An Interactive ADHD Curriculum using a Flipped Classroom Model: Implementation with Pediatric Practitioners in Nigeria: An Abstract from Akron Children’s Hospital Resident and Fellow Academic Day

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral disorder characterized by inattention, hyperactivity, and/or impulsivity resulting in academic, social, or emotional functional impairments. The prevalence of ADHD in children and adolescents is 7.6-8.8% in Nigeria.1-2 Currently, ADHD training during pediatric residency in Nigeria is limited, and ADHD is often managed by psychiatrists, which limits access to care in primary care settings.3 Therefore, new training opportunities are needed to allow pediatricians in Nigeria to provide care for this common childhood diagnosis. We aimed to train pediatric residents and pediatricians in Lagos, Nigeria, to provide primary-level ADHD care, thereby improving patient access to ADHD diagnosis and management. Specifically, we evaluated the effect of the ADHD curriculum on learners’ knowledge, self-efficacy, and attitudes about ADHD diagnosis and management; skills in teaching families behavioral interventions for ADHD; and intent to change practice. We offered the ADHD curriculum to pediatric residents at two institutions and pediatricians in Lagos, Nigeria. We utilized a flipped classroom model to deliver the educational content. First, participants reviewed online modules asynchronously; these were case-based and covered ADHD diagnosis, differential diagnoses and co-morbidities, brief behavioral intervention (BBI) for families, school interventions, and medication management. Four to six weeks later, we held two virtual live sessions involving case-based discussions and role plays. During the first live session, case scenarios were used to teach ADHD diagnosis, considering differentials and co-morbidities. The second live session included case-based discussions on ADHD medication management and school interventions, and we used role plays to teach BBI. To evaluate the impact of the curriculum, we collected participant pre- and post- intervention data on knowledge, self-efficacy, and attitudes on a 5-point Likert scale, and intent to change practice using REDCap. We used a BBI checklist completed by participants to evaluate skills in implementing this intervention. We analyzed data using descriptive statistics and paired t-tests to assess changes in pre- and post-training composite scores. Fifty-seven participants completed the pre-training survey, and 41 (72%) completed the post-training survey. Participants demonstrated significant improvement in overall knowledge, self-efficacy in diagnosing and managing ADHD, and attitude toward accessing school accommodations (Table 1). Pre-intervention, 31.7% of participants assessed and diagnosed most or all ADHD cases, compared to 95.1% intending to do so afterward. Also, 31.8% of participants managed the less complicated cases or most cases with occasional consultation pre-intervention, compared to 83% intending to do so during post-intervention. Participants who practiced BBI in role plays demonstrated most skills included on the BBI checklist (Figure 1). We designed a curriculum for environments with limited access to ADHD care in primary healthcare settings. Participants demonstrated improved knowledge and self-efficacy in ADHD diagnosis and management, and intent to change practice. Limitations such as inadequate time for BBI role plays and post-training attrition were observed. Next steps include assessing participants’ change in practice, including enablers and barriers, and expanding the curriculum to other similarly resourced settings.