title: Caring for Children With Medical Complexity: Challenges and Educational Opportunities Identified by Pediatric Residents.
abstract: OBJECTIVE
  High-quality care for children with medical complexity (CMC) is in its infancy. Residents have the opportunity to view care for CMC with a fresh perspective that is informed by their work across diverse health care settings and significant time spent at the bedside. This study aimed to identify the challenges and potential solutions for complex care delivery and education from their perspectives.
  
  
  METHODS
  We conducted three 60-minute focus groups with a purposeful sample of residents and recent graduates at a US tertiary-care medical center. Data were transcribed verbatim, and themes were identified using an iterative approach and modified grounded theory.
  
  
  RESULTS
  Sixteen participants identified 4 major challenges to caring for CMC: 1) lack of care coordination; 2) complex technology management; 3) patients' pervasive psychosocial needs; and 4) lack of effective health care provider training. Participants identified 3 solutions: 1) greater integration of primary care providers; 2) attention to psychosocial needs through shared decision making; and 3) integration of longitudinal patient relationships into provider training. We found that residents who experienced longitudinal relationships with CMC felt more efficacious and better equipped to handle challenges of caring for CMC as a result of their broader understanding of patients' priorities and of their role as providers.
  
  
  CONCLUSIONS
  Residents recognize important challenges and offer thoughtful solutions to caring for CMC. Although multiple solutions exist, formal integration of longitudinal patient experiences into residency training may better prepare residents to understand patient priorities and identify when their own attitudinal changes can guide them into more efficacious roles as providers.
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, Calif; Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif. Electronic address: jori.bogetz@ucsf.edu.
authors.forename: Jori F
authors.initials: JF
authors.lastname: Bogetz
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Alyssa L
authors.initials: AL
authors.lastname: Bogetz
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Rassbach
authors.affiliation: Palo Alto Medical Foundation, Palo Alto, Calif.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Gabhart
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Blankenburg
mesh_terms: D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000628:therapy*; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D005260:Female; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education* / Q000458:organization & administration; D036301:Qualitative Research; D062606:Tertiary Care Centers
keywords: child; chronic illness; curriculum; graduate medical education; pediatric; resident