Just jump higher

May 1, 1999

It's clear that three years of residency training isn't enough. Since we are unlikely to convince hospitals or the government to fund a fourth year, and since the expectation for comprehensive care by pediatricians is likely to increase, the only answer is to keep learning. If we run hard enough, we might be able to jump over the bar before they have a chance to raise it again.

EDITORIAL

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Just jump higher

The bar keeps being raised. General pediatricians are increasingly calledupon to manage complicated and chronic problems without referral to subspecialistsor other consultants--behavioral and mental health problems as well as medicalconditions. We recently surveyed residents who completed our pediatric residencyprogram at Hopkins during the past six years about their training. I wasdisappointed to learn that, of a long list of specific training areas, theycontinue to feel least well prepared in behavioral and developmental pediatrics,and in recognizing and caring for children with mental illness. These feelingsof inadequacy persist despite our attempts to enhance that part of the curriculum,including adding more faculty.

Like most residency programs, ours could do much more to increase clinicaltime and teaching in these areas. Eventually, residency programs aroundthe country will benefit from the academic credibility lent to developmental-behavioralpediatrics and the study of developmental disabilities by their recent approvalas subspecialties of pediatrics. But even the additional faculty and researchopportunities expected to result from that recognition will not create additionaltime in the three years available for residency training.

Our subspecialists warn that if we take time away from the medical aspectsof training and reallocate it to the psychosocial and psychiatric we willjeopardize our trainees' ability to recognize and care for medical problems.They also fear that residents' interest in subspecialty fellowship training,and their ability to succeed in it, will be compromised.

It's clear that three years of residency training isn't enough. Sincewe are unlikely to convince hospitals or the government to fund a fourthyear, and since the expectation for comprehensive care by pediatriciansis likely to increase, the only answer is to keep learning. If we run hardenough, we might be able to jump over the bar before they have a chanceto raise it again.

Julia A. McMillan, MD, Editor-in-chief of Contemporary Pediatrics, isVice Chair, Pediatric Education,
and Director, Residency Training, Johns Hopkins University School of Medicine,Baltimore.