1. Residency Review and Redesign in Pediatrics (R 3 P) Project Durham, NC August 1-3, 2007

3. 1978

4. 4 Future of Pediatric Education (FOPE I) - 1978 Minimum duration of residency should be 36 months Need for increased educational experience in: –Biosocial and developmental pediatrics –Adolescent medicine –Clinical pharmacology and toxicology –Community pediatrics –Handicapping conditions and chronic illness –Medical ethics –Musculoskeletal, skin, and dental disorders –Nutrition Elective experience in areas of special interest

5. 5 Will History Repeat Itself? “The Task Force’s ten sponsoring organizations and the readers of this report must assume responsibility for continuing the process of reevaluation, incorporating into educational programs as many of the Task Force’s recommendations as continue to seem appropriate, and devising new recommendations to meet emerging needs.” Forward, The Future of Pediatric Education, 1978

7. 7 Future of Pediatric Education II (FOPE II) - 2000 Enhancement of the science of pediatric medical education Flexible 3-year residency to train pediatricians for varied professional roles Development, ongoing revision and evaluation of core competencies and core curriculum Adjustments to residency training as the product of ongoing attention by all pediatric organizations Importance of career counseling and mentorship Individualized professional education plan for 3 rd year residents incorporating anticipated needs for future practice

8. 8 Where We Began Review current training in light of: –thematic aspects of the future of health care for children and adolescents –knowledge, skills and attitudes needed for that future –current understanding of medical education Make recommendations for changes in pediatric graduate medical education

9. 9 Emergent Opportunities To use flexibility within the current residency (9- 16 of 33 months) to explore innovations that serve patients through better resident education To come to terms with the implications of the “continuum of medical education”: –Residency is not an island, entire of itself. –Residency is not the time or place for all learning. To facilitate ongoing, post-R 3 P innovation, evaluation and improvement –Beyond a “better present” –A complicated administrative undertaking

10. 10 [Complex] Systems do not accept direction, only provocation.…They leave us with no choice but to become interested experimenters, sending pulses into the system to see what it notices. Wheatley & Kellner-Rogers, a simpler way, 1998, pp. 97-98

11. 11 Where We Are Now Discussion of a QI approach to innovation in Pediatric GME –Prescribes specific, measurable outcomes, not process –“Offers a path forward” –Takes advantage of situation-specific opportunities, strengths, imagination, energy Early positive responses to the concept from AAP Resident Section, APPD, AMSPDC, ABP committees, RRC for Pediatrics, PAS

12. 12 The “Competencies” A Conceptual Sea Change Outcomes as Competencies –Medical knowledge –Patient care –Professionalism –Interpersonal and communication skills –Systems-based practice –Practice-based learning and improvement Configures the conversation, sets the agenda: a profound culture shift Sets the stage for an outcomes-driven QI approach to Pediatric GME

13. 13 Synchrony with ACGME Outcome Project

14. 14 An Itemized List of Challenges 1. How to permit innovation: regulatory aspects; make sure PD’s know they have permission to innovate 2. How to facilitate and sustain innovation: consider innovation as a professional obligation; imagine it; identify the barriers; identify mechanisms to facilitate; understand what is practical, what works, what doesn’t 3. How to oversee innovation: RRC, ABP, APPD and more broadly the entire pediatric community 4. How to disseminate innovation: collaboratives; narratives describing successes and failures; seminars/colloquia

15. 15 Goals for Colloquium III Develop and prioritize goals for innovation in residency [“goals for an outcomes-based innovation process”] –Create examples of innovative models to achieve the innovation goals Consider differences in pediatric practice Consider differences in pediatric practice –Determine whether differences in pediatric practice justify some variation in pediatric training Determine the direction for R3P and the future for R3P initiatives