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Practice variations by population: training significance
R D Feigin1, J E Drutz, E O Smith
1Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030-3498, USA.
Insights
Pediatricians in smaller communities perform more procedures on sick children than those in larger areas. Current general practice training may not adequately prepare pediatricians for these diverse procedural demands.
Area of Science:
- Pediatric Medicine
- Community Health
- Medical Education
Background:
- General pediatricians provide care to sick infants and children across diverse community settings.
- Understanding variations in procedural frequency and care patterns is crucial for effective medical training.
Purpose of the Study:
- To investigate differences in the frequency of procedures performed by general pediatricians based on community size.
- To analyze variations in the levels of care provided to sick infants and children by pediatricians in different sized communities.
- To inform the development of postgraduate training experiences for pediatric residents.
Main Methods:
- A survey was distributed to 1412 Texas pediatricians.
- The questionnaire requested data on the frequency of 29 specific procedures and the provision of various care levels.
- Responses were analyzed and categorized based on the population size of the pediatrician's practice community (<100,000 vs. >100,000).
Main Results:
- A 54% response rate was achieved.
- Significant differences in procedure performance were observed for 21 out of 29 procedures between community sizes.
- Pediatricians in smaller communities (<100,000 population) performed a higher proportion of these procedures.
- No significant difference was found in providing newborn Level II and III care, with over 65% offering Level II care.
- Physicians in smaller communities were more likely to provide intermediate and intensive care beyond the newborn period.
Conclusions:
- Significant variations exist in procedural frequency and care patterns among general pediatricians practicing in communities of different sizes.
- The current general practice rotation may not offer sufficient training for the range of procedures performed by community-based pediatricians.
- Educational curricula need to be adapted to ensure adequate preparation for diverse pediatric practice settings.
Objective:
This study sought to examine variations in the frequency of procedures performed and patterns of care of sick infants and older children by general pediatricians in different sized communities. The results of the study will be considered in developing relevant educational experiences for postgraduate trainees.
Methodology:
Questionnaires were sent to 1412 Texas pediatricians requesting frequency information for 29 procedures and whether they provided various levels of care to sick infants and older children. Responses were tabulated by the size of the community in which each pediatrician practiced.
Results:
Fifty-four percent of the questionnaires were returned. The proportion of pediatricians performing each procedure was significantly different for all but 8 of the 29 procedures between communities of less than 100,000 and more than 100,000 population. For all procedures with significant differences, the proportion of physicians performing the procedures was significantly greater for pediatricians practicing in communities of less than 100,000 population. No significant difference was found between the proportion of pediatricians providing newborn level II and III care; however, more than 65% of both groups provided level II care. Physicians in communities of less than 100,000 population were more likely to provide intermediate and intensive care beyond the newborn period.
Conclusion:
The general practice rotation in the community setting will not provide adequate training experiences for many of the procedures currently being performed by general pediatricians.