TABLE 2

Parent, Patient, and Trainee Perspectives on Pediatric Training: Problems and Solutions

Current ChallengesRecommendations
Parent and PatientTrainee (Resident and Subspecialty)Parent and PatientTrainee (Resident and Subspecialty)
Limited focus on prevention, promotion of emotional resilience, and treatment of B/MH problemsInadequate engagement in B/MH care from pediatric subspecialists or from primary care pediatriciansEmbed parents, youth, and young adult voice throughout the entirety of trainingDecrease time spent covering topics such as asthma or bronchiolitis that are less common than B/MH concerns
Fragmentation of health care environmentVariability in the types of curricula and the hands-on training experiences being offered across programsSolicit help from family and peer support groups to develop scripts for trainees or practicing pediatricians who may be unsure of how to start conversations about B/MHOffer opportunities for general pediatrics trainees to spend less time in subspecialized inpatient services and more time undergoing intensive B/MH training
Limited recognition of the B/MH issues that children, adolescents, and their families with acute, life-threatening or chronic conditions facePoor preparation of residents to differentiate between low- and high-risk behaviors and normal and abnormal behaviors and to make decisions regarding clinically appropriate next stepsExpand trainees’ understanding of development to include considerations of well-beingOffer clinical opportunities related to B/MH in subspecialty training programs
Negative self-efficacy and professional identity development resulting from powerlessness to address concerning psychosocial problemsDiscard preconceived notions about what the typical child or typical family should like and how they might respond to life events, including acute and chronic illness or other family stressors
Trainee opportunities for learning reduced by faculty discomfort with treating patients with B/MH concerns
Lack of care continuity leading to residents having inadequate hands-on training in how to manage chronic MH conditions