Food allergy education improves first-year pediatric residents’ confidence, comfort level

First-year pediatric residents may benefit from learning about introducing young children to allergenic solid foods, according to a study presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“Traditionally, pediatricians have advised delayed introduction of allergenic solid foods, such as peanut, for many years. Over the past decade or so, research has shown that this practice may have contributed to a rise in food allergy,” Tonia Afshan, MD, MPH, an allergy/immunology fellow physician with University of Wisconsin Hospital and Clinics, said during her presentation.

The researchers hypothesized that first-year pediatric resident physicians may have gaps in knowledge and comfort level about food allergies as guidelines have shifted toward early introduction of common allergenic foods.

Researchers surveyed a new class of 20 first-year pediatric residents at a large tertiary pediatric care center with three questions about discrete knowledge and four questions about comfort level related to the topics of general solid food introduction, allergenic solid food introduction, food allergy, and signs and symptoms of allergic reactions.

The questions about comfort level used a 5-point scale, with scores of 5 indicating the respondent was very confident, 3 being somewhat confident, and 1 indicating no confidence at all.

The residents took the survey and then participated in a lecture and discussion about food allergies. After that, they took the survey again. Approximately 1 year later, the residents took the same survey a third time.

“The presurvey showed that discrete knowledge even before the intervention was fairly high, with 89% of participants answering the knowledge questions correctly. However, there was significant discomfort with all topics,” Afshan said.

Most of the respondents said they were somewhat confident or less about general solid food introduction, allergenic solid food introduction, food allergy and allergic reactions.

After the lecture and discussion, however, 95% of the participants answered the questions correctly. Confidence levels improved as well, with no scores of 1 or 2. Also, most rated their comfort levels at 4 or 5 across all the topics.

The respondents maintained their discrete knowledge a year later, but confidence levels waned, particularly in food allergy.

“While the majority of participants still rated moderate or higher confidence across topics, no participants chose ‘very confident’ for the topics of food allergy or allergic reaction at the 12-month mark,” said Afshan.

Compared to the results of the post-intervention survey, the researchers added, more of the respondents rated their comfort and confidence at a 4 or 5 level over a 3 when it comes to general solid food introduction. More of the respondents rated their confidence and comfort at a 4 than at a 3 for allergic reactions as well.

“This is likely due to the natural gains in confidence and clinical competence after a year of residency training, which was not measured by this project,” Afshan said.

According to the researchers, these findings show that education about solid food introduction and its relation to food allergy can provide initial benefits for new pediatric physicians. The researchers also recommend that future Plan-Do-Study-Act cycles could incorporate mock clinical scenarios as well as repeated educational refreshers on these topics.