Pilot testing of PREPARE for Autistic Adults: An autism training for residents designed with autistic adults

Context: Physicians rarely receive training in caring for autistic adults, resulting in low self-efficacy in meeting autistic adults’ needs. Partnering with autistic adults and family members of autistic adults, we developed a training for resident physicians called Promoting Residents’ Excellence in Patient-centered cARE (PREPARE) for Autistic Adults.

Objective: To pilot test feasibility, acceptability, appropriateness, and effectiveness.

Study Design and Analysis: In this single-group pre-test post-test pilot study, participants completed an autism knowledge assessment before and after the training. After the training, they also rated feasibility, acceptability, and appropriateness and completed qualitative interviews. Quantitative data were analyzed with descriptive statistics, and changes in autism knowledge were analyzed with Wilcoxon-signed rank tests. Qualitative interviews were analyzed using inductive thematic analysis.

Setting: Academic medical center.

Population Studied: Internal medicine, family medicine, and internal medicine/pediatrics residents.

Intervention: The training was delivered virtually over eight weeks and consisted of six pre-recorded lectures, six facilitator-led case studies, and two standardized patient encounters.

Outcome Measures: Implementation outcomes were evaluated with the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness measure. Autism knowledge was measured with a bespoke questionnaire.

Results: Fourteen residents consented to participate and N=11 completed the post-test. Feasibility, acceptability, and appropriateness were rated highly for the training as a whole and for the individual training components. Autism knowledge improved by a median of 11.8 points (p=0.015). Qualitative analysis revealed four themes: 1) Flexibility facilitates feasibility, 2) High-value experiences increase acceptability, 3) Other practicalities affecting implementation, and 4) It’s made me a better doctor. Five subthemes were also identified.

Conclusions: Our results suggest that PREPARE for Autistic adults is highly feasible, acceptable, appropriate and yields significant gains in autism knowledge. Next, we will make necessary refinements to the training and conduct a randomized waitlist-controlled study among residents measuring self-efficacy, attitudes and beliefs, and knowledge about providing care for autistic adults.