Pediatric Residency Education: A Survey of the Future of Pediatric Education II FOPE II Project

1
Pediatric Residency Education A Survey of the
Future of Pediatric Education II (FOPE II)
Project

• Holly J. Mulvey, MA
• Ethan Alexander Jewett, MA

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The following organizations fundedthe FOPE II
Project and this survey

• American Academy of Pediatrics
• American Board of Pediatrics Foundation
• Association of Medical School Pediatric
  Department Chairmen
• Center for the Future of Children of the David
  and Lucile Packard Foundation
• Project MCJ379381 from the Maternal and Child
  Health Bureau

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Purpose of Survey

• Query program directors on the implementation of
  the new Residency Review Committee (RRC) Program
  Requirements that became effective
• on Feb. 1, 1997.
• Obtain feedback for the RRC and pediatric
  community on 5 key components of residency
  education.
• Solicit ideas about pediatric education in the
  21st century.

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Residency Review Committee (RRC)for Pediatrics

• Accredits pediatric residency programs under the
  direction of its parent organization, the
  Accreditation Council for Graduate Medical
  Education.
• RRC Program Requirements specify minimum
  requirements for accreditation.
• Program Requirements address core educational
  content, instructional activities,
  responsibilities for patient care and
  supervision, and program facilities.

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Methods

• 20-question survey, with both multiple-choice and
  open-ended questions.
• Sent to the 201 members of the Association of
  Pediatric Program Directors (APPD).
• 2 mailings in August and September 1998.
• Final response rate of 70.

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Limitations

• Findings were drawn exclusively from the
  subjective expertise, experience, and
  perspectives of residency program directors.
• Input from other stakeholders in the educational
  process, such as faculty and residents, was not
  solicited.
• Respondents may have chosen to emphasize the
  strengths, rather than the weaknesses, of their
  respective programs.

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Input Solicited on 5 Key Areas

• Time requirements for training in clinical
  settings
• Teaching of other competencies mandated by the
  pediatric RRC
• Practice settings
• Career development
• Pediatricians in the 21st century

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Teaching of other RRC Competencies

• Multicultural dimensions of health care
• Community-based experience
• Medical ethics
• Professional behavior
• Health care organization
• Financing

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Teaching of other RRC Competencies (cont.)

• Practice management
• Quality assessment/improvement
• Risk management
• Cost-effectiveness
• Medical information sciences
• Child advocacy

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Identified Proficiencies and Skills?
AMulticultrl BCommunity CEthics DProf
Behavr EHC Org FFinancing GPract Mgt HQual
Imprv IRisk Mgt JCost-effect KMd Info
Sci LAdvocacy
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Established Curricula?
AMulticultrl BCommunity CEthics DProf
Behavr EHC Org FFinancing GPract Mgt HQual
Imprv IRisk Mgt JCost-effect KMd Info
Sci LAdvocacy
12
Identified Both Proficiencies/Skills
andEstablished Curricula?
AMulticultrl BCommunity CEthics DProf
Behavr EHC Org FFinancing GPract Mgt HQual
Imprv IRisk Mgt JCost-effect KMd Info
Sci LAdvocacy
13
Quality of Resident Exposure in 6 Practice
Settings

• Private office-based practice for continuity
  clinic
• Private office-based practice for outpatient
  rotation
• Predominately managed-care practice
• Community clinics for continuity clinic
• Community clinics for outpatient rotation
• Hospital-based practice for continuity clinic

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Summary of Findings on the Quality of Resident
Exposure in Practice Settings

• Exposure excellent or satisfactory in
• private office-based practice (64) and
  community clinics (67)
• Exposure to managed-care practice in greatest
  need for improvement (18)
• No faculty development program for
  community-based pediatric generalist faculty (67)

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Adequacy of Patient Populations for Training
Residents in Inpatient and Outpatient Settings

• Inpatient Settings
• Adequate total numbers of patients seen (87)
• Adequate number of patients available per
  resident (88)
• Adequate variety of patients (92)
• Outpatient Settings
• Adequate total numbers of patients seen (91)
• Adequate number of patients available per
  resident (89)
• Adequate variety of patients (95)

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Conclusions

• Programs have been generally successful in
  implementing new RRC requirements.
• Programs have identified a need for further
  guidance in implementing some of the nonclinical
  competencies, such as financing and the
  multicultural dimensions of health care.

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Conclusions (cont.)

• Although required to teach these new
  competencies, many programs have not developed
  curricula based on a set of identified
  proficiencies/skills for each competency.
• Many programs do not measure/evaluate residents
  acquisition of the new competencies.

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What will be the primary challenges for
pediatricians in the 21st century?

• Remain the primary and most competent providers
  of pediatric care, despite the pressures of
  managed care and increasing competition from
  nonpediatrician providers.
• Maintain and enhance the role of the pediatrician
  as the best advocate for the health needs of
  children.
• Survive the difficulties posed by
  underreimbursement and other developments in
  health care financing.

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How could residency training programs prepare
pediatricians to meet these challenges?

• Provide broad, well-rounded training in all areas
  of pediatrics, so as to produce a confident,
  competent skilled pediatrician, who will be
  recognized as a superior care giver for children.
• Maintain exposure to competencies through a
  specific, standardized curriculum and structured
  educational experiences supported by strong
  evaluation methods.
• Increase emphasis on the importance of the
  psychosocial, legal, economic, ethical, and
  cultural aspects of care by expanding training in
  these areas.

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• Mulvey HJ, Ogle-Jewett EAB, Cheng TL, Johnson
  RL. Pediatric residency education. Pediatrics.
  2000 Aug106(2)323-329.