Training Gaps for Pediatric Residents Planning a Career in Primary Care: A Qualitative and Quantitative Study

Abstract

Background Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. Objectives To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. Methods Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003–2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from “not at all well prepared” to “extremely well prepared” for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders. Results Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence. Conclusions Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.

Individualisation of resident education through pathways and longitudinal experiences

“…Accreditation Council for Graduate Medical Education (ACGME) requirements for paediatric programmes mandate individualisation of resident education. Graduates of paediatric residencies commonly note specific areas of paediatric care as important but not adequately covered in training, supporting the need for more career‐focused training during residency . We aimed to address both of these issues simultaneously as we enhanced our curriculum.…”

Transition Care: Future Directions in Education, Health Policy, and Outcomes Research

“…9 Recent graduates of pediatric residency programs cite gaps in training regarding chronic disease management. 10 Further, 33% of programs did not provide any education about the transition from pediatric to adult care. 11 Although the Accreditation Council for Graduate Medical Education Next Accreditation System (NAS) Common Program Requirements refers to competencies in “transition,” this is regarding the transfer of patients from different levels of care and team handoffs, not specifically YSHCN.…”

A Longitudinal Career-Focused Block for Third-Year Pediatrics Residents

“…12 Needs assessment for the primary care experience was based on feedback from program graduates and focus group interviews with pediatricians from 8 different pediatrics practices in Colorado. 3 In designing the curriculum, we developed a list of entrustable professional activities (EPAs) 13 that comprise the essential skills required for primary care pediatrics (B O X 1). The EPAs were vetted by our primary care faculty, using a Delphi approach, 14 and served as the foundation for the primary care CFE.…”

“…Although most graduating residents are able to function independently, their clinical experience during training may be too dependent on chance exposures, with resulting knowledge gaps. [2][3][4] Finally, while educators aim to equip graduating residents to function as lifelong learners, the learning curve they experience on entry into practice may be unnecessarily steep. These concerns are broadly shared, and the Accreditation Council for Graduate Medical Education's (ACGME's) new requirements for training in pediatrics that went into effect in July 2013 call for 6 months of career-focused mentored training, along with continued emphasis on individual learning plans.…”