The History of the Med-Peds Program Free

Commentary From the Section on Med-Peds

The Section on Med-Peds (SOMP) is committed to education, research, advocacy, communication, and well-being of the med-peds community of students, residents, fellows, and practicing primary care and subspecialist clinicians. In 1995, the American Academy of Pediatrics (AAP) approved the med-peds interest group. A year later, the Section on Med-Peds was approved as a provisional section, followed in 1997 with the designation as a formal section of the AAP. Since 1999, the SOMP has held educational sessions and poster competitions at the AAP National Conference.

However, the story of med-peds starts before this time. This year, combined internal medicine and pediatrics (med-peds) celebrated its 55^th anniversary as a formal residency training option. The articles that are cited were chosen as they highlight the training, the workforce impact, the continuum of care across the age spectrum that med-peds physicians provide, and the contributions to transitions of care and health care disparities provided by the med-peds physicians in the community.

The History of the Med-Peds Program

Jayne Barr, MD, FAAP

Affiliation: Chair, AAP Section on Med-Peds; Associate Professor, Internal Medicine and Pediatrics, MetroHealth Case Western Reserve University, Cleveland, OH

Highlighted Articles From Pediatrics

1. Ferrari ND, Shumway JM. Combined internal medicine/pediatric residency training programs. Pediatrics. 1989;84(1):94-97
2. American Board of Pediatrics. Guidelines for combined-internal medicine-pediatrics residency training programs. Pediatrics. 1989;84(1):190-194
3. Middelkamp JN. Combined medicine/pediatrics training programs. Pediatrics. 1989;84(1):181-182
4. Hart A, Shetty V, McDonnell J, Golden R, Nolan C, Smith R. A Rush collaboration: a quality improvement project in a resident internal medicine-pediatrics clinic in development of a universal, system-wide screening for adverse childhood experiences and social determinants of health. Pediatrics. 2019;144(2 MeetingAbstract):109
5. Cooley WC, Sagerman PJ, American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians Transitions Clinical Report Authoring Group. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128(1):182-200
6. Kuusinen MM, Kaferly JG, Frank A. Aging out—quality improvement in transitions of care for adolescents leaving the foster care system. Pediatrics. 2021;147 (3 MeetingAbstract): 85-87

Med-peds training programs began to emerge in the 1960s. In 1967, the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP) endorsed the concept of combined training, leading to dual board eligibility. Dr. Lawrence Cutchin, the first graduate, is credited for the continued success of med-peds. Currently, there are 79 training programs (in 78 institutions), with approximately 1,500 med-peds residents in training. Approximately 8,000 physicians have completed med-peds residency training.

In a 1987 survey,¹ there was a wide range of curricular structure of med-peds programs. Then in 1989, Pediatrics published, with the approval from the ABIM and the ABP, the objectives and general requirements of a combined residency program in internal medicine-pediatrics.² Prior to this time, the only requirement to petition the boards for approval for individuals to take the board examination was a qualified program leader. The article describes for the first time in the literature the components for a combined internal medicine and pediatrics training program. It highlights that combined residencies can meet the requirements for accreditation of internal and pediatrics residency training, stating that residents will have the experiences and education of the evaluation, treatment, prevention, ethics, socioeconomic, and team approach to provide care. The curriculum outlined utilized rotations derived from the “parent” internal medicine and pediatrics residency programs. The article presents the components of the curriculum that spans all ages and includes the spectrum of care for families. Moreover, by meeting these requirements, it was made known that residents were eligible take each of the certifying examinations and obtain dual certification. In 2007, the Accreditation Council of Graduate Medical Education (ACGME) began accreditation of the structure and function of med-peds programs. This has allowed for standards across all med-peds programs, input from med-peds residents about their training, and ease of licensure of med-peds graduates in all 50 states. Currently, according to 2023 match data, there are 78 med-peds programs with a total of 392 residency positions per year, which included 351 US senior graduates.

The practice of med-peds has changed since its inception. As one of the earliest med-peds articles published in Pediatrics,³, the author emphasized the importance of trending the med-peds workforce. The med-peds workforce is diverse, ranging from primary care, hospital medicine, subspecialties, academics, transitional diseases, and research. In a 2014 workforce survey, 63% of med-peds graduates were practicing primary care, 20% subspecialty training, and 22.5% hospital medicine. Opportunities for med-peds clinicians are almost unlimited in direct patient care, advocacy, clinical research, hospital staff positions, teaching, and/or administration.

Med-peds clinicians have an important role in the community and in addressing health care disparities, social determinants of health, and transitions of care. For example, a med-peds clinic site in Chicago adopted an institutional goal of screening all at-risk patients for adverse childhood experiences and social determinants of health.⁴ Additionally, med-peds trained physicians are well-suited for transitions of care. W. Carl Cooley and Paul J. Sagerman outlined materials, algorithms, and processes for implementation of transition of adolescents to adult care.⁵ They noted that dually boarded med-peds physicians seem ideally equipped to care for transitioning adolescents and young adults and to assist in the training of other primary care generalists. The importance of med-peds physicians as providers for transitions for adolescents in the foster care system was emphasized in a recent Pediatrics article.⁶ This article discussed the development of a transition of care clinic specifically for young adults aging out of foster care that was led by a med-peds clinician.

Physicians trained in a med-peds residency program bring a unique insight and scope to the care of patients throughout the patients’ lifespan. The med-peds workforce impact continues to grow in primary care, hospital medicine, and subspecialities. Up to 25% of med-peds graduates pursue subspeciality training, either in internal medicine, pediatrics, or both. Med-peds subspecialists work in various clinical settings to care for children and adults with medical conditions such as cystic fibrosis, sickle cell disease, congenital heart disease, or developmental disabilities; have careers in international health; and flourish as clinician-scientists or researchers. Many med-peds physicians hold an academic appointment with a medical school. About half of graduates pursue primary care practice, and the great majority care for both children and adults. Caring for multiple generations of the same family lends a med-peds physician a more in-depth understanding of family dynamics and the effect of acute and chronic illnesses at all ages within the family context. Given the continuity of care with the establishment of deep relationships, the med-peds physician can truly be the “health mentor” for families over several decades.