Design:  Resident and attending physicians received a pre-survey to assess knowledge about and comfort level with topics related to solid food introduction and food allergy. An educational intervention was performed in the form of a brief lecture and discussion during winter 2019.The same providers then completed an immediate post-survey comprised of the same knowledge and comfort level questions. There were 3 knowledge-based questions with discrete correct answers and 4 comfort level questions regarding knowledge using a 5-point scale (5-very confident, 3-somewhat confident, 1-not confident at all). This was initially done with a mixed group of residents (PGY1-3) and attendings; it was then repeated separately with just the new incoming intern class of 20 residents starting clinical duties in summer 2020. The initial group of residents and attendings received a 6-month post-survey comprised of the same questions (discrete knowledge and confidence) to gauge retention.

Main Findings:  Among the mixed group of residents (PGY1-3) and attendings in the initial PDSA cycle, correct answers to discrete knowledge questions improved from 93 to 97%, while the majority of confidence levels regarding knowledge about various solid food and food allergy related topics also increased to 4 and 5 ratings. At 6 months, this group of providers showed high retention of both discrete knowledge and the majority of people still rated confidence about these topics at either a 4 or 5. Among new interns in the second PDSA cycle, correct responses to knowledge questions improved from 89% to 98%. The majority of these first-year residents initially rated confidence levels of 1, 2, or 3 regarding knowledge about solid food and food allergy related topics; this improved to 4 and 5 in the majority of interns after the initial educational intervention.

Impact on Practice:  Education about current guidelines regarding allergenic solid foods and food allergy was beneficial for general pediatric resident and attending physicians. Both initial and subsequent PDSA cycles of this QI educational intervention showed increased knowledge and comfort with topics relating to introduction of solid foods and food allergy. This, in theory, allows for accurate counseling of families by resident and attending physicians about solid food introduction and food allergy. Next steps include retention post-surveys at 12 months for the initial PDSA cycle group of providers and at 6 and 12 months for the second PDSA cycle group of interns, with repeat educational interventions as needed.

Submitted by Tonia Afshan, MD MPH; Courtney Cotter, DO; Miranda Hillard, MD; Theodore Kelbel, MD from Spectrum Health/Michigan State University/Helen DeVos Children's Hospital Pediatrics Residency Program