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Residency Review and Redesign in Pediatrics (R 3 P) Project Update

Residency Review and Redesign in Pediatrics (R 3 P) Project Update. AMSPDC March 8, 2009. Few “Traditional” Aspirations. Freed et al., 2009. Implications for Residency?. Medical School. 4 yrs. Residency. Maintenance of Certification. 3 yrs. 35+ yrs. Residency doesn’t matter?

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Residency Review and Redesign in Pediatrics (R 3 P) Project Update

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  1. Residency Review and Redesign in Pediatrics (R3P) Project Update AMSPDC March 8, 2009

  2. Few “Traditional” Aspirations Freed et al., 2009

  3. Implications for Residency? Medical School 4 yrs Residency Maintenance of Certification 3 yrs 35+ yrs • Residency doesn’t matter? • Residency should prepare for every possibility?

  4. Challenging Some Assumptions • Residency should encapsulate as much as possible, as the last, best opportunity to prepare for independent practice. • One general pediatric residency for everyone.

  5. Reason to Challenge • One-size residency = steep learning curve in primary care (and hospitalist) practice • If format says “Learn and become competent at everything (a month at a time)!” • How do residents prioritize? • How do programs prioritize? • How can one deny hospital/faculty requests for “just another month of …”? • How many years?

  6. That’s How Opportunity Evaporates • 9 mos. not specified by ACGME • Subspecialties as true electives: 16 mos. • Where did they go? • Do all choices serve resident education and future patients of the ~70% of PL-2’s with firm career goals?

  7. R3P Goals for Change • Weight residency experiences toward career choices. • Create a continuum of education to match the continuum of learning. • Document incorporation of attitudes and habits that will close the gap between optimal and current health care outcomes.

  8. Crazy?

  9. Dr. Eric Warm’s Hypothesis: One year of true continuity would be better for care and education than 3 years of non-continuous care. • Improve rates of chronic illness care measures • Diabetes • Hypertension • Prevention • Increase satisfaction scores • Improve PCP specific continuity • Reduce conflict between inpatient and outpatient medicine • Improve satisfaction and reward in the ambulatory setting • Improve knowledge and increase skills in quality improvement From Gregory W. Rouan, M.D.

  10. After Eric Warm, M.D. The Long Block: 3 Year Schedule

  11. What’s Next?

  12. Our Dilemma • Change is inevitable • More regulations not the answer • Less flexibility • Worked for neonatology, shift to ambulatory • For adolescent, developmental-behavioral? • Will it work for mental health, genetics, obesity…? • Need more than RC consensus • Need to know outcomes

  13. Beyond R3P Director (appointed by Oversight Committee)

  14. Oversight Committee • Two representatives each: • AMSPDC (Friedman, Stapleton) • APPD (Burke, McGregor) • ABP (Lister, Ludwig) • AAP Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) (Jost Starmer) • Director (TBR) • Liaison Representatives from ABP and ACGME (McGuinness, Vasilias)

  15. To Facilitate Innovation • RFP to solicit formal proposals re 3 R3P goals • Review Committee for RFP’s • Project Support Group with expertise in program evaluation research • Director with expertise in education • Ongoing connection to ACGME and ABP • Start-up funding from the ABP Foundation

  16. Next Steps

  17. In Addition • Together with APPD, IIPE will create a Pediatric GME Learning Collaborative • Together with ACGME, IIPE will promote non-R3P innovation projects

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