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After having made decisions about college, medical school, and specialty training, some residents may delay consideration of their future career in pediatrics. Others, having decided what path they will pursue, are not clear as to what steps need to be taken to ensure that they approach their choice armed with the most appropriate and accurate information. Residents seek career choice information from various sources. For many, the resources may not be able to provide as complete information in all facets of career decision-making. An Internet accessible site for career planning for pediatric residents has been developed (). The advantages, beyond ease of access by all residents, are many, particularly the power of links to other Internet resources. In addition, a website provides the ability to rapidly update and add information, which is not feasible in printed form. career planning, pediatric residents, jobs, private practice, pediatric specialties.

Background: While the number of internal medicine-pediatrics (med/peds) residency training programs has increased considerably in the past decade, questions continue to be raised about career paths of the graduates of these programs. It is uncertain whether med/peds graduates follow a generalist career path and whether they continue to practice both specialties., Objective: To determine the career outcomes of graduates of med/peds residency programs., Design: A survey questionnaire of graduates of med/peds residency programs., Methods: The computer databases of the American Board of Pediatrics and the American Board of Internal Medicine were used to identify 1482 individuals who had completed training in combined med/peds residency programs between 1986 and 1995 and who had applied to either board for certification. The survey questionnaire was mailed to all graduates identified., Main Outcome Measures: Time spent in professional activity (patient care, teaching, administration, and research), site of principal clinical activity, ages of the patient population, types of hospital privileges, practice organization, subspecialty activity, night and weekend coverage arrangements, community size of practice, involvement in teaching, and membership in professional organizations., Results: Of the total group of 1482 graduates, 87.3% are certified by the American Board of Internal Medicine, 91.3% by the American Board of Pediatrics, and 81.6% by both boards. The survey was completed by 1005 graduates (67.8%). The principal activity of almost 70% of the graduates was direct patient care. Most graduates cared for patients of all ages. More than half of all respondents noted that their principal clinical site is a community office practice. Eighty-five percent managed patients who require hospitalization. Approximately 50% of respondents had a medical school appointment., Conclusions: This study, the largest survey to date of med/peds graduates, provides strong evidence that most med/peds graduates are practicing generalists who care for adults and children. In addition, the fact that 80% of graduates achieve dual board certification suggests that these physicians are well qualified to care for the spectrum of health care needs of children and adults. Because the changing US health care system mandates a strong primary care base, these physicians will play a small but important role in providing high-quality generalist care.

Computer assisted diagnosis was evaluated for its ability to hasten the time to initial diagnosis and reduce laboratory studies. The time to diagnosis averaged 2.8 days for a control group and 1.9 days for the group in which the computer printout was made available. In a small group in whom the diagnosis was not established until after 48 hours, there was a further trend to reduction in number of days to diagnosis and irrelevant laboratory studies. The ability of the computer to include the final diagnosis in the initial list of differential diagnoses remained unchanged for patients whose conditions were diagnosed before or after 48 hours, while the physicians' ability decreased. In a university hospital setting, computer-assisted diagnosis may be most beneficial for patients whose conditions have not been diagnosed within 48 hours of admission.

Patient, contact data, collected by two first year pediatric residents, separated in time by 25 years, were compared, and it is concluded that pediatric residency has undergone major changes throughout the past quarter century. Pediatric training has increased in length and includes more female residents. The overall intensity of patient care pediatric residents provide has increased. Children with chronic disorders that were often lethal conditions 25 years ago now make up a large portion of pediatric admissions to teaching hospitals.