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Related Information
The following materials have been used as resources for the Residency Review and Redesign in Pediatrics project. There are currently two sets of reference materials. One set was made available prior to the first Colloquium on August 2 – 4, 2006. The second set has been made available prior to the second Colloquium on January 31 - February 2, 2007. These documents can be reviewed as you have interest and time. Use the links below to access these materials.
Related Information For Colloquium III
The following resources are being provided prior to Colloquium III on August 1 – August 3, 2007. These documents can provide additional information about some of the content we may be discussing during the session.
Pediatric Practice
Residency Review and Redesign in Pediatrics Project Themes
The Residency Review and Redesign in Pediatrics Project recognizes that there are a number of factors that must be considered as part of a comprehensive evaluation of the current status of pediatric residency education and the necessary refinements for future pediatric residency education over the next 15-20 years.
Overview of the Content of Health Supervision for Young Children: Reports From Parents and Pediatricians
Olson et al. summarize the content of their article in the title. They document both strengths and shortcomings of health supervision for young children. These imply, in the context of information developed by Ed Schor and associates with the support of the Commonwealth Foundation and by Paul Wise, how health supervision might be organized as a team responsibility with the pediatrician as the leader rather as the direct care provider, and how, as a consequence, future pediatricians should be educated and trained.
Change Management
Developmental Evaluation (MS Word)
Developmental Evaluation (PDF)
The two articles by Patton describe what he and associates call “developmental evaluation.” In their words: “Developmental evaluation refers to long term, partnering relationships between evaluators and those engaged in innovative initiatives and development. Developmental evaluation processes include asking evaluative questions and gathering information to provide feedback and support developmental decision-making and course corrections along the emergent path.” The Word document is excerpted from Getting to Maybe. The Adobe document is a 1994 paper.
An Elusive Balance — Residents’ Work Hours and the Continuity of Care
Update on the Impact of Duty Hour Restrictions on Residency Training
The article from The New England Journal of Medicine notes that the effects of restricting duty hours on resident education and patient care need to be evaluated in the context of a complex environment. A change in one aspect of that environment, resident hours on duty, has consequences for all the rest, some of which carry new risks for both patient care and education.
Medical Education
Shifting Paradigms: From Flexner to Competencies
This reviews the evolution of thinking from structure- and process-based education to competency-based education and measurement of outcomes. As stated in the abstract: “The development of appropriate assessment tools to measure competence remains the challenge of this decade, and educators must be responsible for studying the impact of this paradigm shift to determine whether its ultimate effect is the production of more competent physician.
Otitis Media: The Need for a New Paradigm in Medical Education
The article by Varrasso argues for more specific teaching and evaluation of competence in managing one of the most common pediatric illnesses, acute otitis media. He states that “osmosis can no longer be the preferred method to train our medical students and residents for the diagnosis and management of otitis media.”
Returning to the Basics: A New Era in Pediatric Education
Friedman et al. argue that the rapid growth of new knowledge obligates educators to be more systematic in ensuring that students and residents understand how advances in basic sciences affect practice. In their words: “In many cases, medical school and residency curricula contain only anecdotal references to... [new] concepts. It is time to develop a systematic approach to their inclusion in the education of the next generation of pediatricians.” They suggest ways in which this might be done.
Assessing Competency
Comment: The 1999 article by Grant and the recent articles by Klass and by Huddle and Heudebert along with the accompanying editorial by Whitcomb argue that education and assessment practices that rest on the concept of professional behavior as a collection of many specific, or even a few general, competencies represent invalid reductionist thinking. They take the view that assessment of individual competencies wastes valuable time better spent in evaluation of behavior in actual clinical settings and, worse, endangers the “traditional excellence of American clinical training” (Huddle and Heudebert). The same point was made by Norman in an article (Advances in Health Sciences Education (2006) 11:217–220) posted in eResources for Colloquium II. As an alternative to evaluation of competencies, Huddle and Heudebert argue for incorporation of “trained clinician evaluators” into resident teams. Evaluators would have no responsibility other than to perform several evaluations per resident per rotation. The article by ten Cate argues for an approach that combines appraisal of competencies and clinical performance. Although it is important to heed the admonition against overspecification of competencies and over-reliance on their measurement, one wonders, reading the 2002 article by Batalden et al. giving the rationale behind the six ACGME/ABMS competencies, at the vehemence of the rhetoric. In science, neither a reductionist nor a holistic approach is in itself sufficient; it seems the same will inevitably be true of professional assessment. To presume proficiency in the six competencies from even repeated “global” observations of professional behavior seems credulous; to presume that even the most precise measurement of the six competencies can yield an accurate picture of professional function seems equally credulous. Surely it is important to assess both. And while there is much to admire about the “traditional excellence of American clinical training,” we need also to find ways to improve and to change another less admirable tradition: wide, unexplained variations in medical practice and patient outcomes.
Related Information For Colloquium II
The following resources are being provided prior to the Colloquium on January 31 – February 2, 2007. These documents can provide additional information about some of the content we may be using during the session.
Maintenance of Certification
Maintenance of Certification in the United States: A Progress Report
This article describes Maintenance of Certification as a policy of the American Board of Medical Specialties (ABMS) and places it in the context of policies of the Accreditation Council for Graduate Medical Education (ACGME) and policy positions taken by the Institute of Medicine (IOM).
Conceptual challenges in tailoring physician performance assessment to individual practice
This in an exceptionally thoughtful and challenging piece. It represents discussions at the 10th Cambridge Conference, an international forum, focused that year on assessment of physicians in practice. A quote from the article describes it: “This paper provides the rationale for the development of practice-tailored assessments for relicensure, revalidation [the British term for recertification], recertification and continued professional development. However, the tools that would allow this tailoring to occur are rudimentary and much of the conceptual framework that might support such tailored assessment is undeveloped.” The article describes the opportunities, as it notes problems and lists questions that must be answered.
Renewing Board Certification
Recertification for Internists — One “Grandfather’s” Experience
Personal Metrics for Practice — How’m I Doing?
Accreditation of Education Institutes
Article describes an innovative, decentralized education program proposed by the American College of Surgeons to facilitate acquisition of new surgical skills and maintenance of existing ones. The ACS with accredit regional/local Education Institutes for that purpose.
Assessment Tools
Assessment in Medical Education
Like all of the articles in the Medical Education series in the New England Journal of Medicine, this one is exceptionally well written and provides a well-referenced overview of the topic.
Evaluation of Resident Communication Skills and Professionalism: A Matter of Perspective?
Pediatric residents received higher communication and professionalism ratings from attendings than from nurses. Attendings were often unable to rate residents because they were did not observe certain behaviors. This emphasizes the importance of multi-source assessment. It also points out a weakness in an apprentice model of education in which the “master” is unable to observe and give feedback to the “apprentice.
Assessment tools for foundation programmes—a practical guide
This provides an overview of the four-part workplace-based assessment program that has recently been instituted in the United Kingdom. It is referenced for those who would like to read further.
Multi source feedback: development and practical aspects
The review describes practical aspects of multisource feedback instruments. References are provided for more detail.
Assessing professional competence: from methods to programmes
This review argues that the best approach to assessment will employ multiple methods to sample performance on multiple occasions. Just as important, an assessment program is only a part of the overall learning program; what is assessed will be a major determinant of what is learned.
ACGME Bulletin September 2005
This issue of the ACGME Bulletin contains is a brief description by Carraccio et al. (pp. 9-10) of the on-line ACGME learning portfolio scheduled for introduction in 2008. (David Leach’s piece on resident supervision is also well worth reading.) An education portfolio gathers together a number of assessment and self-assessment tools. It is meant to be monitored constantly by the learner and periodically by a mentor. Those who wish to read further should consult: Carraccio C, Englander R. Evaluating competence using a portfolio: a literature review and web-based application to the ACGME competencies. Teaching and Learning in Medicine 2004;16:3812-387.
Accuracy of Physician Self-assessment Compared With Observed Measures of Competence - A Systematic Review
Self-assessment, Self-direction, and the Self-regulating Professional
These two reviews come to the same sobering conclusion. Davis et al. conclude: “While suboptimal in quality, the preponderance of evidence suggests that physicians have a limited ability to accurately self-assess. The processes currently used to undertake professional development and evaluate competence may need to focus more on external assessment.” Regher and Eva conclude: “In particular, research demonstrates repeatedly that 1) self-assessment is not an effective mechanism to identify areas of personal weakness and that 2) even when areas of weakness are obvious to the adult learner, we often avoid engaging in learning in these areas because such learning often takes more energy and commitment than we are willing to expend.” Self-assessment is bedrock of what is casually termed “adult learning theory”; Regher and Eva suggest this may be more appropriate for recreational learning than for professional self-regulation. The conclusions emphasize the importance of objective, external assessments of competence. Apparently, like inhabitants of Lake Wobegone, when we rate ourselves we have an irresistible tendency to conclude that we are at least “above average.”
Training the Evaluators
Effects of Training in Direct Observation of Medical Residents’ Clinical Competence
This describes the utility of a comprehensive faculty development program that provides training in evaluation of resident clinical competence by direct observation. An evolved form of this program is currently offered by the American Board of Internal Medicine.
Medical Education
“Continuity” as an Organizing Principle for Clinical Education Reform
David A. Hirsh, M.D., Barbara Ogur, M.D., George E. Thibault, M.D., and Malcolm Cox, M.D. •
This article and the accompanying editorial discuss the importance of continuity in medical education and the challenges associated with implementation. The focus is undergraduate medical education. The importance and challenges are much the same for graduate medical education.
Educational Continuity in Clinical Clerkships
David M. Irby, Ph.D. •
Educational Strategies to Promote Clinical Diagnostic Reasoning
This exceptionally clear article and the accompanying editorial by Normal from the NEJM series on Medical Education distills a large amount of literature on the development of medical expertise to practical points for the medical educator.
What every teacher needs to know about clinical reasoning
This paper summarizes what cognitive psychology has to say us about how medical learners learn and how best to help them. The final section on "Implications for Clinical Teachers" is an especially useful summary.
Shifting Paradigms: From Flexner to Competencies
This reviews the evolution of thinking from structure- and process-based education to competency-based education and measurement of outcomes. As stated in the abstract: “The development of appropriate assessment tools to measure competence remains the challenge of this decade, and educators must be responsible for studying the impact of this paradigm shift to determine whether its ultimate effect is the production of more competent physician.
Research in clinical reasoning: past history and current trends
Superb summary by one of the eminent figures in medical education of the history of research in clinical reasoning along with comments about such topics as the role of basic science and assessment of clinical reasoning.
Editorial – Outcomes, Objectives, and the Seductive Appeal of Simple Solutions
A provocative editorial that reminds the medical education community that jumping on a bandwagon risks a fall. This bandwagon is the assumption that configuring education exclusively around outcomes will lead to better public health. His concluding sentence gives the flavor: “I fear that in a few years the outcomes movement too will emerge as one more educational fad, whose major impact was on committee hours reported by academics. This would be unfortunate. The goal of achieving some kind of uniformity is laudable, but the means to the end appears too simplistic to be successful.”
Editorial – Inverting the Pyramid
The Miller pyramid is an icon in medical education, with progression from “knows,” at the base, to “knows how” to “shows how” to “does,” at the pinnacle. The implication is that assessment is best in a performance setting, how one “does” in the language of the pyramid. By implication, this devalues knowledge as a criterion of satisfactory performance in practice. The editorial questions the evidence for this. Although knowledge alone is not sufficient for satisfactory performance, it appears to correlate with capabilities that are sufficient. The last sentence: “Whether high-level simulations are used for assessment or learning, both applications base their appeal in part on the unwritten assumption of Miller, that the closer you can get to the top of the pyramid, the better you are. But the higher you get, the further you have to fall. The time is overdue to reexamine the basis of these assumptions.”
Generalist-Subspecialist Interface
How Pediatricans Refer Children and Adolescents to Specialty Care
Data from the PROS network show what and to whom pediatricians refer. Only 30% of referrals went to medical subspecialists. The majority (52%) went to surgeons, the remaining 18% to non-physicians and mental health professionals. The authors report the top 3 reasons for referral to individual subspecialists and the 51 most commonly referred conditions, in rank order, and to whom they were referred. [Ed: These epidemiologic data are instructive when considering specific learning objectives.]
Determinants and Impact of Generalist–Specialist Communication About Pediatric Outpatient Referrals
The authors found less than optimal communication between subspecialists and primary care physicians. Although 70% of subspecialists and primary care providers preferred co-management, only 50% of referrals to subspecialists were accompanied by communication from the primary care provider. Communication from subspecialist to primary care provider occurred 84% of the time. Better communication depended on the presence of appropriate systems (staff, computer links, etc.). [Ed: Quality of care problems are often described as failures of individuals. More commonly, as here, failure is the property of the system, and requires a systems remedy.]
Quality Improvement
A Framework for Teaching Medical Students and Residents about Practice-based Learning and Improvement, Synthesized from a Literature Review
This paper reviews 27 articles that map to the search terms “quality improvement,” “medical education,” and “health professions education.” They integrated information in these articles with the Dreyfus model of skill acquisition, the Institute for Healthcare Improvement knowledge domains for improving health care and the ACGME competencies to generate a system of educational objectives in practice-based learning and improvement and systems-based practice for medical students and residents. They suggest that residents at the end of residency should be at least “competent” on the Dreyfus continuum. They should be able to identify systems problems, and use measures and change cycles in an interdisciplinary effort to improve care in a discrete population.
Epidemiology of Pediatric Healthcare
The following two articles describe the prevalence (12.8% of US children in 2001) and cost (42.1% of total medical costs attributable to children in 2000) of Children with Special Health Care Needs.
A National Profile of Health Care Utilization and Expenditures for Children with Special Health Care Needs
Prevalence and Characteristics of Children with Special Health Care Needs
Patient Visits to a National Practice-Based Research Network: Comparing Pediatric Research in Office Settings With the National Ambulatory Medical Care Survey
Article describes the demographics of patient visits within the Pediatric Research in Office Systems (PROS) network: 12% were for chronic conditions or pre- or post-surgery care; 57% for acute conditions; 31% for non-illness care. Parents reported cough, sore throat, fever, earache as the reason for 27% of visits, well-child examination the reason for 29% of visits. Fifty-six per cent (56%) of visits to private-practice office settings are for common acute conditions and well-child care; few (11.3%) were for chronic conditions. Results from the National Ambulatory Medical Care Survey were similar.
Duty Hours
The article by Landrigan et al. reports the results of a survey of compliance with ACGME regulations on duty hours. The authors found frequent non-compliance. A different point of view is expressed in the ACGME News Release. The editorial by Leach and Philibert discusses duty hours in the context of a multifaceted approach to both excellent, safe patient care and excellent medical education.
Intern's Compliance with Accreditation Council for Graduate Medical Education Work-Hour Limits
ACGME Press Release
High-Quality Learning for High-Quality Health Care: Getting it Right
Transition to Practice and Life-long Learning
Expertise development: The transition between school and work
Why, one might ask, is a paper by an educator at the Open University in Amsterdam on the list? This chapter (especially pages 15-16 and 27-31) makes relevant points. First, it reminds us that the difficulty of the transition from formal learning to a workplace, learning-in-practice environment in not unique to medicine. Second, it explains how the pace of change of knowledge dictates when trainees must be “certified” as capable of entering the workforce. If knowledge is static, a long period of education must precede certification; the graduate will be expected to know everything there is to be known. At the other extreme, if the pace of change is very rapid, what was learned initially may be obsolete before training in complete. Furthermore, as important as initial education is the ability to continue to learn and adapt. The latter is more the situation for medicine. The contradictory expectation placed on residency education, that the graduate should know most of what can be known and be competent to do most of what can be done, is closer to the former.
Residency Redesign in Internal Medicine
Modernizing the Paths to Certification in Internal Medicine and Its Subspecialties
This provocative article asks, “Is certification still consistent with the realities of training and practice?” The short answer is “No.” Goldman proposes that current training treats Internal Medicine residents as “pluripotent stem cells” for one year too long. He suggests two years of core training, after which the resident differentiates along one of three paths: primary care training or inpatient training leading to certification with “added qualification” in office or hospital medicine, or standard subspecialty training.
The following three articles represent policy statements of the Society of General Internal Medicine, the Association of Program Directors in Internal Medicine and the American College of Physicians. They express similar concerns and suggest similar solutions. Two of the three organizations, most prominently the American College of Physicians, suggest revisions in undergraduate teaching as well.
Redesigning Training for Internal Medicine
Reforming Internal Medicine Residency Training
A Report from the Society of General Internal Medicine’s Task Force for Residency Reform
Redesigning Residency Education in Internal Medicine:
A Position Paper from the Association of Program Directors in Internal Medicine
Educational Innovation Project
Educational Innovations Project (EIP) in Internal Medicine: The Internal Medicine RRC has written requirements to encourage programs to explore innovations in GMR that construct training around patient-centered quality improvement. Programs must meet certain criteria, then apply and go through an approval process. To date 17 (of over 400) IM training programs have been accepted as participants. The PowerPoint presentations from those 17 programs are on the site and well worth a look.
This written summary (MS WORD) and PowerPoint presentation (.PPT file) summarize recent articles arguing for major changes in the structure of Internal Medicine residency education. The original articles can be found in the eResources section of the web site.
Certification of Pediatricians in Canada
Introductory Letter
Rotation Evaluation Form –
StandardizedAssessment of a Clinical Encounter Report (STACER)
Final In-Training Evaluation Report (FITER)
Objectives of Training and Specialty Training Requirements in Pediatrics
Use of an Objective Structured Clinical Examination as a Certifying Examination in Pediatrics
Related Information From Colloquium I
The following resources were provided prior to the Colloquium on August 2 – 4, 2006. These documents provided additional food for thought and are provided here as reference material as the project moves forward.
Epidemiology of Pediatric Healthcare
The Transformation Of Child Health In The United States
Social disparities in child health persist despite dramatic improvements in child health overall.
Wise uses demographic and utilization data to identify trends of profound importance to the future of pediatric practice and training. As a result of this sweeping epidemiological “check-up,” he finds that because of social trends and medical progress over the past three decades, the threats to children’s health have changed so dramatically that many of our current health policies and systems of delivery have been rendered obsolete.
Children of Immigrant Families: Analysis and Recommendations
As the 21st century progresses, our nation will become increasingly dependent on the current generation of children, a generation that is dramatically more diverse than previous generations. This article provides a summary of information in other articles in the same volume [Children of Immigrant Families. Future of Children 2004;14(2)] along with recommendations for action.
Future of Pediatrics
Rethinking Well-Child Care
4
Schor notes that parents are showing their dissatisfaction with the current system of well-child care by failing to take advantage of half of recommended preventive care services. He argues that “it is time for major revision of well-child care, taking into account the varying needs of individual children and families, the operation of child health care practices, and the broad issues of access to primary care and payment for services within the US health care system.”
Rethinking Well-Child Care: Lack of Standardization at the Beginning
A Letter to the Editor by Seidel takes up Schor’s challenge to rethink the delivery of well-child care. He extends this to speculation on the nature of pediatric practice and education and concludes that the “questions that arise suggest a sea change in our present approaches, and if we are to improve the lot of the child, we must keep our minds open and unfettered by the obvious difficulty inherent in change.”
Primary Care Pediatrics: 2004 and Beyond
Cheng notes the multiple roles that the pediatric primary care practitioner must fulfill if the needs of children are to be met. She suggests that “educators will need to define core content in training and emphasize techniques on accessing evidence-based information for life-long learning. Just as translational research from bench to bedside is important, education must be translational in integrating concepts spanning from the genes, to organs, to persons, to communities.”
Armstrong Lecture 2005: If I Were King of Pediatrics
Ludwig’s Armstrong Lecture covers a wide range of topics. His suggestions for revision of pediatric residency training have much in common with suggestions by Seidel (above) and by articles in the Residency Redesign in Internal Medicine section (below).
Pediatric Hospitalists: Report of a Leadership Conference
This is one of several recent articles summarizing the current state of affairs with regard to pediatric hospitalists.
The Changing Face of Pediatrics: Where is our Discipline Headed?
Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century? An opinion
These two short articles represent the thoughts of leaders who have spent many years considering pediatric residency education. Chesney notes dramatic changes in what pediatricians need to know, with implications for modifications in undergraduate, medical school and residency curricula. Lovejoy and Pizzo argue that “greater programmatic flexibility [in residency] is essential to ensure that trainees can develop more creative training pathways for future success, especially given the enormous changes taking place in the biomedical sciences.”
Quality Improvement
Measure, Learn, And Improve: Physicians’ Involvement In Quality Improvement
Payers, accreditors, and consumers are using quality improvement (QI) methods, but little is known about whether physicians do so. The results from this 2003 national physician survey indicate that most do not.
These articles describe current successful collaborative quality improvement projects in children. The first discusses projects in neonatal intensive care. The second describes interventions in children with cystic fibrosis.
Establishing Habits for Improvement in Neonatal Intensive Care Units
Improving Subspecialty Healthcare: Lessons from Cystic Fibrosis
Physicians’ Professional Responsibility to Improve the Quality of Care
Brennan makes the case for quality improvement as a fundamental aspect of professional obligation to patients. He challenges the medical profession to be leaders and role models for quality improvement. Providers need to be educated about the problem and solutions, and they need to come together in quality collaboratives that measure outcomes openly and often in conjunction with payers and government agencies.
Study Designs for PDSA Quality Improvement Research
This article discusses strengths and weaknesses of quasi-experimental designs used in health care quality improvement research. The target groups are investigators in plan-do-study-act (PDSA) quality improvement initiatives who wish to improve the rigor of their methodology and publish their work and reviewers who evaluate the quality of research proposals or published work.
Education: Theory and Practice
Factors in Optimizing the Learning Environment for Surgical Training
This article from Toronto represents a refreshing discussion of the theory and practice of mentoring and a discussion of the importance of finding the right balance between challenge (stress) and support in education. It raises, by implication, interesting questions. To be successful, a program must assume the role of mentor, i.e. be a “mentoring program” with rotation-specific mentors/quasi-mentors. How likely is that to succeed and with what fraction of residents? What if that does not work for a particular resident? How well does/can a program monitor the balance between challenge and support?
GME Reform
The Most Serious Challenge Facing Academic Medicine’s Institutions
This editorial introduces a group of articles on graduate medical education. Whitcomb notes the Institute of Medicine’s statement that of the three traditional roles of the academic medical center, the “education role is to face the most profound changes in coming decades.” A principal reason is the conviction that the quality of medical care cannot be raised substantially unless the way doctors are educated to care for patients is changed.
Reforming Graduate Medical Education
This article suggests 4 strategies for reasserting the primacy of education in GME: limit the number of patients house officers manage at one time, relieve the resident staff of noneducational chores, improve educational content, and ease emotional stresses.
Training Tomorrow's Doctors: The Medical Education Mission of Academic Health Centers
This is the fifth in a series of reports prepared by the Commonwealth Fund Task Force on Academic Health Centers. Although it focuses on undergraduate education, it applies equally to GME. Among a number of recommendations, they suggest that accrediting (and, by implication, certifying) organizations should “take a leadership role in assisting AHCs to develop the methods needed to train physicians to be lifelong learners and should develop new capabilities to measure the costs and quality of the medical education mission.”
Academic Health Centers: Leading Change in the 21st Century
A This is the report of a 2001 IOM Committee on the Roles of Academic Health Centers. It considers how AHC roles in education, research, and patient care will need to adapt if they are to continue to meet the public's needs in the coming decades.
Physician Education for a Changing Health Care Environment
This 1999 report is the 13th COGME report. It predicts much of the thinking incorporated into later documents, among them the IOM report on Academic Health Centers and the Commonwealth Fund document (above) and articles recommending changes in Internal Medicine residency training (below).
Changing Habits of Practice. Transforming Internal Medicine Residency Education in Ambulatory Settings
The majority of healthcare, both for acute and chronic conditions, is delivered in the ambulatory setting. Despite repeated proposals for change, the majority of residency training still occurs in the inpatient setting. Substantial changes in ambulatory education are needed to correct the current imbalance. To assist educators and policy makers in this process, this paper reviews the literature on ambulatory education and makes recommendations for change.
Viewpoint: Educating for Professionalism in Medicine
By any indicator - the appearance of new essays, research, curricula, feedback instruments, or innovation in certification and continued learning - in this past decade there has been a remarkable intensification of interest in professionalism in medicine.
Viewpoint: "Culture Change at Academic Medical Centers: A Pebble Drops..."
All of us lead our professional lives within academic medical centers, each with its own strong traditions, standard ways of doing things, shared language, and a context of community values/meanings/mission — in other words, organizational cultures. These cultures affect our work and what we can achieve in a myriad of ways. They also constitute a major component of the hidden (informal) curriculum that radically influences our students as they become physicians.
Compact Between Resident Physicians and Their Teachers
The AAMC Compact Between Resident Physicians and Their Teachers is a declaration of the fundamental principles of graduate medical education and the major commitments of both residents and faculty to the educational process, to each other and to the patients they serve. The Compact's purpose is to provide institutional GME sponsors, program directors and residents with a model statement that will foster more open communication, clarify expectations and re-energize the commitment to the primary educational mission of training tomorrow's doctors.
How well do pediatric residency programs prepare residents for clinical practice and their future careers.
A questionnaire sent to 434 recently certified pediatricians (generalists and subspecialists) practicing in Canada yield a 55% response rate and a 96% agreement that they were adequately or very well trained. Only 20% felt that training should be increased from the current 4 years to 5 years of training and only 2% felt that it should be reduced to 3 years.
Maintenance of Certification
Accreditation of Education InstitutesArticle describes an innovative, decentralized education program proposed by the American College of Surgeons to facilitate acquisition of new surgical skills and maintenance of existing ones. The ACS with accredit regional/local Education Institutes for that purpose.
Renewing Board Certification
Recertification for Internists — One “Grandfather’s” Experience
Personal Metrics for Practice — How’m I Doing?
Workforce
The U.S. Physician Workforce - The Impact of Education and Training
This paper describes the nature of the U.S. medical education system, provides insight into how the system affects the design and conduct of GME programs, and explains why the ability of the country’s GME system to produce graduates capable of providing high quality care is becoming increasingly problematic with each passing year.
Workforce Issues in General Pediatrics and the Pediatric Specialties
This 2004 commentary by Stockman provides perspective on conflicting viewpoints about the “right” size for the pediatric workforce of the future.
Final Report of the FOPE II Pediatric Workforce Workgroup
This represents the thinking of the Future of Pediatric Education II Project.
Predicting the Pediatric Workforce: Use of Trend Analysis
Relation of Per Capita Income and Gross Domestic Product to the Supply and Distribution of Pediatricians in the United States
These two articles by Freed and co-workers employ Cooper’s use of past trends as predictors of the appropriate pediatric workforce of the future.
The General Pediatrician: Projecting Future Workforce Supply and Requirements
Projecting, Predicting, Shaping: The Challenge of Workforce Models
Pediatric Workforce Projections and Unintended Consequences
The article by Shipman et al. compares projected growth in the number of children with projected growth in numbers of pediatricians until the year 2020. It concludes that the trend is for an increasing surplus of pediatricians. The articles by Berkowitz and by Felice et al. represent editorial comments. Stockman (above) also comments on this article.
The American Board of Pediatrics 2005-2006 Workforce Data
For a number of years, the American Board of Pediatrics has accumulated workforce data using a number of methods. One method involves the tracking system in which program directors enter workforce data through the ABP Residency Tracking Program. Another method uses a short questionnaire that first-time applicants complete when applying for the general pediatrics or a pediatric subspecialty certifying examination. In addition, the ABP Master File is continuously updated to reflect the most current and accurate candidate and diplomate information.
Pediatric Workforce: A Look at General Pediatrics Data from the American Board of Pediatrics
The article by Althouse and Stockman represents one of a series of articles in the Journal of Pediatrics analyzing data drawn from the large, continuously updated data base maintained by the American Board of Pediatrics.
Pediatrician Workforce Statement: Committee on Pediatric Workforce
This represents the official statement of the American Academy of Pediatrics. It makes the recommendation, controversial to some, to: ”Maintain the current numbers of first-year graduate medical education positions and US medical school graduates.”
The Pediatric Subspecialty Workforce: Public Policy and Forces for Change
This article describes the complexity of the pediatric subspecialty workforce situation. It emphasizes that workforce adequacy differs substantially from one subspecialty to the other.
Royal College of Paediatrics and Child Health
Good Medical Practice in Paediatrics and Child Health
Duties and Responsibilities of Paediatricians
This remarkable document is of great relevance to US pediatric practice. It is comprehensive, and it is bold. It details the professional attributes that every pediatrician should possess; it is equally specific about “Unacceptable practice,” separately noted in a box at the end of each section.