ARE PEDIATRIC RESIDENTS ADEQUATELY INSTRUCTED IN MEDICO-LEGAL PEDIATRICS?
Steven M. Donn, Gretchen Caspary, Gary McAbee.. Pediatrics, University of Michigan, Ann Arbor, MI; Research, American Academy of Pediatrics, Elk Grove Village, IL; Pediatrics (Neurology), Robert Wood Johnson School of Medicine, Camden, NJ.

BACKGROUND: Medical malpractice litigation continues to be a serious threat to health care delivery. The Pediatric Residency Review Committee has mandated that Medico-Legal Pediatrics be included in training curricula. The importance of medico-legal training during residency is underscored by the the results of the AAP fellowship survey demonstrating that 10% of residents are sued for care provided during residency.

OBJECTIVE: To ascertain whether graduating residents in categorical pediatric training programs had received necessary instruction in various aspects of Medico-Legal Pediatrics.

DESIGN/METHODS: As part of the annual AAP Graduating Residents Survey, several questions were asked about medico-legal training. Surveys were mailed to residents up to four times at the end of the academic year in both 2004 and 2005. The results for each year were virtually identical, and items were pooled across years. A total of 1,000 residents were contacted (500 in 2004, 500 in 2005) with responses returned from 580 (58%; 61% in 2004, 56% in 2005).

RESULTS: A large majority of the respondents reported receiving instruction in medical record documentation (92%), informed consent and minors (92%), and risk communication (70%). However, very few had received training about expert witness testimony (25%), vaccine injury liability (28%), and the malpractice crisis (34%). Issues taught with intermediate frequency included risk management/loss prevention strategies (53%), medical liability insurance (47%), and medical malpractice litigation (45%). The differences in training rates among the most-, intermediate, and least-frequently taught medico-legal issues were statistically significant (p<0.001). Only 21% reported that the malpractice crisis had influenced a career decision.

CONCLUSIONS: The results of this survey indicate that residents nearing the end of their pediatric training have very limited familiarity with several important medico-legal issues. With an increasing emphasis on adding new educational content in fewer didactic hours, pediatric program directors are encouraged to develop novel methods of introducing medico-legal issues during residency training.