Improving Care for Children with Special Health Care Needs: An Introductory Curriculum for Medical Students

Children with special health care needs (CSHCN) represent a vulnerable population of children with chronic conditions who require health and related services of a type or amount beyond that required by children generally. CSHCN face unique barriers to care including a health care workforce that lacks adequate training. Advocacy skills are also necessary to optimize care. Trainees report a lack of baseline knowledge and understanding of CSHCN. Therefore, an opportunity exists to enhance education by presenting the care of CSHCN to future physicians early-on in training. Medical students represent an optimal educational target. Relatively few standardized curricula have been published. Existing curricula are longitudinal in nature, presenting numerous challenges for implementation during medical school. Here, we developed, implemented, and evaluated a short, targeted, curriculum regarding care of and advocacy for CSHCN based upon standardized learning objectives. The curriculum consisted of a pre-session assignment, a didactic presentation, and group case discussion. Subjects were third-year medical students participating in the pediatrics clerkship. We used a cluster, randomized, controlled design. Clerkship groups were randomized to receive the curriculum or not. Pre- and post-survey instruments were used to assess knowledge, attitudes, skills, and self-rated knowledge. A qualitative assessment of the curriculum was also completed. We demonstrated statistically significant improvements in perceived skills and self-rated knowledge in the experimental group, compared with control group. Changes in knowledge and attitudes trended towards significance. Compared with other studies evaluating similar curricula, our curriculum is quite short and is neither longitudinal nor experiential in nature. Despite the educational advantages of a longitudinal, experiential curriculum in the care of advocacy for CSHCN, there is a need for effective, short curricula that can be easily introduced in the context of existing UME. The short focused educational offering described here can effectively introduce students to this important content area. The curriculum may function in a way to “frame” the care of and advocacy for CSHCN and may stimulate students to seek dedicated experiences to enhance their understanding of CSHCN. Limitations of this study include the cluster study design and small sample size. Future directions include implementing this curriculum at other institutions