Setting A Course For Pediatric Training

Ruzanna Harutyunyan's picture
Setting A Course For Pediatric Training

The face of pediatric medicine is changing. Beyond new technology, treatments and vaccines, more children than ever before are requiring care for chronic diseases and more families also are seeking pediatricians who have expertise in specialty areas such as sports medicine and mental health.

But are future pediatricians getting the training they need to meet the demands of the changing world of medicine, as well as the needs of their patients?

Although medical training has been adapted to educate trainees about new diseases and therapies, the fundamentals of the training process in pediatrics have remained relatively unchanged during the past decade.

Four studies led by the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan C.S. Mott Children’s Hospital finds recently trained pediatricians and pediatricians-in-training agreed that a one-size-fits-all approach to education in pediatrics may no longer be the right course of action. The studies are set to appear in November Pediatrics supplement

Many physicians-in-training who took part in the studies noted a desire for more instruction in mental health, outpatient specialty care, oral health, sports medicine and developmental-behavior health. Few, however, felt they needed additional training in patient safety, patient communication and coordination of care for children with complex illnesses, despite studies that have pointed to the contrary.

“We need to make sure that we are educating physicians in the new millennium in a way that is not only responsible, but also responsive to the changing needs of medicine and our patients and their parents,” says lead author of the studies Gary L. Freed, M.D., MPH, chief of the Division of General Pediatrics and director of the CHEAR Unit at Mott.

“In order to meet those needs, there must be a balance in the workforce between general pediatricians and specialty pediatricians who focus their careers on a specific disease. But to ensure that happens, we first need to understand what makes people want to go into pediatrics and how they select particular training programs.”

To take a closer look at medical training for future pediatricians, the studies asked general pediatric residents, pediatric fellows, and recently trained general and subspecialty pediatricians about their decisions to choose certain residency or fellowship programs and career paths in pediatric subspecialties.

The studies show:


* Location matters. The majority of pediatric residents, fellows and subspecialists say they selected their residency or fellowship program based on its location.

* Structured hours/lifestyle and interest in a specific disease/patient population were the two most important factors in physicians’ decisions to pursue a particular career path in pediatrics.

* Fifty-four percent of recently trained pediatric subspecialists say they would have shortened either their pediatric residency or fellowship training, if given the opportunity

* Half of the respondents made the decision to pursue subspecialty training in the first or second year of residency, while 36 percent decided prior to residency training

* Fifty-two percent of pediatric fellows would have selected a two-year fellowship without research training, if it were offered.

Training and decision-making related to a physicians’ career choice in pediatrics was last assessed in1995 as part of the Future of Pediatric Education II (FOPE) project. Since then, there have been significant changes in the structure of pediatric resident education, medical technology, and the prevalence of the children with chronic illnesses.

The new findings from the four studies provide important insight into the future of pediatric workforce. As Freed notes, the past decade has seen an increase in more pediatricians pursuing careers in subspecialty areas as oppose to primary care in pediatrics. The findings also point toward the need to adapt medical training in pediatrics to ensure a balanced pediatric workforce in the future.

“We need to take a closer look at how we’re educating our physicians and determine the proper balance of that content,” says Freed, the Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery at the U-M Medical School. “Do we teach them more about issues related to mental and behavioral health, and do we provide more training in an outpatient setting since pediatric care is increasingly being delivered there? These are all important questions to address to ensure our future pediatricians are prepared to handle those issues.”

Already, the American Board of Pediatrics is working with other pediatric organizations across to the country to launch a new medical training program. This project will allow medical education sites to experiment with new training structures to adequately prepare future physicians to care for patients and their families as the field of pediatrics evolves.

“The challenge has been, and will continue to be, to ensure excellence of care across a broad spectrum of clinical areas while preserving a measure of flexibility relative to the individual interests and needs of each trainee,” says Freed.

Methodology: For the studies, the researchers used a database of physicians maintained by the American Board of Pediatrics to select groups of general pediatric residents, pediatric fellows, and recently trained general and subspecialty pediatricians to participate in the studies. Each study sent its own questionnaire via mail to a specific group of either trainees or recently trained pediatricians.