Training Experiences of Combined Internal Medicine and Pediatrics Residents

William Cull¹, Thomas Melgar², David C Kaelber³, Brian D Kan⁴ and John K Chamberlain⁵. (Sponsored by Beth K Yudkowsky)¹Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL ²Internal Medicine and Pediatrics, Michigan State University Kalamazoo Center for Medical Studies, Kalamazoo, MI; ³Internal Medicine and Pediatrics, Case Western Reserve University, Cleveland, OH; ⁴Internal Medicine and Pediatrics, Cedars Sinai Medical Center, Los Angeles, CA; and ⁵Internal Medicine and Pediatrics, University of Rochester, Rochester, NY.

 

Background: Combined Internal Medicine and Pediatrics (Med-Peds) has become a popular career option in the 37 years since its inception. In 2003, 4.4% of those matching to Internal Medicine and 13.1 % of those matching to Pediatrics chose dual training in Med-Peds. The training experience in combined programs and the impact of these programs on the physician workforce and patients, particularly the care of children, has not recently been systematically studied.

 

Objective: To survey Med-Peds residents demographics and training experience.

 

Design/Methods: An annual survey addressing demographics, training experience, and career plans of graduating Med-Peds R4s identified in the American Academy of Pediatrics database was initiated in May, 2003. Surveys were mailed up to 4 times to non-responders through August 2003.

 

Results: Valid responses were received from 203 of the 380 graduating residents (53% response rate). 45% of respondents were female, 34% were non-white, and 5% were international medical graduates. The overwhelming majority (90%) reported upon graduation that they would choose Med-Peds training again. NICU training was the only topic area for which the majority of residents (67%) reported too much time was devoted, and outpatient procedures the only area the majority (72%) desired more time spent. A significant minority (33%) desired more outpatient pediatric and medicine training. Despite 80% of residents having a mentor, a majority of residents wished that more time had been devoted to career planning (62%) and office management (81%). Nearly all (94%) residents plan to care for children and adults, and 98% plan to take both Internal Medicine and Pediatrics boards. Almost half of residents (47%) reported that their program offered interdisciplinary subspecialty electives (Mean Offered = 2.3). Resident self-assessment of their preparation was good to excellent for evidence-based medicine (91%), caring for patients with special health care needs (86%), and use of information technology (81%).

 

Conclusions: Med-Peds residents are generally satisfied with their decision to train in Med-Peds and their level of preparation. They feel competent with patients that may transition to adulthood with complex needs, with assessing evidence, and use of information technology. Too much training time, however, still may be devoted to the NICU rather than outpatient training.