Preparing Future Pediatricians: Making Time Count

Abstract

At the 2011 annual meeting of the Pediatric Academic Societies participants debated whether the duration of pediatric residency should be extended. Those favoring a longer residency argued that there is more to learn now than 30 years ago and, because of regulations curtailing resident work hours, less time in which to learn it. Their opponents argued that the purpose of residency is basic competence, not mastery, and there is still sufficient time and flexibility for residents to achieve basic competence. Moreover, adding time to the residency would be prohibitively expensive. A proposal to extend residency is a simple (and simplistic) solution to complex issues. In addition to the increase in medical knowledge in recent decades, the scope of pediatrics has widened, and subspecialization has progressed; learners' exposure to various aspects of pediatrics is now occurring, if at all, in distinct and separate silos. Although setting basic competence, rather than mastery, as the outcome measure may seem reassuring, defining “basic competence” is challenging: does the term refer to a basic level of competence in the vast breadth of pediatrics or to competence in a narrow basic “core” of pediatrics? This is a fundamental distinction for educators, future pediatricians, and the public, and there are implications for length of medical school and residency training and breadth of experiences required or necessary during training. The Association of American Medical Colleges is undertaking a pediatrics redesign project for students interested in pediatrics that begins in the second year of medical school and progresses to the end of residency.1 Transition from medical school to residency and residency to practice will be based on competence rather than time. This effort is an exciting opportunity to create a true … Address correspondence to Kenneth B. Roberts, MD, 3005 Bramblewood Drive, Mebane, NC 27302. E-mail: kenrobertsmd{at}gmail.com