Community Pediatrics Training Research Articles

Pediatric Residents Address Critical Child Health Issues in the Community

Practicing pediatricians are challenged to look beyond the clinical settings for local resources to address health threats to children and families. Pediatric residents' perceptions of the realities faced by families that they frequently see in the emergency room and outpatient or inpatient units are inadequate. The Community Pediatrics Training Initiative (CPTI) is a national initiative within the American Academy of Pediatrics designed to prepare future pediatricians to serve families from traditionally underserved communities. The three unique components of this CPTI at Children's Hospital of Wisconsin (CHW) and the Medical College of Wisconsin (MCW) support child health improvement through (1) interactive discussions with families, (2) exposure to programs in community agencies, and (3) community initiatives. Pediatric residents, along with community partners, have implemented more than 25 community initiatives in the areas of access to care, adolescent health, child advocacy, and environmental and public health. The immediate assessment from our CPTI curriculum demonstrates community experiences significantly promote their competencies in child advocacy and system-based practice while expanding their knowledge of the impact of poverty. In 2005, a survey of 84 postgraduates (75% response rate) assessed the effectiveness of community pediatrics training. All graduates self-reported that they are moderately to greatly prepared to respond to children's culture, age, gender, and disabilities. Of the 43 (68%) graduates who are currently in practice, 10 (23%) are working directly with underserved populations. The development of community initiatives by pediatric residents in partnership with community stakeholders greatly expanded residents' competencies in child health improvement.

Community Pediatrics: A Consistent Focus in Residency Training From 2002 to 2005

To assess changes in community pediatrics training from 2002 to 2005. Pediatric residency program directors were surveyed in 2002 and 2005 to assess resident training experiences in community pediatrics. Program directors reported on the following: provision of training in community settings; inclusion of didactic and practical teaching on community health topics; resident involvement in legislative, advocacy, and community-based research activities; and emphasis placed on specific resources and training during resident recruitment. Cross-sectional and matched-pair analyses were conducted. A total of 168 program directors participated in 2002 (81% response rate), and 161 participated in 2005 (79% response rate). In both years, more than 50% of programs required resident involvement with schools, child care centers, and child protection teams. Compared with 2002, in 2005, more programs included didactic training on legislative advocacy (69% vs 53%, P < .01) and offered a practical experience in this area (53% vs 40%, P < .05). In 2005, program directors reported greater resident involvement in providing legislative testimony (P < .05), and greater emphasis was placed on child advocacy training during resident recruitment (P < .01). In the last several years, there has been a consistent focus on legislative activities and child advocacy in pediatric residency programs. These findings suggest a strong perceived value of these activities and should inform efforts to rethink the content of general pediatric residency training in the future.

Pediatric Residents’ Perceptions of Community Involvement Prior to Residency

To describe baseline perceptions of first-year pediatric residents of participating in community activities, to determine whether demographic factors are related to perceived benefits and constraints, and to identify factors associated with expected community involvement. Pediatric residents beginning their training in the fall of 2000 to 2003 participated in a 12-item self-administered written survey as part of the national evaluation of the Dyson Community Pediatrics Training Initiative. Of the 612 first-year residents surveyed (90% response rate), most reported they receive personal satisfaction (92%) and gain valuable skills and knowledge (83%) from their involvement in community activities. Less than a quarter felt peer support and professional recognition were benefits. Almost two thirds reported logistics and lost personal time as constraints to community involvement. Compared with their colleagues, older residents (> 29 years) and underrepresented minority residents reported fewer constraints. Most residents (72%) expect moderate to substantial involvement in community activities after graduating. Those expecting greater involvement were more likely to report personal satisfaction, gaining valuable skills and knowledge, peer support, and the opportunity to spend time with like-minded peers as benefits. Pediatric residents beginning their postgraduate training perceive numerous benefits from their participation in community activities and most expect a moderate degree of future community involvement. Residency directors should: 1) consider their trainees' insights from prior community involvement and 2) integrate meaningful community experiences in ways that confront logistic barriers and time constraints.

Value of a community pediatrics rotation for residents

Value of a community pediatrics rotation for residents

A Walk in the Patients’ Shoes: A Step Toward Competency Development in Systems-Based Practice

To implement and evaluate the effectiveness of scenario-based learning as a method for teaching systems-based practice to pediatric residents. Twelve pediatric residents at the University of Florida/Jacksonville participated in an active learning scenario experience during their 1-month community pediatrics block rotation from January 2003 to April 2004. A scenario, developed in partnership with community-based organizations, required the residents to assume the role of a parent faced with multiproblem life situations requiring skills in prioritizing problems and identifying and accessing community resources to address them. Residents documented their assessment of the experience as they went through it by making entries into a learning portfolio and at the end of the experience through written evaluations and exit interviews. A case study design was used to assess resident-perceived impact of this experience. Qualitative methods were used to analyze data from resident portfolio entries, resident written evaluation surveys, and resident exit interviews. Five themes, some of which reflect competencies in systems-based practice, emerged from the data: development of empathy and compassion, increased understanding of the barriers facing patients and families, increased appreciation of social determinants of health, self-perceived increased ability to serve patients, and advantages of active learning. Active learning experiences that simulate patient situations can be incorporated into community pediatrics training for residents, increasing perceived competence in systems-based practice.

Teaching Community Pediatrics to Pediatric Residents: Strategic Approaches and Successful Models for Education in Community Health and Child Advocacy

To improve child health at a community level, pediatricians require knowledge and skills that have not been traditionally included in residency training. Recent policy statements from the American Academy of Pediatrics and requirements from Accreditation Council for Graduate Medical Education Residency Review committees emphasizing the importance of community pediatrics training have provided additional incentive for pediatric residency programs to actively explore methods of teaching the principles and promoting the practice of community pediatrics to resident trainees. With a growing number of diverse educational models in various stages of practice or development, common themes and approaches to promote successful teaching of community health and child advocacy can be described. This article defines strategies for 2 critical elements of community pediatrics training, engaging residents and building strong community partnerships, then highlights a number of educational models that illustrate key curricular components and methods. Published results from evaluations of some programs suggest that community pediatrics training of this caliber will cultivate a cadre of pediatricians (academic and community based, generalists and subspecialists, researchers and practitioners) who understand child health in the context of community and have the leadership and collaborative skills to improve the health of children in their communities.

Competency in Community Pediatrics: Consensus Statement of the Dyson Initiative Curriculum Committee

During the past few years, the Accreditation Council of Graduate Medical Education has aimed to change the model of physician residency training to a competency-based system. The adoption of a competency-based training system is now required, and residency programs are expected to define and evaluate the achievement of competency. In an effort to facilitate this endeavor, the Anne E. Dyson Community Pediatrics Training Initiative Curriculum Committee developed competencies for physician training in community pediatrics. These competencies refer to 8 domains thought to be integral to the practice of community-based pediatrics: 1. Delivery of culturally effective care: Pediatricians must demonstrate interpersonal and communication skills that result in effective information exchange with children and families from all cultural backgrounds and diverse communities. 2. Child advocacy: Child advocacy pediatricians should advocate for the well-being of patients, families, and communities; must develop advocacy skills to address relevant individual, community, and population health issues; and understand the legislative process (local, state, and federal) to address community and child health issues. 3. Medical home: Pediatricians must be able to identify and/or provide a medical home for all children and families under their care. As defined by the American Academy of Pediatrics, the medical home is an approach to providing comprehensive primary health care services in partnership with families. Care received in the medical home is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. … Address correspondence to Beth Rezet, MD, Children's Hospital of Philadelphia, Primary Care Center, 3819 Chestnut St, Suite 120, Philadelphia, PA 19104. E-mail: rezet{at}email.chop.edu

Making an impact: Community Pediatrics Training Initiative empowers residents to become community leaders

During a radio program run by pediatric residents from the Indiana University (IU) School of Medicine, a man who had been violent toward his family called to say that he needed help for his problem and was interested in obtaining resources. This is one example of how the Anne E. Dyson Community

Educating the Next Generation of Pediatricians in Urban Health Care: The Anne E. Dyson Community Pediatrics Training Initiative

To improve the health of children who are exposed to urban health risks, there has been a national recognition of the need for better models of training pediatricians. In 2000, in response to this need, the Dyson Foundation launched a new residents-training model that focuses on community health and advocacy, The Anne E. Dyson Community Pediatrics Training Initiative (the Initiative). The Initiative is made up of 12 programs at ten sites, which are working in their communities to improve the health of the children. At its core are five objectives: to equip residents with tools and knowledge to provide community-based health care, to make use of community resources so that residents learn to practice as medical home providers, to engage residents in the communities in which they work, to develop meaningful partnerships between departments of pediatrics and their communities, and to enhance pediatrics training through interdisciplinary collaborations among schools and departments. Curricular approaches at the participating sites differ slightly, but all have explicitly incorporated teaching community pediatrics into their standard rotations and continuity clinics. The authors showcase the programs of the Initiative and explore how the programs have sought buy-in from their parent institutions, faculty, residents, and communities.