Keystones of Development

This article describes the creation of the Keystones of Development, a curriculum on parenting and early child development for residency programs. Following Kern's 6-step model of curriculum development, we first determined a need for pediatrician training on key facets of early cognitive, self-regulatory, and social-emotional development and the parenting behaviors that promote them. We also ascertained interest among pediatric residency directors, who reported a lack of available curricula. A multidisciplinary group identified 6 key domains of early development for inclusion in a new, animated, self-guided curriculum. We designed the curriculum to have 2 parts: the first providing expert information about the key domains of development, and the second demonstrating opportunities to promote those domains of development during well-child visits. Since the curriculum was piloted, it has been adopted by nearly all pediatric residency programs and nearly half the family residency programs in the U.S.

Objective This pilot outcome evaluation assesses the effectiveness of an online curriculum, the Keystones of Development, aimed at improving residents' knowledge, attitudes, and reported behaviors around promoting positive parenting and childhood development in well-child visits. Methods We used an explanatory mixed-methods approach, including a single-arm pre-posttest of intervention effects on self-reported behavioral outcomes (discussing, modeling, and praising) and secondary outcomes (knowledge, perceived barriers, attitudes, and self-efficacy). Following this, a subset of residents participated in in-depth interviews to describe participant responses to the intervention. Results The study was conducted at 8 pediatric residency programs across the United States with 67 pediatric residents (mean age = 29; 79% female; 57% PGY1). Within one month postintervention, there was a statistically significant increase in the behaviors that promote positive parenting: discussing (P < .01;d = 0.73) and modeling (P < .01;d = 0.61) but not praising (P = .05; d = 0.3). Significant changes in the secondary outcomes: knowledge (P < .01), perceived barriers, (P < .01), and retrospective self-efficacy (P < .01) were seen. Interviews revealed that integration of curriculum content into clinical practice was due to the relevance of the material to primary care and the modeling of how to apply in the clinical setting. Curriculum format, content, and clinical application helped participants weave recommendations into the well-child visit. Conclusions In this study, we demonstrated that the online curriculum, Keystones of Development, increased resident behaviors, knowledge, and self-efficacy, and decreased perceived barriers to promote parenting behaviors associated with improved child development outcomes in well-child visits. These findings were observed across participants demonstrating equal success regardless of demographic characteristics or study site.