Recently Trained Pediatric Subspecialists: Perspectives on Training and Scope of Practice

Abstract

OBJECTIVES. Little is known regarding the factors influencing the decision to pursue pediatric subspecialty fellowship training and the timing of when such a decision is made. In addition, there is no information regarding whether the general pediatrics training received in residency is perceived as valuable by subspecialists. This study was conducted to characterize the strengths and weaknesses of residency and fellowship training from the perspective of recently trained pediatric subspecialists and to assess their current and future career goals and intended scope of practice. RESULTS. The overall response rate was 77%. More than half (54%) of the recently trained subspecialists would have shortened either their pediatric residency or fellowship training if given the opportunity, and 7% were unsure. More than one third of the respondents made the decision to pursue subspecialty training before the start of residency (36% [n ϭ 198]), whereas approximately half of them made this decision during the first (19% [n ϭ 106]) or second (27% [n ϭ 150]) year of residency.CONCLUSIONS. Many subspecialists would have been interested in modifications to their pediatric residency and fellowship training programs, which may reflect changing patterns of professional activities or the preferences of a younger generation of subspecialists. Given that a substantial proportion of subspecialists decide to pursue subspecialty training before or early in residency, greater flexibility in configuring some residency experiences to meet their career goals would be feasible. Pediatrics 2009;123:S44-S49 M OST PEDIATRIC SUBSPECIALISTS in practice in the United States have completed 3 years of general pediatrics residency training. A small number of trainees, who wish to combine training in pediatrics with another specialty or focus their future careers in subspecialty-oriented research, complete alternative training pathways that shorten the time spent in residency and allow for a more rapid transition to additional research training and subspecialty clinical experiences. 1 Little is known regarding the factors that influence the decision to pursue pediatric subspecialty fellowship training and the timing of when such a decision is made. Previous studies have identified research exposure during residency and academic career goals as important considerations to residents who are contemplating a subspecialist career. [2][3][4] In addition, there is no information regarding whether the general pediatrics training received in residency is perceived as valuable by subspecialists and if such training is viewed by some as simply a necessary prerequisite to enter subspecialty training. A better understanding of the utility of residency training from the perspective of subspecialists may help to guide efforts to modify the structure of residency training to provide the greatest possible relevance for pediatricians who undertake fellowship training.This study was conducted to characterize the strengths and weaknesses of residency and fellows...

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

“…There is a range of opinions about the numbers of pediatricians needed for the future. 24-26 R 3 P conversations along with resident and practitioner surveys [13][14][15][16] have highlighted progressive segmentation of practice, even among general pediatricians. Competencies are different enough that considerable adaptation, even additional training, will likely be needed to switch from one practice setting to another.…”

“…Surveys of residents, fellows, and practitioners have shown that most programs provide some flexibility in selection of subspecialty electives or access to particular groups of patients, but only one third provide both, and only a few allow residents maximum flexibility to organize their education to match their preferences. [14][15][16] Surveys revealed that most third-year pediatric residents decided on a specific career path early in their third year. This makes it possible to use a portion of the third year, and perhaps of the second, to prepare for a particular career.…”

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

“…The Freed et al survey of 7882 pediatrics residents as part of the 2007 American Board of Pediatrics in-training examination 51 sheds light on the pediatrics residency experience. In 3 other articles they examine the perspectives of pediatrics generalists 52 and subspecialists 53 within the first 2 to 5 years after certification, as well as current pediatrics subspecialty fellows 54 regarding their residency experiences and career choices. The tables display the results of additional analyses generated for this commentary: Table 1 compares the answers of generalists and subspecialists to questions about the factors considered in selecting a particular residency program and, generally, how more discretionary, flexible time in residency might be used; Table 2 compares preferences for more learning opportunities in specific content areas; and Table 3 examines the opinions of subspecialists and current fellows regarding the length of time required for residency and fellowship training.…”

“…For example, Table 1 shows that although geographic location of the residency program was the most important factor for both generalists and specialists, the importance of lifestyle issues, subspecialty expertise/training opportunities, prestige, and patient population varied. Response differences associated with gender, medical school (US or Canadian versus international), size of residency program, and subspecialty are discussed in detail by Freed et al [52][53][54] A second question raised by R 3 P Project participants was: Are current training programs flexible enough to meet training needs both for residents going into general pediatrics and those choosing subspecialty fellowship training? A careful review of the current review committee guidelines for pediatrics reveals a high degree of flexibility, with 8 to 9 months of undifferentiated time across the 33-month (allowing for 3 months of vacation) training period.…”

“…54 Despite this early differentiation, approximately two thirds of current fellows and subspecialists endorsed maintenance of a 3-year residency program. 53,54 In addition, one third of PGY-3 residents desired more career mentorship for their career decisions. 51 This desire for mentorship may partially reflect residents who are not yet certain regarding their future career trajectories; it may also signal the need for counsel regarding the factors to be considered in identifying a practice site or fellowship training program.…”