Career In Paediatrics Research Articles

Language Traps

My first paediatric job in the UK was a locum junior house officer in 1975. It was at Northwick Park Hospital on the outskirts of London adjacent to the Borough of Harrow, for which the school of that name is an icon. Free access to the school's old squash courts was a much appreciated privilege bestowed upon junior staff at the hospital. The hospital itself was a burgeoning hive of academic and clinical expertise, which included the Department of Paediatrics. I was challenged by an admission in my first week on duty. An 11-month-old girl of Pakistani ethnic origin presented with a febrile convulsion. Investigations revealed hypocalcaemia. My examination identified short stature and, with some biochemical clues, clinical evidence of infantile rickets. I found the extraction of an accurate dietary history difficult because of language problems. As best as I could ascertain, the child had been fed on goat's milk. With some excitement but uncertainty, I conveyed my findings to the senior registrar. This happened to be Harvey Marcovitch, who has enjoyed an illustrious career in paediatrics and journalism, culminating in becoming editor-in-chief of Archives of Diseases of Childhood. Uncertain of the implications, Harvey pursued this to identify whether goat's milk was likely to be deficient in vitamin D. His enthusiastic search took him to the research centre of the hospital to which there was an attached veterinary section. After some hours of fruitless research, he returned to the parents to take his own history and conduct his own examination. He did not identify any dietary indiscretions. With some cynical and disparaging comments regarding ignorant Aussies who have lost touch with the Queen's English, he informed me that the child had never been on goat's milk. In fact, she had been on a very orthodox brand of formula, well known in the UK but not so well known in the Antipodes, called ‘Cow and Gate’.

Reflection of a career in paediatrics: A calling becomes a fulfilling profession

Reflection of a career in paediatrics: A calling becomes a fulfilling profession

Does Fellowship Pay: What Is the Long-term Financial Impact of Subspecialty Training in Pediatrics?

To (1) analyze the financial returns of fellowship training in pediatrics and to compare them with those generated from a career in general pediatrics and (2) evaluate the effects of including the newly enacted federal loan-repayment program and of changing the length of fellowship training. Although the choice to enter fellowship is based on many factors, economic considerations are important. We are not aware of any study that has focused on the financial impact of fellowship training in pediatrics. Using standard financial techniques, we estimated the financial returns that a graduating pediatric resident might anticipate from additional fellowship training followed by a career as a pediatric subspecialist and compared them with the returns that might be expected from starting a career as a general pediatrician immediately after residency. The financial returns of pediatric fellowship training varied greatly depending on which subspecialty fellowship was chosen. Pursuing a fellowship in most pediatric subspecialties was a negative financial decision when compared with pursuing no fellowship at all and practicing as a general pediatrician. Incorporating the federal loan-repayment program targeted toward pediatric subspecialists and decreasing the length of fellowship training from 3 to 2 years would substantially increase the financial returns of the pediatric subspecialties. Pediatric subspecialization yielded variable financial returns. The results from this study can be helpful to current pediatric residents as they contemplate their career options. In addition, our study may be valuable to policy makers evaluating health care reform and pediatric workforce-allocation issues.

Factors influencing choice of paediatrics as a career among medical students at the University of Nairobi, Kenya

Objective. We aimed to determine factors influencing choice of a career in paediatrics by medical students in Kenya. Methods. A cross-sectional survey of 450 medical students from the University of Nairobi, Kenya, was undertaken using a questionnaire designed to assess their preferences with regard to future specialisation, and timing of and factors influencing this choice. The data were analysed using the Statistical Package for Social Sciences. Results. The response rate was 385/450 (85.6%). Paediatrics was the second most preferred specialty after surgery, and was chosen by 50 students (13.0%). Female students were five times more likely than males to select paediatrics. Choice of paediatrics as a career was mainly determined by perceived intellectual challenge, presence of a role model, and ease of combining a career with raising a family. Those who had completed a clerkship in the specialty reported that they were encouraged by the teaching and clinical staff ( p =0.006), but found the specialty less prestigious than others ( p =0.030). None of the male students but 12 of the female students (30%) considered gender distribution to be a factor influencing their career choice ( p =0.046). Conclusion. This study indicates that paediatrics is popular among female students and that several factors influence choice of this specialty. Understanding these factors may help medical school administrators and faculty plan future recruitment strategies.

Launching Your Career in Pediatrics

Basic techniques to schedule for maximum efficiency based on seasonal variation, provider work styles, monitoring booking, authority to control provider schedules, data systems, and job streams

Longitudinal Assessment of the Timing of Career Choice Among Pediatric Residents

To determine the timing of and key factors in resident decision making to pursue either a career in general pediatrics or subspecialty training. We used a 10-item fixed-choice questionnaire that focused on exploring how and when pediatric residents make career choices. The survey was administered to all categorical pediatric residents in the United States and Canada as part of the General Pediatrics In-Training Examination in 2007 and 2009. The 2007 level 1 residents and 2009 level 3 residents were matched by a unique person identifier to create a longitudinal data set. A total of 2305 individuals completed the survey as level 1 residents in 2007 and level 3 residents in 2009, representing a retention rate of 83.5%. Change in individual and aggregate pediatric resident response over time. A similar number of individuals planned to pursue fellowship training in 2007 and 2009 (1026 vs 1062). Among this group, 745 (72.6%) of the 2009 residents were the same individuals who had indicated that they planned to pursue fellowship training in 2007. A total of 258 (71.9%) of all residents who reported in 2007 that they intended to pursue careers in general pediatrics with little or no inpatient care were still planning to do so in 2009. Most pediatricians make their decisions regarding pursuit of a career in primary care or to complete a fellowship before they ever enter residency training. It is unknown whether a similar timeline of decision making is consistent across specialties.

Launching Your Career in Pediatrics

Discussion of scheduling methodologies to build a practice

Launching Your Career in Pediatrics

Setting office hours based on desired style, market analysis, community needs, and other factors

Who wants to be a paediatrician? Medical students' views on considering paediatrics as a career

Aims The increasing numbers of UK medical students should lead to an increase in UK paediatricians. Recent research, however, shows a fall in the number of foundation trainees selecting paediatrics as their specialty choice. The aims of this study were to survey the views of medical students about a career in paediatrics. Method A 28-item questionnaire was distributed to final year medical students doing paediatrics as the last module in their clinical rotation. Results 97% responded (127/131) with 55% (70/127) students being male. A majority were single (94%, 120/127) and aged between 21 and 24 years (78%, 99/127). A career in paediatrics was considered by 29% of students prior to their paediatric attachment. Less than half (42%, 53/127) had enjoyed their clinical attachment. However, students had found paediatricians to be enthusiastic (80%, 101/127) and keen on teaching (67%, 85/127) with a good ward atmosphere (66%, 84/127). Following their attachment, 50% of students said they would consider paediatrics as a career. However, many viewed paediatrics as a difficult specialty with high competition for training posts and long hours. High profile media cases worried only 9% (11/127). Students reported that paediatrics was too emotional and clinical experience too limited for them to make a choice. Others felt their experience of paediatrics was negative due to cancelled teaching or being attached to highly specialised firms. Some students had already chosen an alternative career prior to the paediatric module and felt early exposure, career advice or taster weeks in paediatrics early in undergraduate training would have been useful. Conclusion In order to safeguard future paediatric services, it is important to inspire medical students about a career in paediatrics. A focus on improving clinical paediatric attachments in final year training will not suffice. Student interactions with paediatric patients need to start from year one. Early careers advice and guidance needs to be introduced into the curriculum to dispel current myths regarding paediatric career options. Such changes will need to involve stronger working links between Schools of Paediatrics, Trusts and Higher Education Institutions.

Assessing Trends in Practice Demographics of Underrepresented Minority Pediatricians, 1993–2007

To assess whether underrepresented minority (URM) pediatricians serve minority and/or publicly insured or uninsured children to a greater degree than non-URM pediatricians, and to evaluate trends in these relationships. Respondents to American Academy of Pediatrics surveys in 1993, 2000, and 2007, provided their race/ethnicity, practice locations, and estimated race/ethnicity and insurance sources of their patient panels. We classified pediatricians by race/ethnicity as either URM (black, Hispanic, Hawaiian/Pacific Islander, or American Indian/Alaskan Native) or non-URM (white, non-Hispanic/Latino, Asian, or other). We compared the average percentages of minority individuals (excluding Asians) in the patient panels of URM and non-URM pediatricians, and compared the average percentages of publicly insured (includes TRICARE) or uninsured patients. Response rates were >50% for all surveys. There were 1003 (10.2% URM) postresidency respondents in 1993, 707 (11.8% URM) in 2000, and 900 (11.1% URM) in 2007. In all 3 surveys, the average percentage of minority children in URM pediatricians' patient panels was higher than for non-URM pediatricians by approximately 20 percentage points (all P < .001). The differences in the percentages of patients who were either publicly insured or uninsured widened over the study period, from 46% in URM pediatric practices versus 38.8% in non-URM practices in 1993 to 59.7% vs 40.7%, respectively, in 2007 (P < .001). In multivariable analyses, URM pediatricians' patient panels had a higher mean percentage of minorities (15.2 percentage points greater; 95% confidence interval [CI]: 12.1-18.4) and a higher mean percentage of publicly insured and uninsured patients (10.9 percentage points greater; 95% CI: 6.7-15.4) compared with non-URM pediatricians' patient panels. Over the last 14 years, URM pediatricians were more likely than their non-URM peers to care for minority children and publicly insured or uninsured patients. This relationship has not appeared to attenuate over time, and these data support ongoing and enhanced efforts to recruit qualified URMs into pediatric careers to meet the growing needs of the expanding minority child population.

Money, Lifestyle, or Values? Why Medical Students Choose Subspecialty Versus General Pediatric Careers

Although there are many published studies on factors associated with medical student career choice, few are specific to pediatric careers, and even fewer address the choice between general and subspecialty pediatric training. Fourth-year medical students surveyed at 2 schools reported their demographics, anticipated future income, the factors influencing their career choice, and their anticipated career. This study included the subset of 337 students planning pediatric careers. Results indicated that marital status, anticipated income, and career values are associated with pediatric career plans. Specifically, married students were more likely than unmarried students to pursue general pediatric careers (P < .01). Compared with students planning subspecialties, those intending to pursue general pediatric careers anticipated lower incomes ($110,906 vs $135,984; P < .001) and rated lifestyle, comprehensive patient care, and working with the poor as more important (P < .05) when choosing a career. Students planning subspecialty pediatric careers placed more value (P < .05) on prestige, income, and research opportunities.

Henry Jeffray Weston

Henry Jeffray Weston—known by family, friends, and colleagues as “Jeff”—was born on 9 September 1926 in New Plymouth, New Zealand, where his father was a newspaper proprietor. He studied medicine...

Anthony Costello: making climate change part of global health

Anthony Costello: making climate change part of global health

Adolescents in Santo André Hospital: health needs

In the context of the National Health Youth Program, Department of Pediatrics of Santo André Hospital (SAH) has as one of its objectives to extend its age limit up to 18 years of age. To evaluate adolescents' health needs followed up at SAH and to determine the impact of the proposed new age limit policy. Retrospective descriptive study that included adolescents (10-18 years old) seen at the emergency department (ED), outpatients or admitted to the pediatric ward between 2000 and 2004. Adolescents represented 7.3% (average) of all the patients seen at SAH during this period. Approximately 11130 adolescents were seen yearly in the ED, 57% of these in the pediatric ED, 39.5% in general ED, and 3.5% in obstetrics/gynecology ED (the majority of these patients were between the ages of 15 and 18). Medical causes represented 53% of the final diagnosis and 43% were surgical related. The average number of outpatients consultations was 7657 per year and of these, 25% were seen by pediatricians (87% were 10 to 14 years of age). The specialties with the greatest number of consultations were: dentistry (13.3%), orthopedics (13.1%), ear, and nose and throat specialist (8.3%), ophthalmology (7.7%), dermatology (7.2%), psychiatric (5.3%) and obstetrics (5.2%). General medicine and other medical specialties were responsible for 6.4% of the consultations. Yearly about 590 adolescents were admitted, 60.3% in the pediatric ward regardless of the underlying cause. The remaining were admitted to the surgical ward, orthopedics ward and obstetrics/gynecology ward. With the proposed new age limit policy we expect a 10% overall increase in the numbers of patients in the pediatric ED, 6.4% in the pediatric outpatients and 15.5 as inpatients. Adolescents will represent 33.7 of the pediatrics total inpatients population. Management of the patients will require the development of new installations, the training of medical professionals, both pediatric and adult health careers, that will in the future deal with this patient group.

A Comparison of Canadian Pediatric Resident Career Plans in 1998 and 2006

Studies of pediatric resident career plans and preferences help to forecast changes in the demographic profile and practice patterns of North American pediatricians, providing insights that can guide child health care and medical education policy making. With this study we aimed to compare 4 aspects of Canadian pediatric resident career plans in 1998 and 2006: (1) weekly work hours; (2) scope of practice; (3) professional activities; and (4) community size. Canadian pediatric residents were invited to participate in a national cross-sectional survey to explore career plans and preferences in 1998 (mailing) and 2006 (on-line). Response rates were 69% in 1998 and 52% in 2006. In both survey years, the majority of respondents were female (69% and 73%, respectively). Overall, residents planned to work a similar number of weekly hours in both survey years (47.8 vs 48.8). Women planned to work significantly fewer hours than men; this gap was wider in 2006 than in 1998 (1998: 2.8 fewer hours; 2006: 7.8 fewer hours). After adjusted analysis, the association between proportion of time in primary care and study year became significant; however, time in consultant general or subspecialty pediatrics remained nonsignificantly changed. Residents planned to spend less time in clinical work in 2006 than 1998 (64.4% vs 58.1%), and more planned to work and reside in metropolitan areas (68% vs 78% of decided respondents). Between 1998 and 2006, there was no overall change in the number of hours that Canadian pediatric residents planned to work, but the gender gap widened because of an increase in planned weekly work hours among men. The results also suggest that new strategies may be needed to improve future pediatrician availability in small communities by addressing barriers to nonmetropolitan practice, especially for women.

Malcolm Panter-Brick

Malcolm Panter-Brick was born on the Wirral, the son of a shoe factory owner. After medical school in St Andrews, he chose a career in paediatrics, and he had an...

Creating a Faculty Development Office in an Academic Pediatric Hospital: Challenges and Successes

Faculty in academic medical centers are challenged by demands for excellence and productivity in clinical care, research, and teaching. The increased competition for National Institutes of Health grants, the creation of new medical school curricula and residency competencies, and the multitude of quality and cost measures for clinicians have resulted in new stresses among academic faculty of all ranks. The expectations for productivity often conflict with the desire of young faculty to achieve a work-life balance and can jeopardize faculty “vitality.”1–3 The dramatic increase in women graduating from medical schools in the past 2 decades has resulted in increasing percentages of women at the lowest academic ranks but with only a modest change in the percentage of women at professorial rank, which is currently 16% across US medical schools.4 Although female scientists and medical faculty in general face a number of barriers related to childbearing and bias,5–7 the future of academic pediatrics is likely to be particularly affected because of the high percentage of women entering this specialty. As of 2003, 70% of pediatric residents and 63% of pediatricians who took the boards for the first time were women.6,8 In contrast, 37% of current pediatric subspecialists are women.8 In a survey of women faculty at Stanford in 2001–2002, McGuire et al7 found that the highest-ranked needs were for a flexible work environment without adverse consequences for women with children (including part-time appointments, child care, ability to attend school events, etc); a 3-month sabbatical from administrative and clinical duties to write grants and papers; mentoring; and administrative support for manuscript preparation. Indeed, the authors of 2 commentaries in Pediatrics recently called for significant changes to make pediatric careers more family-friendly9 and to provide part-time options, child care, flexibility … Address correspondence to Sarah Jean Emans, MD, Office of Faculty Development and Division of Adolescent Medicine, Children's Hospital Boston, 300 Longwood Ave, LO 637, Boston, MA 02115. E-mail: jean.emans{at}childrens.harvard.edu or ofd{at}childrens.harvard.edu

Ivo John Carré

Ivo John Carre received his early training in paediatrics in London and Birmingham, and was later a research fellow in Melbourne. In 1956 he became senior lecturer in child health...

Career preference and medical students’ biographical characteristics and academic achievement

Background: We know that medical students’ biographical characteristics and academic achievement influence career preference. Less is known about the differential association of these characteristics with preference for distinct specialties at different stages of medical training. Aim: To investigate the association between biographical characteristics and academic achievement with preference for specific medical specialties among first year medical students, before the clerkships, during clerkships and at the end of medical school.Methods: A written questionnaire was completed by medical students from two Dutch medical schools in 2002. Five medical specialties were selected for analysis (general practice, internal medicine, surgery, paediatrics and psychiatry). Biographical characteristics (gender, parental education and profession, and academic achievement were used to construct a prognostic model related to the preference for a medical career.Results: Being female and having a parent in general practice was positively associated with a preference for a career in general practice. Male gender was positively associated with a preference for a career in surgery. In first-year students, and in students with no clerkship experience, male gender was positively associated with a preference for a career in internal medicine. Among students with clerkship experience and final-year students the duration of study was positively associated with a preference for a career in internal medicine. For all students together, female gender was positively associated with a preference for a career in paediatrics. In first-year students, and in students with no clerkship experience, female gender was positively associated with a preference for a career in psychiatry.Conclusions: Our findings show that the medical background of the parents and gender are positively associated with a preference for a career, especially for general practice. Work experience in health care, personal experience with medical care and academic achievement plays a minor role in the career preference of medical students.

Ross Galbraith Mitchell

Having served in the Royal Naval Volunteer Reserve, 1944-7, Ross Galbraith Mitchell embarked on a career in paediatrics and was appointed consultant in Dundee in 1955. In 1961 …