OBJECTIVE. Because of the increase in both the prevalence and complexity of chronic diseases in children, there is heightened awareness of the need for general pediatricians to be prepared to comanage their patients with chronic disorders with subspecialists. It is not known currently how well prepared general pediatricians believe themselves to be for these roles after residency training. This study was conducted to determine the perspectives of recently trained general pediatricians in practice regarding their decisions on residency choice, career choice, and adequacy of training.METHODS. A random sample of 600 generalists whose initial application for general pediatric certification occurred between 2002 and 2003 (4 -5 years out of training) and 600 generalists who applied for board certification between 2005 and 2006 and who were not currently enrolled in or had completed subspecialty training (1-2 years out of training) received a structured questionnaire by mail. The survey focused on decision-making in selection of residency programs, strength of residency training in preparation for clinical care, and scope of practice.RESULTS. The overall response rate was 76%. The majority of generalists reported that their residency training was adequate in most subspecialty areas. However, a large proportion of generalists indicated that they could have used additional training in mental health (62% [n ϭ 424]), sports medicine (51% [n ϭ 345]), oral health (52% [n ϭ 356]), and developmental/behavioral pediatrics (48% [n ϭ 326]). Most generalist respondents reported that they are comfortable comanaging cases requiring subspecialty care with a subspecialist. However, generalist respondents without local access to subspecialists were more likely to report that they are comfortable managing patients who require subspecialty care.CONCLUSIONS. The training of general pediatricians, and the needs for their adequate preparation to care for patients, should be a dynamic process. As the nature and epidemiology of pediatric care change, our educational system must change as well. Pediatrics 2009;123:S38-S43 T HE SCOPE AND manner of residency training and physician decision-making regarding career choice for pediatricians was last assessed systematically in 1995 as part of the Future of Pediatric Education II (FOPE II) Project. 1 However, that project relied mostly on expert opinion and small-scale, limited research studies to assess nationally the then-current educational programs. 2 Since the FOPE II Project, there have not been significant changes in the structure of pediatrics resident education. However, the prevalence of the types of patients encountered by pediatricians today is different from at the time of the FOPE II Project. Currently, pediatricians provide care to more children with chronic illnesses than in years past. 3 In addition, new technologies have created the need for pediatricians to be aware of new genetic and other types of recently discovered illnesses and conditions. 4 Because of the increase in ...

Regulatory organizations have recently emphasized the importance of structuring graduate medical education around mastery of core competencies. The difficulty is that core competencies attempt to distill a range of professional behaviors into arguable abstractions. As such, competencies can be difficult to grasp for trainees and faculty, who see them as unrelated to the intricacies of daily patient care. In this article, the authors describe how two initiatives are converging in a way that should make competencies tangible and relevant. One initiative is based on the idea that competencies will be more meaningful if trainees understand specifically how they relate to important professional activities in their own specialty. The authors suggest that there is a dyadic relationship between competencies and major professional activities in pediatric medicine. They also suggest that these relationships should be discussed as part of the process by which trainees are entrusted to perform clinical activities without direct supervision. The other initiative proposes to construct narrative milestones that provide a picture of what progression toward mastery of core competencies might look like. Together, the authors argue, these two initiatives should illuminate the core competencies by providing relevant clinical context and valuable educational substance.