PM3025: Immigrant and Refugee Health Training in Pediatric Residency Programs

Background: Pediatricians care for a growing number immigrant children and children in immigrant families, who now encompass one quarter of the U.S. pediatric population. While great strides have been made describing global health training in pediatric residency, the landscape of U.S. immigrant/refugee health (IRH) education is largely unknown. We aim to describe the extent and content of IRH training offered in pediatric residency programs

Methods: A 10-question on-line survey was distributed to pediatric residency program leadership via the Association of Pediatric Program Directors (APPD) between 10/2020 and 4/2021. The survey tool was developed by IRH curriculum experts and was piloted prior to distribution.

Results: Of the programs surveyed, 27% (n=53) responded. Approximately one-half (55%) of programs reported that they were offering specific training on IRH for their residents. An additional 13% reported that they were currently planning to develop training.

Of those programs offering IRH training, the majority (90%) offered clinical experience and didactics (79%). About half offered community-based experiences (55%) and mentored projects (e.g. quality improvement, research) (66%). Only 8% offered all four types of immigrant training, and one program reported having an immigrant track. Most programs offered a curriculum or training around diversity, equity and inclusion (DEI, 75%).

The majority of programs offering IRH training incorporated training as core didactics (76%), or in continuity clinics (69%). Almost half (48%) offered an IRH elective. Only 13% included training during intern orientation. IRH training was often embedded in DEI teachings (38%), or in another track or pathway (34%), most frequently in global health tracks (28%).

With regards to IRH content offered, the majority of programs included required components on working with interpreters (79%) and content on DEI (90%). Other required components included cross cultural training (59%), evidence-based clinical care of immigrant children (66%), health care access and disparities for immigrants (62%), and community-based organization engagement (55%). Fewer offered acculturation and post-migration stressors (17%), international adoption (10%), or research/quality improvement (17%) as a required part of any their IRH training. While none offered asylum evaluation training as a required component of their training, 34% offered it as an optional training or elective.

Finally, the top three barriers to IRH curriculum development were reported to be lack of faculty with expertise, lack of time in residency, and lack of educational tools (in order of ranking).

Conclusion: In this first reported national survey of immigrant and refugee health training among U.S. pediatric residency programs, we found that while half of the responding programs offer IRH training, only a third offered such training as a required component, and many were embedded in other curricular teaching such as global health tracks. Further research is needed to define core competencies, evaluation strategies and best practices in IRH training.