OBJECTIVE. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. As part of a dedicated process of reexamining the structure of residency training in pediatrics, the American Board of Pediatrics sought information to better understand the influences, process, and sequencing of both residency program selection and career decision-making among residents.METHODS. All pediatrics resident physicians in all training programs in the United States and Canada (N ϭ 8290) received the survey as part of the general pediatrics in-training examination. The survey focused on exploring how and when pediatrics residents make career choices and assessed perceived flexibility of their individual pediatrics residency program.RESULTS. The response rate was 95%. Location was the most important factor in selecting a residency program for 42% of all residents. Almost half of the pediatrics residents planned to pursue fellowship training after residency, a proportion that changed little across the 3 training years (level 1: 47%; level 2: 49%; level 3: 47%). Those who planned to pursue a general pediatrics career (either with or without inpatient care) were more likely than those who intended to pursue fellowship training to report that lifestyle was the most important factor in their career choice (63% vs 21%).CONCLUSIONS. Not surprisingly, different priorities motivate pediatricians to pursue specific programs for training and specific career options. The finding that those with the highest priority regarding lifestyle are more likely to pursue generalist training has implications for the generalist workforce, because those persons may also be more likely to seek part-time employment. Lifestyle concerns may need to be addressed in subspecialty training and subsequent subspecialty careers to ensure a continued flow of residents into fellowship training. Pediatrics 2009;123:S26-S30 T HE DECISION-MAKING PROCESS of residents regarding their future career paths is believed to be associated with a variety of factors. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. Previous studies have attempted to examine potential predictors during medical school through residency. [1][2][3] It is likely that there are particular subgroups of residents for whom specific influences and experiences have greater influence than others.It is also unknown whether residents choose specific training programs because of their perceived flexibility, whether they desire additional flexibility in their training experiences, and whether such flexibility would have an affect on career choice and the decision to pursue subspecialty fellowship training.Residency training, with respect to duty hours, has changed considerably with the advent of the 80-hour workweek requirements. However, the fundamental structure of pediatrics programs, their mix of inpatient and outpatient care, and their degre...

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BACKGROUND AND OBJECTIVES: This article is the second of a 2-part series examining results regarding self-reported learning and practice change from the American Board of Pediatrics 2017 pilot of an alternative to the proctored, continuing certification examination, termed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds). Because of its design, MOCA-Peds has several learning advantages compared with the proctored examination.METHODS: Quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or the end-of-year survey (January 2018) and compose the analytic sample.RESULTS: Nearly all (97.6%) participating pediatricians said they had learned, refreshed, or enhanced their medical knowledge, and of those, 62.0% had made a practice change related to pilot participation. Differences were noted on the basis of subspecialty status, with 68.9% of general pediatricians having made a practice change compared with 41.4% of subspecialists.Within the 1456 open-ended responses about participants' most significant practice change, responses ranged widely, including both medical care content (eg, "care for corneal abrasions altered," "better inform patients about. . .flu vaccine") and nonspecific content (eg, providing better patient education, using evidence-based medicine, increased use of resources in regular practice). CONCLUSIONS: As a proctored examination alternative, MOCA-Peds positively influenced selfreported learning and practice change. In future evaluation of MOCA-Peds and other medical longitudinal assessments, researchers should study ways to further encourage learning and practice change and sustainability. WHAT'S KNOWN ON THIS SUBJECT: Maintenance of Certification Assessment for Pediatrics is a Web-based knowledge assessment developed by the American Board of Pediatrics as an alternative to an examination at a secure test center. Both the model and Web-based platform were developed with extensive input from practicing pediatricians in 2016.WHAT THIS STUDY ADDS: This article is the second of 2 articles in which results are reported from the Maintenance of Certification Assessment for Pediatrics 2017 pilot conducted with over 5000 pediatricians. We review learning and clinical practice change resulting from participation in this new longitudinal assessment format for continuing certification.

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