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Educating pediatricians for the 21st century

As noted in Dr. McMillan's editorial on page 9, the report on the Future of Pediatric Education, affectionately known as FOPE II, was released last month. Three years in the making, this update of the 1978 version is a thoughtful response to the tremendous changes that have occurred in the intervening years, changes in the world US children inhabit, the technologies physicians can command, and the ways in which the delivery of health care is organized. According to James Stockman, MD, President of the American Board of Pediatrics and a participant in the project that produced FOPE II, the strength of the report is that it addresses the whole future of pediatrics, providing "a detailed picture of what all of us in pediatrics will be up to in the next 10 to 20 years. FOPE II forms the new template for the practice of pediatrics at both the generalist and subspecialty level."

To meet those future challenges, FOPE II came up with a long list of recommendations for educating pediatricians now and in the years to come. Some of the most important of these are:

  • Standards of care should be established by pediatricians, even when non-pediatricians provide the services, and all children should have access to pediatricians as consultants.

  • All children should receive primary care services in a consistent medical home "from a pediatrician or physician the family trusts."

  • Pediatric residents should complete a three-year curriculum that includes "core competencies" for all and flexible training to meet individual needs and interests.

  • All pediatric organizations should focus on continuous adjustment of pediatric residency requirements.

  • Residency programs whose graduates do not pass board certification examinations should be monitored and, if the deficiency persists, closed.

  • Every pediatric practitioner should have a continuing medical education (CME) home to assess, evaluate, and offer guidance in an ongoing professional education plan.

  • Pediatric education should be funded by a multipayer system, with funding flowing into a national medical trust.

  • Optimum workforce numbers can be maintained with an entering class of 3,000 pediatric residents each year. Pediatric workforce totals should not be increased or decreased.

  • Extensive efforts should be made to increase the percentage of minority pediatricians in practice and in academic medicine.

  • Pediatrics should lead the field of medicine in addressing role conflicts between professional and family responsibilities. Practices and academic settings should consider leave policies, day care, and flexibility in promotion, and the development of multiple points of entry to academic medicine and research systems.

School days

According to a survey by the Alan Guttmacher Institute, only 9% of US students attend schools with a "comprehensive" sex education policy, that is, one that includes discussion of abstinence, contraception, and prevention of sexually transmitted diseases (STDs). Some 45% of students attend schools that have an "abstinence plus" policy, one that treats abstinence as the preferred option but permits discussion of contraception as effective in preventing pregnancy and STDs; 23% go to schools with an "abstinence only" policy that treats abstinence as the only option outside of marriage, with discussion of contraception either prohibited or limited to discussion of its lack of effectiveness; and 14% attend schools that have no policy on sex education at all (Landry DJ, Kaeser L, Richards CL: School district policies on abstinence promotion and on the provision of information about contraception, Family Planning Perspectives, November/December, 1999). The study, which was completed in October 1998, is based on a nationally representative sample of 825 school district superintendents.

Of course, even the students who are exposed to comprehensive or abstinence plus sex education classes don't necessarily learn what they need to know about preventing pregnancy and STDs. A recent Kaiser Family Foundation survey of 1,000 high school students found big gaps in teens' knowledge. Specifically, the Kaiser study found that 40% to 50% of the respondents said they needed more information about birth control and HIV and other sexually transmitted infections. About half the students said they didn't know where to go for contraceptive services or for screening and treatment for STDs. Similarly, about half were not aware minors could get birth control pills without parental permission and about half the young women in the survey did not know about emergency contraception. One in five was not aware she or he could buy condoms without parental permission, and one in three needed more information about how to use condoms (The Henry J. Kaiser Family Foundation: Teens and sexual health, Kaiser DailyReproductive Health Report, October 1999).



In the nation's capital, the new millennium began with a spark of light racing across the reflecting pool, traveling up the Washington Monument, then blossoming out into a spectacular fireworks display that lit up the night sky for miles around. Soon Congress will begin a new session, President Clinton will give his final State of the Union message, and leaders of both parties will have their last chance to make a record to impress voters in next November's elections. Families and pediatricians will be watching, to see what kind of a record it is.

Meanwhile, even during the holiday recess, the business of federal government continued:

The Office of Management and Budget fired the first shot in a battle over prescription drug prices that is bound to erupt as soon as the new Congress convenes. In a broad hint to the pharmaceutical industry, OMB officials who prepare the Administration's budget request drew attention to new data showing the drug industry earns higher profits and pays lower taxes than most other industries. Said Daniel N. Mendelson, Executive Director of the OMB, "My personal view and I think the view of some others in the administration is that if we don't do something about that now, by expanding access and availability to insurance, price controls are an inevitable outcome."

The 25th annual Monitoring the Future Survey, released by the Department of Health and Human Services, found that high school students' use of illicit drugs, alcohol, and cigarettes remains basically unchanged—not increasing, but still too high for healthful living. Specifically, the survey found that a little more than a third of high school seniors use marijuana, one quarter smoke cigarettes daily, and about half have used alcohol in the last month.

The Food and Drug Administration has added new capabilities to its Web site to provide consumers with information on buying prescription drugs and medical products online. Consumers can get this information by visiting www.fda.gov and clicking on the "Buying medical products online" banner. The FDA's effort is part of an Administration initiative intended to protect consumers who buy prescription drug products over the Internet.

The Environmental Protection Agency announced new clean air regulations intended to cut down on air pollution from automobiles. The new regulations should slash overall tailpipe releases of smog-causing chemicals by 90% in the next decade. For the first time, sport utility vehicles and light trucks must meet the same standards as cars, while oil refineries will be required to cut the sulfur content of gasoline by 90%.

The Department of Agriculture, concerned about the high-fat content in children's diets, is considering allowing schools and day-care centers to serve tofu, veggie burgers, and other soy products as meat substitutes in federally subsidized school meals.

The Substance Abuse and Mental Health Services Administration has released two treatment protocols designed to provide best practice guidelines for brief substance abuse interventions and therapies. Said SAMHSA Administrator Nelba Chavez, PhD, "Brief interventions and therapies are less costly but have proven effective; [they] fill the gap between primary prevention efforts and more intensive treatment for people with more serious substance abuse disorders." You can order these protocols (Tip #34 and Tip #35) from the SAMHSA National Clearinghouse for Alcohol and Drug Information by calling 800-487-4889.

The Federal Aviation Administration has announced it intends to require safety restraints for all children traveling on commercial airlines. It is unclear whether airlines or parents will be expected to provide the required safety seats, and—as the Air Transport Association that represents major airlines was quick to point out—no uniform standard for child safety seats on airplanes is currently available.


March 30­31, National Association of Pediatric Nurse Associates and Practitioners (NAPNAP), Atlanta, GA. For information, call the NAPNAP Conference Registration Office, 856-256-2300

April 14­16, North American Society for Pediatric and Adolescent Gynecology (NASPAG), Atlanta, GA. For information, call 215-955-6331 or fax 215-923-3474

April 26­29, National Pediatric Infectious Disease Foundation, New Orleans, LA. To register, call 317-488-1234 or fax 317-488-1254

May 13­16, American Academy of Pediatrics, Society for Pediatric Research, and the Ambulatory Pediatric Association, Boston, MA. For information, call 281-419-0052

May 25­28, American Pediatric Surgical Association, Orlando, FL. To register, call 978-526-8330 or fax 978-526-4018

May 25­30, American Academy of Pediatric Dentistry, Nashville, TN. To register, call 312-337-2169 or send a fax to 312-337-6329.

Judith Asch-Goodkin

Contributing Editor


Judith Asch-Goodkin. Updates. Contemporary Pediatrics 2000;2:13.

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