1. Addition of an Early Childhood Development Component to a Family Medicine Residency's Pediatric Curriculum Ann Tseng, MD Clinical Instructor of Family Medicine Oregon Health and Science University Family Medicine Cassie Landers, Ph.D. Columbia University School of Public Health Anita Softness, MD Assistant Professor of Family Medicine Columbia University Family Medicine

2. RRC Requirements for Pediatric Training in Family Medicine Residencies at least 4 months total in pediatric ambulatory and inpatient settings Specifically… newborn nursery, care of the “distressed neonate” growth/development of newborn through adolescence child rearing and emotional development of children “behavioral, surgical, medical” problems of children and adolescents in home, school, ambulatory, hospital settings

3. Why do an early childhood development rotation (age 0 to 3)? Young children under age 3 constitute most pediatric visits Many residents feel ill prepared to speak about common issues in early childhood (sleep, picky eating, thumb sucking) that arise Common early childhood issues are rarely formally taught in FP residencies

4. Early Childhood Rotations

5. Structure of the Rotation at Columbia As part of their ambulatory pediatric rotation, each 3 rd year resident spends one half day per week at Columbia University Head Start, a program of the School of Public Health The Head Start program offers a bilingual early childhood development program for infants, toddlers, and preschoolers Head Start participants are low income, highly motivated, first generation families

6. More about Columbia University Early Head Start… Pregnancy Support Groups Home Visiting Child Development /Health Screening Nutrition and Mental Health Counseling Parent/Toddler Groups Preschool /School Readiness Parenting Education

7. Resident Learning Objectives at Columbia Head Start Common child development issues explored with a focus on normal development from infancy through toddler years to pre-school : Ages and stages Language development Feeding and Toilet training Temperament and Discipline

8. Normal development milestones in language, social, emotional, cognitive and motor development Application and interpretation of several evaluative instruments Ages and Stages parent report questionnaire Ages and Stages

9. Language Development Normal early language development acquisition Recognition of signs necessitating further diagnostic evaluation Review of development of bilingual language Early Literacy/Numeracy/School readiness Role of physician in encouraging early literacy

10. Feeding and Toilet Training Culturally determined patterns and practices Need for age appropriate independence Breastfeeding/Infant feeding Overfeeding/ Childhood obesity Residents to gain confidence in handling toilet training questions

11. Different categories of temperament and effect on behavior Connection between temperament and discipline Helping parents set age appropriate limits Behavioral Issues: Attachment Sleeping/Crying/Colic Discipline/Temper Tantrums Temperament Temperament and Discipline

12. One three-hour session per week x 4 weeks Guided Classroom Observation: normal child development Child Development Screening and Assessment Instruments Home Visits: Developmentally appropriate activities and social services Parenting Education Sessions Prepared readings How are the objectives taught:

13. Structure of the Elective Rotation at OHSU Elective for a pgy-3, July 2008 Many possible early childhood topics, tailored to resident interest. Centered around major themes:  TEMPERAMENT: Why we are the way we are  ATTACHMENT: formation of relationships  FEEDING: picky eating, failure to thrive  DISCIPLINE: tantrums, red flags, positive guidance

14. How the Resident will learn the themes TEMPERAMENT: Head Start Class/playgroup ATTACHMENT: home visit for a resident patient FEEDING: moderated by local pediatric nutritionist DISCIPLINE: parent group at resident’s home clinic joint moderation by myself (family physician) and longtime teacher of early childhood development at Portland State University tailored to resident’s clinic population at OHSU resident learns about clinic’s community resources

15. Future Directions at Columbia Interest level high, will move to full day curriculum for 2008/2009 Need for greater attention throughout residency, plan to start monthly longitudinal lecture series offered throughout three years Support for individual research initiatives; resident may choose to follow one family or explore one issue further

16. Future Directions at Oregon Health and Science University An elective or a residency requirement? Four distinct Family Medicine Clinics, four different patient populations Teaching residents to bill for a developmental screen such as Ages and Stages NY Times Developmental Question of the Week Standardizing a rotation