Presentation (June 2009)


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  • Need to note that we have reps from x subspecialties and liaisons to ABP etc to make it clear that we have clout
  • Should comment on the heavy research requirements in peds fellowships and the need to allow increasing independence in decision-making, including time management. Shift length and frequency should comment on the “one size does not fit all” issue for fellowships.
  • Need data here
  • Need to look into pediatric nursing shortage too
  • Let me see what I can add for “physician extender shortage”…and a note that this is different from adult medicine. #2 is a patient safety issue
  • Presentation (June 2009)

    1. 1. Council of Pediatric Subspecialties Victoria F. Norwood, MD – Chair James Bale, MD – Vice-Chair
    2. 2. Council of Pediatric Subspecialties Organized in 2006 by the leadership of US pediatrics to address issues of concern to all pediatric subspecialties. Our mission is to integrate approaches to subspecialty education, research and patient care by providing a forum for members and other organizations and by serving as the common voice for the pediatric subspecialties.
    3. 3. Council of Pediatric Subspecialties IOM RECOMMENDATION CoPS POSITION 80 Hour Rule No Changes CoPS agrees. However, non- patient care educational activities should be exempt from the 80 hour rule. Maximum Shift Length 30 hours; admitting patients for up to 16 hours; 5 hours of protected sleep CoPS opposes this recommendation. More data are needed on the relationship between continuous duty hours and competency of fellows. Maximum frequency of in- hospital shifts 4 night maximum; 48 hours off after 3 or 4 nights CoPS opposes this recommendation. This is costly to implement for small programs.
    4. 4. Council of Pediatric Subspecialties IOM RECOMMENDATION CoPS POSITION Days off per month Mandatory 5 days off per month CoPS agrees. Moonlighting External and internal moonlighting should count toward the 80 hour rule. CoPS agrees . However, educational debt is a major concern. Any reduction in moonlighting must be linked to new mechanisms to reduce the burden of educational debt for fellows.
    5. 5. Council of Pediatric Subspecialties IOM RECOMMENDATION CoPS POSITION On Site Supervision Establish measurable standards of supervision CoPS agrees. However, fellows must receive sufficient opportunities for autonomy, especially in their final year of training. Continuity of Care Programs should train teams how to handover efficiently and effectively CoPS agrees. Studies must be performed to define the necessary and sufficient elements.
    6. 6. Council of Pediatric Subspecialties Preparation of residents for fellowship training  Program directors in critical care specialties observe that residents are increasingly less well prepared for fellowship.  Additional duty hour restrictions will necessitate educational strategies that could include increasing the length of training in categorical and fellowship programs which may negatively affect subspecialty career choices.
    7. 7. Council of Pediatric Subspecialties Effects on small programs  Most programs have 1 or 2 trainees per year.  Restricting duty hours further will be costly and difficult to implement.  Current workforce shortages in many pediatric subspecialties means that substitute providers are not available to absorb the work displaced from residents and fellows.
    8. 8. Council of Pediatric Subspecialties A workforce crisis exists in pediatric subspecialties.  Pediatric subspecialty workforce shortages are limiting access to care for children with complex health needs - this is a patient safety issue.  The current workforce is unable to serve as a substitute workforce for residents and fellows.  Modifications in duty hours and supervision must take into account effects on current and future workforce.
    9. 9. Council of Pediatric Subspecialties Pediatric fellowships face unique funding problems.  Children’s hospital GME funding is already tenuous.  Current lower subspecialty funding rate is a financial disincentive for health systems to train individuals for these roles.  Decisions to train more individuals without substantial changes in financial support mechanisms could result in program closures or ineffective expansion.
    10. 10. Council of Pediatric Subspecialties Fellowship training must be viewed differently.  The “one size fits all” approach to graduate medical education should be modified.  Fellows must be develop gradual autonomy in order to ultimately exercise their varying roles as clinicians, educators, and scientists.  Flexibility and awareness of subspecialty differences are necessary to maximize the beneficial effects of change.
    11. 11. Council of Pediatric Subspecialties CONCLUSIONS  CoPS supports the IOM and the ACGME on the importance of patient and trainee safety, supervision and handovers.  We support an evidence based-approach to evaluation of past changes as a necessary component of future planning.  The complexity of subspecialty training and the unique challenges of cost and workforce must be considered.  We will welcome the opportunity to participate in a more “individualized” approach to subspecialty graduate medical education.