Table 1 Key changes proposed to program requirements by ACGME, identified problems/opportunities, and NPSCW recommendations.

Int.B

No mention in overview of role of pediatricians as scientists and knowledge generators

No charge to engage in life-long scholarship only limited mention that the discipline is “characterized by a scholarly approach”

Encourages programs to place less emphasis on research development as a core area for innovation in education

Limits pediatricians ability to practice in lifelong scholarly inquiry and integrate new discoveries into clinical and teaching practice

Emphasize crucial and necessary role that pediatricians must play in creation of generalizable knowledge while creating an expanded scholarship that addresses discovery, integration, implementation, and teaching (https://doi.org/10.1097/00001888-200009000-00007)

II.B.1.e (initial ACGME proposal)

Elimination of specific requirement for board certified specialists in adolescent medicine, developmental-behavioral pediatrics, neonatal-perinatal medicine, pediatric critical care, peds EM

Limits exposure to subspecialty trained pediatricians with research expertise. Further limits development of scholars in under-subscribed specialties like adolescent medicine and DBP

Emphasize the role of subspecialty pediatricians throughout core training domains and acknowledge their unique training provides a different perspective from clinicians whose experience is primarily in delivery of clinical care

II.B.1.e (revised proposal July 2023)

Strong emphasis on requirement for board-certified subspecialists

Increases and maintains exposure to subspeciality trained pediatricians who often have research expertise

Revision strengthens role of subspecialists which will enhance exposure to scholarship for residents

IV.B.1.b).(2).a

Changes in specific requirements for procedural mastery

May limit preparation of residents for some fellowships. May become a barrier for residents who select fellowship training later in residency or select later based on scholarship rather than procedural interest

Work with fellowships to create common pathways/requirements that will prepare residents for the entry-level procedural requirements of all major subspecialty training programs to facilitate diverse training and decision pathways including late bloomers. Encourage ongoing assessment of trainees by programs to meet procedural needs for likely career paths

IVv.C.6ff

Changes to required blocks and duration of specific clinical experiences

Reductions in inpatient, critical care, and emergency coverage by residents will create financial pressures for hospitals; hospitals may change their commitment to residency training

Reductions in block coverage may lead to greater ad hoc coverage of these services during electives

Changes in financial incentives may reduce number of hospitals that can provide pediatrics training. Different sizes and locations of hospitals provide unique research opportunities and perspectives. The economic impact should be modeled.

The impact of changes in required rotations on overall coverage should be assessed. Scholarly time should be protected from shift-based coverage requirements.

IiV.C.6.e

Specification of minimum of 40 weeks of individualized curriculum with 20 of those weeks in selected clinical settings

The individualized curriculum provides opportunity for possibly 20 weeks of research and perhaps more if research is included in any of the clinical training settings.

The potential research time is about half what is offered in the IRP and ARP programs as detailed in Table 2. At the same time, 20+ weeks of personalized training could be a springboard to additional research time and focus for residents and could increase exposure to physician-scientist pathways.

IV.B.1.c).(5)

No knowledge statement included to engage in continuing education in research discoveries and potential integration of resulting improved therapies

Encourages pediatricians to use standards of care that may not reflect future medical advances including rapidly advancing fields like precision medicine

Emphasize commitment to understanding new biomedical research advances and potential impact on health advances to encourage pediatricians to be “inquiry-minded”