During the past few years, the Accreditation Council of Graduate Medical Education has aimed to change the model of physician residency training to a competency-based system. The adoption of a competency-based training system is now required, and residency programs are expected to define and evaluate the achievement of competency. In an effort to facilitate this endeavor, the Anne E. Dyson Community Pediatrics Training Initiative Curriculum Committee developed competencies for physician training in community pediatrics. These competencies refer to 8 domains thought to be integral to the practice of community-based pediatrics:
Delivery of culturally effective care: Pediatricians must demonstrate interpersonal and communication skills that result in effective information exchange with children and families from all cultural backgrounds and diverse communities.
Child advocacy: Child advocacy pediatricians should advocate for the well-being of patients, families, and communities; must develop advocacy skills to address relevant individual, community, and population health issues; and understand the legislative process (local, state, and federal) to address community and child health issues.
Medical home: Pediatricians must be able to identify and/or provide a medical home for all children and families under their care. As defined by the American Academy of Pediatrics, the medical home is an approach to providing comprehensive primary health care services in partnership with families. Care received in the medical home is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.
Special populations: Pediatricians must be able to identify children and youth at risk for poor health outcomes and those with special health care needs. Pediatricians, in concert with other child health professionals, must collaboratively develop and implement management plans that are realistic, family centered, community referenced, nonrestrictive, and effective. They must have a working knowledge of specific psychosocial issues, legal protections/implications, policies, and services provided for these populations at the local, state, and federal levels.
The pediatrician as a consultant, partner, and collaborative leader: Pediatricians must be able to act as child health consultants in their communities. Using collaborative skills, they must be able to work with multidisciplinary teams, community members, and representatives from schools, child care facilities, and legislative bodies.
Educational and child care settings: Pediatricians must be able to interact with the staff of schools and child care settings to improve the health and educational environments for children.
Community and public health: Pediatricians must be able to understand and potentially modify the health determinants affecting patients and families in the community that they serve. To effect change in health outcomes, pediatricians must be able to identify and mobilize community assets and resources toward preventing illness, injury, and related morbidity and mortality.
Research and scholarship: Pediatricians should be capable of pursuing inquiries that advance the health of children, families, and communities.
In this article, each domain is introduced by a competency statement (Tables 1–8). The competency statement contains the expectations for all pediatricians in that specific area of professional performance. These competency statements describe the outcomes thought to be essential for professional functioning of pediatricians with a community-based approach. The competency statements are followed by a list of learning objectives. Because competencies are theoretical constructs, the specific learning objectives represent tangible ways to define and evaluate competency. In addition, each learning objective is related to ≥1 of the 6 Accreditation Council of Graduate Medical Education competency areas. This article does not attempt to address competencies in classic pediatric diagnostic or clinical skills. Although competency is expected at completion of residency, lifelong learning will be necessary for lasting proficiency and mastery of these competencies. This article does not establish the level of competency expected for each learning objective.
A, Delivery of Culturally Effective Care: Pediatricians must demonstrate interpersonal and communication skills that result in effective information exchange with children and families from all cultural backgrounds and diverse communities.
B, Child Advocacy: Child advocacy pediatricians should advocate for the well-being of patients, families, and communities; must develop advocacy skills to address relevant individual, community, and population health issues; and understand the legislative process (local, state, and federal) to address community and child health issues.
C, Medical Home: Pediatricians must be able to identify and/or provide a medical home for all children and families under their care. As defined by the American Academy of Pediatrics, the medical home is an approach to providing comprehensive primary health care services in partnership with families. Care received in the medical home is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.
D, Special Populations: Pediatricians must be able to identify children and youth at risk for poor health outcomes and those with special health care needs. Pediatricians, in concert with other child health professionals, must collaboratively develop and implement management plans that are realistic, family centered, community referenced, nonrestrictive, and effective. They must have a working knowledge of specific psychosocial issues, legal protections/implications, policies, and services provided for these populations at the local, state, and federal levels.
E, The Pediatrician as a Consultant, Partner, and Collaborative Leader: Pediatricians must be able to act as child health consultants in their communities. Using collaborative skills, they must be able to work with multidisciplinary teams, community members, and representatives from schools, child care facilities, and legislative bodies.
F, Educational and Child Care Settings: Pediatricians must be able to interact with the staff of schools and child care settings to improve the health and educational environments for children.
G, Community and Public Health: Pediatricians must be able to understand and potentially modify the health determinants affecting patients and families in the community that they serve. To effect change in health outcomes, pediatricians must be able to identify and mobilize community assets and resources toward preventing illness, injury, and related morbidity and mortality.
H, Research and Scholarship: Pediatricians should be capable of pursuing inquiries that advance the health of children, families, and communities.
CURRICULUM COMMITTEE MEMBERS
Gregory S. Blaschke, MD, MPH, co-chair (Naval Medical Center San Diego); Beth Rezet, MD, co-chair (Children's Hospital of Philadelphia); Steve Shelov, MD, MS, co-chair (Dyson Initiative Program Advisory Committee); Arturo Brito, MD (University of Miami); Mary Ciccarelli, MD (Indiana University); Virginia Cleppe, AM, ACSW (Medical College of Wisconsin); Eva Desrosiers, MD (Harlem Hospital Center); Carole Ewart, MS, EdD (University of Florida, Jacksonville); Lynn C. Garfunkel, MD (University of Rochester); Anthony P.S. Guerrero, MD (University of Hawaii); Louise Iwaishi, MD (University of Hawaii); Dianne Littlefield, MPH (University of California Davis); Dodi Meyer, MD (Columbia University); Dean E. Sidelinger, MD, MSEd (University of California San Diego); Earnestine Willis, MD, MPH (Medical College of Wisconsin); Wanessa Risko, MD, DSc (Dyson Initiative Technical Advisory Team); and Grace Chi, ScM (Dyson Initiative National Program Office).
Footnotes
- Accepted December 22, 2004.
- Address correspondence to Beth Rezet, MD, Children's Hospital of Philadelphia, Primary Care Center, 3819 Chestnut St, Suite 120, Philadelphia, PA 19104. E-mail: rezet{at}email.chop.edu
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
No conflict of interest declared.
- Copyright © 2005 by the American Academy of Pediatrics
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