Peds vs. MedPeds Training

[supergirl7561]

Hi everyone, I'm in the middle of my third year and trying to decide what to apply for for sub-Is and where to get LORs, so I need to start making some more decisions. I think I'll end up in either congenital heart or peds endo (I know, very different). What I'm trying to decide is whether to do Peds or MedPeds. I really liked my inpatient IM experience, but felt a little dead inside during some of my outpatient general medicine. I didn't love ambulatory peds either, but it was better. However, I enjoyed my inpatient IM more than my inpatient peds, although I was able to experience hospital peds only. I foresee myself treating at least some of my patients throughout their lifespan, although I know some peds subspecialists do this with no formal IM training.

My question is this- do peds residents at other institutions feel they get enough autonomy/procedures? At my institution, I felt there was a lot of oversight, which is understandable, but I'm the kind of person who needs to be kicked out of the nest a little bit before I can imagine getting comfortable taking care of sick kids. I'm wary of doing MedPeds because of locational limitations as well as not being confident that I can handle the information it will take to be a good IM AND Peds resident. But I also want to make sure I do what I personally need to do to be the best physician I can be. My institution has a big Med Peds program, so I've had a lot of exposure to those residents, but I wanted to get some fresh opinions. Thanks!

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[thetubes]

At my institution, I felt there was a lot of oversight, which is understandable, but I'm the kind of person who needs to be kicked out of the nest a little bit before I can imagine getting comfortable taking care of sick kids.

I don't know how I feel about that statement. My peds residency has a lot of oversight but I don't see this as a bad thing. We still get to do procedures but we are supervised by attendings/fellows. This is done for the safety of patients/ensuring they get proper care. I don't think you have to feel the burn from making a mistake/mucking around to be good at something.

 

[supergirl7561]

I don't know how I feel about that statement. My peds residency has a lot of oversight but I don't see this as a bad thing. We still get to do procedures but we are supervised by attendings/fellows. This is done for the safety of patients/ensuring they get proper care. I don't think you have to feel the burn from making a mistake/mucking around to be good at something.

I in no way mean for this to sound offensive or like I'm hoping to make mistakes. This is just an observation that I personally need to be pushed outside of my comfort zone, at least at this point I have a hard time being confident enough to push myself forward, whereas the peds residents I worked with pushed themselves. This may also be a side effect of being a student and not actually knowing very much. In my clinical experiences so far, I have done better and stepped up the most with less oversight. It seems like there are different types of people who learn in different ways, and I'm just trying to be conscious of mine

 

[thetubes]

I in no way mean for this to sound offensive or like I'm hoping to make mistakes. This is just an observation that I personally need to be pushed outside of my comfort zone, at least at this point I have a hard time being confident enough to push myself forward, whereas the peds residents I worked with pushed themselves. This may also be a side effect of being a student and not actually knowing very much. In my clinical experiences so far, I have done better and stepped up the most with less oversight. It seems like there are different types of people who learn in different ways, and I'm just trying to be conscious of mine

Believe me, you'll get your chances for "motivation"...residency can be a scary time.

 

[WheezyBaby]

Essentially all peds residencies are going to have comparatively more oversight / less autonomy than medicine. It's just the way it is - we're less accepting of bad outcomes in kids. I'm med/peds, and I value the differences in training offered by the respective fields, but I certainly don't think it's essential to be a strong clinician. For adult congenital heart, it's now a superfellowship offered to those who have completed either adult or peds cards fellowship. Endo would still be a combined adult / peds fellowship out of med/peds. If you really want to see patients throughout the age spectrum, the med/peds training would certainly be valuable. Peds subspecialists will often still see patients into young adulthood though. Ultimately it's a personal decision and yours to make. With regard to your concern about being able to learn both medicine and peds, if your performance through med school has been solid, I wouldn't worry about it; if it's been borderline / poor, give it some thought / introspection and maybe get some advice from your program leadership.

 

[DeadCactus]

You can reach your stated goals with either training route. The question now comes down to what career would you rather have if you never make it to fellowship. If you would not be satisfied without seeing adults, then do the combined training.