mytirf

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I just finished my pediatrics rotations (I'm almost a IVth year) and really loved it. I enjoyed the kids, the diseases, and the challenge of diagnosis with sometimes-limited information and even enjoyed working with some of the parents. So I am seriously considering doing a peds residency over adult medicine, but I have a couple of concerns that I thought people might help me with.

In general I get a sense that peds residents are a little less academic than those in general internal medicine residencies. I have a strong research background and it seems that peds residents (and attendings) don't really read the literature as much as IM residents (and attendings). Is this a universal feature or just specific to my experience? I realize there are limited double-blind trials in children for obvious reasons but I wonder if this mindset is more prevalant among pedi people.

Also, I have noticed there is generally less independence of the residents (and especially interns) as compared to IM. I realize that kids are well someone's children and thus there is a heightened sense of not wanting mistakes to occur, and so how do people deal with the lack of independence during residency? Are there certain hospitals with greater independence than others for residents and interns?

Finally (sorry for the length), for people interested in trying to combine research and medicine, what specialties are common for people to apply to within pediatrics, any word about short tracking or this new integrated research residency? Thank you all for your help

-V
 

GeneGoddess

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Well, there are two MD/PhDs in my class going into Pedi this year, and at least one next year (maybe more). I've never understood why people think of Pedi as the cold/cold/vaccination specialty. We take care of everything from a 24wk preemie to 18yr olds (and beyond, depending on the speciality). How much changes from birth until the body is capable of GIVING birth (or supplying sperm). I think it is one of the most intellectually challenging specialties. Of course, I'm biased.

I think the "academic" attitude varies from location to location. During interviews, I've seen the entire spectrum (though most places I looked were more "academic" in nature. But I went to several places where the residents, fellows, and attendings actively discussed the latest papers and studies when deciding on patient care. And most of the programs required some form of research.

I'm interested in Pedi and Genetics, which is tailor made for MD/PhDs. We do research that is directly applicable to our patients. MOST sub-specialties can offer research opportunities (endocrine, GI pulmonary, heme/onc, neuro, ID, immuno, etc etc). MD/PhDs from my program have gone into four of those subs in the last decade, but the three most recent grads haven't entered fellowships yet.

If you like Pedi, DO IT!!!
 

kas23

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I agree with GG.

Just like with IM, some programs are more or less academic. And also within the programs, different attendings will stress EBM more than others. But, it has been my experience that at most of the top programs (and I use this loosely for the top 20-30 programs in the country), most of the attendings are very academic. I don't know what hospital you rotated in, but it sounds like you were at one of the not-so-good pograms. And when I say not-so-good, I mean not-so-good for EBM and academics. Some people are perfectly fine with those types of programs and choose to pick a program like that. There is a program for everyone.

If you want to go into research and be involved in very up to date treatments, pick one of the top university programs. Do NOT let your experience scare you away. I know plenty of people like you, that have a bunch of research experience or PhDs that are going into peds and will likely end up at a more research-oriented program.

Remember, it is an unfortunate stereotype to think that all pediatricians are "just baby doctors" and love well-visits and treating sniffles. You may not love that stuff, I certainly don't. But, I do love the children, so I find the sniffles and well-visits tolerable and sometimes fun.
 

oldbearprofessor

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mytirf said:
I just finished my pediatrics rotations (I'm almost a IVth year) and really loved it. I enjoyed the kids, the diseases, and the challenge of diagnosis with sometimes-limited information and even enjoyed working with some of the parents. So I am seriously considering doing a peds residency over adult medicine, but I have a couple of concerns that I thought people might help me with.

In general I get a sense that peds residents are a little less academic than those in general internal medicine residencies. I have a strong research background and it seems that peds residents (and attendings) don't really read the literature as much as IM residents (and attendings). Is this a universal feature or just specific to my experience? I realize there are limited double-blind trials in children for obvious reasons but I wonder if this mindset is more prevalant among pedi people.

Also, I have noticed there is generally less independence of the residents (and especially interns) as compared to IM. I realize that kids are well someone's children and thus there is a heightened sense of not wanting mistakes to occur, and so how do people deal with the lack of independence during residency? Are there certain hospitals with greater independence than others for residents and interns?

Finally (sorry for the length), for people interested in trying to combine research and medicine, what specialties are common for people to apply to within pediatrics, any word about short tracking or this new integrated research residency? Thank you all for your help

-V
Dear mytirf:

Welcome back....glad to see you still are interested in pedi even though we tend to say a lot of things in pedi like "he just looks sick" and "yeah, we'll start {insert name of medicine of choice for reflux}, even though it's never really been tested for GER in premature babies."

We take a lot of stock regarding how sick a child is based on what a kid tells us by his appearance and activity level. Being able to tell a sick kid from one that is not too ill is a clinical skill that may seem trivial, but is a challenge to develop. Labs and radiology help, but clinical experience counts for a lot.

In pedi, especially neo, we all quickly learn that therapies that we simply must use have often had little or no testing on our small patients. This has made the use of evidence-based medicine practice a challenge. Often some of the evidence-based reviews have been questionable at best in their conclusions based on wholly inadequate studies. As such, often it is frustrating to try to teach based on what the literature says is the best choice of medicines or therapies. That doesn't mean we don't follow the medical literature carefully, it's just that we can't rely on it often the way medicine folks do.

However, this does not mean that we do not need more both clinical and basic science investigators to help improve this situation.

As far as specialties, any specialty can be compatible with basic science research. Among the common ones with lots of basic science research ongoing are heme-onc, neonatology, allergy and immunology, endocrine, and genetics. Cardiology, GI and nutrition, and critical care are increasingly interested in having basic science and good clinical investigators as well.

Finally, with regard to independence of action of residents, this is, of course, very program dependent. Ultimately, however, it is a matter of time and experience and you will get the experience and independence you need regardless of where you go. However, if this is a big issue for you, you will definitely have more independence early on in medicine than most, if not all, pedi programs.

If you believe that your future is in caring for children and helping to solve the diseases that affect them, then you will make a great pediatrician and I look forward to having you as a colleague.

Regards

OBP
 

notstudying

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I'm also a research geek, having come into med school with an MPH and significant research experience, and at least at my program there is a very strong emphasis on academics (we have an entire EBM curriculum in residency, and as an intern I'm constantly asked about the evidence behind my therapeutic and diagnostic choices). There is a current push to recruit more academic research types into peds, since there aren't enough, and my program has been very cooperative in supporting my plans to continue doing research in residency (mine is clinical rather than basic science work). We have brilliant faculty, and our morning report sometimes degenerates into a citation-tossing argument over management! (The ESR vs CRP debate is perennial!). There's huge meeting every May of the Pediatric Academic Societies, where thousands of the best minds in peds get together to present research. And for those interested, the 2008 (I think) meeting is in Hawaii (time now to plan fellowships around this :)).

A word of caution though-I interviewed with one university program, with one of the highest rates of peds NIH funding in the US, that was quite unsupportive of residents' research efforts, so if you think you'd like to get experience in residency,rather than waiting for fellowship, ask specific questions.
 

oldbearprofessor

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notstudying said:
There's huge meeting every May of the Pediatric Academic Societies, where thousands of the best minds in peds get together to present research. And for those interested, the 2008 (I think) meeting is in Hawaii (time now to plan fellowships around this :)).
2007 in Toronto will be fun too. But, 2008 in Honolulu will be the all-time winner.

http://www.pas-meeting.org/FutureMeetings.htm

Meanwhile, perhaps we should have a "pediatrics" forum mtg at SPR 2005 (in DC)? Who here is going?

Regards

OBP
 

sjkpark

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GeneGoddess said:
Well, there are two MD/PhDs in my class going into Pedi this year, and at least one next year (maybe more). I've never understood why people think of Pedi as the cold/cold/vaccination specialty. We take care of everything from a 24wk preemie to 18yr olds (and beyond, depending on the speciality). How much changes from birth until the body is capable of GIVING birth (or supplying sperm). I think it is one of the most intellectually challenging specialties. Of course, I'm biased.....

I'm interested in Pedi and Genetics, which is tailor made for MD/PhDs. We do research that is directly applicable to our patients. MOST sub-specialties can offer research opportunities (endocrine, GI pulmonary, heme/onc, neuro, ID, immuno, etc etc). MD/PhDs from my program have gone into four of those subs in the last decade, but the three most recent grads haven't entered fellowships yet.

If you like Pedi, DO IT!!!
Hi,

I'll just piggyback on this thread.

I'm a medical student in New Zealand and interested in taking a year off to do a research degree. I'm just shopping around for suitable project and supervisor and funding.

The MD/PhD's that you talk about, what did they do for their PhD? Did they do something that is paeds related?

Until last week I was thinking of doing research in fetal programming, cos I've always been fascinated by that subject. But I went to see a researcher at my school who is a geneticist and general physician (hoping for an unbiased opinion). And because he's a very cool guy and very encouraging and understanding, I'm thinking of doing research with him.

He said that it didn't matter what kind of research you did - as long as you have sound science principles and ability to think, you'll be well-prepared for a career in academic medicine no matter what specialty you go into.

I was worried about spending 4+ years doing research in fetal programming and then deciding not to become a paediatrician.... :(
 

GeneGoddess

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Let me think: neuronal genetics, muscle development, tb resistance, histones/antineoplastic drugs, bone development, retroviruses, chloride channel stuff, and one I can't remember. I don't think any were "pedi specific". In fact, I think only the person doing tb research actually used human subjects.