Med-Peds Abstracts and Articles 2010-Present

In 1967, the American Board of Pediatrics and the American Board of Internal Medicine uniformly recognized the 4-year combined medicine and pediatrics training program. Since that time, the number of combined internal medicine and pediatrics programs has increased. Today, there are more than 78 combined residency programs with more than 354 first-year residency positions throughout the United States. Medicine/pediatrics residency programs give the resident the opportunity to rotate 24 months in each specialty. Graduates of combined medicine/pediatrics residency programs have several career options available to them. In 2007, a total of 55% of medicine/pediatrics residents went into primary care practice, 18% went into subspecialty training, 17% went into hospital medicine, and 10% chose other careers. 

The results of the 2010 National Resident Matching Program (NRMP) reflect a small but promising increased level of student interest in family medicine residency training in the United States. Compared with the 2009 Match, 75 more positions (with 101 more US seniors) were filled in family medicine residency programs through the NRMP in 2010, at the same time that seven more positions were filled in primary care internal medicine (one more US senior), 14 fewer positions were filled in pediatrics-primary care (16 fewer US seniors), and 16 more positions were filled in internal medicine-pediatrics programs (58 more US seniors). Multiple forces including student perspectives of the demands, rewards, and prestige of the specialty; national dialogue about health care reform; turbulence in the economic environment; lifestyle issues; the advice of deans; and the impact of faculty role models continue to influence medical student career choices. Ninety-four more positions (90 more US seniors) were filled in categorical internal medicine. Fifty-seven more positions (29 more US seniors) were filled in categorical pediatrics programs. The 2010 NRMP results suggest that there is a small increase in primary care careers; however, students continue to show an overall preference for subspecialty careers. Despite matching the highest number of US seniors into family medicine residencies since 2004, in 2010 the production of family physicians remains insufficient to meet the current and anticipated need to support the nation’s primary care infrastructure.

Physicians who complete combined residency training in internal medicine and pediatrics (med-peds) have a variety of career options after training. Little is known about career transitions among this group or among other broadly trained physicians.  To better understand these career transitions, we conducted semistructured, in-depth, telephone interviews of graduates of the University of North Carolina-Chapel Hill School of Medicine med-peds program who self-identified as having had a career transition since completing training. We qualitatively analyzed interview transcripts, to develop themes describing their career transitions.  Of 106 physicians who graduated during 1980-2007, 20 participated in interviews. Participants identified factors such as personality, work environment, lifestyle, family, and finances as important to career transition. Five other themes emerged from the data; the following 4 were confirmed by follow-up interviews: (1) experiences during residency were not sufficient to predict future job satisfaction; work after the completion of training was necessary to discover career preferences; (2) a major factor motivating job change was a perceived lack of control in the workplace; (3) participants described a sense of regret if they did not continue to see both adult and pediatric patients as a result of their career change; (4) participants appreciated their broad training and, regardless of career path, would choose to pursue combined residency training again.  CONCLUSIONS:  There are many professional opportunities for physicians trained in med-peds. Four consistent themes surfaced during interviews about med-peds career transitions. Future research should explore how to use these themes to help physicians make career choices and employers retain physicians.

Residencies with Dual Internal Medicine-Pediatrics Programs Outperform Others on the American Board of Pediatrics Certifying Examination. John L. Falcone. Clinical Pediatrics, May 6, 2014.  DOWNLOAD PDF

Objective. The purpose was to evaluate American Board of Pediatrics Certifying Examination performance based on if a residency offers a dual internal medicine–pediatrics program, hypothesizing that having a dual-accreditation program is associated with higher exam performance. Methods. Pediatric residency programs in the United States were retrospectively evaluated from 2010 to 2012. The accreditation status was determined. Mann–Whitney U tests were performed for continuous variables, and χ2 tests were performed for categorical variables, using an α = .05. Results. For 190 residencies, 75 (39%) had dual Med-Peds accreditation whereas 115 (61%) did not. The median overall residency pass rate for Med-Peds accredited programs (83%; interquartile range = 74% to 91%)was higher than other programs (78%; interquartile range = 65% to 89%; P = .02). The pass rate for examinees from Med-Peds accredited programs (n = 4,108; 84.2%) was higher than examinees from other programs (n = 4,310;79.6%; P < .001). Conclusions. The presence of a dual-accreditation residency program should be a consideration of future applicants.

Aylward, Michael MD; Nixon, James MD; Gladding, Sophia PhD. An Entrustable Professional Activitiy (EPA) for Handoffs as a Model for EPA Assessment Development.  Academic Medicine 2014.  DOWNLOAD PDF

Medical education is moving toward assessment of educational outcomes rather than educational processes. The American Board of Internal Medicine and American Board of Pediatrics milestones and the concept of entrustable professional activities (EPA)-skills essential to the practice of medicine that educators progressively entrust learners to perform-provide new approaches to assessing outcomes. Although some defined EPAs exist for internal medicine and pediatrics, the continued development and implementation of EPAs remains challenging. As residency programs are expected to begin reporting milestone-based performance, however, they will need examples of how to overcome these challenges.

The authors describe a model for the development and implementation of an EPA using the resident handoff as an example. The model includes nine steps: selecting the EPA, determining where skills are practiced and assessed, addressing barriers to assessment, determining components of the EPA, determining needed assessment tools, developing new assessments if needed, determining criteria for advancement through entrustment levels, mapping milestones to the EPA, and faculty development. Following implementation, 78% of interns at the University of Minnesota Medical School were observed giving handoffs and provided feedback. The authors suggest that this model of EPA development-which includes engaging stakeholders, an iterative process to describing the behavioral characteristics of each domain at each level of entrustment, and the development of specific assessment tools that support both formative feedback and summative decisions about entrustment-can serve as a model for EPA development for other clinical skills and specialty areas.

Gardner SE, Gonzaga AM, Kolarik RC. New Program Requirements Present Challenges and Inspire Innovations in Med-Peds Programs. Academic Pediatrics 2014;14:566-568. DOWNLOAD PDF

O’Toole JK, et al.  The Practice Patterns of Recently Graduated Internal Medicine-Pediatrics Hospitalists.  Hospital Pediatrics 2015:5;309-14 DOWNLOAD PDF

OBJECTIVES: To identify the current practice patterns and professional activities of internal medicine–pediatrics (med-peds) hospitalists who have graduated in the past 5 years (June 2009–June 2013).  METHODS: The national Medicine-Pediatrics Program Directors Association (MPPDA) conducted a cross-sectional survey study of the 79 residency program directors who are members of the MPPDA regarding the practice patterns of recent graduates (from 2009–2013) currently practicing as hospitalists. The survey was distributed in the spring of 2014 on the MPPDA listserv. The survey inquired about time spent caring for hospitalized adults and children, medical school appointments, practice in freestanding children’s hospitals, and completion of hospital medicine (HM) fellowships. RESULTS: Forty-nine program directors (62%) completed the survey and provided data on 1042 graduates from 46 programs. Of those graduates, 26.4% (n = 275) practice as hospitalists, and none had completed an HM fellowship. Approximately two-thirds (65%) of med-peds hospitalists provide care to hospitalized children and adults, with one-third providing care solely to hospitalized adults. Approximately one-half (53.5%) have an appointment with a medical school and roughly one-quarter (28%) practice in a freestanding children’s hospital. CONCLUSIONS: An increasing percentage of recent med-peds graduates are pursuing careers in HM, and two-thirds are providing care to hospitalized children. As consideration for an accredited pediatric HM fellowship continues, certifying and accrediting bodies should consider how this will impact the med-peds workforce and allow med-peds graduates flexibility in their training requirements that will permit them to acquire the necessary skills to care for hospitalized children and adults.