Система медицинского образования в США

1. Подготовка врача-педиатра: Система медицинского образования в США

Детский Национальнa Медицинский Центр,
Университет Джорджа Вашингтона, Вашингтон, США
Подготовка врача-педиатра:
Система медицинского
образования в США
Натэлла Рахманина
Доктор Наук
Адъюнкт-Профессор
Директор Программы
Специммунологии
April 15, 2014

2. Pediatrics in the US

• Born and trained in
medicine in Germany
• Lived and practiced in
New York City
• Children’s Hospital of
Philadelphia – 1855
• Boston Children’s
Hospital – 1869
• Children’s National
Health System – 1870
• Today - ~250 pediatric
hospitals in the US
Abraham Jacobi
1830–1919

3. Pediatric Medicine in the US

• Pediatrics in the US represents the branch of
medicine that deals with care of infants from birth,
through childhood and adolescence until 21 years of
age
• For certain chronic medical conditions the upper
limit for age can be extended to 24 years of age and
older
• Majority of the pediatric subspecialties require
training in pediatrics as a first step followed by more
specialized training in a fellowship program

4. Pediatric Subspecialties in the US

• Adolescent Medicine
• Pediatric
Gastroenterology
• Pediatric Cardiology
• Pediatric HematologyOncology
• Child Abuse
• Pediatric Infectious
Diseases
• Pediatric Critical Care
Medicine
• Neonatal-Perinatal
Medicine
• DevelopmentalBehavioral Pediatrics
• Pediatric Nephrology
• Pediatric Emergency
Medicine
• Pediatric Pulmonology
• Pediatric Endocrinology
• Pediatric Rheumatology

5. Medical Training

• Grade school & High school – 12 years (6-18 years of
age)
• College – 4 years (may be less or more)
• Medical school – 4 years
• Qualifying exams for entry into Medical School
• Vigorous selection process involving transcripts from
college, exams, letters of the recommendation and
curriculum vitae
• Previous experience in research, volunteer work matter!
• In person interview is required

6. Residency in Pediatric Medicine

• 3 years in training at accredited Pediatric Residency
Programs following completion of medical school
• Vigorous selection process at each program
• Application involves transcripts of the medical school,
exams, letters of the recommendation and curriculum
vitae
• Previous experience in research and academic output
matter!
• Additional degree matters
• In person interview is required
• Computerized matching process at the end determines
the final selection

7. Accreditation of the Pediatric Residency Program

• Site visit every 10 years
• Yearly surveys of the residents, fellows tailored to
evaluate their perception of their educational
experience, clinical experience
• Yearly survey of the faculty tailored to evaluate the
protected time for teaching, continued medical
education
• Yearly data on the program scholarly productivity
(faculty and fellows) including publications,
presentations, national recognition
• Data on the ABP and subspecialty Boards certification
success of the graduates

8.

December 13, 2017

9. Children’s National Health System Residency Training Program

• 3 year program with 120 residents
• 2600 applicants representing 63% of all medical
students applying for training in pediatrics
• 500 invited for an interview, 40 selected
• Six tracks available (primary care, community
health, categorical, child neurology, neurodevelopmental disabilities, medical genetics track)
• Yearly in service exams to access the progress in
training and preparation for the Certifying American
Board of Pediatric Exam

10. Children’s National Health System Residency Training Program

• Fixed number of obligatory rotations with several
months of electives and opportunity for research during
third year
• Maximum 80 hours per week, 16 hours shifts
• The longest time of uninterrupted service up to 28
hours, no more than 24 hours direct patient care
• Daily rounds with an attending and medical team
• Separate teaching rounds (3-4 times weekly) and
simulation training (1-2 times per week)
• Weekly interactive professorial rounds and weekly
hospital grand rounds

11. REACH Program

• Research , Education, Advocacy and Child Health
Care
• Half day per week second and third year of training
• REACH results 2013:
11 peer-reviewed manuscripts published
6 awards at the institutional and national levels
12 grants awarded
33 abstracts presented at the regional, national and
international meetings

12.

December 13, 2017

13. The Pediatric Milestone Project

• Joint Initiative of the Accreditation Council for
Graduate Medical Education and American Board of
Pediatrics
• Feedback from the Association of Pediatric Program
Directors
• Follow up through the Longitudinal Educational
Assessment Research Network

14. Performance oriented and Practice based Competencies Evaluated at 5 levels

Patient care
Medical knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Professionalism
System-based practice
Personal and professional development

15. Patient Care Competency

• Gathering detailed anamnesis
• Organizing and prioritizing responsibilities for safe,
effective and efficient patient care
• Assuring seamless transition of care
• Interviewing patients and families for the medical
condition
• Complete and accurate physical examination
• Making therapeutic and diagnostic decisions that
result in optimal clinical judgment
• Develop and carry out management plan

16. Patient Care Competency

• Prescribe and perform all medical procedures
• Counsel patients and families
• Provide effective health maintenance and
anticipatory guidance
• Use information technology to optimize patient care
• Provide appropriate role modeling
• Provide appropriate supervision

17. Entrustable Professional Activities (EPAs)

Early
Development
Intermediate
Development
Advanced
Development

18. Example of Entrustable Activities

• Observer - observation only
• Advance beginner – partial involvement in
assessment and care
• Direct supervision - supervised assessment and care
• Indirect supervision – independent assessment,
discussion of care plan, independent care
• Proficient – independent assessment and care
• Mastery – supervision of others

19. Innovative Approaches to Training

Active instead of passive learning
Concept of knowledge “pearls”
Regular feedback to the trainee and to the trainer
Evaluations of trainees oriented at “what would you
be able to do”
• Evaluations of trainer oriented at “how can I help
you to learn and master”
• Algorithms for assessment and care
• Cross-training with nursing and physician assistants

20. Acknowledgments

• Mary Ottolini ,MD, MPH, Vice Chair for Medical
Education, Professor of Pediatrics, George
Washington University, Children’s National Health
System
• Dewesh Agrawal, MD, Director, Pediatric Residency
Program, Associate Professor of Pediatrics and
Emergency Medicine, George Washington
University, Children's National Health System

21.

“Pediatrics does not
deal with miniature
men and women, with
reduced doses and the
same class of diseases
in smaller bodies,
but….it has its own
independent range and
horizon…”
Dr. Abraham Jacobi, 1889