Association Combined Internal Medicine amp Pediatrics Med Peds Versatile training for the 21 st century physician Lets G et Basic Internship The first year out of medical school The first year of residency Post Graduate Year 1 PGY1 ID: 432774
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Created by Allen Friedland, MD, FACP, FAAP ' Association
Combined Internal Medicine & PediatricsMed-Peds
Versatile training for the 21st century physicianSlide2
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 gynecologySlide3
Residency ProgramsProgram TypeNumber Programs
Number Residents
Duration
Pediatrics
201
8,529
3 years
Internal Medicine
390
22,971
3 years
Med-
Peds
Combined specialty
80
1,441
4 years
not 6 years
Family Medicine
469
10,777
3 years
Obstetrics-Gynecology
242
4,942
4 years
General Surgery
252
7,890
5 yearsSlide4
Who We Are As Med-PedsPediatricians are specialists for childrenInternists are specialists for adults
As 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 people
A
s Med-
P
eds
physicians we are specialists for a populationSlide5
The Versatile Med-Peds Physician
Survivors of chronic health conditions
Treat/prevent
common diseases
Global
Health
We draw from the skills and abilities of internists &
pediatricians to care
for
individuals and
generations
of
families
Flexibility
and versatility are synonymous with
Med-
Peds
Graduates
follow many
careers paths that can change over timeSlide6
The Versatile Med-Peds Physician
Preventative care for families
Adolescents have
unique needs
ICU settings
Rural settings
Can
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 combination
We are able to tailor our practices to what the
community,
individual
and your needs Slide7
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) http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/700_med_peds_07012013.pdf 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 Slide8
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 includedMost graduates are in outpatient practices but many also care for hospitalized patients or become a hospitalist or specialize in any pediatric and medicine fellowshipSlide9
Med-
Peds RequirementsSlide10
Internal MedicineNumber of months
Pediatrics
Number of months
General Inpatient Medicine
8
General Inpatient Pediatrics
5
Medical Intensive Care Unit
1-2
Pediatric Intensive Care Unit
1-2
Cardiac Intensive Care Unit
1-2
Neonatal Intensive Care Unit
2
Geriatrics
1
Newborn Nursery
1
Emergency Medicine
1
Emergency Pediatrics and Acute Illness Pediatrics
3
Outpatient Med-Peds continuity
36 clinics per year
Behavioral-Developmental
Adolescent Medicine
2
Subspecialty experience (e.g. Infectious Diseases, Nephrology, etc.)
4
Subspecialty experience (e.g. Infectious Diseases, Nephrology, etc.)
5
Overall Ambulatory Experience (minimum)
33%
8 months
Overall Ambulatory Experience (minimum)
40%
10 monthsSlide11
The Changing LandscapePediatric survivors now adults Congenital heart diseaseCystic fibrosisSickle cell diseaseCancerSpina Bifida
Adult disorders in childrenDiabetes Obesity
HypertensionSleep 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 2014
People are surviving conditions that were once fatal in childhood. As well, illnesses that used to be seen only in adults are becoming epidemic in childrenSlide12
Fellowships After Med-
PedsCan do an adult fellowship, pediatric fellowship or combined (adult-pediatric) fellowshipCheck out how and see the fellowship guide
http://www.medpeds.org/residents/fellowship-guide/
Adolescent MedicineAllergy-ImmunologyCardiology (general, interventional congenital heart, electrophysiology)
Child AbuseCritical Care (MICU, PICU)Developmental-BehavioralEndocrinologyGastroenterology
GeneticsGeriatricsHematology-OncologyHospice and Palliative Care
Infectious Diseases
Medical Informatics
Nephrology
Neurodevelopmental Pediatrics
Pediatric Emergency Medicine
Perinatology
Pulmonary
Rheumatology
Sleep Medicine
Sports Medicine
Toxicology
Transplant Hepatology
Weight ManagementSlide13
Med-Peds Programs5-8% of internal medicine residents & 13% of pediatric residents 15% of internal medicine programs & 40% of pediatric programs
National Residency Matching Program data 2012, 2013, 2014Slide14
OR
UT
MT
NM
CO
SD
ND
NE
KS
OK
TX
LA
AZ
AR
MI
IN
IA
IL
ID
ME
NV
NH
OH
NC
NY
PA
SC
TN
VT
VA
WA
WV
WI
WY
MN
MO
KY
NJ
DE
MD
CT
MA
MS
AL
GA
HI
Med-
Peds
Match 2015 (78 programs with 380 positions
)
FL
RI
CA
DC
CA (4): 18 spots
CO: 4 spots
UT: 3 spots
AZ: 6 spots
VA:6 spots WV(3): 8 spots
TN(2
):18 spots NC(3):18 spots MS: 4 spots SC(2): 7 spots AL: 6 spots FL(2): 11 spots P. Rico: 2 spots
NE: 2 spots IN: 14 spots
MI(6): 26 spots OH(4): 27 spots
MN: 10 spots WI (2): 8 spots
KY(2): 11 spots IL(5): 24 spots
ME: 3 spots
NY(4): 19 spots
MA(4): 20 spots
CT: 4 spots
RI: 4 spots
PA(4): 17 spots
NJ(2): 7 spots
DE: 4 spots
DC: 4 spots
MD: 8 spots
OK(2): 6 spots
AR: 6 spots
TX(2): 14 spots LA(3):16 spots
MO (2): 9 spots
KS
: 3 spots
PRSlide15
Med-Peds Resident DistributionOn Duty December 31, 2013Brotherton S and Etzel S. Graduate Medical Education, 2013-2014. JAMA 312 (22); December 14, 2014; pages 2427-2445.Slide16
Med-Peds Gender DistributionOn Duty December 31, 2013Brotherton S and Etzel S. Graduate Medical Education, 2013-2014. JAMA 312 (22); December 14, 2014; pages 2427-2445.Slide17
How it All Fits Together
Complete both
Practice
both
Pass
both
Learn bothSlide18
It is Possible to Complete BothEstimates calculated from American Board of Pediatrics Annual ReportsSlide19
John Chamberlain, MD 2002
It 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 lifeSlide20
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 improvement
Clinical RelevanceNichesSlide21
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 schoolSlide22
Fortuna, Ting,
Kaelber and Simon. Characteristics of Medicine-Pediatrics Practices. Academic Medicine (84) 3; March 2009: 396-401It is Possible to Practice Both
43% children
15% children
Age
Distribution (percentages)
of Patient Visits to Primary Care Providers Recorded in the National Ambulatory Medical Care Survey from 2000-2006
% visitsSlide23
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. Accepted for Publication Journal of Pediatric Hospitalist
MedicineHunt, S. and Sharma, N. Pediatric to adult-care transitions in childhood-onset chronic disease: Hospitalist perspectives. J. Hosp. Med. 2013, 8: 627–630Slide24
It is Possible to Pass Both Board Pass Rate (2010-2015)American Board of Internal Medicine & American Board of PediatricsThe pass rate for med-peds graduates is statistically equivalent to categorical residents
MPPDA Annual Meeting with American Board of Internal Medicine and American Board of Pediatrics. 2015Slide25
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):854-857Slide26
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 2015Slide27
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. Slide28
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 training
Liked bothFlexible career Primary care focus
Ability to specializeRole modelsDid not want OB/SurgTransition & adolescentMore PediatricsSlide29
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 pathsSlide30
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 45 years of rich history in Med-PedsVisit www.med-peds.org
& http://www2.aap.org/sections/med-peds/