title: Learning to deliver care in a medical home: a qualitative analysis of residents' reflections on practice.
abstract: OBJECTIVE
  We used online structured reflection to improve residents' understanding of care delivery in the medical home.
  
  
  METHODS
  Third-year pediatric residents participated in an online curriculum on delivering effective, patient-centered primary care in the medical home to children with special health care needs. Residents were prompted to respond to questions designed to stimulate reflection. We qualitatively assessed their responses, graded their depth of reflection, and provided structured feedback.
  
  
  RESULTS
  Residents identified aspects of their practice consistent with medical home principles. Depth of reflection increased over time. Residents realized they needed to better understand families' financial, emotional, and social needs and increase families' involvement in care planning. Residents identified systems issues and practice changes to improve care delivery.
  
  
  CONCLUSIONS
  Online reflective writing with feedback is a powerful strategy to improve residents' learning. Residents identified and began to make practice changes to provide patient-centered care in a medical home.
authors.affiliation: Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA tkind@childrensnational.org.
authors.forename: Terry
authors.initials: T
authors.lastname: Kind
authors.affiliation: George Washington University Graduate School of Education and Human Development, Washington, DC, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Goldman
authors.affiliation: Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Fratantoni
authors.affiliation: Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Bernhard L
authors.initials: BL
authors.lastname: Wiedermann
authors.affiliation: Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Dewesh
authors.initials: D
authors.lastname: Agrawal
authors.affiliation: Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Coddington
mesh_terms: D000328:Adult; D003479:Curriculum; D004503:Education, Medical, Graduate; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D008297:Male; D018802:Patient-Centered Care; D010372:Pediatrics / Q000193:education*; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: children with special health care needs; medical home; reflection