Medical Resident Needs for Training in Autism Spectrum Disorder: Comfort Level and Scope of Practice in Primary Care

Background: The increased prevalence of autism spectrum disorder (ASD) and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. Given that most concerns for ASD initially present in primary care, pediatricians play an important role from first concerns to follow-up care. Unfortunately, many practicing pediatricians feel ill-equipped and uncertain assessing diagnostic risk and management of children with ASD.

Objectives: During development of a service system intervention introducing enhanced learning opportunities for residents in our pediatric residency program, we conducted the current study to assess the confidence of residents with regard to ASD screening, diagnosis, and follow-up care for ASD, in relation to other common concerns seen in primary care. This in turn helped identify potential training targets for our DBP rotation.

Methods: We designed an 18-item survey based on review of existing literature on physician and resident comfort level with a range of presenting concerns. Specific to ASD, residents were asked to rate the importance of education about ASD to their career, how strongly they felt that ASD concerns should fall within their scope of practice, their confidence in their ability to distinguish between ASD and other delays, their proficiency at using ASD screening tools, and their ability to connect families to specific services. Residents also completed rating scales assessing their confidence in providing care for patients presenting with ASD versus other common medical and developmental/behavioral concerns that present in primary care. Specifically, they rated their confidence in their ability to a) screen for and identify symptoms, b) communicate effectively about concerns, c) definitively diagnose, d) treat/manage symptoms, and e) facilitate follow-up care.

Results: Fifty-one residents completed REDCap surveys. Residents were significantly more confident in their skills with respect to caring for patients with other common concerns than for patients with ASD including significant differences in their perceived ability to diagnose, communicate with families about, treat/manage, and facilitate follow-up care. Of the 80% of residents that reported proficiency using screening tools for ASD, 68% answered that they had no/low confidence in distinguishing ASD from other delays, and 56% reported no/low confidence in formally diagnosing ASD. Of those residents who reported career plans in primary care, 92% indicated that further training and education about ASD is important/very important to their careers with 93% indicating that they moderately/very strongly feel that ASD concerns should fall within their scope of practice. For the residents in their last year of residency, 80% believed ASD concerns should fall within their scope of practice (regardless of career plans), but only 25% reported moderate/high levels of confidence in distinguishing ASD from other delays, and only 45% reported moderate/high levels of confidence in diagnosing ASD.

Conclusions: Pediatricians are the central figures within the medical home, which is increasingly functioning as the entry point for developmental and behavioral health intervention. In this capacity, enriching pediatric resident education through expanded training and experience in ASD detection and management will likely yield enhanced perceptions of care for providers and families alike.