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Preamble: Uncertainties about the future of pediatric health care,
along with uncertainty as to the ability and willingness of the public to pay
for that health care, argue for models of pediatric education that are flexible
enough to provide for a variety of professional futures. 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. These include:
1. Changes in society and health care:
a. A shift in the causes of health-related morbidity and
mortality in children and adolescents from acute to chronic illnesses and
disorders;
b. Changes in families that may impede access to health care,
especially more single-parent families and families in which both parents work;
c. Increasing cultural diversity of children and parents, with a
corresponding need for effective ways of increasing cultural competence and
cultural diversity of the pediatric workforce;
d. Changes in biomedical and psychosocial knowledge, as well as
diagnostic and treatment methods;
e. Changes in information technologies that affect access to
health care information by health professionals, patients, and families, and
the exchange of information among them;
f. Changes in the expectations of the pediatric workforce, with
more individuals seeking part-time employment and, in general, a greater
emphasis on family and personal priorities.
2. The current and future practice of pediatrics:
a. General pediatricians will continue to be the experts in
offering a comprehensive approach to health care for children and adolescents,
especially those with chronic physical, mental, developmental, and behavioral
disorders. Pediatric education must ensure that distinct pediatric expertise in this regard continues to be
maintained and enhanced.
b. The professional practices of pediatricians in large cities
with ready access to subspecialists tend to differ from practices in smaller
cities or rural locations; roles also vary with the staffing structure of
pediatric practices and local practice demographics. Pediatric education needs to acknowledge this diversity.
c. Pediatric health care is increasingly delivered by teams of
professionals from health care and the community working in concert with
patients and parents. Pediatric education must foster the development and maintenance
of the leadership, collaboration, and communication skills needed to function
within such teams.
3. Flexibility for multiple career paths and child health
needs:
a. Education in pediatrics must be flexible, acknowledging the
diversity of pediatric practice and the variety of practice settings that exist
now and will exist in the future. The current model of education must be
compared with alternatives that allow for greater differentiation according to
career goals.
b. Certification and maintenance of certification must be
correspondingly flexible. Maintenance of certification must be able to
accommodate reentry into practice after prolonged absences, as well as
mid-career changes in the type of practice.
4. Changes in the educational process:
a. No single educational method will suffice for pediatric
education. The general principle, however, is that education must facilitate
active personal ownership of learning; the process of training must foster
reflective practice and develop the skills of self-directed lifelong learning.
b. The expectations
for pediatric education must be articulated and staged along the educational
continuum, from medical school to resident education to continued, career-long
professional development. Better use of the fourth year of medical school to
enhance pediatric education should be explored.
c. The “basic science” requirements
for the study of pediatrics should be re-examined and possibly modified in
content and timing of learning.
d. Pediatric residents are closely
supervised; opportunities for independent decision-making, even for advanced
residents, are limited. The period of transition from residency to workplace or
to the next phase of training and education has become progressively important
and should be critically analyzed.
e. The principles of continuous quality improvement must be
taught as such and by example. Patient care and education must both be based on evidence where evidence
exists, and both must be continuously re-evaluated according to measured
outcomes.
f. Pediatric health care is patient- and family-centered. The
advice and counsel of patients and parents must be utilized in the design of
education programs for pediatricians.
g. Pediatricians must understand the
principles of public health, i.e., the health of populations as well as the
health of individuals, in order to be effective care providers and advocates
for children. This perspective
must be incorporated across different stages of the educational process.
h. Evaluation of achievement of
clinical competencies during residency requires appropriate mechanisms and
competent evaluators. Programs to assure competency in evaluation are urgently
needed.
3/22/07
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