title: Challenges and potential solutions to educating learners about pediatric complex care.
abstract: OBJECTIVE
  To identify existing challenges and potential strategies for providing complex care training to future pediatricians from a national group of educators.
  
  
  METHODS
  Data were collected from pediatric educators involved in complex care at the Pediatric Educational Excellence Across the Continuum national meeting. Participants completed an anonymous 15-item survey adapted from the Association of American Medical Colleges (AAMC) Best Practices for Better Care initiative and participated in a focus group to understand the challenges and potential solutions to pediatric complex care education. Data were analyzed using grounded theory.
  
  
  RESULTS
  Of the 15 participants, 9 (60%) were in educational leadership positions. All participants provided care to children with medical complexity (CMC), although 80% (n = 12) reported no formal training. Thematic analysis revealed learners' challenges in 2 domains: 1) a lack of ownership for the patient because of decreased continuity, decision-making authority, and autonomy, as a result of the multitude of care providers and parents' distrust; and 2) a sense of being overwhelmed as a result of lack of preparedness and disruptions in work flow. Participants suggested 3 mitigating strategies: being candid about the difficulties of complex care, discussing the social mandate to care for CMC, and cultivating humility among learners.
  
  
  CONCLUSIONS
  Residency education must prepare pediatricians to care for all children, regardless of disease. Training in complex care involves redefining the physician's role so that they are better equipped to participate in collaboration, empathy and advocacy with CMC. This study is the first to identify specific challenges and offer potential solutions to help establish training guidelines.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, Calif. Electronic address: jbogetz@stanford.edu.
authors.forename: Jori F
authors.initials: JF
authors.lastname: Bogetz
authors.affiliation: Stanford Center for Medical Education Research and Innovation (SCeMERI) at Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Alyssa L
authors.initials: AL
authors.lastname: Bogetz
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: David
authors.initials: D
authors.lastname: Bergman
authors.affiliation: Section of Academic General Pediatrics, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
authors.forename: Teri
authors.initials: T
authors.lastname: Turner
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Blankenburg
authors.affiliation: Division of General Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Allison
authors.initials: A
authors.lastname: Ballantine
mesh_terms: D002983:Clinical Competence; D003226:Congresses as Topic; D004503:Education, Medical, Graduate / Q000592:standards*; D017144:Focus Groups; D017408:Guidelines as Topic; D006801:Humans; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education*; D011795:Surveys and Questionnaires; D014481:United States
keywords: child; chronic disease; graduate medical education; medical education; pediatric; residents; social identity