Report of the Task Force on The Future of Pediatric Education II

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Report of the Task Force on The Future of
Pediatric Education II

• Organizing Pediatric Education to Meet the Needs
  of Infants, Children, Adolescents, and Young
  Adults in the 21st Century

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Sponsoring Organizations

• Center for the Future of Children of the David
  and Lucile Packard Foundation
• American Academy of Pediatrics
• Maternal and Child Health Bureau
• American Board of Pediatrics Foundation
• AAP Friends of Children
• National Association of Childrens Hospitals and
  Related Institutions
• Assn. of Medical School Pediatric Dept. Chairmen

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Principal Participants

• Jimmy L. Simon, MD, FAAP
• Task Force Chairperson
• Department of Pediatrics
• Bowman Gray School of Medicine
• Errol R. Alden, MD, FAAP
• Principal Investigator
• Deputy Executive Director
• American Academy of Pediatrics

• Russell W. Chesney, MD, FAAP
• Task Force Vice Chairperson
• Department of Pediatrics
• University of Tennessee, Memphis
• Holly J. Mulvey, MA
• Director
• Division of GME Pediatric Workforce
• American Academy of Pediatrics

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Project Goal 1

• To evaluate the 1978 Future of Pediatric
  Education Report with respect to its relevancy to
  the education of pediatricians and others
  providing health care to children in the 21st
  century.

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Project Goal 2

• To provide direction for the improvement of
  pediatric education, with special emphasis on
  workforce requirements, new instructional
  methodologies, and the financing of pediatric
  education.

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Project Goal 3

• To recommend essential changes in the
  educational process to meet the current and
  future health care needs of all infants,
  children, adolescents, and young adults.

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FOPE II Workgroups

• Pediatric Generalists of the Future
• Pediatric Subspecialists of the Future
• Pediatric Workforce
• Financing of Pediatric Education
• Education of the Pediatrician

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Task Force Surveys

• 17 medical and surgical subspecialties
• AAP multidisciplinary sections
• Pediatric subspecialists
• AAP Chapter leaders
• Pediatric program directors
• Resident physicians

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Forces for Change

• Demographic Changes
• Biomedical/Technological Advances
• New Pediatric Health Care Delivery Models
• An Expanding Child Health Care Team
• Pediatrician Workforce Trends
• Issues and Trends in Subspecialization
• Changes in Financing Medical Education

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Changing Demographics

• More children living in poverty
• Increased cultural/ethnic diversity
• Changing family structure
• Increased number of families with dual wage
  earners

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Biomedical/Technological Advances

• New vaccines
• Human Genome Project
• Information systems
• Telemedicine

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Changes in Health Care Delivery

• Shift to managed care
• Increased focus on prevention
• Changing patterns of morbidity

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Changing Child HealthCare Team

• Continued evolution of the child health care
  team concept
• Increasing numbers and expanding roles of
  nonpediatrician child health care professionals
• Competition and collaboration with FPs
• Increasing impact of Med/Peds

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Changes in the Pediatrician Workforce

• Substantial growth in pediatric workforce
• Continuing maldistribution problem
• Declining number of minorities
• Growing preponderance of women
• Changing attitudes toward work and family

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Changes Involving Subspecialization

• Declining interest in subspecialization
• Shift to ambulatory care settings
• New skill sets and roles emerging
• Declining financial support for pediatric
  subspecialty programs

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Changes in Financing Pediatric Medical Education

• Serious flaws in current funding model
• Increased pressure on faculty to generate
  clinical revenues
• Fewer discretionary funds to support medical
  education
• Need to identify more stable, rational, equitable
  sources of revenue

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Child Health Needs in the Context of Family and
Community
Advances in Biomedical Psychosocial Sciences
Health Care System
Roles for Pediatricians
Core Competencies
Educational Standards Core Competencies at
the Educational Level

• National Resources
• Innovations in
• Educational Methods
• Model Curricula
• Faculty Development

• Evaluation
• Program
• Learner

Educational Programs at the Local Level
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Reaffirmation of 1978 FOPE Principles and
Recommendations

• Pediatricians will see more problems of a
  developmental, psychological, social nature
• Pediatric residency of 36 months, in a variety of
  ambulatory and inpatient settings
• More attention in residency on biosocial aspects
  of pediatrics and adolescent health
• Emphasis on health care team/collaboration
• Importance of personal CME plan

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FOPE II Task Force Recommendations

• Health needs of children
• Medical home concept
• Barriers to child health
• Pediatrician workforce
• Work-family and gender issues

• Medical education funding
• Scientific foundation of pediatric medical
  education
• Core competencies and core curriculum

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FOPE II Task Force Recommendations (Cont.)

• Subspecialist training
• The CME Home concept
• The individualized professional education plan

• Career counseling
• Intra-professional and inter-professional
  collaboration
• Guidelines and quality of care

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Health Needs of Children

• Pediatric medical education at all levels must
  be based on the health needs of children in the
  context of the family and the community.

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Medical Home Concept

• All children should receive primary care
  services through a consistent medical home,
  which provides continuous and comprehensive
  primary pediatric care from infancy through young
  adulthood, with availability 24 hours a day, 7
  days a week.

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Barriers to Child Health

• Identify and address barriers to the health and
  well-being of infants, children, adolescents, and
  young adults.
• Continue to develop effective mechanisms to
  increase the pediatrician-to-child ratio in
  underserved areas.

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Pediatrician Workforce

• Stabilize the number of pediatric residents in
  the pipeline at the current level.
• Increase the number of pediatrician scientists.
• Increase the number of underrepresented
  minorities in pediatric practice and in academic
  medicine.

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Work-Family and Gender Issues

• Take the lead in addressing role conflicts
  between career and family responsibilities.
• Consideration should be given to coordinated
  schedules, fair leave policies, quality day care,
  and flexibility in career advancement.
• Implement strategies to promote the success of
  women pediatricians in fellowship training and
  academia.

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Medical Education Funding

• Core pediatric residency education should be
  supported fully for all required years by a
  multipayer mechanism.
• Pediatric trainees at freestanding childrens
  hospitals should receive the same level of
  federal support as those trained elsewhere.
• Federal formulas for GME reimbursement should be
  applied equally to pediatric core and
  subspecialty residents.

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Scientific Foundation of Pediatric Medical
Education

• Pediatrics should take steps to enhance the
  scientific foundation of pediatric medical
  education and ensure that its programs
  (curriculum, teaching, and evaluation methods)
  are based on this science.

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Core Competencies

• Pediatrics should assume the leadership in
  establishing a process by which core competencies
  for educating pediatricians at all levels are
  continuously developed, revised, and evaluated.

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Core Curriculum

• The goal of residency education should be to
  emphasize the knowledge, skills, experience, and
  attributes necessary for a pediatrician in varied
  roles.

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Subspecialist Training

• Education of subspecialists should be based in
  high resource centers of educational excellence,
  with core scientific teaching and adequate
  patient volume to develop a full range of
  cognitive and technical proficiencies.

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The CME Home Concept

• To assess individual educational needs
• To provide information on and facilitate access
  to local and national CME resources
• To provide guidance in constructing a
  professional educational plan unique to each
  individual pediatrician

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Individualized Professional Education Plan

• Residency programs must ensure that all
  residents have designed and implemented an
  individualized professional education plan (CME)
  by the 3rd year of residency training that
  incorporates anticipated needs for their future
  practice.

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Career Counseling

• Pediatric program directors should work with
  pediatric department chairs to ensure that career
  counseling and mentorship assume more prominence
  in training programs.

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Intra-Professional Collaboration

• Systems of care must be structured to facilitate
  timely, ongoing communication and integration of
  care between general pediatricians and pediatric
  subspecialists.

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Inter-Professional Collaboration

• Need to recognize that there are many
  nonpediatrician child health care professionals
• Collaborative approach has the most potential
• Must continue to forge strong ties with
  organizations of other child health care providers

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Guidelines and Quality of Care

• Empirically based, data-driven guidelines and
  quality of care measures need to be developed by
  respected child health-related organizations and
  adopted by health care delivery systems.

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For Further Information

• Supplement to the January 2000 issue of
  Pediatrics 105(1) (suppl.) 161-212
• http//www.aap.org/profed/fope1.htm