A public health approach to pediatric residency education: responding to social determinants of health.

Objective: To evaluate the impact of a public health approach to pediatric residency education on learner knowledge, skills, attitudes, beliefs, and career choice.
Background: Incorporating public health principles into traditional residency education can give pediatricians the population-oriented perspective to address social determinants of health.
Methods: The Community Health and Advocacy Training (CHAT) program is an educational intervention with a public health framework. From 2001-2007, 215 categorical pediatric residents and 37 residents in the CHAT program were evaluated by using an annual survey of community pediatrics exposure, knowledge, attitudes, and beliefs. American Board of Pediatrics (ABP) examination passage rates for both groups were also examined, as was career choice after graduation.
Results: While interns in both the categorical and CHAT programs scored similarly on attitudes, beliefs, skills, and knowledge of community pediatrics, the postgraduate level-3 (PL-3) year CHAT residents scored higher in attitudes (P < .001) and skills (P < .05). Exposure to both didactic (P < .05) and practical (P < .001) community pediatrics curricular experiences were higher for CHAT residents than for categorical residents. No significant differences between ABP examination scores were found for the 2 groups, although 100% of CHAT graduates passed on the first try compared to 91% of categorical graduates during this time period. A greater percentage of CHAT graduates (82%) than categorical graduates (53%) reported pursuing careers in primary care.
Conclusion: With a public health approach to residency education, residents gain the knowledge, attitudes, and skills to address child health problems from a population perspective. Participation in such a curriculum still resulted in high passage rates on the ABP examination.