Child protection: a neglected area of pediatric residency training

Abstract

Background: Child maltreatment is prevalent in Canadian society, and medical professionals are frequently required to provide care in these cases. Physician knowledge and training in child protection have been questioned. This study examined the experience, perceived adequacy of training, and perceived competency of Canadian pediatric residents in child protection.

Methods: Structured questionnaires were sent to child protection program directors (CPPDs), pediatric program directors (PPDs) and pediatric residents at the 16 Canadian pediatric academic centers. Data were analyzed using descriptive statistics, chi(2)-analyses, a Mann-Whitney test, and linear regression.

Results: Responses were obtained from 15 of 16 CPPDs, all 16 PPDs, and 190 of 348 (54.6%) residents. All programs provided didactic teaching sessions. Only 3 programs had mandatory clinical rotations, 9 programs offered clinical electives, and 7 programs did not offer any specific clinical experience in child protection. Half of the residents had seen 5 or fewer cases of maltreatment. Residents and program directors most commonly rated the training as "somewhat adequate, needs improvement" with a significant minority rating it as "poor, inadequate." Residents' self-rating of competency was positively associated with number of years of training and number of cases of maltreatment seen. Almost all residents (92%) felt that they needed further training in child protection, including 85% of graduating residents. Some of the residents (16.4%) did not anticipate dealing with child protection cases as practicing pediatricians.

Conclusions: Canadian pediatric residents receive little exposure and limited training in child abuse and neglect. As a result, even senior pediatric residents feel poorly trained. These results highlight the need to establish effective training programs for residents in child protection.