OBJECTIVE. Because of the increase in both the prevalence and complexity of chronic diseases in children, there is heightened awareness of the need for general pediatricians to be prepared to comanage their patients with chronic disorders with subspecialists. It is not known currently how well prepared general pediatricians believe themselves to be for these roles after residency training. This study was conducted to determine the perspectives of recently trained general pediatricians in practice regarding their decisions on residency choice, career choice, and adequacy of training.METHODS. A random sample of 600 generalists whose initial application for general pediatric certification occurred between 2002 and 2003 (4 -5 years out of training) and 600 generalists who applied for board certification between 2005 and 2006 and who were not currently enrolled in or had completed subspecialty training (1-2 years out of training) received a structured questionnaire by mail. The survey focused on decision-making in selection of residency programs, strength of residency training in preparation for clinical care, and scope of practice.RESULTS. The overall response rate was 76%. The majority of generalists reported that their residency training was adequate in most subspecialty areas. However, a large proportion of generalists indicated that they could have used additional training in mental health (62% [n ϭ 424]), sports medicine (51% [n ϭ 345]), oral health (52% [n ϭ 356]), and developmental/behavioral pediatrics (48% [n ϭ 326]). Most generalist respondents reported that they are comfortable comanaging cases requiring subspecialty care with a subspecialist. However, generalist respondents without local access to subspecialists were more likely to report that they are comfortable managing patients who require subspecialty care.CONCLUSIONS. The training of general pediatricians, and the needs for their adequate preparation to care for patients, should be a dynamic process. As the nature and epidemiology of pediatric care change, our educational system must change as well. Pediatrics 2009;123:S38-S43 T HE SCOPE AND manner of residency training and physician decision-making regarding career choice for pediatricians was last assessed systematically in 1995 as part of the Future of Pediatric Education II (FOPE II) Project. 1 However, that project relied mostly on expert opinion and small-scale, limited research studies to assess nationally the then-current educational programs. 2 Since the FOPE II Project, there have not been significant changes in the structure of pediatrics resident education. However, the prevalence of the types of patients encountered by pediatricians today is different from at the time of the FOPE II Project. Currently, pediatricians provide care to more children with chronic illnesses than in years past. 3 In addition, new technologies have created the need for pediatricians to be aware of new genetic and other types of recently discovered illnesses and conditions. 4 Because of the increase in ...

OBJECTIVES. Little is known regarding the factors influencing the decision to pursue pediatric subspecialty fellowship training and the timing of when such a decision is made. In addition, there is no information regarding whether the general pediatrics training received in residency is perceived as valuable by subspecialists. This study was conducted to characterize the strengths and weaknesses of residency and fellowship training from the perspective of recently trained pediatric subspecialists and to assess their current and future career goals and intended scope of practice. RESULTS. The overall response rate was 77%. More than half (54%) of the recently trained subspecialists would have shortened either their pediatric residency or fellowship training if given the opportunity, and 7% were unsure. More than one third of the respondents made the decision to pursue subspecialty training before the start of residency (36% [n ϭ 198]), whereas approximately half of them made this decision during the first (19% [n ϭ 106]) or second (27% [n ϭ 150]) year of residency.CONCLUSIONS. Many subspecialists would have been interested in modifications to their pediatric residency and fellowship training programs, which may reflect changing patterns of professional activities or the preferences of a younger generation of subspecialists. Given that a substantial proportion of subspecialists decide to pursue subspecialty training before or early in residency, greater flexibility in configuring some residency experiences to meet their career goals would be feasible. Pediatrics 2009;123:S44-S49 M OST PEDIATRIC SUBSPECIALISTS in practice in the United States have completed 3 years of general pediatrics residency training. A small number of trainees, who wish to combine training in pediatrics with another specialty or focus their future careers in subspecialty-oriented research, complete alternative training pathways that shorten the time spent in residency and allow for a more rapid transition to additional research training and subspecialty clinical experiences. 1 Little is known regarding the factors that influence the decision to pursue pediatric subspecialty fellowship training and the timing of when such a decision is made. Previous studies have identified research exposure during residency and academic career goals as important considerations to residents who are contemplating a subspecialist career. [2][3][4] In addition, there is no information regarding whether the general pediatrics training received in residency is perceived as valuable by subspecialists and if such training is viewed by some as simply a necessary prerequisite to enter subspecialty training. A better understanding of the utility of residency training from the perspective of subspecialists may help to guide efforts to modify the structure of residency training to provide the greatest possible relevance for pediatricians who undertake fellowship training.This study was conducted to characterize the strengths and weaknesses of residency and fellows...

No abstract

OBJECTIVE. Training for pediatric residents who intend to pursue fellowship differs little from training for residents who intend to practice general pediatrics. It is unknown how well residents who intend to pursue subspecialty training believe that residency prepares them for subspecialty fellowships or future careers. To characterize the strengths and weaknesses of residency training and the factors influencing subspecialty choice from the perspective of subspecialty fellows, we conducted a survey of current fellows on these issues. METHODS.A random sample of 1000 physicians who were entering their second or third year of fellowship in the United States in 2007 received a structured questionnaire by mail. The survey focused on decision-making in selection of residency and fellowship programs, strength of residency training in preparation for fellowship, and plans for future practice.RESULTS. The overall response rate was 81%. A majority of the fellows would not have shortened their general pediatrics residency before fellowship if given the option (64% [n ϭ 482]). However, more than half (52% [n ϭ 390]) of the fellows would have chosen a 2-year fellowship without research or scholarly activity over the current 3-year structure. Few current fellows believed they could have used any additional training in the areas of patient safety, coordination of care for children with complex illnesses, or patient communication.CONCLUSIONS. The finding that a large proportion of fellows would opt for shortened subspecialty training should prompt discussion and debate within the profession regarding the skills necessary for a pediatric subspecialist. Patient safety, physician-parent communication, and care coordination are emphasized primarily through informal training during residency. Although most clinicians believe themselves to be adequately prepared, research has identified gaps in clinician skills and understanding of these issues of great importance to patients and their families. Pediatrics 2009; 123:S31-S37 W ITH RARE EXCEPTIONS, pediatric subspecialists complete 3 years of fellowship training after pediatric residency. Training for residents who intend to pursue fellowship differs little from training for residents who intend to practice general pediatrics. Requirements for rotations, experiences, and competencies are similar for all residents, as prescribed by the Accreditation Council for Graduate Medical Education (ACGME). To the extent that differences exist, they would be principally in selection of subspecialty electives or, perhaps, in the type of patients seen in a continuity clinic. It is unknown how well residents who intend to pursue subspecialty training believe that residency prepares them for subspecialty fellowships or future careers.To characterize the strengths and weaknesses of residency training and the factors that influence subspecialty choice from the perspective of subspecialty fellows, we conducted a survey of current fellows on these issues. METHODS SampleThe American Board of Pedi...

Almost 1 in 8 pediatricians has suspended clinical care for > or =1 year, and a similar proportion of respondents were inactive at the time of our survey. Currently, all of these physicians may maintain both their licensure and board certification during these periods. The impact of clinical inactivity on patient care and patient safety is unknown.