Report of Colloquium III: Challenges for Pediatric Graduate Medical Education and How to Meet Them—A Quality Improvement Approach to Innovation in Pediatric Graduate Medical Education

Abstract

Participants of the third colloquium of the Residency Review and Redesign in Pediatrics (R 3 P) Project concluded that pediatricians who practice ambulatory, hospital-based, a combination of ambulatory and hospital-based, and subspecialty pediatrics are sufficiently different to justify differences in general pediatric residency training. This conclusion along with others of previous colloquia led to the creation of a list of goals for innovative change in residency education and a draft of a quality improvement process by which they might be achieved. Pediatrics 2009;123:S22-S25 T HE THIRD AND final colloquium of the Residency Review and Redesign in Pediatrics (R 3 P) Project was held on August 1 through 3, 2007. At the first colloquium, participants envisioned the creation of a set of new recommendations for training programs that would meet the needs of pediatric residents and their patients in the future. By the third colloquium, there was agreement that a simple revision of current Accreditation Council of Graduate Medical Education (ACGME) requirements for pediatric training 1 would be insufficient. Taking into account the uncertainties identified in the first colloquium regarding the future needs of children and how to meet them, it was clear that there are too many variables and no easy solutions. There is an obvious need for a sustainable process that can respond to changing health care needs, new models of assessment, and variations in health care-delivery systems, as opposed to recommendations developed at one point in time. Therefore, participants decided to support the creation of a supple system that would continuously seek improvements in what and how pediatricians are taught.The third colloquium had 4 primary goals. The first goal was to determine if the competencies needed for 4 different types of pediatric practice (ambulatory, hospital based, comprehensive general practice [a combination of ambulatory and hospital based], and subspecialty care) were sufficiently different to justify differences in general pediatric residency training. The second goal was to refine and prioritize a list of problems requiring innovative solutions in residency training. These were formatted as guidelines or goals for innovative program change. The third goal was to determine how the initiatives begun as part of R 3 P might continue into the future, and the fourth goal was to consider administrative aspects of how to deal with residency improvement initiatives. PROCESSThe colloquium began with a keynote presentation by Dr David Leach, former chief executive officer of the ACGME. Dr Leach emphasized the importance of clear aims for any change that might be proposed. He went on to note that people are attracted to the novelty and challenge of change but seldom like the inconvenience of transition, so we will need to work to minimize the disruptions. He encouraged us to see the future as "larger than we are" and, thus, something that can be noticed but not really "redesigned." He urged us to observe what is "...

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

“…They appear in the list of goals for innovation in pediatric residency education in the article that summarizes colloquium III. 12 Colloquium II participants also discussed how residency, as only a portion of a career-long continuum of learning, can help pediatricians close the gap between care that is recommended and care that is actually delivered. 39 Restated, what role does residency have in the formation of habits by which new competencies are acquired and incorporated into daily practice?…”

“…A final draft, slightly modified by subsequent discussions, was a principal product of colloquium III. 12 A second focus of colloquium III was how to promote exploration of innovative solutions across pediatric residency training programs. We learned much from similar projects in internal medicine and family medicine.…”

“…Completion of what is intended to be only the first phase of an ongoing effort is anticipated in early 2009. In addition to this introductory article, the supplement consists of an article that provides historical context for the R 3 P Project, 9 articles that summarize each of the colloquia, [10][11][12] and articles that describe results of the surveys requested by the R 3 P Committee and Project Group, [13][14][15][16] along with a commentary, 17 an article that describes the likely consequences of maintenance of certification on residency education, 18 and an article that projects the likely long-term future of evolutionary change in pediatric graduate medical education. 19 The colloquium summaries document a dramatic change in thinking that occurred during the course of the project.…”

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 Residency Education and Evolving Pediatric Health Needs

“…With this thinking in mind, R 3 P project members selected 3 high-priority goals for residency programs 15,16 : (1) curricula should be weighted toward career choices; (2) programs should reach out to medical schools and postresidency maintenance of certification to make learning a continuum; and (3) programs should document incorporation of attitudes and habits that close the gap between optimal and current health care outcomes (ie, incorporation of qualities that enhance reliable, safe patient care through practice-based learning and improvement). The project concluded that methods of achieving these goals should be based on data.…”