P0051 - Leveraging eLearning and Community Assets to “TEACH” Residents to Address Child Poverty

Background:

Children in poverty are more likely to experience trauma and adverse health outcomes, but trainees often lack the knowledge or confidence to address the effects of child poverty.

Purpose:

To evaluate the effectiveness of a multimodal child poverty curriculum

Methods:

The objective of the Trainee Education in Advocacy and Community Health (TEACH) curriculum is to train pediatric residents to recognize and address the effects of child poverty in primary care. It is based on learning objectives modified from the Academic Pediatric Association US Child Poverty Curriculum. This evaluation of the “The Epidemiology of Child Poverty” (Year 1) portion of the curriculum includes 2 years of resident participation and a comparison group. Residents were randomized to participate based on their continuity clinic site and compared to a group of residents who had not participated in the curriculum. The curriculum includes interactive modules, simulation activity of applying for government benefits, experiential learning at a government benefits site, a museum exhibit on evictions, and an in-person debrief/reflection with program staff. Pre/post knowledge and attitudes regarding child poverty were compared within and between the intervention and control groups. Residents’ experience with the curriculum was analyzed using qualitative coding of audio-recordings of the debrief sessions.

Results:

Fifty-two residents who completed the curriculum between June 2018 and March 2020 were compared to a control group of 10 residents. Intervention and control groups were similar in race, gender, training year, and age. Both groups had comparable pre-test knowledge scores (36.4% and 37.8%, control and intervention group respectively). The intervention group significantly increased their average post-test score (70.8%) (P<.001) and increased their confidence with identifying and addressing health effects of poverty (P<.001). The intervention group also reported increased preparedness (P<.001) and effectiveness (P <.001) in addressing social determinants of health (SDH) after completing the curriculum (Table 1). Attitudes that did not change significantly after the curriculum were already rated high at baseline, such as recognizing that addressing financial and social needs can have a positive impact on a child's life. The themes that emerged from qualitative analysis of the intervention group were: empathy for patients and (unexpectedly) for government agency staff; increased ownership of their role in addressing SDH; increased understanding of challenges in the benefits process; recognition of personal biases related to poverty; and increased knowledge about eviction and housing insecurity as a SDH (Table 2).

Conclusion:

The Epidemiology of Child Poverty portion of the TEACH curriculum improved resident knowledge, confidence, and attitudes in addressing child poverty. Given the ubiquitous nature of child poverty and the generalizability of the online modules, the TEACH curriculum can be an asset to other residency programs.