Linking Process to Outcome: Are We Training Pediatricians to Meet Evolving Health Care Needs?

Abstract

The Residency Review and Redesign in Pediatrics (R 3 P) Project began in 2005 and will have been completed in 2009. The purpose was to conduct a comprehensive reassessment of general pediatric residency education. The project convened 3 major colloquia supplemented by numerous meetings of an R 3 P committee and by surveys of residents, subspecialty fellows, and generalist and subspecialty practitioners. A principal conclusion was that resident learning opportunities should be more flexibly directed toward the variety of career choices available to pediatricians. Another conclusion was that reasonable expectations for residency education are most likely if learning is regarded as an integrated continuum, beginning in medical school and continuing throughout a career in practice. The R 3 P Committee declined to create a list of recommendations for immediate changes in residency education; instead, it recommends that changes be based on evidence of education outcomes that are important to improving the health of children, adolescents, and young adults. Pediatrics 2009;123:S1-S7 D ESPITE RAPID AND ongoing changes in the environment in which residency education occurs, 30 years have passed since the last comprehensive examination of general pediatric residency education by the pediatric community as a whole. 1 In 2000, the Future of Pediatric Education (FOPE) II Project made important suggestions for modification of residency education, 2 and the Accreditation Council for Graduate Medical Education (ACGME) considers these suggestions along with other proposals when its review committee for pediatrics periodically revises the program requirements for pediatric residency education. 3 However, the FOPE II Project was not able to delve into fundamental aspects of the purpose and scope of pediatric residency training, and that is not the function of periodic revisions of ACGME program requirements. Given the magnitude of changes in the context in which residency education occurs, a thorough reappraisal is in order. Thirty years have seen primary care pediatric practice move from preoccupation with treatment of common infectious diseases to greater emphasis on the management of well-child care, behavioral and developmental aspects of growth and development, and the supervision of care for the child with special health care needs. [4][5][6] The structure of pediatric health care has also changed. The small, private office caring for members of a relatively homogeneous community has been replaced with a fragmented "system" in which patients and families move in and out of a complicated web of hospitals, practice networks, insurance plans, home health services, laboratory and imaging units, and various care settings. The racial, ethnic, and financial demographics of children, adolescents, and young adults and their families are different. [4][5][6] Scientific advances in understanding the molecular, chemical, and genetic nature of health and illness move at such a rapid pace that "up-to-date" care can easily lag behin...

Validating objectives and training in Canadian paediatrics residency training programmes

“…We recognize that the competencies required of paediatricians are constantly evolving and may be different for different types of paediatricians. This observation is in keeping with the Residency Review and Redesign project (R 3 P) participants conclusions in the US that residency training should be tailored to meet the diverse career needs of individuals who choose to care for disparate patients, in diverse settings, with a variety of health-related needs ( Jones et al 2009;Leslie 2009). Residency training programmes should allow flexibility and take a patient-based and familycentred perspective, tailoring training to the diverse and emerging health care needs of the paediatric population ( Jones et al 2009;Leslie 2009).…”

“…This observation is in keeping with the Residency Review and Redesign project (R 3 P) participants conclusions in the US that residency training should be tailored to meet the diverse career needs of individuals who choose to care for disparate patients, in diverse settings, with a variety of health-related needs ( Jones et al 2009;Leslie 2009). Residency training programmes should allow flexibility and take a patient-based and familycentred perspective, tailoring training to the diverse and emerging health care needs of the paediatric population ( Jones et al 2009;Leslie 2009). Forrest et al's (1999) survey of the referral practices of general paediatricians to specialists suggested that educators should ensure that the 50 most commonly referred conditions (which were similar to the competencies surveyed in this study) are emphasized during paediatric residency training.…”

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

“…Instead of recommending general changes in the number of months in a particular setting or the required numbers of continuity clinics for all residency training programs, those participating in the R 3 P Project embraced encouraging diverse innovative approaches to improving education. 3,60 In this endeavor, we can profit from the experiences of internal medicine and family medicine, because both fields are going through a similar methodology to achieve improvements in their residency training programs. [61][62][63][64][65] It is our hope that creative approaches fostered under this process will enhance learning, improve patient and family outcomes, and lead to more efficient, effective pediatric care.…”

Innovation in Pediatric Education: Promoting and Undergoing Transformational Change

“…1 To that end, the ABP began funding the Initiative for Innovation in Pediatric Education (IIPE) program in 2009 with the purpose of stimulating and facilitating innovation in pediatric education. 2 As a program, the IIPE comprised a director and a project support team who answered to the IIPE oversight committee.…”