Ambulatory Margaret
C.
Pediatric
Heagarty, MD, Zulema Fischbarg,
Pediatric ambulatory fellowships are postresidency training programs designed to prepare pediatricians to deliver, organize, and evaluate primary pediatric care. A survey of the members of the Ambulatory Pediatric Association details the funding, structure, content, and outcome of these training programs. The Ambulatory Pediatric Association has recently approved guidelines for the standards and content of these fellowship programs.
In lowships
subspecialty fel¬ have flourished in this country. In general, these programs are designed to train physicians who have completed the core years of their residency and who desire further training in an area of subspecialty interest. In pediatrics, for example, well-defined fellowship programs in such areas as cardiology, endocrinol¬ ogy, or neonatology are offered com¬ monly at university centers. The field of ambulatory pediatrics is one of the newer entries into the area of postrecent years,
residency training. The Ambulatory Pediatrie Associa¬ tion, "an organization concerned with fostering and promoting excellence in all aspects of ambulatory care includAccepted
for publication June 15, 1974. From the Department of Pediatrics, Cornell University Medical College, New York. Reprint requests to New York Hospital, 525 E 68th St, New York, NY 10021 (Dr. Heagarty).
Fellowship Programs
MD
ing service, teaching and research," has a membership that includes many if not most of the pediatrie educators responsible for ambulatory fellowship programs in this country. Since the association is in the process of defin¬ ing the field of ambulatory pediatrics as a scholarly discipline, it has con¬ cerned itself with ambulatory pediat¬ rie fellowships. The association's gen¬ eral goal in this matter has been to define the content and to establish guidelines for these training pro¬ grams. This report details a survey of the members of this organization con¬ cerning their involvement with and their opinions about ambulatory pe¬ diatrie fellowship programs. SUBJECTS AND METHODS In the winter of 1971 each member of the Ambulatory Pediatrie Association re¬ ceived a questionnaire that included questions concerning the requirements, funding, content, and outcome of any ambulatory fellowship program for which the member was directly responsible. For the purpose of this survey, a pediatrie am¬ bulatory fellowship was defined as "any program in which most of the activity in¬ volves such areas as ambulatory care for children, interest in normal growth and de¬ velopment, and/or in community pediat¬ rics." Seventy-three percent (230) of the members responded to the questionnaire. Of the 230 members who responded, 59 (26%) directed ambulatory fellowship pro¬ grams. This report is concerned with these 59 fellowship programs.
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RESULTS
In the academic year 1970 and 1971, 104 physicians enrolled in 59 fellow¬ ship programs. Twenty-one, or 36%, of these programs contained one fel¬ low, and 27% contained two or three fellows. Nine programs trained be¬ tween four to six fellows; no program contained more than six fellows. Most (51%) of the fellowships were one year in duration; many (41%) offered the pediatrician the option of one or two years of training. Nine of the 59 programs required two years for com¬ pletion of the fellowship. Most pro¬ grams (71%) required two years, and a minority (11%) required three years of pediatrie training as a prerequisite for admission to the fellowship. Four¬ teen (25%) limited their fellowship to citizens of this country. ·
The following list shows the of the financial support of these fellowships (No. = 56; three programs did not respond to this source
question)
:
Source Federal government Hospital operating funds Both federal and hospital funds Other combinations Total
%of Programs Receiving Support 39 30 9 22 100
were supported solely by the federal government, but an equal number were financed entirely or in part by the hospital sponsoring the program. Twelve programs were sup¬ ported by combinations of funds from private philanthropy, state, and city
Many
government. By definition, all of these fellow¬
ships
were
based in
ambulatory
care
facilities; however, the pattern of the training showed considerable vari¬
ation among the programs. In 11 pro¬ grams, the individual fellow spent 50% or more of his time in providing comprehensive pediatrie care to a group of children in families. In eight, the fellow spent at least 50% of his time working in a community or neighborhood health center. Three programs were oriented predomi¬ nantly toward subspecialty clinics and three toward general or emer¬ gency clinical experience. In the re¬ maining 34 programs, the fellow's clinical activity was divided more or less evenly among all these types of activities. Formal research endeavors did not constitute a major focus for the fellowships; in only two programs did research require as much as a third of the total activity. As might be expected, most of the directors (62%) of these fellowships were based in a university hospital complex, but a significant number (23%) were located either in commu¬ nity hospitals or community health centers. None was in private practice. These educational directors were asked to rate certain broad aspects of pediatrics in order of their relevance for an ambulatory pediatrie fellow¬ ship program. The resulting ranking of these topics is as follows: 1. Growth and development of children 2. Psychodynamics of children and fam¬ ilies 3. Techniques of interviewing 4. Issues of the organization and delivery of pediatrie care 5. Chronic diseases of childhood 6. Acute diseases of childhood 7. Techniques of medical care research 8. Epidemiology of diseases of childhood 9. Techniques and evaluation of medical education 10. Subspecialty care of children
This list supports the higher priority to clinical rather than research issues in these fellowships. However, the emphasis on developmental pe¬ diatrics and behavioral sciences as re¬ lated to clinical practice distinguishes these fellowships from other subspe¬ cialty programs in pediatrics. A summary of the professional ac¬ tivity of the pediatricians who com¬ pleted ambulatory fellowships be¬ tween the years 1965 and 1970 is given in this list:
given
Career
practice University hospital outpatient service Community or neighborhood Private
health centers
Non-university hospital outpatient service Other or unspecified career Armed services Full-time research Total
% (No.= 210) 34.0
21.0 14.0 10.0 8.5 8.5 4.0 100.00
The 39 programs
responding to this questionnaire had trained 210 pedia¬ tricians in this five-year period. One third of these
physicians had
entered
private practice, but 45% of them had form of institutional Few were engaged in fulltime research in ambulatory care. entered
some
practice.
COMMENT
The
pediatrie internship and res¬ idency have been subjected to both prospective and retrospective stud¬
ies.17 Several of these studies have suggested a need for increased train¬ ing in and emphasis on certain issues and techniques generally included under the canon of ambulatory pe¬ diatrics. The American Board of Pe¬ diatrics and the Residency Review Committee of the American Medical Association's Council on Medical Edu¬ cation have recently revised their requirements for pediatrie residency programs."s These new requirements for residency training include an in¬ creased emphasis on and experience in the ambulatory care of children. Formal fellowship training pro¬ grams have flourished during the past
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Iowa User on 05/27/2015
ten years and
are a
reflection of the
trend toward increased
pediatrie subspecialization. Ambulatory fellow¬ ships, a recent addition to the roster of pediatrie fellowships, have arisen for two reasons. First, the change in the pattern of pediatrie disease has required pediatricians to understand and become competent in the diag¬
nosis and treatment of conditions better managed in the clinic or office than on an inpatient service. The evi¬ dence from this survey seems to sup¬ port the premise that ambulatory pe¬ diatrie fellowships have served to supplement the clinical experience of the pediatrie residency more oriented toward the hospitalized child. It is too early to predict what impact the re¬ cent changes in the content of the pe¬ diatrie residency will have on these
ambulatory fellowships. Second, the increased concern with the delivery of pediatrie care has fos¬ tered the development of these fel¬ lowships. The need for clinically com¬ petent pediatricians who are also prepared to organize, manage, and investigate the delivery of pediatrie care
has become urgent. While
am¬
bulatory fellowships appear to be ori¬ ented more toward clinical experience than research, issues of pediatrie care delivery are considered important by
the directors of these programs. In addition, the eventual careers of those completing these fellowships in¬ dicate a commitment to some form of institutional practice: 45% of the fel¬ lows from this sample have entered careers
borhood,
involving outpatient, neigh¬ or community care clinics.
Guidelines for Pediatrie
Fellowships
Recognizing the importance of this
aspect of postgraduate pediatrie edu¬ cation, the Ambulatory Pediatrie As¬
recently developed and approved guidelines for the standards and content of ambulatory pediatrie fellowships. These guidelines should be useful to those pediatricians seek¬ ing this type of fellowship training. They should also serve pediatrie educators as standards against which they can measure their own existing or prospective ambulatory fellowship sociation has
programs. The
below.
guidelines
are
given
Definition: A period of formal education in addition to the core years of pediatrie residency training during which time the trainee acquires the knowledge, skill, and attitudes necessary for a career in all phases of ambulatory care, its delivery, or¬ ganization, and evaluation. Prerequisite: A medical degree from an approved medical school followed by two years of clinical training in an approved residency program. The requirement for two years of clinical training may be waived at the discretion of the director of the training program if such training is to be taken on completion of the fellowship. Duration: One year required, but two years recommended. Objectives: On completion of the fellow¬ ship, the trainee should be competent to perform the following activities: 1. Provide comprehensive pediatrie care to children. 2. Organize, manage, and evaluate am¬ bulatory care programs for children. 3. Plan, execute, and evaluate research in ambulatory pediatrics. 4. Participate in the teaching of the principles of child health to both lay and professional groups. Contents of Fellowship: To attain these objectives, the following guidelines should be considered in the development of the content and organization of any pediatrie ambulatory fellowship program. Directors of these fellowship programs will elaborate and decide the emphasis of the elements of the training program. Patient Care: Each fellow should have the
following opportunities: 1. To have supervised clinical responsi¬ bility during a minimum of 12 months for the primary care of the children of at least 50 families. This patient care responsi¬ bility should also include provision for night and weekend pediatrie coverage for these families. 2. To give direct service to these and other patients not to exceed more than 50% of the individual fellow's work week. 3. To gain experience with clinical prob¬ lems commonly found in the childhood pop¬ ulation and with the available techniques for detection, diagnosis, and therapy of these conditions. 4. To develop an understanding of the
by a member of the pediatrie department. This director should have regular meetings with the fel¬ low and periodically appraise his per¬ formance. Finally, the director should be an individual whose major commitment (teaching, research, or service) is in am¬
developmental process in children with de¬ viations of development. 5. To develop an understanding of the psychological characteristics of normal children and the dynamics of normal fam¬ ily life. 6. To develop skills in the techniques of interviewing both children and adults. 7. To gain supervised clinical experience in the diagnosis and treatment of behav¬
programs must be directed
ioral disorders of children. 8. To develop skills and knowledge of techniques useful in the promotion of health (both personal and community). Administration of Health Care: Each fellow should become familiar with the
appears at this time to be If pediatricians are to be involved in the planning and ex¬
following:
1. Current and
livering pediatrie
proposed
methods of de¬
Finally, the financing of medical education, particularly postgraduate
education, in
some
jeopardy.
ecution of new patterns of health care for children, these types of fellowship programs must not only be supported but also expanded.
care.
2. Economics of pediatrie care. 3. Techniques available for the quality control of pediatrie care. 4. Medical care administration with em¬ phasis on the principles of management of an
bulatory pediatrics.
organization.
5. Dynamics of small groups as related to the interaction of the members of the health team. 6. Concepts of community organization and health planning especially in relation to family health care. 7. All agencies in the community con¬ cerned with the health, education, and wel¬ fare of children. Research: 1. Each fellow should have the time and opportunity for independent study and in¬ vestigation of specific topics in the broad area of ambulatory pediatrics. 2. Each program must ensure that the pediatrie ambulatory fellow has developed some expertise in the area of research methodologies, biostatistics, and epidemi¬
ology.
fellowship program must show tangible evidence that research ef¬ forts are an integral part of the fellowship 3. Each
some
program.
Teaching: Each fellow must have the fol¬ lowing opportunities: 1. To develop skills necessary to teach other health professionals. 2. To experiment with techniques for teaching and educational evaluation. 3. To develop skills needed for communi¬
cating with lay groups. Supervision of Fellowship:
All
fellowship
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Assistance was provided by Katherine Lobach, MD; John Kennell, MD; Donald Fink, MD; Bar¬ bara Ashe, MD; and Margaret O'Connell. The guidelines were submitted by the follow¬ ing members of the Committee on Standards and Content of Ambulatory Pediatrie Fellow¬ ships: Philip Nader, MD; Burris Duncan, MD; Alvin Novack, MD; Harold Dobbs, MD; Dale Garell, MD; and Margaret Heagarty, MD, Chairman. The
guidelines
were
approved by
the Ambula¬
tory Pediatrie Association, May 1973.
References 1. Haggerty RJ, Janeway CA: Evaluation of a pediatric house officer program. Pediatrics 26:858-861, 1960. 2. North AF Jr: Evaluation of a pediatric house-officer program by its alumni. J Med Educ 40:1145-1153, 1965. 3. Hansen AE: Pediatricians' reactions regarding residency training. Pediatrics
14:82-84, 1954.
4. Pfundt TR: A
retrospective residency
evaluation by practicing pediatricians. J Med Educ 36:414-417, 1961.
5. Levine MD, Robertson LS, Alpert JJ: Descriptive study of a pediatric internship. Pediatrics 44:986-990, 1969. 6. Wallace PD, Silver DL: Analysis of a straight pediatric internship. J Pediatr 79:110, 1971. 7. Alpert JJ, Youngerman J, Breslow J, et al: Learning experiences during the internship year: An exploratory study of pediatric graduate education. Pediatrics 51:199-205, 1973. 8. Council on Medical Education and Hospitals: Directory of Approved Internships and Residencies. Chicago, American
Medical Association, 1972. 9. Residency Review Committee for Pediatrics: Guide for Residency Programs in Pediatrics. Chicago, American Medical Association, 1973.
C.
Pediatric
Heagarty, MD, Zulema Fischbarg,
Pediatric ambulatory fellowships are postresidency training programs designed to prepare pediatricians to deliver, organize, and evaluate primary pediatric care. A survey of the members of the Ambulatory Pediatric Association details the funding, structure, content, and outcome of these training programs. The Ambulatory Pediatric Association has recently approved guidelines for the standards and content of these fellowship programs.
In lowships
subspecialty fel¬ have flourished in this country. In general, these programs are designed to train physicians who have completed the core years of their residency and who desire further training in an area of subspecialty interest. In pediatrics, for example, well-defined fellowship programs in such areas as cardiology, endocrinol¬ ogy, or neonatology are offered com¬ monly at university centers. The field of ambulatory pediatrics is one of the newer entries into the area of postrecent years,
residency training. The Ambulatory Pediatrie Associa¬ tion, "an organization concerned with fostering and promoting excellence in all aspects of ambulatory care includAccepted
for publication June 15, 1974. From the Department of Pediatrics, Cornell University Medical College, New York. Reprint requests to New York Hospital, 525 E 68th St, New York, NY 10021 (Dr. Heagarty).
Fellowship Programs
MD
ing service, teaching and research," has a membership that includes many if not most of the pediatrie educators responsible for ambulatory fellowship programs in this country. Since the association is in the process of defin¬ ing the field of ambulatory pediatrics as a scholarly discipline, it has con¬ cerned itself with ambulatory pediat¬ rie fellowships. The association's gen¬ eral goal in this matter has been to define the content and to establish guidelines for these training pro¬ grams. This report details a survey of the members of this organization con¬ cerning their involvement with and their opinions about ambulatory pe¬ diatrie fellowship programs. SUBJECTS AND METHODS In the winter of 1971 each member of the Ambulatory Pediatrie Association re¬ ceived a questionnaire that included questions concerning the requirements, funding, content, and outcome of any ambulatory fellowship program for which the member was directly responsible. For the purpose of this survey, a pediatrie am¬ bulatory fellowship was defined as "any program in which most of the activity in¬ volves such areas as ambulatory care for children, interest in normal growth and de¬ velopment, and/or in community pediat¬ rics." Seventy-three percent (230) of the members responded to the questionnaire. Of the 230 members who responded, 59 (26%) directed ambulatory fellowship pro¬ grams. This report is concerned with these 59 fellowship programs.
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Iowa User on 05/27/2015
RESULTS
In the academic year 1970 and 1971, 104 physicians enrolled in 59 fellow¬ ship programs. Twenty-one, or 36%, of these programs contained one fel¬ low, and 27% contained two or three fellows. Nine programs trained be¬ tween four to six fellows; no program contained more than six fellows. Most (51%) of the fellowships were one year in duration; many (41%) offered the pediatrician the option of one or two years of training. Nine of the 59 programs required two years for com¬ pletion of the fellowship. Most pro¬ grams (71%) required two years, and a minority (11%) required three years of pediatrie training as a prerequisite for admission to the fellowship. Four¬ teen (25%) limited their fellowship to citizens of this country. ·
The following list shows the of the financial support of these fellowships (No. = 56; three programs did not respond to this source
question)
:
Source Federal government Hospital operating funds Both federal and hospital funds Other combinations Total
%of Programs Receiving Support 39 30 9 22 100
were supported solely by the federal government, but an equal number were financed entirely or in part by the hospital sponsoring the program. Twelve programs were sup¬ ported by combinations of funds from private philanthropy, state, and city
Many
government. By definition, all of these fellow¬
ships
were
based in
ambulatory
care
facilities; however, the pattern of the training showed considerable vari¬
ation among the programs. In 11 pro¬ grams, the individual fellow spent 50% or more of his time in providing comprehensive pediatrie care to a group of children in families. In eight, the fellow spent at least 50% of his time working in a community or neighborhood health center. Three programs were oriented predomi¬ nantly toward subspecialty clinics and three toward general or emer¬ gency clinical experience. In the re¬ maining 34 programs, the fellow's clinical activity was divided more or less evenly among all these types of activities. Formal research endeavors did not constitute a major focus for the fellowships; in only two programs did research require as much as a third of the total activity. As might be expected, most of the directors (62%) of these fellowships were based in a university hospital complex, but a significant number (23%) were located either in commu¬ nity hospitals or community health centers. None was in private practice. These educational directors were asked to rate certain broad aspects of pediatrics in order of their relevance for an ambulatory pediatrie fellow¬ ship program. The resulting ranking of these topics is as follows: 1. Growth and development of children 2. Psychodynamics of children and fam¬ ilies 3. Techniques of interviewing 4. Issues of the organization and delivery of pediatrie care 5. Chronic diseases of childhood 6. Acute diseases of childhood 7. Techniques of medical care research 8. Epidemiology of diseases of childhood 9. Techniques and evaluation of medical education 10. Subspecialty care of children
This list supports the higher priority to clinical rather than research issues in these fellowships. However, the emphasis on developmental pe¬ diatrics and behavioral sciences as re¬ lated to clinical practice distinguishes these fellowships from other subspe¬ cialty programs in pediatrics. A summary of the professional ac¬ tivity of the pediatricians who com¬ pleted ambulatory fellowships be¬ tween the years 1965 and 1970 is given in this list:
given
Career
practice University hospital outpatient service Community or neighborhood Private
health centers
Non-university hospital outpatient service Other or unspecified career Armed services Full-time research Total
% (No.= 210) 34.0
21.0 14.0 10.0 8.5 8.5 4.0 100.00
The 39 programs
responding to this questionnaire had trained 210 pedia¬ tricians in this five-year period. One third of these
physicians had
entered
private practice, but 45% of them had form of institutional Few were engaged in fulltime research in ambulatory care. entered
some
practice.
COMMENT
The
pediatrie internship and res¬ idency have been subjected to both prospective and retrospective stud¬
ies.17 Several of these studies have suggested a need for increased train¬ ing in and emphasis on certain issues and techniques generally included under the canon of ambulatory pe¬ diatrics. The American Board of Pe¬ diatrics and the Residency Review Committee of the American Medical Association's Council on Medical Edu¬ cation have recently revised their requirements for pediatrie residency programs."s These new requirements for residency training include an in¬ creased emphasis on and experience in the ambulatory care of children. Formal fellowship training pro¬ grams have flourished during the past
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Iowa User on 05/27/2015
ten years and
are a
reflection of the
trend toward increased
pediatrie subspecialization. Ambulatory fellow¬ ships, a recent addition to the roster of pediatrie fellowships, have arisen for two reasons. First, the change in the pattern of pediatrie disease has required pediatricians to understand and become competent in the diag¬
nosis and treatment of conditions better managed in the clinic or office than on an inpatient service. The evi¬ dence from this survey seems to sup¬ port the premise that ambulatory pe¬ diatrie fellowships have served to supplement the clinical experience of the pediatrie residency more oriented toward the hospitalized child. It is too early to predict what impact the re¬ cent changes in the content of the pe¬ diatrie residency will have on these
ambulatory fellowships. Second, the increased concern with the delivery of pediatrie care has fos¬ tered the development of these fel¬ lowships. The need for clinically com¬ petent pediatricians who are also prepared to organize, manage, and investigate the delivery of pediatrie care
has become urgent. While
am¬
bulatory fellowships appear to be ori¬ ented more toward clinical experience than research, issues of pediatrie care delivery are considered important by
the directors of these programs. In addition, the eventual careers of those completing these fellowships in¬ dicate a commitment to some form of institutional practice: 45% of the fel¬ lows from this sample have entered careers
borhood,
involving outpatient, neigh¬ or community care clinics.
Guidelines for Pediatrie
Fellowships
Recognizing the importance of this
aspect of postgraduate pediatrie edu¬ cation, the Ambulatory Pediatrie As¬
recently developed and approved guidelines for the standards and content of ambulatory pediatrie fellowships. These guidelines should be useful to those pediatricians seek¬ ing this type of fellowship training. They should also serve pediatrie educators as standards against which they can measure their own existing or prospective ambulatory fellowship sociation has
programs. The
below.
guidelines
are
given
Definition: A period of formal education in addition to the core years of pediatrie residency training during which time the trainee acquires the knowledge, skill, and attitudes necessary for a career in all phases of ambulatory care, its delivery, or¬ ganization, and evaluation. Prerequisite: A medical degree from an approved medical school followed by two years of clinical training in an approved residency program. The requirement for two years of clinical training may be waived at the discretion of the director of the training program if such training is to be taken on completion of the fellowship. Duration: One year required, but two years recommended. Objectives: On completion of the fellow¬ ship, the trainee should be competent to perform the following activities: 1. Provide comprehensive pediatrie care to children. 2. Organize, manage, and evaluate am¬ bulatory care programs for children. 3. Plan, execute, and evaluate research in ambulatory pediatrics. 4. Participate in the teaching of the principles of child health to both lay and professional groups. Contents of Fellowship: To attain these objectives, the following guidelines should be considered in the development of the content and organization of any pediatrie ambulatory fellowship program. Directors of these fellowship programs will elaborate and decide the emphasis of the elements of the training program. Patient Care: Each fellow should have the
following opportunities: 1. To have supervised clinical responsi¬ bility during a minimum of 12 months for the primary care of the children of at least 50 families. This patient care responsi¬ bility should also include provision for night and weekend pediatrie coverage for these families. 2. To give direct service to these and other patients not to exceed more than 50% of the individual fellow's work week. 3. To gain experience with clinical prob¬ lems commonly found in the childhood pop¬ ulation and with the available techniques for detection, diagnosis, and therapy of these conditions. 4. To develop an understanding of the
by a member of the pediatrie department. This director should have regular meetings with the fel¬ low and periodically appraise his per¬ formance. Finally, the director should be an individual whose major commitment (teaching, research, or service) is in am¬
developmental process in children with de¬ viations of development. 5. To develop an understanding of the psychological characteristics of normal children and the dynamics of normal fam¬ ily life. 6. To develop skills in the techniques of interviewing both children and adults. 7. To gain supervised clinical experience in the diagnosis and treatment of behav¬
programs must be directed
ioral disorders of children. 8. To develop skills and knowledge of techniques useful in the promotion of health (both personal and community). Administration of Health Care: Each fellow should become familiar with the
appears at this time to be If pediatricians are to be involved in the planning and ex¬
following:
1. Current and
livering pediatrie
proposed
methods of de¬
Finally, the financing of medical education, particularly postgraduate
education, in
some
jeopardy.
ecution of new patterns of health care for children, these types of fellowship programs must not only be supported but also expanded.
care.
2. Economics of pediatrie care. 3. Techniques available for the quality control of pediatrie care. 4. Medical care administration with em¬ phasis on the principles of management of an
bulatory pediatrics.
organization.
5. Dynamics of small groups as related to the interaction of the members of the health team. 6. Concepts of community organization and health planning especially in relation to family health care. 7. All agencies in the community con¬ cerned with the health, education, and wel¬ fare of children. Research: 1. Each fellow should have the time and opportunity for independent study and in¬ vestigation of specific topics in the broad area of ambulatory pediatrics. 2. Each program must ensure that the pediatrie ambulatory fellow has developed some expertise in the area of research methodologies, biostatistics, and epidemi¬
ology.
fellowship program must show tangible evidence that research ef¬ forts are an integral part of the fellowship 3. Each
some
program.
Teaching: Each fellow must have the fol¬ lowing opportunities: 1. To develop skills necessary to teach other health professionals. 2. To experiment with techniques for teaching and educational evaluation. 3. To develop skills needed for communi¬
cating with lay groups. Supervision of Fellowship:
All
fellowship
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Iowa User on 05/27/2015
Assistance was provided by Katherine Lobach, MD; John Kennell, MD; Donald Fink, MD; Bar¬ bara Ashe, MD; and Margaret O'Connell. The guidelines were submitted by the follow¬ ing members of the Committee on Standards and Content of Ambulatory Pediatrie Fellow¬ ships: Philip Nader, MD; Burris Duncan, MD; Alvin Novack, MD; Harold Dobbs, MD; Dale Garell, MD; and Margaret Heagarty, MD, Chairman. The
guidelines
were
approved by
the Ambula¬
tory Pediatrie Association, May 1973.
References 1. Haggerty RJ, Janeway CA: Evaluation of a pediatric house officer program. Pediatrics 26:858-861, 1960. 2. North AF Jr: Evaluation of a pediatric house-officer program by its alumni. J Med Educ 40:1145-1153, 1965. 3. Hansen AE: Pediatricians' reactions regarding residency training. Pediatrics
14:82-84, 1954.
4. Pfundt TR: A
retrospective residency
evaluation by practicing pediatricians. J Med Educ 36:414-417, 1961.
5. Levine MD, Robertson LS, Alpert JJ: Descriptive study of a pediatric internship. Pediatrics 44:986-990, 1969. 6. Wallace PD, Silver DL: Analysis of a straight pediatric internship. J Pediatr 79:110, 1971. 7. Alpert JJ, Youngerman J, Breslow J, et al: Learning experiences during the internship year: An exploratory study of pediatric graduate education. Pediatrics 51:199-205, 1973. 8. Council on Medical Education and Hospitals: Directory of Approved Internships and Residencies. Chicago, American
Medical Association, 1972. 9. Residency Review Committee for Pediatrics: Guide for Residency Programs in Pediatrics. Chicago, American Medical Association, 1973.
