Career In Paediatrics Research Articles

Pediatric Resident Debt and Career Intentions

To examine current levels of educational debt among pediatric residents and the relationship between educational debt and career intentions. Annual national random samples of 1000 graduating pediatric residents from 2006 through 2010 were surveyed. Responses were combined. We used t tests and 1-way analysis of variance to compare debt, linear regression to examine factors associated with educational debt, and logistic regression to assess the influence of debt on clinical practice goal. Response rate was 61%. Three in 4 residents reported having educational debt. The mean debt (in 2010 dollars) among all residents, which included spouse's debt if married, increased 34% from $104 000 in 2006 to $139 000 in 2010. Among the subgroup who reported having any debt, the mean debt increased 24% from $146 000 in 2006 to $181 000 in 2010. Residents had varied clinical practice goals; 43% had goals that required fellowship training (subspecialty and combined primary-subspecialty) and 57% had goals not typically requiring fellowship training (primary care and hospitalist). In multivariate analyses, debt level (low, medium, high) remained an independent predictor of practice goal. Residents with medium debt (adjusted odds ratio: 1.46, 95% confidence interval: 1.16-1.84) and high debt (adjusted odds ratio: 1.51; 95% confidence interval: 1.20-1.90) had higher odds than residents with low debt of having a practice goal that does not typically require fellowship training. Other factors also had an independent association with career choice. Multiple factors shape decisions about careers. Higher educational debt is one factor that may push residents toward primary care or hospitalist practice, rather than pursuing fellowship training.

Pediatric Resident Debt and Career Intentions

Pediatric Resident Debt and Career Intentions

L’enseignement et l’enseignant influencent le choix de la spécialité médicale. Enquête auprès de 207 étudiants

Determinants of career choice are numerous. The impact of teaching has not yet been reported.The objectives were to assess determinants of career choice among DCEM 4 (sixth year) medical students at Paris Descartes University and Pierre-et-Marie-Curie University; and to determine the impact of teaching on career choice.Prospective study based on an online survey, after the 2011 National Grading Examination, among 865 DCEM 4 students. Collection of socio-demographic data, commonly reported determinants of medical specialty choice, and the impact of the teaching on this choice.Two hundred and seven (24%) students (67% female) answered the survey. During their medical studies, students changed their mind on their career choice an average of 3 times (range 0-10). Nearly 60% of them made their final choice during the fifth year. Choices varied significantly between the beginning and end of the studies (P<0.0001), with interest in surgical and pediatric careers falling significantly (P<0.0001 and p=0.0003 respectively). At the time of expressing the final choice, surgical careers were mainly chosen by male students (19.8% of males vs. 9.9% of females, P=0.04), whereas medical careers were chosen equally by males and females (37.7% vs. 35.5%, P=0.75). The main determinant was interest in the specialty (96% of students), followed by perceived quality of life (56% of students). Teaching was a determinant for 74% of students, of whom 88% were influenced by the teaching they received during their clinical training. In 42% of cases, the teacher did not belong to the university corpus. In 10% of cases, students were discouraged from their choice by a teacher (a university professor in 50%).Our results highlight the impact of both teaching and the teacher on medical students' career choice. If career choice is now compelled in France by the "careers law", teaching is more than ever an effective way of interesting students in specialties which might appear less attractive. At a time when the selection of candidates for hospital-university careers is mainly based on publications, this study calls for reflection on the evaluation of these candidates' teaching qualities.

1008 Opportunity Costs in Paediatrics: the Specialist Registrar Experience

Background and AimsRecently, the pursuit of a career in Paediatrics has gradually suffered a decline. This observation prompted an evaluation of Specialist Paediatric Registrars’ (SPR) perceptions of their training programme...

Choosing the Right Pediatric Career Path

Choosing the Right Pediatric Career Path

Career Satisfaction and the Role of Mentorship: A Survey of Pediatric Hospitalists

Attending physicians' career satisfaction is associated with higher patient satisfaction, better patient care, and even medical student career choice. Previous studies indicate that adequate mentorship improves job satisfaction, but finding mentors may be challenging for some hospitalists. Little is known about pediatric hospitalist career satisfaction or the role of mentorship. The goal of this study was to assess career satisfaction among pediatric hospitalists, determine which interventions may improve satisfaction, and investigate the role of mentorship in satisfaction. This study included the use of an anonymous electronic cross-sectional survey sent to the American Academy of Pediatrics' Section on Hospital Medicine Listserv between November 2009 and January 2010. A total of 222 pediatric hospitalists responded; 92% agreed with the statement, "Overall, I am pleased with my work." Of the 23 satisfaction statements, "I have adequate mentorship in my career" was rated lowest (< or = .001); only 44% agreed. Adequate mentorship was significantly correlated with overall career satisfaction, having sufficient opportunity for promotion, feeling valued by one's administration, and wishing to remain at one's current hospital. Adequate mentorship was negatively correlated with planning to change specialty or leave clinical medicine. Mentorship satisfaction did not differ by age, years as a hospitalist, gender, or practice setting. Of the 15 potential interventions, creating a formal mentorship program ranked in the top 5. Only increasing base salary received a significantly higher score. Although surveyed hospitalists have substantial overall career satisfaction, lack of mentorship is a significant problem that spans the demographic spectrum. Establishing a mentorship program may be an effective way for hospitalist groups to improve satisfaction.

From primary care to bird’s eye view: A career in paediatrics

From primary care to bird’s eye view: A career in paediatrics

Navigating the stages of an academic career for paediatricians

In Canada, a major proportion of the country’s paediatricians work within the context of the paediatric academic health science centres (PAHSCs). These are either free-standing children’s hospitals or children’s units within general hospitals, all affiliated with a university faculty of medicine. In a recent work force analysis by the Paediatric Chairs of Canada (PCC), an association linking the 16 medical school departments of paediatrics, 1701 full-time and major part-time faculty members were identified, representing slightly more than one-half of the country’s paediatricians (1). The remaining paediatricians are increasingly involved in academic activities as more community hospitals become associated with expanding medical schools. Medical students intent on a career in paediatrics and, perhaps more importantly, paediatric residents deciding on their career paths, ought to be well informed about the options open to them, the appropriate training for each of these options as well as the expectations when entering their field of choice. Here, we address the issue of stages or phases of an academic career, and what to expect and how to successfully navigate the challenges of each phase. We make some assumptions, namely that the training for the position has been appropriate and that the job or career activity profile into which the candidate has been recruited matches this training. This is not to minimize either of these aspects of career planning and development; rather, they warrant attention in a separate article.

Tomorrow's paediatricians: factors influencing graduating doctors in choosing a career in paediatrics

<h3>Aim</h3> To identify influencing factors for a graduating doctor considering a career in paediatrics. <h3>Methods</h3> An online structured questionnaire was distributed using SurveyMonkey to all graduating doctors at Cardiff, Bristol and Glasgow Schools9 of Medicine. Respondents were asked to provide demographic information, as well as their ideal career choice followed by the specialty they realistically see themselves pursuing. Following this, respondents rated 19 career influences using a 5-point Likert scale. Data was analysed using non-parametric tests. <h3>Results</h3> The response rate was 31% (233/751) with 60.5% from Cardiff, 23.6% from Glasgow and 15.5% from Bristol. 81.5% (n=190) were undergraduates and 63.1% (n=147) were female. Mann-Whitney tests were employed to characterise the differing career influences between males and females. Males were more influenced than females by public prestige (p=0.01), professional prestige (p=0.01) and research opportunities (p=0.03), whereas factors more influential for females were patient relationships (p=&lt;0.001), working hours (p=&lt;0.001), job stress (p=0.01) and lifestyle (p=&lt;0.001). 19.8% (n=46) stated they would ideally like a career in paediatrics, with only 6.9% (n=16) feeling they would realistically end up fulfilling this ambition. Of those 30 students who felt an alternative career was more likely, 28/30 felt they would realistically become GPs. Those who were confident of an eventual career in paediatrics were significantly less influenced by working hours (p=0.002), lifestyle (p=0.02), financial incentives (p=0.006) and training length (p=0.001). <h3>Conclusion</h3> These findings highlight the importance of engaging with the future paediatric workforce, especially for ensuring high quality workforce planning. The apparent move towards specialties that allow a better work-life balance means that those responsible for maintaining adequate recruitment into paediatrics will need to address the priorities of tomorrow9s doctors.

A questionnaire study of final year medical students investigating the factors influencing them to consider or reject a career in paediatrics

<h3>Aims</h3> To report on the factors that influence final year medical students9 career choices, their attitudes to and experiences of paediatrics, and how these have impacted upon their decision to consider or reject paediatrics as a career choice. <h3>Background</h3> Competition ratios for paediatric training are amongst the lowest of all hospital specialties. In order to delicer a high class child health service in the future, paediatrics needs to attract trainees. Junior doctors in the UK are selecting their specialty at an earlier stage than previously, so experiences of paediatrics during medical school are even more important than in the past in influencing career choice. <h3>Methods</h3> Questionnaire study of 135 final-year medical students. <h3>Results</h3> Significantly more of the students who were considering paediatrics were female (76%, with 60% of the respondents overall being female, p&lt;0.0001). 73% of female students and 12% of male students agreed that the opportunity to work less-than-full-time was important to them when considering their career choice. The majority of students felt that paediatrics offered good opportunities for variety of work (89%) and career progression (78%), but only 55% agreed that there were good opportunities for being involved in research. Under half of students (48%) agreed that paediatricians have well balanced lives, yet only 43% felt that paediatricians do lots of out-of-hours work and 35% that paediatricians are busier than other doctors; between 63% and 78% of students reported that these factors did not impact on their career decision. Most students (75%) agreed that paediatricians are positive role models, though only 65% agreed that paediatricians are well respected by other doctors. A considerable number of students (40%) did not feel involved in the team during paediatric attachments, despite agreeing that people were friendly and they felt welcome. <h3>Conclusions</h3> Students should be offered greater patient exposure and team involvement during paediatric attachments, along with targeted and specific careers advice. Opportunities for flexible working within paediatrics should be explored and developed, and it would be valuable to investigate further the professional image of the specialty.

“What does it mean for our family?”: learning from paediatric patient journeys

UCL9s intercalated BSc (iBSc) in Paediatrics in Child Health began in 2010. The iBSc aims to further education in Paediatrics at an Undergraduate level, to promotoe academic paediatrics, and to excite a cohort of medical undergraduates about the possibilities of a career in Paediatrics by giving them learning opportunities and experiences not normally accessed in the medical undergraduate curriculum. The course has two main strands: how patients and families travel through and experience healthcare - “the patient journey” - and research within paediatrics. Learning from cases is central to the study of medicine, yet often the patient experience is lost. We feel that this experience of illness is central to understanding the full implications of long-term conditions, and makes individuals more insightful practitioners. Students follow “patient journeys” in several ways. They are given “patient journeys” as written stories. These are real stories collected from families given in instalments with questions for reflection and discussion. A Paediatrician and a Child Psychiatrist facilitate discussions. Students have to write a reflective essay on one of the issues that have arisen for one of the families as part of their assessment. Additionally students spend regular sessions talking to families, children and teenagers about their experiences of illness. Students also collect their own “patient journey” from families of children with long-term conditions. This usually involves interviewing them in their home setting. Common themes that emerge in these sessions include the importance of communication, difficulties in dealing with different professionals and uncertainty. Feedback from both students and participating families is overwhelmingly positive. One student commented “..the iBSc gave me a better appreciation of the way in which small actions of members of the medical professions could have huge impacts on the family - both positive and negative”. Families valued the opportunity to “tell their story” and one commented “..if it makes them a better doctor then we have both benefited” Learning directly from patient experience is increasingly being recognised but is still not fully embedded in many undergraduate (or postgraduate) paediatric curricula. We hope to extend the scope of this work and make our teaching tools widely available for medical education purposes.

Paediatric society: ongoing initiatives to raise the profile of paediatrics

<h3>Aims</h3> To assess baseline paediatric career intentions and the impact of a student-led paediatric society (PS), which aims to increase student exposure and encourage recruitment to paediatrics. The PS was established in 2009 and runs career events, paediatric/neonatal resuscitation training days, Teddy Bear Hospital (TBH) sessions and provides information for electives. <h3>Methods</h3> Clinical students (2011) joining the PS completed a baseline career choice questionnaire during their introductory week. After attending PS events, students completed anonymous feedback questionnaires to assess changes in attitudes towards paediatrics. Participation in TBH, paediatric electives and student selected components (SSC) were used as other indicators of interest in paediatrics. <h3>Results</h3> The PS has 288 members, representing 64% of clinical students. 53 students responded to the baseline careers questionnaire; of these, 7 (13%) planned to specialise in paediatrics and mean certainty about their future career choice was 2.5 (5-point Likert scale). 30 students attended our careers event in November 2011 and 16 completed the feedback questionnaire; 8 were certain they wished to specialise in paediatrics and a further 8 considering paediatrics. The mean value for certainty about their future career was 3.2 (5-point Likert scale). Students (n=30) attending our Paediatric / Neonatal resuscitation training day rated it a mean of 100% for satisfaction and 97% for increased confidence in dealing with future emergency scenarios. The PS organised 8 TBH health education events for local primary schools, involving over 100 medical student volunteers and 250 children. Over the last 4 years the number of students undertaking paediatric electives has increased from 26 to 42 and SSCs from less than 10 in 2007 to 34 in 2011. <h3>Conclusions</h3> ▶The majority of students entering clinical medicine are unsure about their future career choice, but many consider paediatrics as an option. ▶Events run by the PS with supportive consultants are popular. ▶Increasing student involvement in TBH, paediatric electives and SSCs has increased the profile of paediatrics at this medical school.

Pediatric Training and Career Intentions, 2003–2009

To examine trends in pediatric residents' training and job search experiences from 2003 through 2009. Annual national random samples of 500 graduating pediatric residents from 2003 through 2005 and 1000 from 2006 through 2009 were surveyed. Responses were compared across years to identify trends. We examined resident demographics, training, satisfaction, career intentions, and job search experiences. Overall response rate was 61%. Between 2003 and 2009, there was an increase in the proportion of female graduating pediatric residents (69%-75%), residents from international medical schools (15%-23%), and levels of educational debt among the subgroup of residents with debt ($139 945 in 2003 to $166 972 in 2009). Residents consistently reported (>90% of residents) that they would choose pediatrics again if they had the choice. By 2009, the majority was very satisfied with the quality of their training in most areas, with ratings improving across years in caring for children with special health care needs, evidence-based medicine, and using information technology in practice. Although primary care remained the most common clinical practice goal, there was a modest decline in interest in primary care practice across survey years, whereas interest in subspecialty practice increased. Residents accepting both general pediatric practice and hospitalist positions reported less difficulty in their job search over time. Despite continually changing demographics of pediatric training programs, residents overall remain very satisfied with their decision to become pediatricians. Pediatricians continue to face difficult financial challenges associated with rising debt, but they also report increasing job search success.

Pediatric Training and Career Intentions, 2003-2009

Pediatric Training and Career Intentions, 2003-2009

Taking the Pulse of Pediatrics

* Abbreviations: AAP — : American Academy of Pediatrics “How are you—and how are things going?” These are words spoken each and every day by us as pediatricians to parents and our young patients. We listen to what our patients tell us about their state of well-being and then work with them to make a plan to improve their overall health. In almost all cases, we maintain a state of optimism and encourage our patients and their families to feel likewise, no matter how dire the situation. Now let's try this analogy again—but with the field of pediatrics being our patient. How is our profession faring? If you open a newspaper or watch television, you might say “not so well.” You may find yourself bemoaning children's access to health care and the difficulty of establishing medical homes, the ever-decreasing ability of families to afford health care for their children, the concern that pediatric practices may not stay viable given ever-decreasing reimbursements, or even just the public's suspicion of our standards of care—especially with declines in receptivity by some parents to vaccinate their children. We were struck by the pessimism of many of our colleagues at the American Academy of Pediatrics’ (AAP's) National Conference and Exhibition this past October, not just about the future of our own practice, but also about whether the current environment will attract future medical students to consider a career in pediatrics. It seems that … Address correspondence to Lewis R. First, MD, MS, Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT 05405. E-mail: lewis.first{at}uvm.edu

A study of the pediatric workforce

Linda Althouse and Jim Stockman from the American Board of Pediatrics (ABP) recently completed an update of pediatric workforce data that is analyzed on a regular basis by the ABP. In the past, these studies have been published as a series of reports for general pediatrics and each of the 13 subspecialties. This time, all the workforce data are being published in one Commentary. The ABP has the best data on this topic, and they combine data from three different sources to create a very comprehensive data set. The results are interesting and indicate that there is probably no immediate crisis in the offing, but we will need to monitor the balance between general pediatrics and pediatric subspecialty careers, as well as the distribution of pediatricians from a geographical point of view. In addition, there is information about the increase in proportion of pediatricians that plan to work part-time and the percentage of pediatricians who may start to enter retirement. Article page 1036▶ The Pediatric Workforce: An Update on General Pediatrics and Pediatric Subspecialties Workforce Data from the American Board of PediatricsThe Journal of PediatricsVol. 159Issue 6PreviewFor several decades, the American Board of Pediatrics (ABP) has assimilated workforce data using questionnaires administered in association with its various examinations and through a tracking system that provides an annual update of residents and fellows in training. These data provide critical information regarding trainees and practitioners in pediatrics and the overall workforce landscape. In 2006, The Journal published a series of workforce reports for general pediatrics and the 13 subspecialties for which the ABP currently administered examinations. Full-Text PDF

Training Gaps for Pediatric Residents Planning a Career in Primary Care: A Qualitative and Quantitative Study

Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003-2006) 3years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from "not at all well prepared" to "extremely well prepared" for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders. Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence. Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.

Pediatric Hospitalists’ Perspectives on the Care of Children With Medical Complexity

The aims of this study were to identify pediatric hospitalists' perceived views of (1) barriers to delivering care to children with medical complexity (CMC) and (2) their preferred model of inpatient health care delivery for CMC. American Academy of Pediatrics Section on Hospital Medicine (AAP-SOHM) Listserv subscribers. We conducted a cross-sectional survey of subscribers of the AAP-SOHM Listserv using the survey instrument SurveyMonkey®. Our survey was coadministered with a survey on pediatric hospitalist career satisfaction. The most significant barriers to delivering care to CMC were (1) time constraints (89%), (2) inadequate postdischarge resources (75%), and (3) lack of evidence-based guidelines (64%). Although most pediatric hospitalists in an inpatient service currently care for both CMC and non-CMC patients (91%), only 25% perceive this to be the optimal service model for CMC. The majority of hospitalists (56%) believe that CMC are better served by either an inpatient service dedicated to CMC (30%) or comanaged with an inpatient consult service for CMC (26%). Identifying the perceived barriers to delivering care to CMC can assist pediatric hospitalists to design studies determining if care delivery is affected by these barriers. Most hospitalists care for CMC on the same service as uncomplicated patients, yet over half perceive that a different model of care delivery would better serve the needs of CMC.

Medical students’ views on selecting paediatrics as a career choice

Despite increasing numbers of UK medical students, the number of trainees selecting paediatrics as their specialty choice has decreased. Previous studies show that most students will choose their ultimate career during undergraduate training. We therefore explored the views of students in the final year at Birmingham University about a career in paediatrics. Students completed a 27-item questionnaire during the penultimate week of their paediatric clerkship (PC) and 97% responded (127/131). Prior to the PC, 29% (37/127) of students had considered a career in paediatrics, rising to 50% (63/127) after the PC (p < 0.001). Students felt that paediatricians were enthusiastic and keen on teaching, and the ward working atmosphere was good. However, students perceived paediatrics as a difficult specialty with high competition for training posts. Students felt their paediatric experience was too limited and advice was needed on paediatric careers early in undergraduate training. This study confirmed that focusing on improving the PC is not sufficient if we are to inspire medical students to consider a career in paediatrics. Exposure to the specialty is needed from year 1 of undergraduate training along with career advice to dispel current myths about specialty training. Students would then be able to make more informed career decisions.

A career in paediatrics: views of foundation doctors

Aim▶Explore a potential relationship between undergraduate or postgraduate exposure in paediatrics and an increased likelihood of ranking paediatrics first at time of application to specialty training.▶Explore the reasons why applicants...