BACKGROUND

1
Training Experiences of Combined Internal
Medicine and Pediatrics Residents
Thomas Melgar1, William L. Cull2, David C.
Kaelbar3, Brian D. Kan4, and John K. Chamberlain5
3Internal Medicine and Pediatrics, Case Western
Reserve University
1Internal Medicine and Pediatrics, Michigan State
University Kalamazoo Center for Medical Studies
2American Academy of Pediatrics Division of
Health Policy Research
4Internal Medicine and Pediatrics, Cedars Sinai
Medical Center
5Internal Medicine and Pediatrics, University of
Rochester
SURVEY/METHODS
ABSTRACT
RESULTS (cont.)
RESULTS (cont.)
Background Combined Internal Medicine and
Pediatrics (Med-Peds) has become a popular career
option in the 37 years since its inception. In
2003, 4.4 of those matching to Internal Medicine
and 13.1 of those matching to Pediatrics chose
dual training in Med-Peds. The training
experience in combined programs and the impact of
these programs on the physician workforce and
patients, particularly the care of children, has
not recently been systematically studied.
  Objective To survey Med-Peds residents
demographics and training experience.
  Design/Methods An annual survey addressing
demographics, training experience, and career
plans of graduating Med-Peds R4s identified in
the American Academy of Pediatrics database was
initiated in May, 2003. Surveys were mailed up to
4 times to non-responders through August 2003.
  Results Valid responses were received from
212 of the 380 graduating residents (56 response
rate). 45 of respondents were female, 34 were
non-white, and 5 were international medical
graduates. The overwhelming majority (89)
reported upon graduation that they would choose
Med-Peds training again. NICU training was the
only topic area for which the majority of
residents (67) reported too much time was
devoted, and outpatient procedures the only area
the majority (74) desired more time spent. A
significant minority (33) desired more
outpatient pediatric and medicine training.
Despite 80 of residents having a mentor, a
majority of residents wished that more time had
been devoted to career planning (64) and office
management (81). Nearly all (93) residents plan
to care for children and adults, and 98 plan to
take both Internal Medicine and Pediatrics
boards. Almost half of residents (49) reported
that their program offered interdisciplinary
subspecialty electives (Mean Offered 2.3).
Resident self-assessment of their preparation was
good to excellent for evidence-based medicine
(91), caring for patients with special health
care needs (85), and use of information
technology (82).   Conclusions Med-Peds
residents are generally satisfied with their
decision to train in Med-Peds and their level of
preparation. They feel competent with patients
that may transition to adulthood with complex
needs, with assessing evidence, and use of
information technology. Too much training time,
however, still may be devoted to the NICU rather
than outpatient training.

• A national survey of graduating med-peds
  residents from all US residency programs was
  initiated in May 2003.
• Following up to 4 mailings, 212 of 380 residents
  returned completed surveys (56 response rate).
  Responding residents represented 83 out of 97
  possible programs (86).
• The survey was 5-pages long and included
  questions on residents training, their career
  intentions, their job search, and their new job.
  This poster focuses specifically on the questions
  related to residents training experiences.
• A comparison of respondents and non-respondents
  showed that respondents were younger (32 yrs
  versus 33 yrs, p lt .001) and slightly, but not
  significantly, more likely to be female (46
  versus 40, p .251).
• The 2003 Med-peds resident survey was reviewed
  and approved by the American Academy of
  Pediatrics Institutional Review Board.

• Almost all residents (98) planned to take both
  the Internal Medicine and the Pediatrics board
  exams.
• 94 of residents intend to care for infants,
  children, adolescents, and adults.
• Roughly half (49) of residents reported that
  interdisciplinary subspecialty electives were
  offered in their program. The most common of
  these electives were med-peds rheumatology (26)
  and combined adolescent and sports medicine
  (26).
• Eight of ten residents reported that there was a
  physician who they identified as a mentor who
  provided career advice.
• Despite the help of their mentors, the majority
  of residents wished that more residency time had
  been devoted to career planning (64) and office
  management (81).
• Upon graduation, 89 of residents reported that
  they would choose med-peds training again.

• Figure 2 Activities Offered Twice a Year or More
• Most residents also reported being exposed to a
  variety of supplemental educational
  opportunities.
• Journal club was the most commonly offered of
  these opportunities followed by med-peds
  ambulatory clinics, med-peds noon conferences,
  and board exam review.

CONCLUSIONS
RESULTS
Med-Peds residents are generally satisfied with
their decision to train in Med-Peds. They also
report high levels of preparation for future
clinical activities, including evidenced-based
medicine and using information technology in
practice. While the majority of residents
reported being exposed to a variety of
educational opportunities in addition to their
core training, most wished that greater attention
had been given to outpatient procedures, office
management skills, and career planning. Time
for these activities could be provided by
reducing the time devoted to the NICU. Residents
also reported lower levels of preparation for
research. However, given the limited amount of
training time available, innovative strategies
may be needed to increase residents exposure to
research. Finally, med-peds programs are doing a
good job preparing residents to care for all age
groups, as the overwhelming majority of residents
plan to care for children and adults and plan to
be board-certified in both internal medicine and
pediatrics.

• Figure 1 Resident Assessment of Training Time
  Allocation

• Figure 3 Resident Reported Level of Preparation
  for Post-Residency Activities

BACKGROUND
LIMITATIONS
Combined internal medicine-pediatrics (med-peds)
residency programs have been around since 1967.
From 1990 to 2004, the number of med-peds
residency slots has increased from 273 to 400
(46 increase) and the number of incoming filled
positions increased from 163 to 352 (116
increase). A 1999 cross-sectional survey of
graduates of med-peds programs over the previous
ten years revealed that 80 of med-peds graduates
achieve dual certification and most work as
practicing generalists who care for adults and
children.1 Despite the dramatic increase in the
number of med-peds residents and expectations of
an important future role for med-peds graduates
in the healthcare system2, little recent
information is available about the training
experiences of med-peds residents. In this
study, we surveyed all graduating med-peds
residents in US programs to describe their
residency training, to explore their attitudes
about the allocation of training time, to examine
their self-perceived preparation for various
activities, and to assess their overall
satisfaction with their residency choice. 1
Lannon CM, Oliver TK, Guerin RO, Day SC,
Tunnessen WW. Internal medicinepediatrics
combined residency graduates What are they doing
now? Results of a survey. Arch Pediatr Adolesc
Med. 1999153823-828. 2 The Future of
Pediatric Education II Organizing pediatric
education to meet the needs of infants, children,
adolescents, and young adults in the 21st
century. Pediatrics. 2001 1071447-1450.

• While the target sample for the study included
  all graduating med-peds residents, 56 responded.
  A slight non-response bias was apparent with
  respondents being younger than non-respondents.
  Thus, the results may not represent the
  experiences of older, non-traditional residents
  as well.
• All preparation ratings are self-reported and no
  independent checks of resident skill levels were
  available.

ACKNOWLEDGEMENTS
This research was a collaboration of the AAP/ACP
Section on Medicine-Pediatrics, the Med-Peds
Program Directors Association (MPPDA), and the
National Med-Peds Residents Association (NMPRA).