266 - Training Residents in the Screening Tool for Autism in Toddlers: Learning Outcomes and Resident Perceptions

Poster Number: 266
Publication Number: 266.419

Kira Belzer, Madigan Army Medical Center, PUYALLUP, WA, United States; Michelle Kiger, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Dayton, OH, United States; Eric Flake, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Dupont, WA, United States

Background: Autism Spectrum Disorder (ASD) affects 1 in 54 children. While best outcomes occur when autism-specific interventions are initiated prior to age 3, the average age of diagnosis in the US is 4. Delays in diagnosis stem from long wait times to access specialty care and primary care providers (PCPs) feeling inadequately prepared to diagnose and manage ASD. The Screening Tool for Autism in Toddlers (STAT) is a level 2 screening tool that can be used to aide in the evaluation and diagnosis of autism in children less than 4.

Objective: To develop an autism curriculum to train pediatric residents in the use of the STAT and to asses the impact of the STAT training on resident knowledge and comfort in managing ASD within the medical home.

Design/Methods: Pediatric residents completed in-person, half day training in the STAT that included interactive video and practice-based elements. Residents completed pre-and post-tests assessing knowledge of autism diagnosis and management; pre- and post-training surveys assessing their experience and comfort with ASD; and (3) post- training interviews exploring their perceptions of the training and barriers to ASD diagnosis and treatment. We performed an inductive thematic analysis of interview responses.

Results: Thirty-two residents attended the training; 29 completed the evaluations. There was a significant increase in test scores following the STAT training (M=9.8 vs 11.7, t(28) =4.93, p < 0.0001), significant increases in resident comfort levels with ASD management (figure 1), and increased resident comfort and likelihood of using the STAT to make an ASD diagnosis (table 1). We identified 4 themes in interview responses: 1) while STAT training increased residents’ sense of empowerment in managing patients with ASD, they remained reluctant to make a formal autism diagnosis due the implications of the diagnosis; 2) residents felt that logistical barriers would impede successful long term implementation of the STAT in their clinics; 3) access to a Developmental-Behavioral Pediatrician impacted resident’s comfort levels with utilizing the STAT in their clinics; and 4) residents most valued the interactive components of the curriculum.Conclusion(s): An autism curriculum that included training in the STAT increased resident knowledge and comfort level in diagnosing and managing ASD, and empowered residents to manage ASD as a PCP. While logistical barriers impact the ability of PCPs to identify and diagnose ASD earlier in clinical practice, providing a rich area for future study, use of this curriculum has potential to improve the long-term outcomes for children with ASD.
Kira Belzer CVCV Kira Belzer 2021.pdf
Table 1Resident comfort levels and likelihood of utilizing the STAT in their general pediatrics clinic following the STAT training. Ratings were based on a Likert scale of 1-5 with 1 being not likely and 5 being extremely likely. The CI represents the 95% confidence interval for the mean.