CORNET Card Study #1: Do You See What I See? Provider Confidence in Caring for Children With Special Health Care Needs

Objective: Understanding differences between trainee and faculty experience with and confidence caring for children with special health care needs (CSHCN) can inform pediatric resident education. Methods: Residents and faculty across the continuity research network (CORNET) reported on a consecutive series of 5 primary care encounters. Respondents answered questions about visit characteristics, patient demographics, and applied the CSHCN Screener. Respondents also reported on how confident they felt addressing the patient's health care needs over time. We dichotomized confidence at “very confident” versus all other values. We used logistic regression to describe the correlates of provider confidence managing the patient's care. Results: We collected data on 381 (74%) resident-patient and 137 (26%) attending-patient encounters. A higher proportion of attending encounters compared to resident encounters were with CSHCN (49% vs 39%, P < .05), including children with complex needs (17% vs 10%, P < .05). The odds of feeling “very confident” (AOR [95% CI]) was lower with increasing CSHCN score (0.61[0.51–0.72]) and was lower for resident versus attending encounters (0.39 [0.16–0.95]). Confidence was higher if the provider had previously seen that patient (2.07 [1.15–3.72]), and for well (2.50 [1.35–4.64]) or sick visits (3.18 [1.46–6.94]) (vs follow-up). Differences between residents and attending pediatricians regarding the relationship between confidence and visit characteristics for subsets of CSHCN are reported. Conclusion: All providers felt less confident caring for CSHCN; however, for certain needs, resident confidence did not increase with level of training. The data suggest potential educational/programmatic opportunities.