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Post-publication Peer Reviews to:

ARTICLES:
Gary L. Freed and the Research Advisory Committee of the American Board of Pediatrics
Comparing Perceptions of Training for Medicine-Pediatrics and Categorically Trained Physicians
Pediatrics 2006; 118: 1104-1108 [Abstract] [Full text] [PDF]
*P3Rs: Submit a response to this article

P3Rs published:

[Read P3R] Combined Training
Edmund A Liles, Michael Steiner   (15 November 2006)

Combined Training 15 November 2006
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Edmund A Liles,
Physician
UNC Hospitals,
Michael Steiner

Send letter to journal:
Re: Combined Training

liles{at}med.unc.edu Edmund A Liles, et al.

Dear Editor,

We read the recent article entitled “Comparing Perceptions of Training for Medicine/Pediatrics and Categorically Trained Physicians” with great interest.1 The work of Freed and the American Board of Pediatrics provides important insights into the education of both categorical residents and residents in combined Internal Medicine and Pediatrics (MedPeds) training programs. We would like to comment on several of the findings based on our experiences training residents in the combined and categorical programs at our institution.

We are concerned that the reported difference in recall of training preparedness is the result of a biased sample. The survey of MedPeds graduates revealed that 14% provided no care to children under 1 year of age.2 However, that 14%, along with the other respondents, were asked to retrospectively evaluate their preparedness to care for infants. These respondents likely finished residency training up to 30 years ago and we would expect that physicians who had not cared for infants for many years would report that they did not feel well trained for that activity during residency. Since we believe that a very small percentage of categorically -trained Pediatricians provide no care to infants, their response regarding training in this area was not subject to the same recall bias. The 14% of MedPeds physicians who provide no care to infants may have significantly influenced the 15% difference between Pediatricians trained in categorical and combined programs and their perception of preparedness.

We agree with the authors that perception of care does not necessarily reflect competence or quality of care. Medical organizations and accrediting groups struggle with the question of how to evaluate quality of care and competency. In-training exam scores and first time pass rates on the American Board of Pediatrics and American Board of Internal Medicine Certifying Examinations are other possible markers of competence. Based on our experience and previously published national surveys, MedPeds residents have test scores at least equal to categorically trained residents.3-5

MedPeds training benefits from learning about medical care across the entire age spectrum and principles of care taught by one specialty may be value added to the other specialty. The skill to care for patients in continuity across a wide age range will gain increasing importance as more children survive chronic childhood diseases and transition into adulthood. Simultaneously, the current generation of children is increasingly developing formerly “adult” diseases like obesity, hypertension, and Type II diabetes.

We look forward to using this data and the conclusions drawn by the authors to maximize our curriculum for both the combined and the categorical residency training programs.

Sincerely,

E. Allen Liles, Jr. MD Program Director, Internal Medicine and Pediatrics Residency The University of North Carolina School of Medicine

Michael Steiner, MD Assistant Professor of Pediatrics Assistant Professor of Internal Medicine The University of North Carolina School of Medicine

Reference List

1. Freed GL, and the Research Advisory Committee of the American Board of Pediatrics. Comparing Perceptions of Training for Medicine- Pediatrics and Categorically Trained Physicians. Pediatrics, 118: 1104- 1108.

2. Freed GL, Fant KE, Nahra TA, Wheeler JRC. Internal medicine- pediatrics physicians: Their care of children versus care of adults. Academic Medicine, 80: 858-864.

3. Campos-Outcalt D, Lundy M, Senf J. Outcomes of combined internal medicine-pediatrics residency programs: a review of the literature. Acad.Med., 77: 247-256.

4. Frohna JG, Melgar T, Mueller C, Borden S. Internal medicine- pediatrics residency training: current program trends and outcomes. Acad.Med., 79: 591-596.

5. Lee MW. Weighing the benefits of combined residency programs. JAMA., 266: 1867.

Conflict of Interest:

None declared