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The pediatric residency program of the future. III. Modifying pediatric residency training programs.

The numerous shifts in health care provision, enumerated in the previous two articles of this series, necessitate change not only in the practicing physician but also in the approach to training tomorrow's pediatricians. Many directors of pediatric residency programs, recognizing the need for increased emphasis on outpatient care, are establishing two-track training systems, with one track emphasizing primary care in the ambulatory setting, while the other emphasizes the standard program, giving relative emphasis to inpatient experiences. Primary care training programs generally include 19 months of ambulatory care and 17 months of inpatient rotations, whereas most standard residency programs have the reverse. THE PRIMARY CARE OPTION Primary care training programs vary among institutions that offer this training alternative. At the University of Colorado, Denver, for example, the emphasis is on training in a group practice clinic, behavioral development of children, and preventive and community medicine. In addition, residents spend a substantial