Finding the Right Pediatric Residency

As you embark on your core rotations during your clinical years of medical school, you will begin to work with advisors and clerkship directors to investigate residency options. Remember that any accredited residency program can lead to fellowship training if desired. Moreover, it is important to keep an open mind about your future career goals when applying for and starting residency.

Residency programs view training as a time for exploration and growth, so change is expected and welcomed. The key to finding the right residency is knowing what matters to you – particularly your values and priorities – as you start planning for your professional future.

Every pediatric residency has a similar core structure that adheres to Accreditation Council for Graduate Medical Education (ACGME) requirements. For example, the ACGME mandates that a minimum amount of clinical time must be spent on inpatient care, with a nearly equivalent minimum amount of time mandated for subspecialty exposure.

Elective time outside of these requirements allows the programs or residents to tailor their training according to their interests. Some programs utilize tracks to provide a cohesive experience centered around a population or type of pediatric care, like rural health or primary care. Signing up for a track should not restrict your ability to explore other types of pediatric practice.

Each program will present pros and cons. For instance, for a future resident committed to primary care, a large program with a significant catchment area might enable broader exposure to different problems, which is often seen as beneficial for primary care training. However, for future residents committed to academic subspecialty practice, catchment area may not be as important as exposure in their intended fields.

Your pediatric mentors, clinical advisors, clerkship director, and other knowledgeable providers can offer valuable insight into finding the right pediatric residency. Most importantly, the interview process will help crystallize priorities and clarify options.

Program Size

Programs may range from 4 to more than 50 residents per year. See below for examples of pros and cons for smaller vs. larger residency programs:

Smaller Programs

PROS

Individualized attention
Close relationships with co-residents
Close relationships with faculty

CONS

Fewer residents to cover urgent needs
May experience decreased exposure to complex cases
Fewer subspecialty projects and faculty

Larger Programs

PROS

More residents to cover urgent needs
More clinical training venues
More subspecialty faculty

CONS

May require greater effort to establish close relationships with faculty
May be challenging to bond with all members of the residency class

University-Affiliated vs. Community Programs

Most residency programs are affiliated with medical schools. These university-affiliated programs may offer an advantage in applying for fellowship training, especially for the more competitive fellowship programs. However, programs that are not directly associated with medical schools may be excellent choices for future residents depending on location or desired features.

Stand-Alone Children's Hospital vs. Integrated Hospital

Most pediatric residencies fit into one of 3 categories: hospitals that exclusively serve children (“stand-alone” children’s hospitals), children’s centers attached to adult hospitals (“lean-to” children’s hospitals), and pediatric floors and/or clinics embedded within an adult hospital.

Stand-alone and “lean-to” children's hospitals tend to provide the most comprehensive care for children since all aspects of providing care are developed with pediatric patients in mind. This allows for a unified approach to policy and practice that may be more difficult to achieve for pediatric departments that are embedded in an adult care system.

However, training at general hospitals with pediatric units also offers unique advantages. Residents often have more contact with adult specialty providers. This can result in more cross-specialty resident events and exposure. Some pediatric areas within general hospitals are quite developed, which may minimize the differences between these areas and stand-alone children's hospitals.

Institutions With or Without Fellowship Programs

Opportunities to work with fellows during residency are excellent ways to evaluate subspecialty options. Programs with many fellows offer multiple educational resources for residents. However, institutions without fellowship programs may allow for greater contact between residents and subspecialty attendings, which may lead to greater autonomy with respect to clinical decision-making. For applicants considering fellowship, it is worth comparing fellowship-related opportunities and resources at each prospective residency program.

Residency Program Tracks

Certain residency programs have been approved to offer tracks that allow residents to explore options related to their post-residency career goals. In addition, the American Board of Pediatrics (ABP) offers multiple routes for residents embarking on non-standard training pathways to accomplish their professional goals, including residents interested in becoming pediatrician-scientists.

Information from the ABP on Non-Standard Pathways

Combined Training Programs

Residency applicants who are interested in becoming board-certified in pediatrics as well as an additional specialty or subspecialty should consider a combined training program. Graduates of combined programs are able to sit for multiple boards examinations.

Combined programs offer fewer years of training in total than a traditional sequential training pathway. All combined programs include rotations from both general pediatrics and the other area(s) of training within each year of residency. Specifics regarding ABP-approved combined training programs vary; more information can be found on the ABP website. The ABP-approved combined training programs include:

Internal Medicine/Pediatrics (4 years)
Pediatrics/Anesthesiology (5 years)
Pediatrics/Emergency Medicine (5 years)
Pediatrics/Medical Genetics (4 years)
Pediatrics/Physical Medicine and Rehabilitation (5 years)
Pediatrics/Psychiatry/Child and Adolescent Psychiatry (5 years)

Pediatric Neurology Training Programs

Although medical graduates interested in child neurology and neurodevelopmental disorders  have an option that condenses training by 1 year, this is not a "combined program" in the same sense as those discussed above.

Pediatric neurology programs admit residents who have completed 2 years of a pediatrics residency; after 3 years in the neurology residency, graduates are able to sit for both the pediatrics and neurology boards. The 2 years of pediatrics residency must be designed to include all of the core rotations required by the ABP; residents cannot simply start a pediatrics residency and leave after 2 years to join a neurology residency.

Passing the neurology boards results in certification in neurology with "special qualifications in child neurology." An alternative path is to take 2 years of a pediatric residency followed by 4 years in a program in neurodevelopmental disabilities. As they are not truly "combined" programs, the applications are a bit different. Some residency programs will coordinate the first 2 years of pediatrics with the last 3 or 4 years of neurology at the same institution, but others do not.

Military Pediatric Residencies

Among the broad spectrum of military medical specialties, pediatrics and pediatricians have played essential roles in providing necessary primary and specialty care to hundreds of thousands of pediatric and adolescent dependents of active duty and retired military personnel.

Set apart from their civilian counterparts, however, uniformed services pediatricians practice the science and art of their specialty in every corner of the globe and stand alongside their adult medicine and surgery counterparts in supporting operational forces and unique humanitarian missions.

Learn more about pediatric military residencies by reading this comprehensive guide from the AAP Section on Uniformed Services.

Last Updated

01/31/2024

Source

American Academy of Pediatrics