Evaluating the Keystones of Development - An Online Curriculum for Residents to Promote Positive Parenting in Primary Care

Blair Hammond, Aliza W. Pressman, Carrie Quinn, Mariel Benjamin, Hiershenee B. Luesse, Leora Mogilner

Research output: Contribution to journalArticlepeer-review


Objective: This pilot outcome evaluation assesses the effectiveness of an online curriculum, the Keystones of Development, aimed at improving residents’ knowledge, attitudes, and reported behaviors around promoting positive parenting and childhood development in well-child visits. Methods: We used an explanatory mixed-methods approach, including a single-arm pre-posttest of intervention effects on self-reported behavioral outcomes (discussing, modeling, and praising) and secondary outcomes (knowledge, perceived barriers, attitudes, and self-efficacy). Following this, a subset of residents participated in in-depth interviews to describe participant responses to the intervention. Results: The study was conducted at 8 pediatric residency programs across the United States with 67 pediatric residents (mean age = 29; 79% female; 57% PGY1). Within one month postintervention, there was a statistically significant increase in the behaviors that promote positive parenting: discussing (P < .01;d = 0.73) and modeling (P < .01;d = 0.61) but not praising (P = .05; d = 0.3). Significant changes in the secondary outcomes: knowledge (P < .01), perceived barriers, (P < .01), and retrospective self-efficacy (P < .01) were seen. Interviews revealed that integration of curriculum content into clinical practice was due to the relevance of the material to primary care and the modeling of how to apply in the clinical setting. Curriculum format, content, and clinical application helped participants weave recommendations into the well-child visit. Conclusions: In this study, we demonstrated that the online curriculum, Keystones of Development, increased resident behaviors, knowledge, and self-efficacy, and decreased perceived barriers to promote parenting behaviors associated with improved child development outcomes in well-child visits. These findings were observed across participants demonstrating equal success regardless of demographic characteristics or study site.

Original languageEnglish
Pages (from-to)151-159
Number of pages9
JournalAcademic Pediatrics
Issue number1
StatePublished - 1 Jan 2022


  • early child development
  • keystones of development
  • online curriculum
  • pediatric resident education
  • positive parenting


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