When patients and pediatricians say good-bye in a pediatric resident continuity clinic

Pediatric residency programs require a 3-year continuity clinic experience for residents. To our knowledge, no authors have examined the impact of termination at the end of the residency among the child, parent, and pediatrician. This article discusses an exploration that evolved in response to the questions that third-year pediatric residents asked concerning how to say good-bye to their primary care patients in the context of their continuity clinic. The first panel addressed parental and patient issues, and the second addressed the impact on the pediatrician. The parents on the panel stated that it was important that they be notified in advance of their pediatrician's departure, that they believed they had played an important role in the resident's education, and that they wanted a voice in the selection of their child's future pediatrician. The pediatricians on the panel all felt sadness, relief, and guilt as a result of the termination, but guilt that the family would feel abandoned was the strongest emotion. Few pediatricians on the panel acknowledged the impact of the relationship on themselves and the importance of including the parents in the decision to choose the child's future pediatrician. The issue of termination needs more deliberate attention in pediatric training programs. A structured system for teaching residents to manage the termination process is proposed.