529018
research-article2014
CPJXXX10.1177/0009922814529018Clinical PediatricsStrasburger
Commentary
The Adolescent Medicine Rotation: Should It Stay or Should It Go?
Clinical Pediatrics 2015, Vol. 54(4) 322–323 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814529018 cpj.sagepub.com
Victor C. Strasburger, MD1
“Darlin’ you got to let me know Should I stay or should I go? . . . This indecision’s buggin’ me If you don’t want me, set me free.” —The Clash, by Mick Jones and Joe Strummer (Copyright © Nineden Ltd)
Here is the basic question: Is the 1-month Adolescent Medicine rotation currently required by the Residency Review Committee (RRC) working effectively? Should it stay or should it go? In 1997, the RRC began requiring a 1-month rotation as part of the 33 months of training in a Pediatrics residency. Even then there were concerns that a single month was inadequate.1-3 Now—with duty hour restrictions and other new requirements—perhaps it is time to revisit the issue of what, exactly, constitutes adequate training in adolescent health care. At our institution (as with many others), Pediatric residents have a continuity clinic, a half-day of Resident School, and usually have at least 2 days off during the week to meet duty hour restrictions because they take night call while on the Adolescent rotation. Hence, 4 weeks has now become 3 weeks. Of course, that is true for any of the electives in the Pediatric residency; but the RRC has deemed Adolescent Medicine to be especially important, hence its status as a required elective. Three weeks out of a 33-month Pediatric residency means that residents now spend 2.2% of their training time doing Adolescent Medicine. At present, there is no requirement that a certain percentage of all patients seen in all settings (eg, inpatient, ambulatory, subspecialty clinics, emergency room) be adolescents. It may just be unique to our institution, but our Adolescent Medicine rotation routinely gets lower evaluation scores than other subspecialty elective rotations (yet medical students on rotation—who are electing to take the rotation—are uniformly extremely positive about their experience). So the first possible change would be not to require an Adolescent Medicine rotation at all. Admittedly, deleting the requirement for an Adolescent Medicine rotation would be risky. But residents would not resent having to do a “required elective month” and perhaps half of residents would actually choose to take the rotation and get
more out of it. Lest I be accused of heresy (as a boardcertified adolescent medicine specialist and the author of several adolescent medicine textbooks), this would need to be accompanied by a requirement that 10% to 15% of all pediatric visits in all venues would be with patients in the second decade of life. A second possibility would be to require a 6-week rotation, not 4 weeks, since 6 weeks would boil down to 4 actual weeks on rotation. But again, residents might resent being required to do this. A third possibility—separate from the rotation length or rotation requirement—would be that 1 of the 4 continuity clinics per month would be devoted entirely to adolescents. This would seem to make perfect sense, given that pediatricians practicing in the real world will encounter a great number of teenage patients. Instead of trying to incorporate 1 or 2 adolescents into an existing continuity clinic, with screaming babies all around, teenagers could have their own time and place. In one recent survey of 196 residency programs, one third of the programs reported that less than 10% of the patients seen in continuity clinics were ages 12 to 21 and seldom did residents have an opportunity to see the same adolescent patient for 2 or more visits in a year.4 Along with these potential changes, there still remains a need to expand the number of Adolescent Medicine faculty even 13 years after the RRC requirement. In the 2010 Pediatrics program survey, 30% of residency directors reported a shortage of Adolescent Medicine specialists in their program.4 The RRC has done an excellent job in trying to distill the 33 months of residency into a practical and educationally meaningful schedule—10 inpatient months (5 ward, 2 neonatal intensive care unit, 2 intensive care unit, 1 Newborn), 9 Subspecialty months (including required rotations in Adolescent Medicine and Developmental/ Behavioral Pediatrics), and 5 Ambulatory months 1
University of New Mexico School of Medicine, Albuquerque, NM, USA Corresponding Author: Victor C. Strasburger, University of New Mexico School of Medicine, MSC 10 5590, Albuquerque, NM 87114, USA. Email: [email protected]
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Strasburger (including at least 2 in the emergency room). The new 3-track system (hospitalist, ambulatory, fellowship) will only help whittle away unnecessary rotations for those who already know their future goals. But the RRC has always struggled with Adolescent Medicine and exactly how to get Pediatric residents trained to see teenage patients. No matter what happens with the Adolescent Rotation, at the very least the RRC could institute a new 10% to 15% requirement plus a new continuity clinic rule. It is time for Pediatric residencies to come of age. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Strasburger VC. Adolescent medicine in the 1990s: no more excuses. Clin Pediatr. 1997;36:87-88. 2. Strasburger VC. How not to train pediatric residents. Clin Pediatr. 1999;38:297-299. 3. Mulvey MA, Ogle-Jewett AB, Cheng TL, Johnson RL. Pediatric residency education. Pediatrics. 2000;106: 323-329. 4. Fox HB, McManus MA, Klein JD, et al. Adolescent medicine training in pediatric residency programs. Pediatrics. 2010;125:165-172.
Copyright of Clinical Pediatrics is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
research-article2014
CPJXXX10.1177/0009922814529018Clinical PediatricsStrasburger
Commentary
The Adolescent Medicine Rotation: Should It Stay or Should It Go?
Clinical Pediatrics 2015, Vol. 54(4) 322–323 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814529018 cpj.sagepub.com
Victor C. Strasburger, MD1
“Darlin’ you got to let me know Should I stay or should I go? . . . This indecision’s buggin’ me If you don’t want me, set me free.” —The Clash, by Mick Jones and Joe Strummer (Copyright © Nineden Ltd)
Here is the basic question: Is the 1-month Adolescent Medicine rotation currently required by the Residency Review Committee (RRC) working effectively? Should it stay or should it go? In 1997, the RRC began requiring a 1-month rotation as part of the 33 months of training in a Pediatrics residency. Even then there were concerns that a single month was inadequate.1-3 Now—with duty hour restrictions and other new requirements—perhaps it is time to revisit the issue of what, exactly, constitutes adequate training in adolescent health care. At our institution (as with many others), Pediatric residents have a continuity clinic, a half-day of Resident School, and usually have at least 2 days off during the week to meet duty hour restrictions because they take night call while on the Adolescent rotation. Hence, 4 weeks has now become 3 weeks. Of course, that is true for any of the electives in the Pediatric residency; but the RRC has deemed Adolescent Medicine to be especially important, hence its status as a required elective. Three weeks out of a 33-month Pediatric residency means that residents now spend 2.2% of their training time doing Adolescent Medicine. At present, there is no requirement that a certain percentage of all patients seen in all settings (eg, inpatient, ambulatory, subspecialty clinics, emergency room) be adolescents. It may just be unique to our institution, but our Adolescent Medicine rotation routinely gets lower evaluation scores than other subspecialty elective rotations (yet medical students on rotation—who are electing to take the rotation—are uniformly extremely positive about their experience). So the first possible change would be not to require an Adolescent Medicine rotation at all. Admittedly, deleting the requirement for an Adolescent Medicine rotation would be risky. But residents would not resent having to do a “required elective month” and perhaps half of residents would actually choose to take the rotation and get
more out of it. Lest I be accused of heresy (as a boardcertified adolescent medicine specialist and the author of several adolescent medicine textbooks), this would need to be accompanied by a requirement that 10% to 15% of all pediatric visits in all venues would be with patients in the second decade of life. A second possibility would be to require a 6-week rotation, not 4 weeks, since 6 weeks would boil down to 4 actual weeks on rotation. But again, residents might resent being required to do this. A third possibility—separate from the rotation length or rotation requirement—would be that 1 of the 4 continuity clinics per month would be devoted entirely to adolescents. This would seem to make perfect sense, given that pediatricians practicing in the real world will encounter a great number of teenage patients. Instead of trying to incorporate 1 or 2 adolescents into an existing continuity clinic, with screaming babies all around, teenagers could have their own time and place. In one recent survey of 196 residency programs, one third of the programs reported that less than 10% of the patients seen in continuity clinics were ages 12 to 21 and seldom did residents have an opportunity to see the same adolescent patient for 2 or more visits in a year.4 Along with these potential changes, there still remains a need to expand the number of Adolescent Medicine faculty even 13 years after the RRC requirement. In the 2010 Pediatrics program survey, 30% of residency directors reported a shortage of Adolescent Medicine specialists in their program.4 The RRC has done an excellent job in trying to distill the 33 months of residency into a practical and educationally meaningful schedule—10 inpatient months (5 ward, 2 neonatal intensive care unit, 2 intensive care unit, 1 Newborn), 9 Subspecialty months (including required rotations in Adolescent Medicine and Developmental/ Behavioral Pediatrics), and 5 Ambulatory months 1
University of New Mexico School of Medicine, Albuquerque, NM, USA Corresponding Author: Victor C. Strasburger, University of New Mexico School of Medicine, MSC 10 5590, Albuquerque, NM 87114, USA. Email: [email protected]
323
Strasburger (including at least 2 in the emergency room). The new 3-track system (hospitalist, ambulatory, fellowship) will only help whittle away unnecessary rotations for those who already know their future goals. But the RRC has always struggled with Adolescent Medicine and exactly how to get Pediatric residents trained to see teenage patients. No matter what happens with the Adolescent Rotation, at the very least the RRC could institute a new 10% to 15% requirement plus a new continuity clinic rule. It is time for Pediatric residencies to come of age. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author received no financial support for the research, authorship, and/or publication of this article.
References 1. Strasburger VC. Adolescent medicine in the 1990s: no more excuses. Clin Pediatr. 1997;36:87-88. 2. Strasburger VC. How not to train pediatric residents. Clin Pediatr. 1999;38:297-299. 3. Mulvey MA, Ogle-Jewett AB, Cheng TL, Johnson RL. Pediatric residency education. Pediatrics. 2000;106: 323-329. 4. Fox HB, McManus MA, Klein JD, et al. Adolescent medicine training in pediatric residency programs. Pediatrics. 2010;125:165-172.
Copyright of Clinical Pediatrics is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
