When I chose pediatrics as my medical specialty, I had not realized how fascinating the area of behavioral and developmental pediatrics was. I found fascinating the degree of improvement that patients with behavioral and developmental problems can achieve when they have access to the resources available and the support they need. This is not a pediatrics sub-specialty in Venezuela, even though this area is basically the foundation of Pediatrics. I was surprised to find out that, here in the U.S it has become so important that it is now an entire area of sub-specialty by itself.
Even though this area is so important in the field of Pediatrics, there is a lack of resident training and education in developmental, behavioral and mental health disorders. For decades, the need for improved pediatric residency training in behavioral and mental health has been recognized and even though the process has improved, there is little evidence that residency training prepares pediatricians to care for children with developmental, behavioral and mental health disorders, the most common group of problems likely to affect their general pediatric patients.
The prevalence of behavioral and mental health conditions in children, adolescents, and young adults has increased in the past few decades, yet medical students and pediatric residents do not recognize the importance of this area in Pediatrics. A study published in Pediatrics in 2017 found that in the U.S, around 65% of pediatricians surveyed by the American Academy of Pediatrics indicated that they lacked training in recognizing and treating behavioral and mental health problems (2). This is especially alarming considering that we also face a shortage in Developmental and Behavioral Pediatricians. Unfortunately, practicing in developmental-behavioral pediatrics is characterized by inadequate reimbursement and longer clinic visit lengths. Furthermore, in addition to a small number of specialists, the care is time consuming and that limits the number of visits that each specialist can provide.
Luckily we have slightly improved the residency training experience. Currently, the ACGME requires that all pediatric residents have a one-month rotation in Developmental-Behavioral Pediatrics. Despite this required 4-week educational experience in DBP, many pediatric residents miss some of this educational time, usually by being assigned to other perceived more urgent activities. So unfortunately, although this is an improvement, it still not sufficient to promote the interest of Pediatric residents in the area. Without a focused approach to allow for deliberate practice, self-confidence in diagnosing and managing problems of behavior and development is unlikely to develop.
Pediatric Residency Programs should start incorporating more training in disabilities and mental health to the curriculum, in order to develop pediatricians who can counsel parents to recognize developmental concerns in a timely manner and feel confident with the diagnosis and management of children with ADHD, Autism and common mental health disorders. Pediatricians should be working on promoting not only physical but also emotional wellness. We can no longer deny that developmental, behavioral and mental health concerns are morbidities that threaten the health of large numbers of children, their families, and society.
References:
1. Rosenberg, A. Training Gaps for Pediatric Residents Planning a Career in Primary Care: A Qualitative and Quantitative Study. Journal of Graduate Medical Education. 2011 Sep; 3(3): 309–314
2. Julia, A. McMillan. Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action. PEDIATRICS. Volume 1 39, number 1, January 2017.
3. Soares, N. Developmental-behavioral pediatrics education in the United States: challenges in the midst of healthcare evolution. Int J Med Educ. 2017; 8: 396–399
