50 Years Ago in The Journal of Pediatrics: An Evaluation of Resident Training in the Outpatient Department

Abstract

Ambuel JP. J Pediatr 1961;58:272-6In the early 1960s, the focus in pediatric education and residency training was shifting from caring for and learning from sick inpatients to learning more about the promotion of health in the outpatient clinics. This interesting study surveyed 18 pediatric residency programs (representing about 10% of all pediatric residents) about their outpatient experiences, which included specialty clinics, the emergency department, general pediatric clinics, and the newborn clinic.The surveyed programs noted a wide variation in amount of time spent in the outpatient department, in the structure of the newborn nursery, and in the work load of the residents. It is fascinating to compare training at that time to the Accreditation Council for Graduate Medical Education (ACGME) program requirements that are in effect now. Fifty years ago, time in the outpatient setting ranged from 18% to 54%. Currently, the ACGME requires that at least 40% of training occurs in outpatient settings. In the Ambuel report, resident work load in the general pediatric clinic was 6 to 16 patients (average, 10.5) per day, which is comparable to today’s requirements for 3 to 5 patients per half-day session. However, most programs allowed residents up to an hour (or more) to evaluate each patient; today’s patient-centered clinics would not be able to support this luxury. In the emergency room, residents saw up to an average of 50 patients per day. Even in the 1960s, this was thought to be excessive. As for newborn infants, only 10 of the 18 programs provided residents with ongoing care of newborn infants and 4 programs had no newborn experiences. Today, all continuity clinics must include the care of newborn infants, and all residents must complete one month in the newborn nursery. Ambuel also encouraged programs to survey their graduates to enhance the quality of their programs, advice that is still relevant today.The author concludes by calling for increased oversight of residency programs, stating, “Accreditation boards should be encouraged to evaluate all phases of pediatric training and should pay special heed to the outpatient department training, since so little emphasis has been placed on this in the past.” Today, the ACGME program requirements for pediatrics are almost 50 pages, of which 13 pages are devoted to outpatient education. The resulting education of residents is much more consistent across the country and is being used as a model in other parts of the world. Ambuel JP. J Pediatr 1961;58:272-6 In the early 1960s, the focus in pediatric education and residency training was shifting from caring for and learning from sick inpatients to learning more about the promotion of health in the outpatient clinics. This interesting study surveyed 18 pediatric residency programs (representing about 10% of all pediatric residents) about their outpatient experiences, which included specialty clinics, the emergency department, general pediatric clinics, and the newborn clinic. The surveyed programs noted a wide variation in amount of time spent in the outpatient department, in the structure of the newborn nursery, and in the work load of the residents. It is fascinating to compare training at that time to the Accreditation Council for Graduate Medical Education (ACGME) program requirements that are in effect now. Fifty years ago, time in the outpatient setting ranged from 18% to 54%. Currently, the ACGME requires that at least 40% of training occurs in outpatient settings. In the Ambuel report, resident work load in the general pediatric clinic was 6 to 16 patients (average, 10.5) per day, which is comparable to today’s requirements for 3 to 5 patients per half-day session. However, most programs allowed residents up to an hour (or more) to evaluate each patient; today’s patient-centered clinics would not be able to support this luxury. In the emergency room, residents saw up to an average of 50 patients per day. Even in the 1960s, this was thought to be excessive. As for newborn infants, only 10 of the 18 programs provided residents with ongoing care of newborn infants and 4 programs had no newborn experiences. Today, all continuity clinics must include the care of newborn infants, and all residents must complete one month in the newborn nursery. Ambuel also encouraged programs to survey their graduates to enhance the quality of their programs, advice that is still relevant today. The author concludes by calling for increased oversight of residency programs, stating, “Accreditation boards should be encouraged to evaluate all phases of pediatric training and should pay special heed to the outpatient department training, since so little emphasis has been placed on this in the past.” Today, the ACGME program requirements for pediatrics are almost 50 pages, of which 13 pages are devoted to outpatient education. The resulting education of residents is much more consistent across the country and is being used as a model in other parts of the world.