Schubiner H, Mullan P.  “Medical student interest in combined internal medicine-pediatrics.”  J Gen Intern Med. 1990;5:225-8.  Pub Med ID: 2341922

This questionnaire from 2 university-based mid-western medical schools represents the opinions of 300 medical students regarding their perception of a career in Internal Medicine/Pediatrics. When comparing internal medicine, internal medicine/pediatrics, and family medicine, these students perceived internal medicine and combined internal medicine/pediatrics to be more intellectually stimulating, more likely to incorporate research, and more likely to provide opportunities to attain a position of leadership, whereas family medicine was perceived to be more likely to provide an opportunity to serve others and work relatively free of supervision. Of the students interested in primary care, the majority ranked internal medicine, pediatrics, and family medicine as their first career choice, with internal medicine/pediatrics ranking second or third.

Biro FM, Gillman MW, Parker RM, et al.  “Surveying graduates of combined internal medicine-pediatrics residency programs.” Academic Med. 1990; 65:266-71.  Pub Med ID: 2334509  DOWNLOAD PDF

Graduates of all U.S. combined internal medicine-pediatrics residency programs were surveyed in 1987 regarding a variety of demographic information about their residencies and current practices, the residency curricula they had followed for both specialties, and recommendations for modifications in training. The 71 responding graduates (from a total of112) reported patient care as their major involvement (mean of 42.9 hours per week), with a majority (83%) seeing patients in both pediatric and adult age groups. Most were involved in primary care only (64%). The graduates reported that during both pediatrics and internal medicine training, they had had too many inpatient and intensive care rotations and too few elective and ambulatory rotations. The most important subspecialty rotations in internal medicine were considered to be cardiology,dermatology, and pulmonary medicine; and in pediatrics, infectious disease,cardiology, and adolescent medicine. The graduates recommended moreoutpatient subspecialty rotations, ambulatory rotations in medicine and pediatrics, and a combined medicine-pediatrics continuity clinic.

Sorum P.  “Evaluating whether a combined internal medicine-pediatrics practice was successful.”  Academic Med. 1991; 66:353-8.  Pub Med ID: 2069656  DOWNLOAD PDF

Questionnaire of 1000 patients at a mainly private, suburban faculty-resident teaching practice north of Albany, NY.  50% return rate.  Demographics of the practice were a 50/50 adult/child split, but most of the visits were kids under 2 (41%), and most of the patients were less than 2 or between 18-39 years old.  The authors comment that these are the ages people are when looking for doctors.

Lee MW.  “Weighing the benefits of combined residency programs.”  JAMA.  1991;266:1867.  Pub Med ID: 1890720  DOWNLOAD PDF

This article from the University of Illinois at Urbana-Champaign reviewed the growth of med/peds residency programs and quoted individual med/peds residents and program directors. NRMP statistics regarding proportions of med/peds positions filled in the match were reviewed and compared with other combined residencies.  Board pass rates among med/ peds residents were compared with those of categorical residents.  Finally, attrition rates out of med/peds residency programs were discussed.

In 1980, there were 4 med/peds programs, compared with 77 programs in 1990.  A total of 99 combined residency programs existed in 1990 (including med/peds, medicine/PM and R, medicine/ER and pediatrics/child psychiatry). 

Benefits of med/peds training touted in the article included flexibility after training (the ability to practice primary care in both fields and sub specialize in both or either field), and ideal training for the “chronically undecided” student.  Residents quoted in the article felt the residency was suited for more “intense” students who desire “greater depth” of training in primary care.  Program directors felt there was “disenchantment with family medicine,” particularly the impracticality of being trained in OB/GYN and surgery.  Some program directors believed that combined programs attract more qualified residents than traditional medicine or pediatrics programs.

NRMP and GME statistics demonstrated that 102/280 med/peds positions went unfilled in the 1990 match.    First time pass rate for med/peds residents on the internal medicine boards was 90% compared with 74% for categorical medicine residents, and on the pediatric boards was 92-93% compared with 83% for categorical pediatric residents.  After residency 2/3 of med/peds graduates practiced both fields.  Med/peds resident attrition rate was highest during the switch between departments in the intern year with a rate of 33% in 1986-1987.  Residents quoted in the article reported feeling lost between the 2 departments.

At the time of the article, it was reported that there were few practicing med/peds role models.

Schubiner H, Schuster BL, Moncrease A, Mosca C.  “The perspectives of current trainees in combined internal medicine-pediatrics: results of a national survey”.  AJDC. 1993;147:885-889.  Pub Med ID: 8352223  DOWNLOAD PDF

This nationwide survey of 318 med/peds residents in 1989-1990 from 55 med/peds programs investigated stressors during residency, factors residents deem important in a program, and future plans of med/peds residents. The survey found that resident stress decreases with seniority and with more frequent switches between medicine and pediatrics rotations. Factors that residents considered important in a med/peds program included ambulatory training sites, a specific med/peds coordinator, and affiliation with a university. 64% of residents planned to do primary care of adults and children, 21% planned to do a subspecialty, and 4% planned on working in an emergency room.

Biro FM, Siegel DM, Parker RM.  “A comparison of self-perceived clinical competencies in primary care residency graduates.”  Pediatric Res. 1993;34:555-9.  Pub Med ID: 8284089  DOWNLOAD PDF

One hundred seventy-eight graduates from four primary care residency training programs with common hospital sites (medicine/pediatrics, 72; family medicine, 29; pediatrics, 35; and internal medicine, 42) responded to a mailed survey questionnaire regarding distribution of professional time and self-perceived clinical competencies. Most of the internists, family physicians, and internist/pediatricians (MED/PED) were in primary care, and 57% of the pediatricians were subspecialists. Respondents rated each of 24 clinical vignettes as to their level of comfort in managing the patient problems presented. MED/PED and pediatricians responded similarly to all the infant, child, and adolescent cases. Family physicians were less comfortable in managing the complicated neonatal situations but more comfortable with adolescent health care than the MED/PED or pediatricians. MED/PED reported greater comfort than family physicians in complex internal medicine issues, but less than internists in intensive care and geriatric consultation. Significant differences in reported competency existed among these primary care practitioners despite substantially overlapping training backgrounds.

Reynolds PP, Giardino A, Onady GM, Siegler EL.  “Collaboration in the preparation of the generalist physician.”  J Gen Intern Med. 1994;9;S55-63.  Pub Med ID: 8014745  DOWNLOAD PDF

This article lists the collaborative efforts among health care professionals and institutions toward addressing potential methods to increase production of generalist physicians.  The article highlights methods of collaboration, the concept of a generic generalist physician, and individual specialty approaches to the preparation of the generalist physician

Onady GM.  “The med/peds physician.”  AMSA Prim Care Quart. 1995;2:1 and 4.

A review of the history leading up to the establishment of Med-Peds training, parallels to the evolution of Family Practice, and the role these physicians play in the evolving medical environment. The growth of Med-Peds training programs through the mid-1990s is discussed, and how the Med-Peds trained physician is poised to meet the need of the generic primary care physician.

Onady GM.  Letters to the editor: “Internal medicine and family medicine.”  Ann Intern Med. 1996;125:525.  Pub Med ID: 8779491  DOWNLOAD PDF

This letter was a reply regarding a letter Dr. Saultz discussing the collaborative potential internists and family physicians, but neglected to discuss the Med-Peds potential.  The letter points out the strengths of Med-Peds and family physicians in collaborative practice.

Onady GM.  Med/Peds – “Three decades of the generic primary care physician.”  Academic Med. 1996; 71:16-7.  Pub Med ID: 9217503  DOWNLOAD PDF

A summary update as to the growth of Med-Peds training and the collaborative role of the American Boards of Internal Medicine and American Boards of Pediatrics in creating a training curriculum.  This training curriculum is described in an outline format.  Career development options that have resulted from this collaborative training are summarized.

Onady GM. “Med/peds residency training programs.”  AMSA Prim Care Quart.  1996;4:1 and 4.

This is a continuation of an AMSA series on Medicine-Pediatrics.  This article is focused toward the graduates of Med-Peds training programs and career choices made by these graduates.

Edwards A, Tzelepis A, Klingbeil C, Melgar T, Speece M, Schubiner H, Burack R.  “Fifteen years of a videotape review program for internal medicine and medicine-pediatric residents”  Academic Medicine.  1996;71:744-748.  Pub Med ID: 9158342  DOWNLOAD PDF

The medical interview is the primary way in which a doctor-patient relationship is established and maintained.  Videotaped clinical encounters can be used as a tool to facilitate teaching residents’ communication skills.  Wayne State University has been using video taped encounters for this purpose for more than 15 years.  This article is a review of that process and analysis of the program over the past 15 years. How are videotaped encounters used in a med-peds and internal medicine residency and what are the primary issues being discussed.  A university based med-peds and primary care internal medicine resident continuity clinic.  All residents in the two programs. 

All residents in the two programs were videotaped several times a year throughout their residency.  Tapes were reviewed with the resident and logs were kept of the topics discussed.  Current residents were surveyed for satisfaction with the process.

Resident perspectives – The majority of residents found the reviews helpful in learning about patient communication, structure of visit, and general patient care issues.  54% also reported that the process was helpful in provide support for them during residency.

Comfort with the process increased with experience.

Barriers to videotaped review – Logistical problems, patient, resident and faculty issue present barriers to the process.

Onady GM.  “A community collaborative practice experience between med/peds and family practice.” Am J Med 1997;102:441-8.  Pub Med ID: 9217640  DOWNLOAD PDF

A comparison is made among four primary care specialists – family physicians, pediatricians, internists and Med-Peds physicians in various practice environments. Utilization and demographic data are compared and contrasted  demonstrating  the Med-Peds potential to manage primary care needs in a cost-effective fashion.

Kimball HR.  “The med/peds physician in contemporary medical practice.”  Am J Med 1997;102:513.  Pub Med ID: 9217663  DOWNLOAD PDF

This editorial from the American Board of Internal Medicine first briefly reviewed the history of the combined residency beginning in the late 1960’s, and then outlined the tremendous growth in numbers of med/peds programs and positions offered. Quoting statistics form the 1996 National Residency Match Program, 99 programs offering 421 first year positions existed that year compared with 280 first year positions in 1991.  In 1996, 80% of med/peds positions were filled by graduates from U.S. medical schools compared with 59% of categorical internal medicine positions, 76% of categorical pediatrics positions, and 72% of family medicine positions.  Med/peds residents accounted for 8% of all internal medicine residents and 12% of pediatric residents.  

A survey of 900 board certified med/peds graduates was cited demonstrating that most graduates (71%) spent more than 70% of their time in direct patient care, and 88% practiced in a group setting.  Less than one-third of graduates sub-specialized after training. 

Onady’s report of a collaborative physician group containing 13 med/ peds and family medicine physicians was also discussed.

Schubiner H, Lannon C, Manford L.  “Current positions of graduates of internal medicine-pediatrics training programs.” AJDC 1997;151:576-9.  Pub Med ID: 9193242 DOWNLOAD PDF

This survey of 708 graduates of Internal Medicine/Pediatrics programs from 1987-1993 found that 480 (68%) were practicing primary care. Of this 480, 416 (85%) were practicing internal medicine and pediatrics and 390 (81%) were in private practice settings. From the original 708 graduates surveyed, 12% had chosen to practice either pediatrics or internal medicine and 21% had entered subspecialty training. At the time of publication in 1997, this was one of the largest surveys of med/peds graduates and found that the percentage of physicians in med/peds practicing primary care was higher than that of internal medicine (35-45%), equal to that of pediatrics (67%), and lower than that of family medicine (95%).

Schuster B, Clasen M, Onady G.  “Caring for Adults: A comparison of three residency options.”  Am J Med 1998;104:109-113.  Pub Med ID: 9528727  DOWNLOAD PDF

This article compares the three training options for primary care physicians that provide care to adults.  The training curricula for internal medicine, family medicine and internal medicine-pediatrics are compared and contrasted.  Comparisons between behavioral and ambulatory training is highlighted in this article.

Shah JK, Kahn MJ, Steinmann WC.  “Eliminating redundancies in med-peds training.”  Academic Med. 1998;73:1218.  Pub Med ID: 9883191

Shah et. all question whether the med/peds residency program needs to be 4 years in duration.  They suggest that there is a great deal of overlap between the two fields (by comparing the content of Nelson’s and Cecil’s textbooks), and that a 3 year program may be sufficient to provide the necessary knowledge to practice both internal medicine and pediatrics.  They also believe that more people would be likely to choose a 3 year program than a 4 year one.

Ciccarelli M.  “The clinical philosophy of medicine-pediatrics.”  Am J Med. 1998;104:327-9.  Pub Med ID: 9576404

Two page essay giving an overview of the philosophy of MedPeds as a combination of Internal Medicine and Pediatrics, pointing out certain niches of MedPeds in transitional care.  Interestingly, it is published alongside two other overviews, one of Internal Medicine, and one of Family Medicine.

Doucet H, Shah MK, Cummings TL.  “Comparison of internal medicine, pediatric, and medicine/pediatrics applicants and factors influencing career choices.”  South Med J. 1999;92:296-9.  Pub Med ID: 10094270  DOWNLOAD PDF

Survey of 1996-7 applicants to Tulane’s MP, Med, and Peds residencies given out when they interviewed at Tulane.  Asked about when and how they decided on their residency choice.  Response rate 67%.  MP applicants tended to decide later on their choice, have fewer role models, were as likely to have a residency program at their medical school they were entering, and more likely to entertain academic medicine as a career choice.

Sidwell AB, Kamat DM.  “The combined medicine/pediatrics residency. U of M graduates fill a growing need.”   Minn Med. 1999;82:22-28.   DOWNLOAD PDF

Sidwell and Kamat describe how Med-Peds has thrived in Minnesota, like many other places in the country.  The program at the University of Minnesota has noted an increase in both applicants and available positions over its ten-year history, and it is now one of the largest in the country.  Because of continuity clinic experiences, inpatient and outpatient subspecialty training, and rotations through various intensive care units, Med-Peds residents are uniquely trained to care for patients ranging from infancy to old age.  Graduates from the Minnesota program have had pass rates on board certification exams comparable to those of their categorical internal medicine and pediatric colleagues.  The proportion (slightly over two-thirds) of Minnesota graduates entering primary care is similar to that of Med-Peds graduates nationwide.  Communities throughout the state are increasingly seeking to employ Med-Peds physicians, because they are felt to be an asset for providing both routine and complex primary care.

Irigoyen MM, Kurth RJ, Schmidt HJ.  “Learning primary care in medical school: Does specialty or geographic location of the teaching site make a difference?”  Am J Med 1999;106:561-4.  Pub Med ID: 10335729  DOWNLOAD PDF

The LCMS mandates a core curriculum in primary care.  Some schools and states have interpreted primary care to mean Family Medicine.  There is no evidence that specialty or geographic location impact the quality of the student’s primary care experience. Does the specialty or geographic location of the clinic site affect the student’s experience during the mandatory third year primary care clerkship?

Third year medical students at Columbia University College of Physicians and Surgeons. The paper is not clear on inclusion or exclusion criteria.  It is implied that the clerkship is required of all students for graduation and that all students completing the rotation also receive a grade, take the standardized exam and are given the survey. Students were divided up among family medicine, internal medicine, med-peds, and pediatric sites in urban, suburban and rural settings.

Rural location of teaching sites was associated with greater student satisfaction on all of the survey items.  There were no differences with respect to specialty on the grades, exam scores, overall experience, faculty attitude, and supervision.  Students reported less patient diversity in pediatrics.

Lannon C, Oliver TK, Guerin RO, Day SC, Tunnessen WW.  “Internal medicine-pediatrics combined residency graduates.”  Arch Pediatric Adol Med 1999;153:823-8.  Pub Med ID: 10437754  DOWNLOAD PDF

The objective of this study from UNC was to determine career outcomes of graduates of med/peds residency programs.  Background information provided revealed that in 1998 there were 106 med/peds programs offering 456 first year positions.  Most programs (80%) were located east of the Mississippi River.  That year, 92.1% of positions were filled, and graduates of American medical schools filled 82%.

Study methods included examination of computer databases from the American Board of Pediatrics and the American Board of Internal Medicine to determine graduates of combined med/peds residency programs that applied to either or both boards for certification between 1986 and 1995.  A 12-question survey was mailed to graduates.  Questions on the survey gathered information regarding graduates’ professional activities.   The authors noted that prior studies of this nature surveyed program directors, not graduates.  Response rate for the survey was 67.8% (1005 graduates).  Demographics of graduates were provided:  66% were male, 34% were female, 88% were graduates of American medical schools, and 12% were international medical graduates. 

Of the graduates, 87% were ABIM certified, 91% were ABP certified and 82% were dual certified.  The majority (70%) of graduates spent the majority of their time in direct patient care.  Half of the graduates also held medical school appointments. Most graduates (85%) managed hospitalized patients but spent less than 20% of their time doing so.  More than half practiced in a community-based site, mostly in a group practice, and most graduates cared for patients of all ages.  Of graduates surveyed, 4% trained in fellowships.  Over half of the graduates practiced east of the Mississippi, which mirrored pediatric graduate practices. 

Onady GM.  “The medicine-pediatrics physician: Past present, and future.”  Contemporary Pediatrics 1999;16:129-47.  DOWNLOAD PDF

The professional development of Med-Peds physicians is detailed and compared to the primary care roles that have been adapted by family physicians, internists and pediatricians over the 1990s.  The article highlights the collaborative role the Med-Peds physician can serve in multiple practice environments.