Association Combined Internal Medicine Pediatrics MedPeds Versatile training for the 21 st century physician Lets Get Basic Internship The first year out of medical school The first year of residency Post Graduate Year 1 PGY1 ID: 1034241
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1. Created by Allen Friedland, MD, MACP, FAAP ' AssociationCombined Internal Medicine - PediatricsMed-PedsVersatile training for the 21st century physician
2. Let’s Get BasicInternshipThe first year out of medical school = The first year of residency = Post Graduate Year 1 (PGY-1)ResidencyDepending on the specialty can be from 1 – 7 years in duration = Post Graduate Years 1 – 7Combined specialties Two or more residency specialties offered together: med-peds, internal medicine-emergency medicine, pediatrics-psychiatry-child & adolescent psychiatryFellowshipA physician may also choose to continue their training for a sub-specialty such as cardiology, critical care, pediatric emergency medicine, geriatrics, bariatric surgery, adolescent gynecology
3. Residency Programs: Dec 2021Program TypeNumber ProgramsApproximate # ResidentsDurationPediatrics2129,1823 yearsInternal Medicine59229,5363 yearsMed-PedsCombined specialty781,5184 yearsnot 6 yearsFamily Medicine71914,1903 yearsObstetrics-Gynecology29657384 yearsGeneral Surgery34599005 yearsBrotherton SE, and Etzel Sl. Graduate Medical Education, 2021-2022. JAMA. 2022;328(11): 1123-1146
4. Who We Are As Med-PedsPediatricians are specialists for childrenInternists are specialists for adultsAs Med-Peds physicians we provide care in two specialties, complete two type residency programs, take two separate Board Certifications (Internal Medicine & Pediatrics), care for two groups of peopleAs Med-Peds physicians we are specialists for a population
5. The Versatile Med-Peds PhysicianSurvivors of chronic health conditionsTreat/prevent common diseasesGlobal HealthWe draw from the skills and abilities of internists & pediatricians to care for individuals and generations of families Flexibility and versatility are synonymous with Med-PedsGraduates follow many careers paths that can change over time
6. The Versatile Med-Peds PhysicianPreventative care for familiesAdolescents have unique needsICU settings Rural settingsCan you imagine anyone better prepared than a med-peds physician for these patients?You can choose from primary care, hospital care and subspecialty care or some combinationWe are able to tailor our practices to what the community, individual and your needs
7. Unique Characteristics of Internal Medicine-Pediatrics 4 year integrated residency program of 2 primary care specialtiesIt is the first combined specialty approved by any Board (1967) & the only accredited combined specialty by the Accreditation Council of Graduate Medical Education (2007) & also has the most combined residents (~1400) and graduates (~8000) All 4 years of training are fully funded by CMS under President Clinton Balanced Budget Act (BBA of 1997) http://www.gpo.gov/fdsys/pkg/PLAW-105publ33/html/PLAW-105publ33.htm
8. Unique Characteristics of Internal Medicine-Pediatrics The “perfect double major” to serve age continuum, in/outpatient settings, cross fertilization, versatility and special niches (e.gs. transition and global health)Two years of pediatrics training includedMany graduates are in outpatient practices but also many care for hospitalized patients and become a hospitalist or specialize in any pediatric and medicine fellowship
9. Med-Peds RequirementsACGME Program Requirements for Graduate Medical Education in Internal Medicine-Pediatrics. 2022
10. Med-Peds Requirements/LimitsInternal MedicineNumber of monthsPediatricsNumber of monthsInpatient Medicine (includes floors, specialty, ICU)8Inpatient Pediatrics5Medical Intensive Care Unit1-2Pediatric Intensive Care Unit1Cardiac Intensive Care Unit1-2Neonatal Intensive Care Unit2Geriatrics and Neurology1-2Newborn Nursery1Emergency Medicine1Emergency Pediatrics, Community Pediatrics and Advocacy4Night Float (maximum)2Behavioral-Developmental andAdolescent Medicine2Subspecialty experience (eg. Infectious Diseases, Nephrology, etc.)4 +Subspecialty experience (eg. Infectious Diseases, Nephrology, etc.) and personalized rotations6 +PersonalizedOutpatient Med-Peds continuity36 + clinics per year or X + YOverall Ambulatory Experience (minimum)> 33%8 monthsOverall Ambulatory Experience (minimum)> 40% 10 monthsACGME Program Requirements for Graduate Medical Education in Internal Medicine-Pediatrics. 2022
11. The Changing LandscapePediatric survivors now adults Congenital heart diseaseCystic fibrosisSickle cell diseaseCancerSpina BifidaAdult disorders in childrenDiabetes ObesityHypertensionSleep apneaHyperlipidemia“People with the broadest perspective and the most comprehensive knowledge will lead the transformation in health care” Dr. Dale Vidal- Dartmouth Health Care Delivery Masters Program 2014People are surviving conditions that were once fatal in childhood. As well, illnesses that used to be seen only in adults are becoming epidemic in children
12. Fellowships After Med-PedsCan do an adult fellowship, pediatric fellowship or combined (adult-pediatric) fellowshipSome examplesAdolescent MedicineAllergy-ImmunologyCardiology (general, interventional adult congenital heart disease, electrophysiology)Child AbuseCritical Care (MICU, PICU)Developmental-BehavioralEndocrinologyGastroenterologyGeneticsGeriatricsHematology-OncologyHospice and Palliative Care Infectious DiseasesMedical Informatics Nephrology Neurodevelopmental Pediatrics Pediatric Emergency MedicinePerinatology Pulmonary Rheumatology Sleep MedicineSports MedicineToxicologyTransplant HepatologyWeight Management
13. Med-Peds Resident DistributionOn Duty December 31, 2021Brotherton SE, and Etzel Sl. Graduate Medical Education, 2021-2022. JAMA. 2022;328(11): 1123-1146
14. Med-Peds Gender DistributionOn Duty December 31, 2021Brotherton SE, and Etzel Sl. Graduate Medical Education, 2021-2022. JAMA. 2022;328(11): 1123-1146
15. How it All Fits TogetherComplete bothPractice bothPass bothLearn both
16. It is Possible to Complete BothEstimates calculated from American Board of Pediatrics Annual Reports
17. John Chamberlain, MD 2002It is Possible to Learn BothHOW IS IT POSSIBLE TO LEARN TWO DISCIPLINES?Fundamental clinical skills in common: (history and physical, communication, organization)Advanced clinical skills in common: (information processing, reasoning, hypothesis testing, deduction, epidemiology)Some differences: manifestations/incidence of same conditions at different ages, nuances of treatment, neonatology and first two years of life
18. Why Learn Both?Comprehensive view of health and illnessThe most complicated patients will still need to be managed/led by physicians in outpatient and inpatient settings Know and see as much of health system(s) to bring the proper perspective through the depth and breadth of clinical training across different departments, service lines and systemsCritical and sophistication of thinking so to not consult everyone“Adaptable” the ability to change (or be changed) to fit changing circumstances “Flexible” the ability to cope with variable circumstances“Versatile” having a wide variety of skillsCross fertilization of ideas for system wide improvementClinical RelevanceNiches
19. Freed GL, Fant KE, Nahra TA, Wheeler JR. Internal medicine-pediatrics physicians: their care of children versus care of adults. Academic Medicine 2005;80:858-64. Frohna J, Melgar T, Mueller C and Borden S. Internal medicine-pediatrics Residency Training: Current Trends and Outcomes. Academic Medicine. 2004It is Possible to Practice BothAbout 50-60% of graduates go into primary care practice. The majority (between 77-93%) provide care for both adults and children.40% also have an academic appointment with a medical schoolAbout 18-25% of graduates pursue fellowship and 50% provide care for both adults and children. 60% also have an academic appointment with a medical school
20. Fortuna, Ting, Kaelber and Simon. Characteristics of Medicine-Pediatrics Practices. Academic Medicine (84) 3; March 2009: 396-401It is Possible to Practice Both43% children15% childrenAge Distribution (percentages) of Patient Visits to Primary Care Providers Recorded in the National Ambulatory Medical Care Survey from 2000-2006% visits
21. Well Trained to Practice Inpatient Care 18-25% of recent Med-Peds graduates are hospitalistsMany provide care to adults who survived congenital & child onset conditions40% of hospitalist internists do not feel comfortable caring for adults with child onset conditions but had to care for this group of patients anyway…….but a med-peds hospitalist would feel comfortableO’Toole JK, Friedland A, Gonzaga A. Hartig J. Holliday S, Lukela M, Moutsios S. Kolarik R, The Practice Patterns and Professional Activities of Recently Graduated Internal Medicine-Pediatric Hospitalists. Hosp Pediatr. 2015 Jun;5(6):309-14Hunt, S. and Sharma, N. Pediatric to adult-care transitions in childhood-onset chronic disease: Hospitalist perspectives. J. Hosp. Med. 2013, 8: 627–630
22. It is Possible to Pass Both Board Pass Rate (2010-2023)American Board of Internal Medicine & American Board of PediatricsThe pass rate for med-peds graduates is statistically equivalent to categorical residentsMPPDA Annual Meeting with American Board of Internal Medicine and American Board of Pediatrics. March 2023
23. Impact of Med-Peds on Pediatrics60% of graduating pediatrics residents said that combined programs enhanced their education, 39% no effect, only 1% negative impactFriedland A, Melgar T, Kaelber D, Cull W, Chamberlain J, Kan B. Impact of combined pediatric residency training programs on the educational experience of the categorical pediatric residents. Association Pediatric Program Directors Annual Meeting, Poster Presentation 2009Pediatric residency programs with combined Med-Peds programs did better on pediatrics boards Falcone JL. Residencies with Dual Internal Medicine and Pediatrics Programs Outperforms Others on the American Board of Pediatrics Certifying Exam. Clinical Pediatrics. 2014 May 6;53(9):854-857
24. Frohna J. The Role of the Med-Peds Physician in a Changing Medical World. J of Pediatrics. 2007;151:338-339. “Med-Peds graduates are well positioned to adapt to a changing medical landscape”“It not possible to determine the future shape of health care delivery and to project the workforce needed; therefore, the maximization of provider career flexibility will be crucial”Nasca and Thomas. Medicine in 2035: Selected Insight from ACGME Scenario Planning. Journal of Graduate Medical Education. March 2015
25. The Future of Med-Peds is Bright“Med-Peds graduates will be important in the care of children…an indirect impact will be to help maintain interdisciplinary integration within medical centers…create new collaborative bridges with other fields.. .created a legacy that pediatric departments can use to increase familiarity with access to other areas of excellence within own institutions…improve the morbidities pediatricians strive to prevent will not be underemphasized as children transition to adult care. ..The operative factors will be expanded skill set, an evidence based approach to generalist care across the age spectrum, a unique perspective, and the prevailing emphasis on primary care.”Final Report of the Future of Pediatric Education II Pediatric Generalists for the Future. Working Group 2000. Pediatrics. 106. Supplement. 1199-1223.
26. Robbins BW, Ostrovsky, D, and Melgar, T. Factors in Medical Students’ Selection and Ranking of Combined Medicine-Pediatrics Programs. Academic Medicine. 80 (2), February 2005;199Why Do Medical Students Chose Med-Peds?Age spectrum Variety & depth of trainingLiked bothFlexible career Primary care focusAbility to specializeRole modelsDid not want OB/SurgTransition & adolescentMore Pediatrics
27. Fourth Year ElectivesMany Types of ElectivesMed-Peds specific electivesSettings: Inpatient, outpatient, bothTypes: Primary care, specialty, hospitalist, combinationCan help a student decide if med-peds is for them, role modeling, career pathsCategorical Electives in Pediatrics or Internal MedicineGet on a team with a med-peds resident or attendingTry to arrange to participate in med-peds activities anyway during the elective Get to know the hospital system , career paths
28. Summary of Med-PedsDepth and breadth of two disciplines that allows flexible career goals without Surgery and OB training. The perfect “double major”Four years of training that is rigorous but humane; gives added maturity to your careerWide variety of practice styles and settings; effective with variety of patient problemsDual board certification in Internal Medicine and Pediatrics that is uniqueNiches of special populations; cross fertilization of knowledge 55 years of rich history in Med-PedsVisit NMPRA - The National Med-Peds Residents Association | A resident led association of Internal Medicine-Pediatrics residency programs& About the AAP Section on Combined Internal Medicine and Pediatrics (SOMP)