Melgar T, Schubiner H, Burack R, Aranha A, Musial J. “A time-motion study of the activities of attending physicians in an internal medicine and internal medicine-pediatrics resident continuity clinic.”    Academic Medicine 2000;75:1138-1143  Pub Med ID: 11078677  DOWNLOAD PDF

Med-Peds and Internal Medicine attending physicians have to attend to multiple tasks while supervising clinics.  The degree to which this interferes with medical education and contact with residents is not known. What are the responsibilities of the attending physician while supervising residents in their internal medicine or med-peds continuity clinics?  What portion of their time is spent in teaching and contact with residents?  Six attending physicians (three med-peds, three internal medicine) in a university based internal medicine and med-peds resident continuity clinic. All attending physicians supervising in the clinic were included.  Attending physicians were shadowed and activities were recorded by stop-watch.  The majority of the attending physicians time was spent on activities other than contact with residents.  Clinic operational activities occupied the majority of time not in contact with residents.  Personal and professional activities apparently filled the void when educational and clinic operational activities were completed.  A ratio of 10-14 patients per attending resulted in the maximal contact with residents.  Resident to attending ratios and patient to resident ratios did not affect the attending physicians contact with residents.

Outlaw, DT et. al.  “Description of a combined internal medicine-pediatrics continuity clinic for combined program residents.”  Southern Medical Journal. 2001 Dec;94(12):1173-6.  Pub Med ID: 11811855 DOWNLOAD PDF

Description of the demographics of a Med Peds residency clinic noting 63/37 adult: child ratio and 3.5 patients seen per resident per clinic session regardless of level.  Residents were satisfied with their experience, and DM and HTN were the most common diagnoses.

Duke, MB et. al.   “A clinical performance exercise for medicine–pediatrics residents emphasizing complex psychosocial skills.”  Academic Medicine 2001 Nov;76(11):1153-7   Pub Med ID: 11704520 DOWNLOAD PDF

Report of a clinical performance exercise for Med-Peds residents.  Performance correlated with year of residency.

Garibaldi RA, Subhiyah R, Moore ME, Waxman H.  “The In-Training Examination in Internal Medicine: An Analysis of Performance Over Time.”   Ann Internal Med. 2002;137:505-510  Pub Med ID: 12230352

An examination of the trends in the medicine ITE from 1988 to 2000 among IM and MedPeds residents.  It showed that IMGs consistently outscore USMGs and that scores get better over residency.  At the end of the R4 year, MedPeds residents score slightly below IM R3s after catching up from lagging behind IM R2’s during the MP R2 and R3 year.

Campos-Outcalt D , Lundy M, and Senf, J.   “Outcomes of Combined Internal Medicine-Pediatrics Residency Programs.” Academic Medicine 2002;77:247-256.  Pub Med ID: 11891165  DOWNLOAD PDF

A review of the current research literature in regards to outcomes of Med-Peds residencies.  The review found a paucity of literature since 1993.  It documented a 20-30% attrition rate from MP residencies, an 80% dual board certification rate of MP graduates, and an 80% rate of providing care to both adults and children. 

Senf JH, Kutob R, Campos-Outcalt D.  “Which Primary Care Specialty: Factors that relate to a choice of Family Medicine, Internal Medicine, Combined Internal Medicine-Pediatrics or Pediatrics.”  Family Medicine. 36;2004:123-130.  Pub Med ID: 14872360

Survey of FM, IM, Peds, and MP practitioners asking why they went into that field.  All respondents put as their second reason wanting to be like practitioners in that field.  Their first choices were: FM – patient relationships, Peds – wanting to work with children, IM – wanting to work with adults, MP – wanting to work with children.

Frohna, John, Melgar, Tom, Mueller, Caroline, and Borden, Sam.  “Internal Medicine-Pediatrics Residency Training: Current Trends and Outcomes.”  Academic Medicine. 2004;79:591–596.  Pub Med ID: 15165981  DOWNLOAD PDF

Survey of Med-Peds program directors asking them to give the initial career paths of their graduates of 1998 – 2002.  It showed a 9% attrition rate during residency, 82% see both adults and children, 22% subspecialized, 21% saw rural and underserved patients, and 79% board certified in both Medicine and Pediatrics.

Robbins, BW, Ostrovsky, D, and Melgar, T.  “Factors in Medical Students’ Selection and Ranking of Combined Medicine-Pediatrics Programs .” Academic Medicine. Vol 80, No. 2, February, 2005, p. 199.  Pub Med ID: 15671329 DOWNLOAD PDF

A survey of 4th year medical students applying to at least one MedPeds program revealing that students select Med-Peds to see both adults and children, keep open the possibility of sub-specializing, and getting more intensive training in Pediatrics than Family Medicine.  The issues most important to them in creating their rank lists were location for self and spouse, and subjective feelings of fitting in and a good match for them.

Ken Terry.  “Where do Med-Peds Fit?”   Medical Economics.  April 8, 2005  Pub Med ID: 15929350  DOWNLOAD PDF

Short editorial discussing the differences between Med-Peds and Family Medicine

Melgar, T; Brands, C and Sharma, N.   “Health Care Transition.”  Pediatrics 2005;115:1449 -1450.  Pub Med ID: 15867079  DOWNLOAD PDF

Letter to the editor commenting that a prior study on transition of children to adult providers did not mention Med-Peds physicians, commenting that MedPeds physicians are a natural and necessary part of the process.

Freed GL, Fant KE, Nahra TA, Wheeler JR.  “Internal medicine-pediatrics physicians: their care of children versus care of adults.” Academic Medicine  2005;80:858-64.  Pub Med ID: 16123468 DOWNLOAD PDF

Random sample survey of 1300 generalist and 500 subspecialist MedPeds physicians in 2003 asking about their practice patterns.  While over 85% provided care to all age groups, most of the care they provided was to adults, a difference more pronounced among subspecialists.  In addition 50% received at least one referral from a FM doctor per year while 16% received over 10 per year.

Freed GL.  “Comparing perceptions of training for medicine-pediatrics and categorically trained physicians.”  Pediatrics 2006;118:1104-8.  Pub Med ID: 16951004  DOWNLOAD PDF

Survey of randomly selected “older” IM and Peds graduates (graduated 1980-1997) and randomly selected “recent” graduates (1998-2003) asking their comfort in caring for the varying age populations.  The author compared these responses to a separate survey of Med-Peds graduates.  More general Pediatrics graduates felt “very well prepared” to care for infants than MedPeds graduates, but less “very well prepared” to care for adolescents.  MedPeds graduates were more likely to feel “very well prepared” to care for adults and elderly than IM graduates.

Melgar, T; Chamberlain, J. K.; Cull, W. L.; Kaelber, D. C.; Kan, B. D.  “Training Experiences of Combined Internal Medicine-Pediatric  Residents.”  Academic Medicine  2006;81:440-446.  Pub Med ID: 16639198 DOWNLOAD PDF

First report of the graduating resident survey conducted annually by the AAP.  89% would choose MedPeds again and 93% planned on caring for both adults and children.  On average, they desired more training in outpatient procedures, office management, and career planning, and less time in the NICU.  They felt particularly well prepared in EBM, children with special health care needs, and information technology.  They felt equally prepared to care for adults and children.

Robbins, B, Aronica, M, Melgar, T, and Friedland, A.    “Benchmarks for support among Internal  Medicine-Pediatrics Residency Programs.”  The American Journal of Medicine. 120(5), May 2007, pp. 462-465.  Pub Med ID: 17466661  DOWNLOAD PDF

Survey of Med-Peds programs showing Med-Peds trained physicians ran 88% of the Med-Peds residencies (most often the residency program they attended personally), had a mean salary of $134,000 (lower for academic institutions), were in their jobs for an average of 5 years, have an average age of 39, and are mainly male (63%). Higher board pass rates for Med-Peds programs were associated with filling in the match, having more Med-Peds faculty, and NOT taking money from pharmaceutical companies.

Chamberlain, John; Cull W; Melgar T; Kaelber D; Kan B.  “The effect of dual training in internal medicine and pediatrics on the career path and job search experience of pediatric graduates.”  J Pediatrics. 2007, 151:419-24.  Pub Med ID 17889081   DOWNLOAD PDF

Survey of graduating med-peds and peds residents in 2003 and 2004. Both groups would choose the same specialty again in >90%. Primary care was the most popular choice for both groups (55% vs. 51%), but Med-Peds graduates more often chose hospitalist posts (17% vs. 8%), less likely subspecialty (18% vs. 31%), had as many job offers (3 vs. 2) with fewer applications (8 vs. 15), and made more money than their pediatric counterparts. Top med-peds fellowships in this survey were for med-peds (infectious disease, allergy, critical care and endocrinology) and for peds (neonatology, emergency medicine, heme/onc and infectious disease).

Frohna, JG.  ” The Role of the Med-Peds Physician in a Changing Medical World.”  J of Pediatrics. 2007;151:338-339.  Pub Med ID: 17889064  DOWNLOAD PDF

Commentary on the Chamberlain article in the same edition of JPeds, pointing out that 70% of MedPeds interns plan a career in primary care, but only 55% actually do so on graduation.

Melgar, T; Frohna , JG.  “Choosing a Career in Combined Internal Medicine and Pediatrics: Insights from Interns.”  Family Medicine. 2007;39:326-330.  Pub Med ID 17476605  DOWNLOAD PDF

Survey of MedPeds interns showing that only 18% would have chosen FM as an alternate career if Med-Peds did not exist, 32% would have chosen Pediatrics and 41% would have chosen Internal-Medicine.  Of the approximately 50% that considered either medicine or pediatrics alone, only about 1 of 4 ranked a medicine or pediatrics program. Of the approximately 33% that considered family medicine, only about 1 of 12 ranked a family medicine program.

Sharma N, Melgar T, Brands C.  “Survivors of childhood cancer.”  New England Journal of Medicine 2007 Jan 11; 356(2):191-47.  Pub Med ID: 17225289  DOWNLOAD PDF

Letter to the editor commenting on a previous article about survivors of childhood cancer, pointing out that Med-Peds physicians are well trained to care for this, and other, transitional populations.

Tofil NM, Lee White M, Manzella B, McGill D, Zinkan L.  “Initiation of a pediatric mock code program at a children’s hospital.”  Med Teach 2009 Jun;31(6):e241-7.  Pub Med ID: 19811155  DOWNLOAD PDF

Med/peds residents were significantly more confident in their skills than pediatric residents both pre- (p = 0.041) and post-intervention (p = 0.016). The two skills overall with the lowest score post-intervention were the ability to place an interosseous line and the ability to manage cardiac dysrhythmias.

Fortuna RJ, Ting DY, Kaelber DC, and Simon SR.  “Characteristics of medicine-pediatrics practices: results from the national ambulatory medical care survey.”  Academic Medicine 2009 Mar;84(3):396-401.  Pub Med ID: 19240455  DOWNLOAD PDF

Forty-three percent of visits to med-peds physicians were from children as compared to 15.5% for family medicine in this database. Med-peds physicians, like family physicians and pediatricians, most commonly treated patients for acute problems and reported high levels of continuity of care for patients-pediatric (93.6%) and adult (94.6%).