Medical resident education changed dramatically on July 1, 2011 with the institution of new duty-hour work restrictions. The move to shift scheduling changed the notion of nighttime work from a time of service to one of education. The National Pediatric Nighttime Education Steering Group responded to this paradigm shift by creating a national, peer-reviewed, Web- and case-based curriculum for nighttime learning in pediatrics. Field-test results from implementation in 89 programs revealed statistically significant improvements in knowledge and confidence, but a need for improvement in usability interface, instructional design, and dissemination. Finding support to improve upon the design of the curriculum and provide a robust platform for dissemination and use by residency programs presents a significant challenge, especially in light of severe threats to graduate medical education funding at the national level.
TopOrganization Background
The landscape of medical education is a wide and varied entity. Governing bodies exist at the undergraduate medical level (medical students) and graduate medical level (residents and fellows), as well as with licensure accreditation organizations for practicing physicians. Working in collaboration with these entities, both in training and in practice, are the organizations that represent the field of pediatrics (e.g., American Academy of Pediatrics [AAP]), as well as the pediatric subspecialty representative and academic organizations (e.g., Joint Council of Pediatric Hospital Medicine, formerly known as Pediatric Hospital Medicine; the Society of Hospital Medicine [SHP]; and the Academic Pediatric Association [APA]). Each of these organizations is a stakeholder in the training of medical students, residents, and fellows in pediatrics, but the organizations have varying levels of authority, funding, and resources. When they work together, however, they can often respond to national needs and impact national standards for training physicians.
Though all such organizations have paid employees to run the daily business efforts and elected officials from their memberships to administratively lead the groups, the foot soldiers for many innovations or developments are the members of the organizations. These members are often not compensated for their efforts, but instead dedicate their time out of commitment to the field and to the topics of interest. Pediatrics is a field that serves a vulnerable population, and many pediatricians select their specialties based not on salary or ability to accumulate wealth or prestige, but more often on the significant impact they can have on the lives of children. This culture of pediatrics also carries over to medical education. Most pediatric medical educators consider it their duty to improve the educational experiences of the pediatric trainees who follow them. It is through this organizational culture that structure and change are built.
When the AAP, SHM, or other organization creates a committee or task force, the committee becomes an arm of that organization, working to fulfill its mandate and the goals deemed important by the organization. Although committees function with the unequivocal support of the organizations, these organizations are not for profit; therefore, the financial resources of the committees and the successes of the innovations the committee members hope to achieve are limited. All too often, members must find alternative and creative ways to fund their innovations and/or adapt them to make the most of the available resources and funding. This can include relying heavily on volunteer time commitments, aggrandizing resources from other organizations, and recruiting funds from unique sources.
The Association of Pediatric Program Directors (APPD, 2012a) is a national organization for pediatric residency programs. The primary goal of the APPD is to support pediatric residency program leadership in order to provide the best education for pediatric residents and, in turn, optimize health care delivery to children. The APPD has several task forces, including the Curriculum Task Force, which breaks down into working groups focused on designing and evaluating curricula for residency programs.
In February 2009, the SHM, the AAP, and the APA sponsored a strategic planning meeting that brought together 22 experts in the field of pediatric hospital medicine to discuss the future of the field (the SHM-, AAP-, and APA-supported effort is now referred to as the Joint Council of Pediatric Hospital Medicine). Several strategic initiative committees emerged from this planning roundtable, including the Education Committee. In 2010, the National Pediatric Nighttime Education Steering Group was formed through the Pediatric Hospital Medicine Strategic Initiative Education Committee and a working group within the APPD’s Curriculum Task Force. The 10 members of the steering group are associated with one or both groups, and all volunteer their time.