Innovating to educate paediatric consultant generalists for the new Canadian health care.

Responsibility for training general paediatricians in Canada lies primarily with the 17 paediatric academic health sciences centres with more programmatic emphasis on subspecialty training and less on preparing residents for general paediatrics. However, the greatest unmet demand in the paediatric workforce will be for consulting paediatric generalists. Here, we define the need for paediatric generalists and list deficiencies in current models to promote more consulting community general paediatricians. The limited presence of general paediatricians as role models reduces the potential for learners to better understand the role of generalists in our specialty. Nationally, we need to advocate for change in teaching models to guide the career choices of our graduates to meet societal needs through better mentorship and educational models that heavily include community-based paediatric consulting generalists. This will be essential to meet our responsibility of supporting primary care colleagues closer to home for our funders, patients and families.

Paediatric career decision: a literature review of motivational factors.

Unless decision-makers for the future paediatric workforce are aware of different factors that influence the career choices of candidates, they may not be able to meet the needs of this major specialty. Paediatricians should be perceptive, effective communicators and endlessly patient with children. In this article, we conducted a thorough literature search to explore factors affecting career choices among undergraduate and postgraduate students who choose paediatrics or paediatric subspecialties. We assessed the similarities and differences in decision-making in paediatric, medicine, surgery and orthopaedic career contexts to help the candidates in ranking their career options. The authors found that both intrinsic and extrinsic factors shape the career choices of those seeking to work in paediatrics or paediatric subspecialties. A well-structured career development curriculum and clinical experience are considered the most important extrinsic factors, whereas personal characteristics of the candidate and career needs are considered the most important intrinsic factors. These factors may vary across specialties, and even between different subspecialties within the same major specialty. Some factors are considered very important, while others are deemed less so in comparison. The role of mentoring in career selection is crucial. It has been documented in a sizable body of literature that residents are inspired to pursue the careers of their mentors. Paediatrics is no exception. The decision to pursue a subspecialty training is complex and is affected by multiple factors. Those engaged in managing the workforce of the future in the field of paediatrics must familiarise themselves with the intrinsic and extrinsic factors that affect the candidates' career choices.

Are the career choices of paediatric residents meeting the needs of academic centres in Canada?

BACKGROUND: Responsibility for training paediatric medical subspecialists in Canada lies primarily with the 16 academic paediatric departments. There has been no mechanism to assess whether the number of residents in training will meet the needs of currently vacant positions and/or the predicted vacancies to be created by anticipated faculty retirement in the next five years across the different paediatric medical subspecialties. HYPOTHESIS: At the present time, the training of the paediatric physician is not linked with the current and future needs of the academic centres where the vast majority of these paediatric subspecialists are employed. METHODS: The academic paediatric workforce database of the Paediatric Chairs of Canada (PCC) for the surveys obtained in 2009/2010 were analyzed. Data included the number of physicians working in each subspecialty, the number of physicians 60 years of age or older, as well as the number of residents and their level of training. RESULTS: There are some paediatric subspecialties in which the actual number of trainees exceeds the currently predicted need (eg, cardiology, critical care, hematology-oncology, nephrology, neurology, emergency medicine and genetic-metabolic). On the other hand, for other specialties (eg, adolescent medicine, developmental paediatrics, gastroenterology and neonatology), assuming there is no significant change to selection patterns, an important gap will persist or appear between the need and the available human resources. CONCLUSION: The present analysis was the first attempt to link the clinical orientation of trainees with the needs of the academic centres where the vast majority of these paediatric subspecialists work.

Inequality of Paediatric Workforce Distribution in China.

Child health has been addressed as a priority at both global and national levels for many decades. In China, difficulty of accessing paediatricians has been of debate for a long time, however, there is limited evidence to assess the population- and geography-related inequality of paediatric workforce distribution. This study aimed to analyse the inequality of the distributions of the paediatric workforce (including paediatricians and paediatric nurses) in China by using Lorenz curve, Gini coefficient, and Theil L index, data were obtained from the national maternal and child health human resource sampling survey conducted in 2010. In this study, we found that the paediatric workforce was the most inequitable regarding the distribution of children <7 years, the geographic distribution of the paediatric workforce highlighted very severe inequality across the nation, except the Central region. For different professional types, we found that, except the Central region, the level of inequality of paediatric nurses was higher than that of the paediatricians regarding both the demographic and geographic distributions. The inner-regional inequalities were the main sources of the paediatric workforce distribution inequality. To conclude, this study revealed the inadequate distribution of the paediatric workforce in China for the first time, substantial inequality of paediatric workforce distribution still existed across the nation in 2010, more research is still needed to explore the in-depth sources of inequality, especially the urban-rural variance and the inner- and inter-provincial differences, and to guide national and local health policy-making and resource allocation.