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
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