Pediatric Program Directors Research Articles

Pediatric Resident-as-Teacher Curricula: A National Survey of Existing Programs and Future Needs

We conducted a national survey of US pediatric program directors to explore the current status, content, and teaching methods of Resident-as-Teacher (RAT) curricula. The purposes of the survey were to (1) determine the level and method of evaluation of such curricula, and (2) assess the need for a national curricular resource in this area. A survey was sent to US pediatric program directors that asked questions regarding demographics, support, design, development, content, and evaluation of RAT curricula, as well as existing needs and desires for RAT curricular resources. Sixty-two percent of pediatric program directors completed our survey. Eighty-seven percent have a formal RAT curriculum, but more than 50% allocate 10hours or less to it during residency. The primary teaching modalities are lectures and workshops. Content areas include feedback, in-patient teaching, communication skills, case-based teaching, role modeling, evaluation, leadership skills, 1-minute preceptors, teaching/learning styles, professionalism, and small-group teaching. Sixty-three percent of programs report evaluating their curricula, but only 27% perceive their program to be very/extremely effective. Nearly all respondents expressed interest in a national RAT curriculum, preferring web-based modules for dissemination. Despite an Accreditation Council for Graduate Medical Education requirement for a RAT curriculum, some pediatrics programs still lack one, and some consider their program only moderately effective. A wealth of curricular material exists across programs, which could be shared nationally. Establishing a national RAT curriculum would offer programs resources to meet educational mandates and the ability to tailor programs to best fit their own program needs.

Breastfeeding Education and Support Services Offered to Pediatric Residents in the US

Objective The American Academy of Pediatrics (AAP) encourages pediatricians to support the practice of breastfeeding and residency educators to develop formal curricula in breastfeeding education. Few studies, however, describe breastfeeding education or support services currently provided to pediatric residents in the United States. The goals of this study were to investigate breastfeeding training offered during 3-year pediatric residency programs and to describe residency programs’ policies and services for residents who breastfeed. Methods We conducted a cross-sectional study using a Web-based survey of pediatric program directors regarding breastfeeding education and support services for residents. Results Seventy percent of program directors (132 of 189) completed the survey, with 77.3% of respondents (n = 102) estimating the amount of breastfeeding education offered to their pediatric residents. Residents are provided with a median total of 9.0 hours of breastfeeding training over 3 years, primarily in continuity clinic and in lectures and rounds with attendings. At the programs’ primary teaching hospitals, breastfeeding residents are provided breastfeeding rooms (67.0%), breast pumps (75.3%), and breast milk storage facilities (87.6%). Only 10 programs reported having an official policy to accommodate breastfeeding residents. Conclusions Pediatric residents receive approximately 3 hours of breastfeeding training per year. In addition, there is less than universal implementation by residency programs of AAP recommendations for supporting breastfeeding in the workplace. Pediatric residency programs should find ways to improve and assess the quality of breastfeeding education and workplace support to better role model this advocacy standard.

Resident Work Duty Hour Requirements: Medical Educators’ Perspectives

The Association of Pediatric Program Directors’ (APPD) leadership and members have given significant thought to the Institute of Medicine Committee’s recommendations1 and to the recent Accreditation Council for Graduate Medical Education’s (ACGME) proposed changes to the “Common Program Requirements” written by the ACGME Duty Hours Task Force.2 As expressed through the series of 5 APPD action calls in July and August 2010, members wholeheartedly concurred with most principles of the document, which is clearly aimed at improving supervision, enhancing professional formation with an emphasis on personal responsibility, and ensuring patient safety.

Residency Curriculum Improves Breastfeeding Care

Multiple studies have revealed inadequacies in breastfeeding education during residency, and results of recent studies have confirmed that attitudes of practicing pediatricians toward breastfeeding are deteriorating. In this we study evaluated whether a residency curriculum improved physician knowledge, practice patterns, and confidence in providing breastfeeding care and whether implementation of this curriculum was associated with increased breastfeeding rates in patients. A prospective cohort of 417 residents was enrolled in a controlled trial of a novel curriculum developed by the American Academy of Pediatrics in conjunction with experts from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and Association of Pediatric Program Directors. Six intervention residency programs implemented the curriculum, whereas 7 control programs did not. Residents completed pretests and posttests before and after implementation. Breastfeeding rates were derived from randomly selected medical charts in hospitals and clinics at which residents trained. Trained residents were more likely to show improvements in knowledge (odds ratio [OR]: 2.8 [95% confidence interval (CI): 1.5-5.0]), practice patterns related to breastfeeding (OR: 2.2 [95% CI: 1.3-3.7]), and confidence (OR: 2.4 [95% CI: 1.4-4.1]) than residents at control sites. Infants at the institutions in which the curriculum was implemented were more likely to breastfeed exclusively 6 months after intervention (OR: 4.1 [95% CI: 1.8-9.7]). A targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, practice patterns, and confidence in breastfeeding management in residents and increases exclusive breastfeeding in their patients. Implementation of this curriculum may similarly benefit other institutions.

Is There a Gap Between Program Directorsʼ Expectations and Residentsʼ Performance? Comparing Predictions With Outcomes for Competence in Patient Care

To determine whether a gap exists between program directors' expectations for performance and residents' actual performance on learning objectives designed to address the Accreditation Council for Graduate Medical Education's (ACGME's) competencies. In 2007-2008, the authors analyzed data on the performance of 40 pediatric residents across all levels of training who were assessed a total of 8,974 times during 2002-2005 on 35 learning objectives developed to address the ACGME patient care competency. Residents "passed" the objectives if assessments met the expected performance standards for each level of training that were set by pediatric program directors in a previous survey. To address concurrent validity, the authors also reviewed faculty evaluations of resident performance using a modified version of the American Board of Internal Medicine competency card. The mean pass rate (percentage of residents meeting or exceeding the predetermined standard) for the 35 learning objectives was 92% for first-year, 84% for second-year, and 72% for third-year residents. Actual performance met expected performance standards for all patient care learning objectives except those for procedural competence and some related to patient management. However, faculty competency card evaluations demonstrated that residents met or exceeded competence in patient care, suggesting that program directors set unrealistic standards for these few items. Program directors' expectations predicted residents' actual performance for the majority of patient care learning objectives. The authors offer lessons learned to inform the next iteration of performance standards for clinical competence.

5. Pediatric Resident-as-Teacher Curriculum: A National Survey of Existing Programs and Future Needs

Residents assume significant teaching responsibilities and, over the last 30 years, Residents as Teachers (RAT) programs have been reported in the literature. Currently LCME and ACGME requirements mandate this curriculum. We report results of a nationwide survey of Pediatric residency programs describing curricula of existing RAT programs. 106 of 172 (62%) Pediatric program directors (PDs) completed our survey. 13% of responding programs do not have a formal RAT curriculum and over 50% allocate 10 hours or less to this teaching throughout a three year residency training program.

The Association of Pediatric Program Directors’ Strategic Plan: An Opportunity for Transformational Change

In late February 2010, the leadership of the Association of Pediatric Program Directors (APPD) assembled key representatives of the pediatric undergraduate medical education and graduate medical education community to develop a new APPD strategic plan, a road map that could potentially transform pediatric medical education. This collaborative process included past and present leaders of APPD and current leaders of the Academic Pediatric Association (APA); the dialogue served to inform our understanding of history, where we are now, and consider what we might want to explore.

Renal Stone Disease

1. Charles P. McKay, MD* 1. *Associate Pediatric Program Director, Department of Pediatrics, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC. After completing this article, readers should be able to: 1. Discuss the major risk factors for renal stone disease in children. 2. Perform and interpret the evaluation of a child who has suspected or proven renal stone disease. 3. Provide dietary advice for the child who has renal stone disease, including fluid intake goals. 4. Prescribe potassium citrate or thiazide diuretics appropriately in the treatment of renal stone disease. 5. Recognize the conditions of cystinuria, primary hyperoxaluria, and struvite stones. A 9-year-old boy is referred by his primary care physician for evaluation of abdominal pain and blood in the urine after playing on a trampoline. His past medical history is negative for renal disease, and he takes no medications. A complete dietary history reveals that he eats a lot of fast food and drinks about 1 glass of milk daily. His father and grandfather have a history of renal stones. Findings on his physical examination are unremarkable. A serum chemistry profile yields normal results, and the urinalysis shows a specific gravity of 1.030, pH of 6.5, and the presence of a large amount of blood but no protein. Microscopic examination shows numerous eumorphic red blood cells and calcium oxalate crystals. Spiral computed tomography (CT) scan without contrast shows two very dense stones in the pelvis of the right kidney and one stone in the left kidney. There is moderate hydronephrosis on the left, and a 3-mm stone seen in the left ureter is recovered 24 hours later by straining the urine. Stone analysis shows elements of calcium oxalate, calcium phosphate, and uric acid. Three weeks later, a 24-hour urine collection demonstrates elevated supersaturation for calcium oxalate, low …

The Response of the APPD, CoPS and AAP to the Institute of Medicine Report on Resident Duty Hours

In December 2008, the Institute of Medicine published new recommendations regarding duty hours and supervision of residents' training in the United States. These recommendations evoked immediate concerns from program directors and leadership in all surgical and medical disciplines, including pediatrics. To address these concerns, the Accreditation Council for Graduate Medical Education convened a Duty Hours Congress in Chicago, Illinois, on June 11 and 12, 2009. This report summarizes the opinions and testimony of the organizations (American Academy of Pediatrics, Association of Pediatric Program Directors, and Council of Pediatric Specialties) that were invited to represent pediatrics at the Duty Hours Congress. The American Academy of Pediatrics, the Association of Pediatric Program Directors, and the Council of Pediatric Specialties supported the basic principles of the Institute of Medicine report regarding patient safety, resident supervision, resident safety, and the importance of effective "hand-offs"; however, the organizations opposed additional reductions in resident duty hours given the potential unintended adverse effects on the competency of trainees, the costs of graduate medical education, and the future pediatric workforce. These organizations agreed that additional changes in graduate medical education must be data driven and consider residents within the broader system of health care. The costs and benefits must be carefully analyzed before implementing the Institute of Medicine recommendations.

Innovation in Pediatric Education: The Path to Transforming Pediatric Graduate Medical Education

The mission of the Initiative for Innovation in Pediatric Education (IIPE) is to “initiate, facilitate and oversee innovative change in pediatric residency education through a carefully monitored, outcome-directed experimentation.”1 Our mission in these “IIPE pages” of Pediatrics is to keep the community informed of our progress. To this end, we begin the story of IIPE with a chronicle of its early history. In an article in the January 2010 issue of Pediatrics , Dr M. Douglas Jones addressed the Residency Review and Redesign Project (R3P) of the American Board of Pediatrics (ABP), a 4-year self-study of the state of pediatric residency training.2 Through the generosity of the ABP Foundation, the outcome of this 4-year gestation was the birth of IIPE in May 2009. Three organizations, highly invested in this process, appointed 2 members each to become part of the oversight committee for IIPE. Drs George Lister and Stephen Ludwig represent the ABP, Drs Aaron Friedman and Bruder Stapleton represent the Association of Medical School Pediatric Department Chairs, and Drs Ann Burke and Robert McGregor represent the Association of Pediatric Program Directors (APPD). The first task of the committee was to establish the Federation of Pediatric Organizations (FOPO) as the administrative home for this new entity, which it accomplished with the help of Dr Theodore C. Sectish, executive director of FOPO. Degnon and Associates was contracted to provide management services. A charter was established and agreed on by the 7 member organizations of FOPO. We have come a … Address correspondence to Carol Carraccio, MD, MA, Department of Pediatrics, University of Maryland, Room N5W56, 22 S Greene St, Baltimore, MD 21201. E-mail: ccarraccio{at}peds.umaryland.edu

The Next Phase of Pediatric Residency Education: The Partnership of the Milestones Project

concerns of patient safety, policymakers and the public are demanding a response. The American Board of Pediatrics, the Accreditation Council of Graduate Medical Education (ACGME), the Association of Pediatric Program Directors (APPD), and other organizations are working together to position pediatrics to meet these demands and keep the public trust for excellence in the care of children. Program directors and educators recognize that there are many barriers to medical education reform, including but not limited to lack of resources; traditional training of physicians, which lacks a focus on curricular design and learner and program assessment; and a foundation in conducting educational research. 2 However, the public and government stakeholders expect safe and effective care documented by patient outcome data, 3 ongoing participation in quality improvement activities, and assurances of adequate supervision for trainees. Recent health care reform bills contain specific language that speaks to ‘‘demonstration of outcomes in medical education.’’ 3 Upon graduation, patients and families want assurance that both new generalist and specialist pediatricians have become skilled in all aspects of the 6 ACGME competencies 4 (Table 1), which translates into a physician who provides patient-centered care, applies best evidence, functions effectively in multidisciplinary teams to coordinate care, and advocates for their patient needs by helping them navigate the complexities of the health care system. Moreover, as the hours and structure of training change, we are obligated to demonstrate that future graduates are prepared to enter practice without direct supervision. We must have a sense of urgency to address these expectations or we will face additional external oversight beyond our own programs, institutions, and current accreditation organizations. The Milestones Project provides a way for us, as a self-regulating profession, to uphold the public trust. The ACGME, in partnership with the American Board of Pediatrics, has initiated the Milestones Project as the next step in moving toward an outcomes-based measurement of training, evolving beyond more basic structure and process measures. 5–7 The plan is to partner with each member board within the American Board of Medical Specialties to spearhead the development of a grassroots effort to further define the ACGME competencies within the context of their specialty. Pediatrics is 1 of the first 3 disciplines, along with internal medicine and surgery, to construct Milestones as outcome measures of the competencies.

Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors

BackgroundInformation about the availability and effectiveness of childhood obesity training during residency is limited.MethodsWe surveyed residency program directors from pediatric, internal medicine-pediatrics (IM-Peds), and family medicine residency programs between September 2007 and January 2008 about childhood obesity training offered in their programs.ResultsThe response rate was 42.2% (299/709) and ranged by specialty from 40.1% to 45.4%. Overall, 52.5% of respondents felt that childhood obesity training in residency was extremely important, and the majority of programs offered training in aspects of childhood obesity management including prevention (N = 240, 80.3%), diagnosis (N = 282, 94.3%), diagnosis of complications (N = 249, 83.3%), and treatment (N = 242, 80.9%). However, only 18.1% (N = 54) of programs had a formal childhood obesity curriculum with variability across specialties. Specifically, 35.5% of IM-Peds programs had a formal curriculum compared to only 22.6% of pediatric and 13.9% of family medicine programs (p < 0.01). Didactic instruction was the most commonly used training method but was rated as only somewhat effective by 67.9% of respondents using this method. The most frequently cited significant barrier to implementing childhood obesity training was competing curricular demands (58.5%).ConclusionsWhile most residents receive training in aspects of childhood obesity management, deficits may exist in training quality with a minority of programs offering a formal childhood obesity curriculum. Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children.

Ophthalmology education in pediatric residency training programs

To evaluate the status of ophthalmology education in pediatric residency programs in the United States. A mail survey was sent to 187 directors of pediatric residency programs in the United States, which included questions about current ophthalmology education, desire for additional programs, reasons for dissatisfaction, and types of education desired. Of a total of 187 surveys mailed, 137 (73%) were returned. Pediatric ophthalmology is part of the curriculum at 72% of pediatric residency programs and not included at 28%. Program directors were satisfied with pediatric ophthalmology education at 76% of the residency programs and not satisfied at 24%. A formal program in ophthalmology was desired by 88% of directors. Reasons for dissatisfaction with ophthalmic education included lack of time during the pediatric residency and lack of ophthalmologists available for teaching. Desired educational programs included didactic lectures by pediatric ophthalmologists, a CD-ROM or web-based program, and rotations through pediatric ophthalmology clinics. Most pediatric residency program directors want pediatric ophthalmology as part of their formal curricula, but one-fourth of programs are currently either lacking formal ophthalmic education or their directors are dissatisfied with their ophthalmic curricula. Pediatric ophthalmology training programs should be developed to assist those residency programs that are not satisfied with their ophthalmic education. Ophthalmologists are encouraged to participate in these efforts.

Markers of Overcrowding in a Pediatric Emergency Department

The objective of this study was to identify markers of overcrowding in pediatric emergency departments (PEDs) according to expert opinion and then to use statistical methods to further explore the underlying construct of overcrowding. A cross-sectional survey of all PED directors (n = 12) and pediatric emergency medicine fellowship program directors (n = 10) across Canada was conducted to elicit expert opinion on relevant markers of emergency department (ED) crowding. The list of markers was reduced to those specific to the ED for which data could be extracted from one tertiary care PED from an existing computerized patient tracking system. Data representing 2,190 consecutive shifts and 138,361 patient visits were collected between April 2005 and March 2007. Common factor analysis (CFA) was used to determine the underlying factors that best represented overcrowding as determined by markers identified by experts in pediatric emergency medicine The main markers of overcrowding identified by the survey included measures of patient volume (25%), ED operational processes (55%), and delays in transferring patients to inpatient beds (13%). Data collected on 41 markers were retained for the CFA. The results of the CFA indicated that the largest portion of variation in the data (48%) was accounted for by markers describing patient volumes and flow through the ED. Measures of admission delays accounted for a smaller proportion of variability (9%). The results suggest that for this tertiary PED, markers of ED operational processes and patient volume may be more relevant for determination of overcrowding than markers reflecting delays in transferring patients to inpatient beds. This study provides a foundation for further research on markers of overcrowding specific to the pediatric setting.

Adolescent Medicine Training in Pediatric Residency Programs

The aim of this study was to provide an assessment of pediatric residency training in adolescent medicine. We conducted 2 national surveys: 1 of pediatric residency program directors and the other of faculty who are responsible for the adolescent medicine block rotation for pediatric residents to elicit descriptive and qualitative information concerning the nature of residents' ambulatory care training experience in adolescent medicine and the workforce issues that affect the experience. Required adolescent medicine topics that are well covered pertain to normal development, interviewing, and sexual issues. Those least well covered concern the effects of violence, motor vehicle safety, sports medicine, and chronic illness. Shortages of adolescent medicine specialists, addictions counselors, psychiatrists, and other health professionals who are knowledgeable about adolescents frequently limit pediatric residency training in adolescent medicine. Considerable variation exists in the timing of the mandatory adolescent medicine block rotation, the clinic sites used for ambulatory care training, and the range of services offered at the predominant training sites. In addition, residents' continuity clinic experience often does not include adolescent patients; thus, pediatric residents do not have opportunities to establish ongoing therapeutic relationships with adolescents over time. Both program and rotation directors had similar opinions about adolescent medicine training. Significant variation and gaps exist in adolescent medicine ambulatory care training in pediatric residency programs throughout the United States. For addressing the shortcomings in many programs, the quality of the block rotation should be improved and efforts should be made to teach adolescent medicine in continuity, general pediatric, and specialty clinics. In addition, renewed attention should be given to articulating the core competencies needed to care for adolescents.

Urban Pediatric Orthopaedic Surgical Practice Audit: Implications for the Future of This Subspecialty

The growth and development of the physis distinguishes the child from the adult. There are historical lines of referral that direct a substantial amount of elective procedures for adolescent idiopathic scoliosis and for hip and foot pathology in children and adolescents to pediatric orthopaedic surgeons. Over twenty million children are injured each year, with an incidence of one of every four children1,2. Trauma is the leading cause of death and disability in children3-6. Coincident with an ever-expanding amount of pediatric trauma, many general hospitals have terminated their pediatric trauma services7-9. These factors have resulted in increasing numbers of children presenting to pediatric orthopaedic surgical outpatient clinics and to pediatric hospitals, particularly those with active pediatric trauma programs. Trauma call responsibility has become an important quality-of-life issue for many pediatric orthopaedic surgeons8,10-15. In an attempt to better understand the status quo of pediatric orthopaedic surgical practice, we analyzed the pediatric orthopaedic surgical practice at our institution over the last decade with specific attention directed to the area of trauma surgery. Our goal was to specifically define the current surgical composition of an urban pediatric orthopaedic surgical practice and contrast it to the work done almost a decade earlier. This information should be of value to all practicing pediatric orthopaedic surgeons, residents considering a career in pediatric orthopaedics, hospital administrators, and orthopaedic training program directors designing an optimal residency training exposure. We utilized the operating-room computerized database of surgical cases at our institution to identify all pediatric orthopaedic surgical procedures done in the operating room for fiscal years 1998 and 1999 and compared them with data for fiscal years 2006 and 2007. If necessary, the operative reports were reviewed for further clarification of the …

The Floppy Little Baby

Research Center for Genetic Medicine, Children’s National Medical Center, Washington, DC; †Pediatric Residency Training Program Director, and Division of Emergency Medicine, Children’s National Medical Center, Washington, DC. Presented during the Emergi-Quiz Case competition of the American Academy of Pediatrics Section on Emergency Medicine at the 2007 National Conference and Exposition in San Francisco, Calif. Reprint requests and correspondence: Sabah F. Iqbal, MD, Division of Emergency Medicine, Research Center for Genetic Medicine, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010. siqbal@cnmc.org

Hospitalistsʼ Involvement in Pediatrics Training: Perspectives From Pediatric Residency Program and Clerkship Directors

To explore the use and perceived impact of pediatric hospitalists as teaching attendings among pediatric residency and clerkship programs. Between November 2007 and February 2008, the authors conducted a mail-based survey of all pediatric residency program directors (170) and pediatric clerkship directors (131) in the United States as identified by the Association of Pediatric Program Directors and Council on Medical Student Education in Pediatrics. The surveys focused on the responsibilities of pediatric hospitalists in training programs and their perceived impact on the roles of pediatric residents and medical students. The response rate for residency directors was 86% (146/170) and 87% (114/131) for clerkship directors. One hundred thirteen (77%) residency programs and 91 (80%) clerkship programs used hospitalists as teaching attendings. Among these programs, 65% (73) of residency program directors and 64% (58) of clerkship directors reported that pediatric hospitalists are responsible for all general inpatient services. The majority of residency (76%, 84) and clerkship directors (71%, 64) reported that hospitalists are more accessible to trainees than traditional attendings. A minority of residency program directors (36%, 39) reported that use of hospitalists has decreased senior resident autonomy. The role of hospitalists in resident and student education will likely continue to evolve over the next decade.Additional refinement of the roles and responsibilities of hospitalists will address lingering concerns in some programs about resident autonomy.

Outcome and Process in Pediatric Education: Does the Whole Equal the Sum of the Parts?

I t is both an honor and a great personal pleasure to be giving the Miller-Sarkin Lecture at this, the first combined meeting of Council on Medical Student Education in Pediatrics (COMSEP) and the Association of Pediatric Program Directors (APPD). Any opportunity to honor longtime friends and colleagues Steve Miller and Rich Sarkin is an opportunity for which I’m grateful. The other reason for the personal pleasure is that we are here together today at a meeting that has been a long time coming. When I was a residency program director at the University of Massachusetts (UMass), Al Scheiner, the director of medical student education in pediatrics at UMass (and the first newsletter editor of COMSEP), engaged me in student activities. Al and I collaborated to mutual benefit, and I thought every clerkship director and residency program director enjoyed the kind of relationship we had. In 1999, Rich Sarkin, then president of COMSEP, made me aware that I was incorrect: He estimated that there were more programs in which clerkship directors and residency program directors competed than there were programs in which they collaborated. Well, as I thought about it, we do live in somewhat different worlds (Table 1). In addition to belonging to different organizations that meet separately, we answer to different accrediting bodies, and our learners answer to different credentialing bodies. Developing a relationship between COMSEP and APPD seemed like an obvious (and productive) way to model collaboration, so I began to lobby the leaders of the organizations for a combined meeting. During the next several years, Ed Zalneraitis and Carol Carraccio established task forces for APPD that paralleled COMSEP’s and worked with Bruce Morgenstern to establish collaboration. Steve Miller, Robin Deterding, Bill Raszka, Ed Zalneraitis, Carol Carraccio, Rob McGregor, Ted Sectish, and Susan Guralnick—we are indebted to all of you for this day.

Ethics and Professionalism in the Pediatric Curriculum: A Survey of Pediatric Program Directors

Since 1982, pediatric residency programs have been asked to evaluate trainees for ethical behavior. In 2007, the Accreditation Council for Graduate Medical Education required documenting teaching and evaluation of professionalism. Pediatric residency program directors were surveyed to ascertain what they know about the content and process of their ethics and professionalism curricula. From February to May 2008, 394 program directors from the Association of Pediatric Program Directors were surveyed. Of 386 eligible survey respondents, 233 (60%) returned partial or complete surveys. Programs were evenly divided on whether ethics was taught as an organized curriculum or integrated. Professionalism was combined with the ethics curriculum in 27% of programs and taught independently in 38% of programs, but 35% had no professionalism curriculum. More than one third of the respondents did not answer each content and structure question. Approximately two thirds of those who responded stated that their program dedicated <10 hours per year to ethics and professionalism, respectively. Nearly three fourth of programs identified crowding of the curriculum and one third identified lack of faculty expertise as curricular constraints. Respondents expressed interest in more curricular materials from the American Board of Pediatrics or Association of Pediatric Program Directors. Despite requirements to train and evaluate residents in ethics and professionalism, there is a lack of structured curriculum, faculty expertise, and evaluation methodology. Effectiveness of training curricula and evaluation tools need to be assessed if the Accreditation Council for Graduate Medical Education requirements for competencies in these areas are to be meaningfully realized.