Anne E. Dyson, MD, was a pediatrician with a vision that pediatric residents would come out of their training programs equipped with the tools, knowledge, and experience necessary to improve child health within communities. She knew that for her vision to become reality, however, pediatric residents would need active, intentional training on the concepts of community pediatrics, which would require some fundamental changes in the way pediatricians are trained in this country. To that end, under her direction, the Dyson Foundation launched the Anne E. Dyson Community Pediatrics Training Initiative in 1999. The preceding articles in this supplement are evidence that, thanks to this bold and innovative initiative, Dr Dyson's vision is well on its way to becoming reality.
Although the articles contain much valuable information, there are major points that are particularly noteworthy. Where pediatricians once dealt with the classic and new morbidities, we now care for patients and families affected by millennial morbidities: socioeconomic and technologic influences, health disparities, increasing instances of mental health conditions, and a societal trend toward overweight and obesity. With the 2 biggest determinants of child health being poverty and parents' education level, pediatricians cannot address these issues in isolation. Rather, they call for a community perspective, and pediatricians need to establish partnerships with other leaders in their communities to address today's child health issues successfully. Several articles in this supplement provide models for doing so.
It is demonstrated throughout the supplement that a community-based approach works to improve child health at the community and population levels and benefits pediatric-training programs. This is particularly important in light of the revised requirements of the Residency Review Committee for Pediatrics calling for structured educational experiences that prepare residents to advocate on behalf of the health of children within communities. In response to these curricular shifts, a committee from the 10 Dyson Initiative training sites developed a set of competencies for residency training in community pediatrics. The committee's goal is to share the competencies with all pediatric-residency–training programs around the country. Incorporating these competencies into an already full residency curriculum will be challenging for training-program directors, but the results should be gratifying. The community-based approach benefits our training programs by providing abundant opportunities for academic research and nontraditional resources and funding. The lessons learned from the Dyson Initiative will assist residency programs in meeting the standards set by the Residency Review Committee and the American Board of Pediatrics, which require all those completing training to have demonstrated their ability to practice within systems of health care.
Community pediatrics training works. Two critical elements, engaging residents and building strong community partnerships, are described in this supplement, as are a number of educational models that illustrate key curricular components and methods. It is important to note that the benefits of community pediatrics training seem to go beyond just residency training, because there is evidence that community pediatrics training develops pediatricians who not only understand child health in the context of community but also have the leadership and collaborative skills needed to improve the health of children.
Last, community pediatrics training is good for individual pediatricians and our profession as a whole. When we take a broader focus and establish links with community resources, we are better able to do what is right for children and families. When we concern ourselves with doing what is right, the community and public will become full partners.
These points, although significant, represent just a sampling of the wealth of information contained in this supplement. We applaud the pediatricians and others doing this important work, the Dyson Foundation, the American Academy of Pediatrics Department of Community Pediatrics, article authors, and supplement editors for their efforts to compile this information and share it with the rest of the pediatric community. The American Academy of Pediatrics and American Board of Pediatrics are excited about the changes in pediatric training that will result from this initiative and look forward to playing an integral role in moving community pediatrics training into the next phase.
In closing, we are grateful to Anne E. Dyson for establishing the Community Pediatrics Training Initiative in an effort to move forward the practice of community pediatrics. Thanks to her foresight, a new generation of pediatricians is emerging from our training programs, a generation that not only understands and appreciates the theoretical importance of caring for children within the context of their communities but also has practical, hands-on experience in actually doing it. We believe the result will be healthier children, healthier communities, and ultimately a healthier future. That is Dyson's legacy, and it is a powerful legacy, indeed.
- Accepted December 22, 2004.
- Address correspondence to Errol R. Alden, MD, FAAP, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007.
No conflict of interest declared.
- Copyright © 2005 by the American Academy of Pediatrics