1. Your residents can achieve competency in pediatrics
Scott Krugman, MD, MS
Suki Tepperberg, MD
Harsha Bhagtani, MD

2. Agenda Welcome Introductions
Data on current status of pediatrics in FM residencies
Curriculum guidelines
Incorporating curricula into reality

3. Rationale for Excellence in FM resident training in Pediatrics
Family physicians spend about 10% of their total practice time caring for children
Consider rural communities- FP provide medical home for 1/3 of US children
68% of FP report caring for children, down from 78% in 2000
Phillips RL Jr, Bazemore AW, Dodoo MS, Shipman SA, Green LA.
Pediatrics Sep;118(3): Review

4. Decrease in care of children
Why? Not clear…
Increasing number of pediatricians?
Decreasing OB care provided by FM?
Increased geriatric patients?
Low Medicaid reimbursements?
Implications for rural and underserved communities if FPs are not adequately trained
Decreased overall numbers may result in diluted experience and training challenges
Bazemore AW, Makaroff LA, Puffer JC, Parhat P, Phillips RL, Xierali IM, Rinaldo J.
J Am Board Fam Med Mar-Apr;25(2):

5. Key questions
What are the pediatric competencies FM residents need to learn?
What is the best way to teach these competencies?
How do you best evaluate acquisition of the competencies?

6. Status of pediatrics in FM programs (2009)

7. Demographics 115 programs 88 stand alone without peds residency
76 community based university affiliated
15 community based not university affiliated
15 university based
8 community based, university administered
88 stand alone without peds residency
44 have rotations at University or Children’s Hospital

8. Time on pediatrics Total: Dedicated Pediatric Inpatient:
Mean 4.3, Median 4 months, range 1-7
9% under 4 months, 53% 4 months, 24% 5 months, 5% more than 5 months
Dedicated Pediatric Inpatient:
Median 3, range 0-6
23% 2 months, 21% 3 months, 21% 4 months

9. Time on pediatrics Combo inpatient: PED: Outpatient:
Median 6 months, range 0-36
25-75 IQR 4-6 months
PED:
Mean 0.5, median 0, range 0-2 months
Outpatient:
Mean 1.3, median 1, range months

10. Family Health Center Number of pediatric patients Teachers: Mean 24%
Median 25%
Range 5-50% (25-75 IQR 20-30%)
Teachers:
18% of programs have a pediatrician in the FHC

11. Prior data – Gauthier 2006

12. Child Health Training Time
Mean=4.7 months

13. Child Health Training Settings
Percent reporting
Average time
(range)
in months
General inpatient 96
1.8
(0-6.7)
General specific outpatient 94
(0-5.4)
Newborn
(normal nursery or NICU) 1
(0-5.2)

14. Conclusions Total time continues to fall: 5.2 to 4.7 to 4.3
Total outpatient time lower: 1.8 to 1.3
Despite changing demographics, very few programs have PED rotations
Teaching in FHC varies widely – who and percent of kids

15. Curriculum development
Joint venture between STFM Care of Children Group and APA Pediatrics for Family Practice SIG
Multi-year effort
Published on APA website:

16. Curriculum incorporation
Handouts one example of how

17. Prior RRC requirements
IV.A.5.b).(2) Care of Neonates, Infants, Children, and Adolescents
must complete four months of structured experience in the care of infants, children and adolescents.
IV.A.5.b).(2).(a) The time must include experience in the following
areas: neonates, infant care (both well-baby and ill), hospitalized children, ambulatory pediatrics, emergency care of children and adolescent medicine. This may include experience gained on the Family Medicine Inpatient Service, in the emergency department, in the pediatric hospital and clinic, and experience in nursery care associated with OB experience, provided that appropriate documentation of such experience is maintained for each resident.
IV.A.5.b).(2).(b) This experience must involve teaching and role modeling by family medicine faculty in the care of newborns and sick children. Residents and faculty must provide continuity of responsibility for hospitalized infants and children from their Family Medicine Center patient panel.

18. Current/proposed RRC guidelines
IV.A.6.a).(4).(b) Ten percent of the FMP patient encounters must be  with patients younger than 10 years of age.   
IV.A.6.e) Residents must have at least 200 hours or two months and 250 patient encounters dedicated to the care of ill child patients in the hospital and/or emergency setting. (Core)
IV.A.6.e).(1) This experience should include a minimum of 75 inpatient encounters with children.
IV.A.6.e).(2) This experience should include a minimum of 75 emergency department patient encounters with children.
IV.A.6.f) Residents must have at least 200 hours or two months or 250  patient encounters dedicated to the care of children and adolescents in an ambulatory setting. (Core)
IV.A.6.f).(1) This care must include well-child care, acute care and  chronic care.
 IV.A.6.g) Residents must have at least 40 newborn patient encounters, including well and ill newborns.