title: A modified healthy steps model to improve resident training in behavioral and developmental care.
abstract: OBJECTIVE
  To assess whether implementing a modified Healthy Steps (HS) for young children program in residency clinics could improve resident education and their perception of the quality of care provided for common behavioral and developmental (B/D) issues.
  
  
  METHODS
  Residents and faculty blinded to study intent were surveyed to assess perceptions of resident preparedness and the quality of behavioral and developmental (B/D) care at 4 pediatric residency training sites in North Carolina. Initially, Program 1 (with an established HS program) was compared with 3 sites without established programs at baseline (Programs 2, 3, and 4), and then the results before and after implementation at Programs 2 to 4 were compared.
  
  
  RESULTS
  Initially, subjects at Program 1 were more likely than those at Programs 2 to 4 to rate residents as "well" or "very well" prepared to provide B/D care (63% vs 20% respectively, 95% confidence interval of the difference, 25-61%) and more likely to rate the overall quality of B/D care at their clinic as "high" or "extremely high" (94% and 47% respectively, 95% confidence interval for the difference, 34-59%). After implementation of HS at Programs 2 to 4, the mean percentage of subjects rating residents as "well" or "very well" prepared and the ratings of the care provided increased dramatically.
  
  
  CONCLUSIONS
  A modified HS model focusing on resident B/D education substantially increased attending and resident ratings of residents' preparedness to deliver B/D care and increased the ratings of the quality of B/D care provided.
authors.affiliation: From the *Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics at the University of North Carolina School of Medicine, Chapel Hill, NC; †North Carolina Children's Center for Clinical Excellence, Chapel Hill, NC; ‡Office of Performance Improvement, Minnesota Department of Health, St Paul, MN; §Center for Healthcare Quality, Cincinnati Children's Hospital, Cincinnati, OH.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Randolph
authors.forename: Louise
authors.initials: L
authors.lastname: Stenberg
authors.forename: Rebecca
authors.initials: R
authors.lastname: Socolar
authors.forename: Karen L
authors.initials: KL
authors.lastname: Wysocki
authors.forename: Sandra
authors.initials: S
authors.lastname: Fuller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Check
authors.forename: Wallace D
authors.initials: WD
authors.lastname: Brown
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Steiner
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003479:Curriculum / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D017145:Models, Educational; D010372:Pediatrics / Q000193:education*; D016037:Single-Blind Method