evaluating PEDS

[justwondering]

how are you guys evaluating peds at different Family programs? i really want good outpt peds experience, but it seems pretty hard to compare. i need to match into a particular city and it seems like most of their programs dont have a lot of peds outpt experience. is this a regional thing (the programs in my home city dont have this problem)?

i really dont want to ditch any programs because of subjective reports from residents who may have different standards of what they think is acceptable. so is there any objective way of comparing peds?

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[tatabox80]

I too am interested in a strong peds experience. I asked what percentage of their office visits were peds visits. I also asked about the ability to set up an outpatient peds rotation if I wanted. Also, see how their inpt. peds service is. One program I interviewed at had a peds wing that they ran, however, on average had only 4 patients at a time. I personally would like to see more than that on an inpt. service. Other programs I interviewed at rotated at an outside peds hospital, but they are very busy and I felt had a better learning experience.

how are you guys evaluating peds at different Family programs? i really want good outpt peds experience, but it seems pretty hard to compare. i need to match into a particular city and it seems like most of their programs dont have a lot of peds outpt experience. is this a regional thing (the programs in my home city dont have this problem)?

i really dont want to ditch any programs because of subjective reports from residents who may have different standards of what they think is acceptable. so is there any objective way of comparing peds?

 

[oldbearprofessor]

I too am interested in a strong peds experience. I asked what percentage of their office visits were peds visits. I also asked about the ability to set up an outpatient peds rotation if I wanted. Also, see how their inpt. peds service is. One program I interviewed at had a peds wing that they ran, however, on average had only 4 patients at a time. I personally would like to see more than that on an inpt. service. Other programs I interviewed at rotated at an outside peds hospital, but they are very busy and I felt had a better learning experience.

This is probably directed for Kent, and it may have been answered before, but I wonder if there are a set of core competencies in pediatrics that the board has. If so, you could ask about how any program fulfills those. Is there a sign-off (or a count made?) on the number of patients you manage with specific problems?

In terms of neonatology, I'd be very interested to hear what core competencies are in FP. For example, are you certified in neonatal resuscitation? Kent said he was, but I'm not sure that's universal in FP programs? Do you have the opportunity to manage babies 32-35 weeks gestation in a level 2 setting? How many deliveries do you attend in which you are responsible for supporting the baby? I'm sure there are others.

Finally, I think it is important to consider what your relationship will be with pediatric trainees. Will you work with them, for example in a pedi ER or Level 2 NICU? Will they supervise you on the floors? You might consider the pros and cons of these relationships and the affiliated pediatric programs.

 

[deleted87716]

I wonder if there are a set of core competencies in pediatrics that the board has. If so, you could ask about how any program fulfills those. Is there a sign-off (or a count made?) on the number of patients you manage with specific problems?

Any program that's accredited by the ACGME has to meet certain requirements (detailed here). However, some programs are going to offer a better peds experience than others.

In terms of neonatology, I'd be very interested to hear what core competencies are in FP. For example, are you certified in neonatal resuscitation? Kent said he was, but I'm not sure that's universal in FP programs?

That's probably facility-dependent. At our hospital, the resident on-call for pediatrics responded to all deliveries along with the neonatology attending or neonatal NP on-call. We had the opportunity to perform resuscitations, but individual resident experiences differed depending on how much the resident wanted to do. The lazy ones could simply let the attending or NP run the show, and act as a second pair of hands. The more "aggressive" ones got to intubate, start lines, etc. and sometimes lead the resuscitation (under supervision, of course). If this is the sort of experience you hope to have, definitely ask how this works.

Do you have the opportunity to manage babies 32-35 weeks gestation in a level 2 setting?.

This was part of our peds experience as well. We also got some NICU exposure during our inpatient peds rotations at a local childrens' hospital. Again, not every program does this, so ask about it.

I think it is important to consider what your relationship will be with pediatric trainees. Will you work with them, for example in a pedi ER or Level 2 NICU? Will they supervise you on the floors? You might consider the pros and cons of these relationships and the affiliated pediatric programs.

I was in an unopposed FM program, so the only time we worked with peds residents was during our rotations at the childrens' hospital. They had a couple of other FM programs sending residents through there, too, so it was pretty much a standard part of the way things ran there. We functioned identically to the peds interns. In fact, my first rotation as an intern was inpatient peds at the childrens' hospital, and our program started a week earlier than the peds program, for some reason. Consequently, I had a full week under my belt by the time the peds interns showed up on the wards, which meant that I got to show them how things were done. Kinda interesting.

 

[oldbearprofessor]

Thanks for the answers Kent. Sounds like we basically agree on the types of questions that can be asked about pedi in a FP interview that would give meaningful comparisons. I'd be interested in hearing the types of responses interviewees receive as I think Kent's program was above average in pedi experiences. Or perhaps Kent was a gunner in pedi!

I think any program that doesn't require certification in neonatal resuscitation would be of great concern. If you are ever in a resuscitation as the physician caring for the baby, and if the baby's ultimate outcome is not ideal, even if totally unrelated to your care, documentation that you were certified in, and conducted the resuscitation in accordance with NRP guidelines would be crucial.

This is not a theoretical issue based on situations of which I am personally aware of having occurred.

 

[justwondering]

thanks for the responses.
as for outpatient peds, what percentage of our continuity clinic pts should be peds?

 

[elizabeth5863]

how are you guys evaluating peds at different Family programs? i really want good outpt peds experience, but it seems pretty hard to compare. i need to match into a particular city and it seems like most of their programs dont have a lot of peds outpt experience. is this a regional thing (the programs in my home city dont have this problem)?

i really dont want to ditch any programs because of subjective reports from residents who may have different standards of what they think is acceptable. so is there any objective way of comparing peds?

Hi justwondering,

Outpatient peds doesn't seem to be much of a problem in programs in the west coast but does tend to be a problem anywhere where there are more older folks and less young families. (I've encountered only two programs so far in CA where there are less peds but it was because older folks tend to retire there).

However, you can still get plenty of outpatient peds in peds ER and urgent care clinic. Continuity peds is a problem at some programs (i.e. well child visits), but you can always recruit your OB pts and ask if they need a doctor to take care of their new child. If a program doesn't have a lot of outpt peds, I'd look to see if the program has a peds ER and an urgent care clinic. You can always do an elective outpt peds month in another place as well.

Hope that helps. Good luck!

 

[elizabeth5863]

thanks for the responses.
as for outpatient peds, what percentage of our continuity clinic pts should be peds?

The % differs for residents even at the same program. I think it depends on how you want to tailor your future practice. (If you like more peds, ask for more peds pts). (I like geriatric pts, so I'll be seeking out more geriatric pts). I've often found that residents at the same program often have different interests and some may have mostly peds and OB pts, while others have mostly middle aged adults pts or older pts.

Maybe you can ask a resident at the program(s) you're interested in who wants his/her clinic to be mostly peds and OB, and see what % of peds he/she has.

Hope this is helpful.

 

[deleted87716]

I think Kent's program was above average in pedi experiences. Or perhaps Kent was a gunner in pedi!

Not a gunner in the traditional sense, but no slacker, either.

I feel like I had a pretty good peds experience in residency. The childrens' hospital was a necessity, as the peds inpatient census in our primary facility was pretty low, and usually low-acuity. We also got plenty of outpatient peds experience between our FM clinic and dedicated peds clinic (supervised by peds attendings).

I'm honestly not sure how this compares to other programs.

 

[oldbearprofessor]

Not a gunner in the traditional sense, but no slacker, either.

I feel like I had a pretty good peds experience in residency. The childrens' hospital was a necessity, as the peds inpatient census in our primary facility was pretty low, and usually low-acuity. We also got plenty of outpatient peds experience between our FM clinic and dedicated peds clinic (supervised by peds attendings).

I'm honestly not sure how this compares to other programs.

You can create a new thread for this if you'd like, but I would be interested to hear how much neonatal care you and the other attendings here have in their practice - probably would be helpful to the students to get an idea of this as well. Some would be very glad to dabble in neonatology I suspect and others would be less comfortable with it or consider it (not unreasonably) a relatively high liability risk and time-sink. From what I've seen some family docs refer almost all of the baby stuff and others do a lot - I'm not clear on what the trend in this is. As a practical use of this information, I actually am meeting with the head of family medicine at my medical school in a few weeks related to international training we work together on and might suggest some ideas relative to this issue.

Here are some Q to start you on....

What % of your office time is spent with infants < 2 months of age?
Do you attend deliveries as the doctor responsible for the babies? If so, up to what level of potential problem are you comfortable with (e.g. meconium, 34-36 weeks, monitored fetal distress, etc).
How much non-well baby work do you do at the hospital? Do you manage your own non-oxygen requiring babies in a level 2 type setting?

Thanks for sharing. I like to learn from SDN too....

 

[deleted87716]

I would be interested to hear how much neonatal care you and the other attendings here have in their practice - probably would be helpful to the students to get an idea of this as well.

I see children from 2 wks. of age on up, but pediatrics is a very small part of my practice. I "inherited" a primarily geriatric practice five years ago from one of my now-retired partners, so most of my patients are complex, internal medicine-type patients, with multiple medical problems, etc.

I'd estimate my pediatric panel (age <18) at around 10%. Out of 25 or so patients per day, only 2-3 (on average) are kids. Some of my partners have a much higher percentage of peds patients. In all honesty, I prefer adult medicine, as I find it more challenging, so I haven't done much to encourage the growth of my pediatric practice. Since none of us go to the hospital, we miss out on the opportunity to pick up a lot of the these kids at birth. That's the key, I think. If you're really keen on having a big peds practice, you need to see the kids in the nursery as soon as they're born. Otherwise, they get assigned to a pediatrician, and they're gone.