Residency training is designed to allow trainees to develop the clinical skills and the knowledge base necessary to practice their specialty independently. Most pediatric residency programs have been hospital-based, usually in tertiary care institutions. Even required primary care continuity experiences are often based within urban hospital clinics. As a result, pediatric residency graduates have good preparation to care for critically ill children or children with special needs, but may be less prepared to care for generally healthy children or to answer the practical questions that will comprise the bulk of a primary care pediatrician's practice. In fact, many pediatric residents complete training without exposure to many of the practical aspects of primary care and community pediatrics.2–4 

It is difficult to teach residents many key aspects of community and ambulatory pediatrics effectively. Certain issues and skills require active, hands-on involvement. Participatory teaching formats have equal or more efficacy than...

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