1. Community Pediatrics: Sources of Guidance and Advice for Residents Emily C. Dowling, MHS Candidate Anne E Dyson Community Pediatric Training Initiative National Evaluation Johns Hopkins Bloomberg School of Public Health Women’s & Children’s Health Policy Center February 29, 2004

2. DINE Team Principal Investigators: Bernard Guyer Holly Grason Co- Investigators: Cynthia Minkovitz Karen McDonnell Barry Solomon Staff: Jennifer Mettrick Gillian Silver Lauren Zerbe Students: Emily Dowling

3. Anne E. Dyson Community Pediatrics Training Initiative Objective: To assist in the development of pediatric professionals who have skills and interest in community-based medicine, advocacy, and the capacity to improve the health of children.

4. Importance of Mentoring Mentoring as a tool in other professions (Merriam). Possible role in choice of primary care career and specialty career paths (DeWitt et al., Pan et al.). Little known regarding pediatrics and community child health activities.

5. Objectives To describe the characteristics of those pediatric residents who have a source of guidance and advice regarding community child health activities. To examine the associations of mentoring and perceived benefits of involvement in community child health activities.

6. Hypotheses Residents who identify a mentor will also report more benefits of involvement in community child health activities. Residents will be more likely to report a mentor if they are: –older –smaller size residency programs –male Residents will be less likely to report a mentor if they are: –Foreign graduate student –Under represented minority

7. Design Secondary analysis of DINE National Comparison Survey. –Cross sectional survey of US pediatric residents with expected residency completion in 2002-4. –National random sample (n=1710) from AMA Masterfile. –Four mailings and 43% response rate.

8. Variables Source of guidance and advice about community child health: –Contact with mentor –Type of mentor 7 benefits of involvement in community child health activities. Resident characteristics: –Year of training and program size –Demographics –Educational debt

9. Analysis Chi square statistics to determine bivariate relationships of reporting a source of guidance and support by demographic characteristics and perceived benefits of community child health involvement.

10. Sources of Guidance and Advice 78% identified having a mentor. Less likely among foreign medical graduates (unadjusted OR 0.4; 95% CI 0.3-0.7). More likely among those with educational debt (unadjusted OR 1.7; 95% CI 1.2-2.6).

11. Types of Mentors (n=548)

12. Benefits of Involvement (n=700)

13. Limitations Unknown quality of relationships. Cross-sectional glance at mentoring. Low response rate and possible selection bias among respondents.

14. Conclusions Most pediatric residents identify having a source of guidance and advice. Only educational debt or being a foreign medical student were associated with the reporting of having a mentor. More residents reported receiving guidance and advice from within their own institution than from the community. Residents who identified a mentor were more likely to report perceived benefits of involvement.

15. Implications and Next Steps Fostering mentoring relationships appears promising to encourage young pediatricians to assume active roles in community child health activities. Longitudinal evaluation will assess whether mentoring is associated with higher levels of community involvement post residency. Development of competencies in pediatric residency training programs related to community child health. MCH community and its possible role in bridging the gap between clinical and community activities in pediatric practices to improve the health of all children.

16. References DeWitt, D, JR Curtis, W Burke. “What Influences Career Choices Among Graduates of a Primary Care Training Program?” J Gen Intern Med. 1998; (13): 257-261. Merriam, S. “Mentors and Proteges: A Critical Review of the Literature.” Adult Education Quarterly. 3 (33) Spring 1983. 161- 173. Pan, RJ, N Clark-Chiarelli, AS Peters, SD Block. “Intention to Practice Primary Care by Pediatric Residents: Nature or Nurture?” Clin Pediatr. 1999. 38: 473-479.