Fostering community of practice: International complex care collaborative

Over the past decade, dedicated complex care fellowship programmes have emerged to prepare paediatric trainees to meet the unique clinical care needs of children with medical complexity (CMC). There is significant heterogeneity in the length, structure and curriculum of these training programmes, often based on local resources. Additionally, as new, non-accredited programmes with relatively few learners, often one fellow per year, their learners and programme directors lack a community to share best practices.

In 2021, we developed an international complex care collaborative of learners and programme directors, to serve as an academic community. We designed a framework for the collaborative based in situated learning theory, which identifies learning as a social process occurring through participation in a community of practice, defined as a group of people who share common interests and regularly connect to discuss mutually recognised challenges.¹

The collaborative curriculum consists of quarterly 2-hour virtual seminars grounded in the holistic care of CMC. The seminars, co-designed by programme directors and family caregivers of CMC, include (1) a clinical topic presented by members of a complex care interprofessional team and family partners, (2) a relevant clinical case presentation by a learner, (3) interactive small-group learning, and 4) a large-group discussion centred on professional development topics (i.e. developing communication, collaboration, or leadership skills in complex care).

Small-group breakout activities allow learners to explore aspects of patient care with their peers, including personal and institutional practice variations. A concurrent breakout meeting for programme directors was incorporated, to share challenges and opportunities related to programme design. Immediately following each seminar, learners and programme directors received an electronic feedback survey seeking suggestions for improvement.

The collaborative expanded from three programmes in its first year to seven programmes across Canada and the United States in 2024, with an average attendance of 11 dedicated complex care learners per seminar.

Learners appreciated the opportunity to network with trainees external to their programme, highlighting breakout activities as an important opportunity to learn about different approaches to clinical care (e.g. decision-making around enteral tube placement, medication management and prescribing practices). Additionally, while the original focus was on creating a community of practice for learners, programme directors also identified the importance of a community of practice. Programme directors found the dedicated breakout meetings to be a valuable space to share teaching and assessment practices across a global network and discuss implementation challenges. Based on fellow feedback, an annual in-person networking event for learners was also instituted at an academic paediatric conference. To support the sustainability and equity of the learning model, the responsibility for facilitating each session has rotated between programmes.

We learned that the international complex care fellowship collaborative is a feasible model, valued by learners and programme directors. This model may be replicated for other emerging training programmes, to optimise learning and networking opportunities through a community of practice.

The authors have no conflicts of interest due to financial and personal relationships that could potentially bias their work to disclose.