Innovation in Residency Education and Evolving Pediatric Health Needs

Abstract

The Initiative for Innovation in Pediatric Education (IIPE)1 is the next phase in a comprehensive reevaluation of pediatric residency education that began with the Residency Review and Redesign in Pediatrics (R3P) project.2 As the IIPE begins, it is worth reflecting on questions that arose repeatedly during the R3P project: Just what role does residency play in child health? Does it make a difference where one trains? Can residency improve later adherence to clinical guidelines? and Can residency modify the frequently steep learning curve of subsequent practice? This question is in the same category as whether it matters where one goes to medical school. The answer is elusive, but the imagined answer determines the structure and conduct of residency education. One extreme is that 3 years cannot possibly count for much. The other is that residency is all-important, and an attempt should be made to prepare everyone for everything. That ambitious goal governs our current approach to residency education.3 The goal was appropriate when virtually every pediatrician's practice was similarly broad. However, pediatric health care is increasingly dichotomized into low-acuity disorders treated exclusively in ambulatory settings, away from academic health centers (AHCs), and complex illnesses treated mostly within AHCs.4 Career choices follow epidemiology. Only 29% of third-year residents who intend to practice general pediatrics, just 13% of all third-year residents, plan to practice general pediatrics in both ambulatory and hospital settings.5 This is …