Encourage Future Pediatricians by Example

The year 2025 marks the end of the first quarter of the 21st century, and while Pediatrics in Review continues to be well read (as indicated by strong and increasing circulation), the number of physicians going into pediatrics may be significantly decreasing. The 2024 Main Residency Match® data report states that only 92% of the 3078 offered positions were filled for postgraduate year 1 in pediatrics (categorial), leaving 251 positions unfilled. The 2 prior years, 99% of offered positions were filled. Pediatric societies are concerned that medical students are now dramatically less interested in pediatrics and are choosing instead to go into other medical specialties. Discussions between pediatric organizations suggest bolstering interest in pediatrics by increasing exposure to clinical pediatrics early in the medical school curriculum, creating pediatric interest groups in colleges and high schools, and advocating for a national increase in fee reimbursement for pediatric services. While these approaches are common sense, another overlooked approach to increasing interest in pediatrics is for each of us to impact our patients.Practicing and teaching pediatrics is a joy for me derived from guiding developing minds, nurturing growing bodies, and spreading knowledge that accomplishes both. My first pediatrician was Dr Ben Silverman, who was a soft-spoken, gentle person who conveyed comfort and concern as he listened to my heart, palpated my abdomen, and injected penicillin when I had strep throat. While I was scared of the doctor’s office, I was not scared of the doctor. Though Dr Silverman rarely smiled when he asked questions or performed an examination, he did smile when he concluded the sick visit, and with that smile, the world became calm and good. I wanted to be like Dr Silverman.Dr Silverman was also a storyteller, describing to my mother how my physical findings began a journey for answers. My love of case reports probably began with watching and listening to him. I may have been ill those times in the exam room, but I was captivated, hanging onto every word about my physical findings—findings that harbored clues that were leading to answers. He was like my literary hero, Sherlock Holmes. An illness was a mystery to solve. I wanted to be like Dr Silverman.I believe some physicians practice pediatrics because we had a pediatrician when we were children who, by example, instilled our desire to figure out how to make children healthier. I also believe that it is the child within us pediatricians that wants to hear, read, and experience even more stories. Part of the success of Pediatrics in Review is due to the many case reports published that are submitted by practicing pediatric clinicians throughout the world. These true patient cases include stories of how doctors were challenged by a patient’s problem and solved that problem—doctors who now challenge the reader to experience the same. Case-based learning is an effective teaching method, and the journal’s mission of helping pediatricians and other pediatric practitioners keep their clinical knowledge current is partly accomplished by enticing the pediatrician to learn by example.This past year, Pediatrics in Review has explored the concept of case-based learning by publishing more case reports in a format that grants continuing medical education credit (CME). In our “Three Patient Cases” feature, we present cases that have a common theme, followed by an expert commentary on that theme. Readers have responded positively to this format, emphasizing that they best learn pediatrics from actual cases. Pediatrics in Review last month expanded one complex patient case into a full CME article that was submitted to “Index of Suspicion” (IOS). We hope readers are receptive to that format, too.This year, Dr Peter Belamarich, who is passionate about case-based learning, takes over as associate editor of IOS. Dr Belamarich explains that when reading a published IOS case, he makes his own differential diagnosis from the initial presentation and attempts to make the final diagnosis before the diagnosis is revealed: a process he enjoys because it is a test of the intersection of knowledge and diagnostic reasoning. He believes he learns more from making the wrong diagnosis when reading these cases than from making a successful diagnosis. His belief that being wrong is valuable and that being right is enjoyable will indeed make the IOS feature a continuing success.At the local library or bookstore, children sit engaged by story time, oohing and aahing over picture books while nearby adolescents and adults peruse graphic novels and comic books. Perhaps we as pediatricians can similarly captivate a child by sharing our stories of caring. Maybe we should leave a carefully chosen copy of Pediatrics in Review in the exam room, opened to an IOS page, for the inquisitive adolescent to find. For the child wanting to grow up to be a comic book hero, we should show that we are comic book heroes, too (and PIR could have an occasional comic book cover as well, strategically placed in the exam room).When you notice a child curiously observe you as you practice your clinical skills, go ahead and tempt that child to become a diagnostician, to someday solve mysteries only a pediatrician can.