This report presents findings from Periodic Survey #40 on pediatric generalists� experiences with graduate medical education and their needs for continuing medical education. The survey was initiated by the Future of Pediatric Education II (FOPE II) Project and was designed to complement the surveys of Academy Sections on workforce and education issues relevant to each section. These data will be used to help shape the recommendations of the Education of the Pediatrician Workgroup pertinent to the future of pediatric education.

The survey was sent to 1,602 active U.S. FAAPs from May through September 1998; after five mailings we received a response rate of 69.1%. The analyses on continuing medical education and practice-related issues are based on responses from the 594 post-residency Fellows who spend 50% or more of their time in general pediatrics (ie, pediatric generalists). The analyses on graduate medical education include only responses from pediatric generalists who completed their residency after 1982 (64% of pediatric generalists), and current pediatric residents.

Two-thirds of post-residency pediatricians (66.6%) spend 50% or more of their time in general pediatrics (ie, pediatric generalists). Generalists spend an average of 81.6% of their workweek providing direct patient care, nearly all of which is primary care. Few pediatric generalists (18.0%) have had training in a specialty or subspecialty area other than pediatrics. The average age is 44.2 years; there are a nearly equal number of male and female generalists (50.8% v 49.2%).

Continuing Medical Education:

• The most influential forms of CME according to pediatric generalists are traditional journals (45.5% so reported), self-taught CME (39.0%), and review journals (29.8%).

• Six out of 10 pediatric generalists say the opportunity to acquire practical/clinical advice (61.9%) and degree of relevancy to their practice (59.3%) are among the most important factors when choosing a CME activity.

• Pediatricians receive their accredited CME from a variety of sources, primarily the national AAP (31.7% receive all and 47.7% receive some of their CME from this source) and their local or regional university department of pediatrics (23.4% all CME and 48.0% some CME).

• A majority of generalists (67.0%) say their present practice organization makes it fairly easy for them to participate in CME activities. However, those in group practice and hospital practice find it significantly easier to participate in CME than do generalists in solo or two-physician practices: only 43.2% of generalists in solo/two-physician practices compared to 76.1% of those in group practice and 65.4% in hospital/clinic practice say it is relatively or very easy to participate in CME, p<. 001.

• Six out of 10 generalists do not think they need any retraining in primary care (61.0%) or a subspecialty area (62.0%), although about one-third would like some retraining in these areas (37.0% and 32.0%, respectively).

Perception of Competition for Pediatric Services:

• Four out of 10 generalists (41.0%) believe they face a moderate amount of competition for their pediatric services in their geographical area and 24.0% state they face a great deal of competition.

• Most generalists (87.0%) say other general pediatricians are their main source of competition. Perception of competition varies by type of practice, location, and geographic area in which a practice is located.

• Most generalists who perceive competition (56.0%) have not modified their practice in any way as a result of this competition.

Graduate Medical Education:

Overall, generalists who have completed their residency training within the past 15 years and current pediatric residents rate their training as �very good� or �adequate�. However, a majority of these pediatricians:

• think they are poorly prepared to manage the business and administrative aspects of their practice (81.3%); and, they
• do not think they have been adequately prepared to work within a managed care system (52.9%).

The more recent their residency training, the more prepared generalists think they are to address some of the newer issues in pediatric practice. Compared to those who completed residency in 1983-1993, more very recent or current residents (1994-1998) say their residency training prepared them very well to:

• Determine when to refer patients (69.1%, residency 1994-1998, v 60.8%, residency 1983-1993, p<.05)
• Care for patients from different cultures (44.4% v 32.0%, p<.01)
• Care for patients from different socioeconomic backgrounds (58.1% v 45.9%, p<.05)
• Coordinate patient care with community services and resources (27.7% v 22.6%, p<.01)
• Work in interdisciplinary teams with other professionals (71.4% v 56.7%), p<.001)

• Generalists in practice since 1983, as well as current residents, highly rate their training in various aspects of general pediatrics such as immunizations (77.3%), normal newborn care (73.8%), physical growth (62.6%), pediatric intensive care (60.9%), and anticipatory guidance (52.5%).

• There is considerable variation in opinion on training in subspeciality areas. The majority of pediatric generalists rate their training in neonatology, infectious diseases, and emergency medicine as �very good� (82.9%, 69.4%, 57.9%, respectively). However, far fewer give high ratings to their training in adolescent care (36.3%), allergy (33.7%), developmental/behavioral (30.5%) or preventive medicine (13.8%).

• Large proportions of generalists indicate they feel poorly trained in many clinically allied areas. Areas of residency training rated as �poor� include international health (58.4%), violence prevention/management (43.5%), substance abuse (33.7%), and learning disabilities (37.4%).

• A majority of generalists say too little time was spent during residency training in managed care settings (73.0%), community physician offices (68.1%) and public health clinics (65.5%), while too much time was spent in neonatal intensive care units (55.0%).