Only 42% of pediatric residents who graduated in 2022 said they felt prepared for primary care practice, down from 69% in 2015, according to a new AAP survey.
The results will help inform the AAP’s efforts to advocate for and educate residents.
Nearly 4,000 residents provided feedback in the AAP Annual Survey of Graduating Residents from 2015-2022. They rated how well their program prepared them for primary care pediatric practice, pediatric fellowship training, hospitalist practice/fellowship, child advocacy, research and using telemedicine.
About 46% of the 2022 graduates whose goal was primary care said they felt prepared for primary care practice (rating their program as very good or excellent in preparing them) compared to about 41% with a subspecialty goal and 29% with a hospitalist career goal, according to “Pediatric Residents’ Preparedness and Training Satisfaction: 2015-2022,” (Gottschlich EA, et al. Pediatrics. Jan. 23, 2023).
Residents said they felt more prepared for fellowship training or hospitalist practice, although those numbers also declined. About 69% of the 2022 graduates hoping to pursue a subspecialty said they felt prepared for fellowship training compared to 80% in 2015. About 87% of those with hospitalist aspirations felt prepared for hospital practice or fellowship in 2022 compared to 94% in 2015.
The survey also asked about preparedness for child advocacy, research and using telemedicine. About 40% of the 2022 graduating residents in the survey said they were prepared for child advocacy, while 27% said they were prepared for research. The only category that rose was telemedicine with 29% feeling prepared, up from 16% in 2019.
Hilary M. Haftel, M.D., M.H.P.E., FAAP, AAP senior vice president of education and an author of the study, said declines in preparedness in most categories may be linked to changes in medicine over the past 10 to 20 years, including a reduction in the numbers of hours residents can work and patients they can see. They also are being asked to expand their job description and body of knowledge to areas like mental health. The COVID-19 pandemic also may have played a role, although declines started before 2020.
“Given how much medicine and how much knowledge is out there, it may (be) hard to feel prepared going out of residency compared to their predecessors,” Dr. Haftel said.
She said more programs now offer a broader curriculum with flexibility for residents to spend more time on areas where they feel less confident.
“If there are areas where they really feel like they have gaps, it’s better to identify them and fill them as soon as possible,” she said. “You’re always going to find things you don’t know. We’re always going to be relying on our colleagues and lifelong learning skills to help identify and fill those gaps. But the more we can cover in residency training itself, the better off we are.”
She said the survey data will help inform AAP efforts as it works with its Section on Pediatric Trainees, the American Board of Pediatrics and other partners to create curricula and teaching materials that will best support residents. These materials are especially important in areas where programs may not have as many resources.
The AAP also provides PREP The Curriculum Self-Assessment to residents as a member benefit, which can help them identify knowledge gaps.
A bright spot in the survey was that 93% of the 2022 graduates said they would choose a pediatrics residency again, which has stayed relatively consistent over the years.
“When you’re recruiting for residency training out of medical school, you can’t be 100% sure that everyone is bought in,” Dr. Haftel said. “They’re … young in their careers, most of them. So, it’s very gratifying to hear you’re matching the right people, the people who really are dedicated to pediatrics as a pathway in life.”
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