133 - Defining a New Subspecialty: A Novel, Cross-Disciplinary Clinical Fellowship to Care for Children with Medical Complexity

Poster Number: 133
Publication Number: 133.304

Camila Cribb Fabersunne, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; John I. Takayama, University of California San Francisco, Woodside, CA, United States; Duncan Henry, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background:

Background: Pediatric complex care is an evolving field and provides care for children with medical complexity (CMC). CMCs experience a disproportionate share of health care expenditures, and benefit from being cared for by programs designed to address their complex needs and to coordinate across systems. Advanced training (fellowship) in pediatric complex care may be critical to ensure adequate competency in care delivery for these patients.

Objective: To implement and evaluate a one-year fellowship in pediatric complex care—one of the first in the United States.

Design/Methods: Using newly established Entrustable Professional Activities by Huth et al (2021) as the competency-based framework for both curricula and assessment, we developed a fellowship at the University of California, San Francisco (UCSF). The curricula included a range of clinical training environments, including ambulatory primary and consultative care, inpatient direct and consultative care, and subspecialty experiences (see Figure 1).

Results: A single fellow matriculated during the inaugural year (2020-2021). The fellow participated in 54 clinical sessions, performed 30 inpatient consultations, rotated through 6 subspecialty clinics, 6 multidisciplinary clinics and 3 inpatient consultative services. The fellow attended for 8 weeks on inpatient services. The fellow achieved competency in 11 EPAs, and expanded the ability to provide care in the associated complex care program by 50-75%. The fellow participated in existing supports within UCSF to produce scholarly work, and co-led a quality improvement project developing care coordination plans for expansion of services in the complex care program.Conclusion(s): The single year fellowship is a feasible and effective postgraduate training opportunity for those interested in caring for children with medical complexity. This fellowship may serve as a roadmap for developing a new subspecialty in the field of pediatrics.
Clinical experience categories with corresponding Entrustable Professional Activities (EPAs).
Legend: EPAs in the care of children with medical complexity. Adapted from Huth et al, Academic Pediatrics, 2021