studies are needed to evaluate the effectiveness of this intervention in ensuring successful transitions from the perspective of patients and their families as well.

Nicola Brodie, MD 

Pediatric Chief Resident, St. Christopher’s Hospital for Children

Chung RJ et al. Resident Dyads Providing Transition Care to Adolescents and Young Adults with Chronic Illnesses and Neurodevelopmental Disabilities. Journal of Graduate Medical Education. 2017 Apr;9(2):222-227. PMID: 28439357