PEDIATRICS Vol. 105 No. 1 Supplement January 2000, pp. 162

Preface

Richard E. Behrman, MD

Center for the Future of Children David and Lucile Packard Foundation

  Genuine concern for the health of children and youth demands periodic reassessment of pediatric education so that future generations of pediatricians can better serve their patients. THE FUTURE OF PEDIATRIC EDUCATION II (FOPE II) Project addresses this responsibility in a thoughtful and comprehensive manner. Because of its importance, this task has appropriately involved many groups and individuals from within and outside the pediatric community, representing a great diversity of views. Those responsible for this report have objectively considered all opinions and facts brought to their attention and have used their best judgement based on the information available.

  The health of children is critically dependent on advances in basic and clinical science and technology. Our accelerating knowledge and understanding about disease offer unparalleled promise to improve our ability to prevent, diagnose, and treat. This process must continue as the core of pediatric education. However, the health issues children in the United States will face in the years ahead are also, to a significant degree, related to the social and economic forces that shape their world, especially those that result in increased poverty and disruption of the nurturing role of the family. Many of these forces play a major part in the manifestations and management of illness in infants, children, adolescents, and young adults.

  These threats, which disproportionately affect subpopulations of vulnerable children in our increasingly diverse society, need to be taken into account in educating pediatricians and other child health care professionals. They include the following:

  The number of children and youth with neurosensory and physical disabilities, which is relentlessly compounding each year.
  The many children who are developmentally and behaviorally impaired attributable to injurious social environments.
  Various subsets of children subjected, directly and indirectly, to a diversity of environmental hazards attributable to chemicals, drugs, and contaminated food.
  The management of chronic disease, including behavioral and mental illness, in a manner that optimizes quality of life.
  The prevention, treatment and consequences of intentional and unintentional injury, which continue to plague childhood and adolescence.
  The changes in the organization of health care, which impact greatly on access to and quality of care.

  In considering all of the foregoing issues and many others, this report does not overlook an important basic principle. Although pediatricians are educated to address a broad spectrum of disease and illness in children with understanding derived from science and technology, the "art" of medicine must not be neglected. In the end, pediatric care is fundamentally a very personal, caring interaction between a child, usually with his or her parent, and a pediatrician. Central to this private transaction is the overriding responsibility of the physician to maximize the potential benefit while minimizing the risk of harm to the individual patient. The "bottom line" is not profit, nor cost containment, nor cost efficiency; rather, it is the net personal health benefit for the individual child, a benefit that promotes his or her optimal development into a well adjusted, productive adult.

  The daunting task of proposing changes to meet these challenges of the 21st century, while preserving the accomplishments of the past, has been undertaken with objectivity, sensitivity, and imagination by the leadership of the profession. The outcome is the following report, which provides a basis for constructive dialogue about improvement in the education of the pediatricians who will follow us.