Evaluating the effectiveness of an educational curriculum on physician comfort in screening and managing eating disorders in the outpatient pediatric setting.

BACKGROUND

Eating disorders are among the most prevalent chronic conditions affecting adolescents, yet remain underdiagnosed in outpatient pediatric settings. Physician discomfort with screening and management contributes to this gap, particularly in underserved communities. This study evaluated whether a structured educational curriculum paired with an EMR-integrated clinical decision support tool improves physician comfort with eating disorder screening and management, and increases screening behavior, in an outpatient pediatric clinic.

METHODS

This pre/post study (IRB CHLA-24-00118) was conducted at a CHLA AltaMed outpatient pediatric clinic. Physicians completed surveys at baseline, three months, and six months following implementation of the curriculum and screening tool. Comfort was self-rated on a 1-10 scale across three domains: screening for eating disorders, managing anorexia nervosa/restrictive eating disorders, and managing binge eating disorders. Of 35 enrolled physicians, 11 matched pairs completed both the baseline and six-month surveys and were included in the primary analysis. Wilcoxon signed-rank tests were used to assess change, with Hodges-Lehmann median estimates and bootstrap 95% confidence intervals.

RESULTS

Physician comfort improved significantly across all three domains (all p < 0.05), with a median change of +3.0 points each: screening comfort rose from 5.0 to 8.0 (p = 0.0010), anorexia/restrictive eating disorder management comfort rose from 3.0 to 6.0 (p = 0.0164), and binge eating management comfort rose from 2.0 to 7.0 (p = 0.0090). Self-reported screening rates increased from a median of 5% to 45% of patients (+40 percentage points; 95% CI 10-60; p = 0.0039). The percentage of patients screening positive did not change significantly (p = 0.0625), likely reflecting a floor effect. At six months, 65% of physicians had used the EMR-integrated screening tool and 87% rated the curriculum as beneficial.

CONCLUSION

A structured educational curriculum combined with an EMR-integrated screening tool was associated with significant improvements in physician comfort and self-reported screening behavior for eating disorders in an outpatient pediatric setting. These findings support the feasibility of low-resource, locally developed interventions to close a persistent gap in physician training.