How are pediatric training programs preparing residents for practice?

Article Abstract:

In recent decades, residents in pediatrics were trained chiefly in the areas of medical center practice, subspecialty care, and primary care for urban poor populations, with little exposure to community pediatric practice. Community practice in pediatrics, as in other primary care areas, has changed greatly since the 1980s, with increasing competition and governmental regulation, rising hospitalization costs, and other forces shaping the practice of medicine. Recognizing these changes, some residency programs have realized the need to provide training about these and other aspects of community practice so that graduates of pediatric residencies are well prepared for their careers. The curricula in 137 of 233 pediatric residency programs were evaluated using questionnaires to obtain data. Among the graduates of these programs, 45 percent chose to directly enter pediatric practice, 29 percent chose academic medicine (involved with teaching and research), while others chose military or public health pediatrics, or other fields. Although two-thirds of the programs responding to the survey include experiences to prepare residents for community practice, the number of training hours are somewhat limited and are greater in the later residency years. During the second year, when career choices are often made, 39 percent of programs do not include an office rotation. Only 25 programs devote 100 hours to clinical experiences in the third year of residency. Community practice settings are available in up to 55 percent of the programs. From one to four weeks in an office setting is generally available. Most residents in the practice setting accompany the practitioner on hospital rounds and observe and provide patient care. Military residency programs provide a significantly higher number of hours in course work in the first year of residency and in clinical experience in the third year. The findings indicate that although a significant number of pediatric residencies provide experiences in pediatric practice, the amount of time needs to be increased and more programs need to offer a community practice rotation. A curriculum in practice management is also needed in most programs to prepare physicians who enter competitive pediatric practices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Training, Pediatrics, Pediatricians, Graduate medical education, Postgraduate medical education

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Immunization status and reasons for immunization delay among children using public health immunization clinics

Article Abstract:

Parents may commonly delay having their children immunized on schedule because of minor illnesses in the children. Failure to follow immunization schedules can lead to outbreaks of communicable diseases. A public health clinic reviewed immunization records and surveyed parents of 346 children who came in for immunizations. Seventy-nine percent of the children had received their first dose of diphtheria, tetanus, pertussis (DTP) vaccine on schedule, but this number fell to 52% for the second dose and to only 27% for the third dose. Only 49% of the children had received their measles, mumps, rubella (MMR) vaccine on schedule. Illness of the child accounted for 45% of delayed immunizations. The parents in this study were mostly white, with good education and income, but many of them had misperceptions about immunizations. Public education programs should be developed to increase immunization rates.

Children, Preventive medicine, Immunization of children, Immunization, Preventive health services for children

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