500 Issues of Pediatrics in Review: A Brief History

This February marks the 500th issue of Pediatrics in Review (PIR). In the inaugural July 1979 issue, Founding Editor Robert J. Haggerty, MD, wrote, “Our goal is simple: to help improve child health by providing information useful to those professionals who provide health services to children.”(1) Edwin L. Kendig, Jr, MD, American Academy of Pediatrics President (AAP), wrote, “With this first issue of PEDIATRICS IN REVIEW the American Academy of Pediatrics sponsored pediatric review and education program (PREP) has been launched. The program is multifaceted and will be coordinated with the American Board of Pediatrics for recertification in pediatrics.”(2)

For that first year, PIR published 10 monthly issues per academic year (July—April cycle), each issue consisting of 32 pages, 4–6 review articles, with one-paragraph abstracts scattered throughout the journal. Over the following 40-plus years, PIR evolved from a basic format of practical review articles for practicing pediatricians to a peer-reviewed publication consisting of continuing medical education (CME) articles, abstract summaries, case presentations, and commentaries guiding pediatric providers throughout the world. Through such features as In Brief, Index of Suspicion, and Visual Diagnosis, PIR promotes the practice of evidence-based medicine, shares pediatric expertise with the global community, and helps prepare pediatricians for the American Board of Pediatrics’ (ABP) Maintenance of Certification cognitive exam.

Currently the typical PIR monthly issue consists of 3 CME review articles, 2 In Briefs, 4 Index of Suspicion cases, and one Visual Diagnosis case (online only). Occasionally a commentary and/or supplemental article are included. Today our readership includes over 30,000 subscriptions and over 2.8 million world-wide online readers.

What follows is a timeline listing noteworthy events in the history of Pediatrics in Review.

1979—Inaugural year of publication with Dr Robert Haggerty, Founding Editor. The first two issues appear as a supplement to the AAP journal Pediatrics.

1983—PIR, along with PREP Self-Assessment (PREP SA), switch to a 5-year cycle to cover all ABP educational content necessary for board recertification.

1989—An Associate Editor position is created to be filled by a practicing community general pediatrician with an academic appointment; Dr Lawrence F. Nazarian assumes that role.

1992—Dr Nazarian introduces Index of Suspicion (IOS), which features challenging case reports. This feature quickly becomes the most frequently first-read section of the journal.

PIR switches from 10 issues a year to 12 monthly issues per calendar year, expanding from 32 pages to 40 pages per issue.

1995—The journal introduces the feature In Brief, which is a reformat of Abstracts, into 1—2 short articles per issue. Abstracts were formerly multiple 1—2 paragraphs placed throughout the publication.

2000—PIR introduces the Visual Diagnosis feature; Dr Joseph A. Zenel (academic and practicing general pediatrician) joins PIR as the feature editor.

2005—This is PIR’s 25th anniversary year. Dr Robert Haggerty retires after 25 years, stating, “I am proud to have been Editor-in-Chief for PIR’s first 25 years and am convinced that the next 25 will be even more illustrious!”(3)

Dr Larry Nazarian becomes Editor-in-Chief, writing, “Our editorial board reads like a ‘Who’s Who’ of outstanding pediatric generalists and specialists and includes many of the finest teachers, clinicians, and researchers in the world, all of whom contribute as volunteers. The hundreds of writers of our articles, likewise, are among the best; they consistently provide updates that are current, readable, and useful… we must extend deep thanks to our thousands of readers, whose constructive feedback has allowed us to improve the journal and fill their needs more effectively… Our efforts to reach out to pediatricians and children around the world are ongoing…”(4)

2007—PIR introduces References (and citations) at the end of the CME review articles. Until now, only Suggested Readings were listed after the CME review articles.

2009—PIR introduces Level of Evidence (using Evidence-Based Medicine guidelines) in key summary points at the end of the CME review articles.

2012—Based on the Accreditation Council for Continuing Medical Education (ACCME) newly established requirements, Education and Practice Gaps are added to PIR CME review articles.

2013—Dr Larry Nazarian retires as Editor-in-Chief, and Dr Joseph Zenel assumes the role. Dr Hugh Allen, pediatric cardiologist, becomes Deputy Editor. Dr Nazarian writes, “PIR’s global perspective has expanded. The English language print edition is distributed to 27 countries. The online English language version is accessed in 289 different languages in 189 countries! Readers in developing countries can access the online Journal free or at greatly reduced cost… Each generation of physicians is pledged to teach and encourage those who are following in their footsteps, thus ensuring the preservation of the ideals and the succession necessary to keep the profession alive in service… As I resume my pre-1985 role as another regular reader, I am profoundly grateful to the AAP for the opportunity to serve children through PIR, and deeply thankful for the many outstanding colleagues who have contributed to the production of the Journal, and with whom it has been such a pleasure to work.”(5)

The Visual Diagnosis feature becomes available online only.

2014—This is PIR’s 35th anniversary year. A supplemental poster of past PIR covers is published.

An Editorial Fellow position is introduced to the executive editorial board.

2015—PIR introduces online Blogs.

2016—PIR decides to include topics that address identified gaps in medical knowledge not covered by the ABP content specifications (which now number over 6,500 specifications).

PIR introduces PowerPoint supplements (available online) to the CME review articles.

2017—The ABP restructures the educational content for maintenance of certification (MOC) into 25 Domains, collapsing over 6,500 content specifications into broad categories. The PIR CME review articles now provide MOC Part 2 credit.

2019—This is PIR’s 40th anniversary. A supplement containing commentaries, case reports, and educational topics is published.

PIR introduces quality improvement suggestions at the end of CME review articles.

2020—PIR publishes 1 online IOS supplement of 30 cases

2021—PIR introduces the Chronic Care/Complex Care quarterly feature and publishes 1 online IOS supplement of 35 cases and 1 online Visual Diagnosis supplement of 20 cases.

2023—PIR publishes its 500th issue.

Another key part of PIR history worth discussing is the assessment of a reader’s participation in continuing medical education. Initially PIR offered 40 credit hours per year in Category 1 of the Physician’s Recognition Award of the American Medical Association (AMA PRA Category 1) through a self-assessment multiple-choice questionnaire at the end of each issue. Questions were based on the content of the entire issue. For the first year, over the course of 10 issues, there were 125 questions.

Now, CME questions are solely based on the content of the review articles. Each monthly issue has 3 CME review articles, with each article containing 5 CME questions that pertain to that article. In addition to providing up to 36 AMA PRA Category 1 CME Credits per publication year, PIR provides American Board of Pediatrics Maintenance of Certification (MOC) Part 2 credit. At the end of the publication year, if a reader correctly answers all 180 CME questions by 60% or more, the reader achieves 30 Part 2 MOC credits.

The content and style of questions have also changed over the years. In PIR Issue No. 1, the very first CME question was, “All of the following statements about invasive, group B streptococcal infection in the neonate are true EXCEPT:” followed by 5 answer options. This question, typical of PIR at that time, basically offered 5 true/false statements, asking the reader to identify which one was false. While the question primarily assessed facts the reader learned from the publication, it did not necessarily assess the reader’s clinical expertise, or how the reader would use this knowledge in a clinical situation. Of note, at the end of the first year of PIR, Dr Haggerty, in discussing reader feedback, wrote, “By all odds, the major complaints have been about the self-assessment questions… It is clear the questions have not served the purpose of improving learning.”(6) Clearly, the CME questions needed fixing.

In our 500th issue, a typical CME question now consists of a patient vignette followed by a lead-in question. One example of a lead-in question is, “Which of the following is the most likely pathogen for this patient’s signs and symptoms?” The reader must choose the most likely answer from five options, which involves judging, synthesizing and applying knowledge to a clinical situation. This one-best-answer format is thought to be the most valid and reliable way for a multiple choice question to assess a physician’s clinical expertise. In this way PIR follows its mission “to help pediatricians and other pediatric practitioners to keep their clinical knowledge current.”(7)

As a medical student, I was fortunate to read the first PIR issue the week it was published, and its content helped me perform well during my pediatric hospital rotation. Four hundred and ninety-nine issues later, Pediatrics in Review still performs well thanks to the dedication, input, and insight of its editors, editorial board members, reviewers, staff, and readers. I am honored to work with all.

When Dr Haggerty retired as Editor-in-Chief of PIR, he wrote, “The AAP, since its inception, has been committed to the education of its pediatrician members as one of a number of ways to improve the health of America’s children…PIR, more than any other journal, will contain what the practitioner needs to know to provide the most effective, up-to-date patient care… Not intended as a research journal, PIR was the first continuing education journal focused entirely on clinical pediatrics. The editorial board and the authors have been recognized leaders in pediatric practice and academia. As a result, the product is a reasoned, thoughtful review of clinical conditions.”(3)

We, the editorial board and staff of Pediatrics in Review, strongly believe the journal continues to be that most-effective, continuing pediatric medical education journal. To paraphrase Founding Editor Dr Bob Haggerty, may the next 500 issues be even more illustrious!