Training gaps for pediatric residents planning a career in primary care: a qualitative and quantitative study.
ABSTRACT Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents.
To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps.
Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003-2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from "not at all well prepared" to "extremely well prepared" for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders.
Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence.
Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.
Full-textDOI: · Available from: Anita Glicken, Jun 11, 2015
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ABSTRACT: Background. Roughly 21% of youth in the United States meet criteria for a mental health diagnosis, but only one-fifth of those children obtain help. The Pediatric Behavioral Health Screen (PBHS) utilizes the Pediatric Symptom Checklist-17 (PSC-17) and functional impairment items to assess behavioral health concerns. Methods. Data were obtained from a systematic chart review for children 6 to 16 years old. Descriptive analyses and a confirmatory factor analysis were used to evaluate the clinical performance and utility of the PBHS. Results. A positive screen was endorsed for 26.7% of the sample, of whom 68% also experienced functional impairment. Clinicians appropriately administered the screen 73.5% of the time. The 3-factor model of the PSC-17 exhibited a good model fit. Conclusions. Prevalence rates of psychosocial concerns and functional impairment affirm the need for routine behavioral health screening in the pediatric primary care setting. The PBHS exhibited good psychometric performance and clinical utility.Clinical Pediatrics 03/2014; 53(5). DOI:10.1177/0009922814527498 · 1.26 Impact Factor
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ABSTRACT: Objective To assess pediatric residency program director (PD) perceptions of the current state of mental health (MH) training, their receptivity to curricular changes, and perceptions of their residents' knowledge and skills in MH care. Methods We performed a cross-sectional study utilizing a Web-based survey of pediatric residency PDs to assess program characteristics, learning modalities PDs currently had or would implement, and their knowledge of the new American Academy of Pediatrics' MH competencies. PDs then ranked their residents' knowledge and skills for 29 MH competencies. Analyses included descriptive statistics and bivariate and multivariate analyses to assess for associations between variables, particularly MH model of care and perceived competence. Results Ninety-nine PDs (51%) responded. A total of 87% of PDs reported that MH care was taught as part of another rotation, yet PDs were receptive to curricular changes. Only 45% of PDs were aware of the 2009 American Academy of Pediatrics competencies, and PDs infrequently rated their residents' MH skills and knowledge to be above average. Attention-deficit/hyperactivity disorder (ADHD) was an exception: 64% reported above-average ADHD knowledge in diagnoses and 57% in treatment. There was an association between enhanced MH services in continuity clinics and perceived resident systems-based practice (P < .01) and medical knowledge (P = .04). Conclusions PDs acknowledged that MH training is not emphasized, leading to deficiencies in their residents' knowledge and skills in MH care. The receptivity of PDs suggests the need for targeted dissemination of national guidelines or curriculum. Integrated models of care may be one way to improve resident competencies, but this deserves further study.Academic Pediatrics 10/2014; 14(5):526–532. DOI:10.1016/j.acap.2014.05.011 · 2.23 Impact Factor
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ABSTRACT: The traditional 1-month training blocks in pediatrics may fail to provide sufficient exposure to develop the knowledge, skills, and attitudes residents need for practice and may not be conducive to mentoring relationships with faculty and continuity with patients. We created a 4-month career-focused experience (CFE) for third-year residents. The CFE included block time and longitudinal experiences in different content areas related to residents' choice of urban and rural primary care, hospitalist medicine, or subspecialty care (prefellowship). Content was informed by graduate surveys, focus groups with primary care pediatricians and hospitalists, and interviews with fellowship directors. Outcomes were assessed via before and after surveys of residents' attitudes and skills, assessment of skills with an objective structured clinical examination (OSCE), and interviews with residents and mentors. Twenty-three of 49 third-year residents took part in the first 2 years of CFE. Two residents dropped out, leaving 21 who completed the 4-month experience (9 in primary care, 2 in hospitalist medicine, and 10 in a subspecialty). Residents reported improvement in their clinical skills, increased satisfaction with faculty mentoring and evaluation, and the ability to focus on what was important to their careers. OSCE performance did not differ between residents who completed the CFE and those who did not. Administrative burden was high. Four-month career-focused training for pediatrics residents is feasible and may be effective in meeting part of the new requirement for 6 months of career-focused training during pediatrics residency.12/2013; 5(4):639-45. DOI:10.4300/JGME-D-12-00340.1