The University of Massachusetts Medical Center Office-based Continuity Experience: Are We Preparing Pediatrics Residents for Primary Care Practice?

Abstract

ABSTRACT. Objective. Surveys of residency graduates and employers have suggested that residency programs do not prepare residents well for practice. Since 1988, pediatric residents at the University of Massachusetts have been paired one-on-one with an office-based pediatrician for their 3-year continuity experience. This survey was conducted to determine if graduates of such a program are prepared to enter pediatric practice.Methodology. Graduates of the program from 1991 through 1995 who entered primary care practice were surveyed about their preparedness for practice. The questionnaire was also sent to the residents' first employers. The 32 questions were directed to overall sense of preparedness, ability to manage the pace of practice, common illnesses, common behavior problems, anticipatory guidance, office management, and subspecialty problems.Results. Data from all 25 residents who entered practice and the employers of 20 of the 25 residents were obtained and analyzed. Both groups rated overall resident preparedness to be "well-prepared" or "very wellprepared" and gave high scores on working at the pace of practice, diagnosing and treating common illnesses, diagnosing and treating common behavior problems, and providing anticipatory guidance. Areas in which residents were considered to be less well-prepared included anticipatory guidance about nutrition, managing problems by telephone, office management, gynecology, and orthopedics.Conclusions. The results suggest that continuity experiences in office practices are associated with preparation for the pace and types of visits that occur commonly in primary care practice, abilities which previous surveys of residency alumni and employers have found lacking. Some areas may benefit from a formal curriculum which may be implemented in the office practice, at the medical center, or at both sites. Preceptors may benefit from faculty development and continuing medical education that is directed not only at teaching skills but also at content areas which were not addressed in their own residencies. Pediatrics 1997;100(4). URL: http://www.pediatrics.org/ cgi/content/full/100/4/e2; education, medical, graduate; preparedness for practice; internship and residency; pediatrics/education; physicians; evaluation studies; faculty, medical; health maintenance organizations; questionnaires.ABBREVIATIONS. AAP, American Academy of Pediatrics; UMMC, University of Massachusetts Medical Center; HMO, health maintenance organization; DBP, developmental and behavioral pediatrics.

Validating objectives and training in Canadian paediatrics residency training programmes

“…These findings are similar to those of previous Canadian studies (Macnab et al 1998;Veale et al 1999 Validating paediatric objectives and training e141 multiple other US studies (Camp et al 1997;Roberts et al 1997;Mulvey et al 2000;Blumenthal et al 2001;Blendon et al 2002;Garfunkel et al 2005;Freed et al 2009aFreed et al , 2009bFreed et al , 2009cFreed et al , 2009dLeslie 2009). Lieberman and Hilliard (2006) found that paediatricians certified in Canada between 1999 and 2003 had received excellent training in most paediatric subspecialties and felt adequately prepared for their careers.…”

What Can Data Tell Us About the Quality and Relevance of Current Pediatric Residency Education?

“…26,29 Studies published in the early 1990s that targeted graduates of pediatrics programs and directors of managed care companies decried a lack of preparation for primary care pediatrics practice. [30][31][32][33][34][35][36][37][38] Most research conducted over the last decade has focused on specific topical areas rather than pediatrics residency training in its entirety. Generalists have reported discomfort managing depression, 39,40 nutrition, 41 in-office gynecology, 41 and certain areas of developmental/ behavioral pediatrics (ie, behavior problems, learning disabilities, sleep, anxiety).…”

“…47 Practical aspects of ambulatory care including patient scheduling, telephone management, and cost-effectiveness are areas of relative weakness. 30,41 Changes in residency training over the last decade seem to have improved residents' self-reported preparation for assessing community needs, 48,49 participating in child advocacy efforts, 49,50 and pursuing subspecialty training. 49 The articles by Freed and colleagues in this supplement add to this nascent literature.…”

What are we preparing them for? Development of an inventory of tasks for medical, surgical and supportive specialties

“…Although several studies have investigated how well recently registered specialists felt prepared for clinical practice, none of them covered the full scope of independent practice. Moreover, these studies focused mainly on competencies related to the role of medical expert and relied on a variety of insufficiently validated outcome measures (Liebelt et al 1993;Lenton et al 1994;Roberts et al 1997;Beckett et al 2006;Benstead 2006;Card et al 2006;Lieberman & Hilliard 2006). To remedy the lack of research data and to accommodate the shift from input-oriented to output-oriented training, it has been advocated that a systematic approach to programme evaluation be designed that is uniformly applicable to all PGME programmes (Higgins et al 2005;Musick, 2006).…”