Journal Club

Training experiences of U.S. combined internal medicine and pediatrics residents. Melgar T, Chamberlain JK, Cull WL et al. Academic Med 2006: 81: 440-446.

Reviewed by Sherilyn Smith, University of Washington

What is the problem (issue) and what is known about it so far?
The number of combined medicine pediatric residency programs has expanded in the past 15 years and the demographics of residents and their training experiences have not been recently reviewed.

Why did the researchers do this particular study?
Previous studies relied on program director's knowledge thus were felt to be limited/biased.

Who was studied?
Survey of 4^th year residents in combined medicine/pediatric residencies.

How was the study done?
The survey design was similar to that sent to 3^rd year pediatric residents, containing 27 identical questions and 11 questions designed specifically for medicine pediatric residents. This was sent to 340 eligible residents and 212 returned the survey 62% response). Demographics were similar between respondents and non-respondents except respondents were younger and more likely to be women.

What did the researchers find?
Forty six percent of residents were women, 76% were living with partners and 36% had children. Eighty two percent had educational debt and the mean indebtedness was $119,000. Residents overall were satisfied with the amount of time spent training in the two fields However they felt that they had too much NICU training, too little training in office management and outpatient procedures. Additionally they felt they needed more career counseling even though they expressed high levels of confidence in preparedness for fellowship or practice. The majority (89%) would choose Med/Peds again and 98% planned to take both boards. The article also outlines the types of practices and fellowships these residents choose.

What were the limitations of the study?
Overall a good survey although a higher response rate would help insure the responses are reflective of all respondents.

What were the implications of the study? This is a helpful article to provide to students who are considering Med/Peds residencies if you don't have a program in your institution and are asked to provide career counseling. It also provides a different point of view of the adequacy of training from that of program directors.

(Comment: This article is timely, at least for me. I have seen a significant increase in the number of my students applying to med-peds residencies, and wonder if this is more than a local trend. It is reassuring to see that med-peds residents are quite satisfied with their choice of combined specialty and with their training. From a program director's perspective, I continue to be frustrated with the delicate act of balancing intensive care training time against important outpatient competencies such as office management and procedures (especially in the era of duty hours!). -- Leslie Fall)