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Rebecca M. Jennings, BA; Lindsay A. Thompson, MD, MS; Charles L. Townsend, MA; Carole A. Stashwick, MD, PhD; David C. Goodman, MD, MS

Arch Pediatr Adolesc Med. 2003;157:676-680.

Background  A critical component of pediatric residency training is exposure to diverse and challenging hospitalized patients, yet little is known about the differences in pediatric inpatient educational experiences across residencies.

Objective  To examine variations in inpatient illness severity and diagnostic diversity at the affiliated hospitals of small, medium, and large pediatric residencies.

Design  A retrospective analysis of hospital discharges among children aged 0 to 18 years (excluding newborns) in a sample of pediatric residency programs within the University HealthSystems Consortium.

Main Outcomes of Interest  The study compares the mean and median Diagnosis-Related Group (DRG) weights of hospital discharges (illness severity) as well as the percentage of discharges for the 5 most common diagnoses and the percentage of discharges for asthma (diagnostic diversity).

Results  There was no relationship between mean and median medical DRG weights and residency size (mean DRG weight: small, 0.89; medium, 0.86; and large, 0.85; small vs medium, P = .29; small vs large, P = .23). Larger programs had surgical patients with more severe illness (mean DRG weight, small, 2.11; medium, 2.08; and large, 2.47; small vs medium, P = .85; small vs large, P = .02) but less diagnostic diversity (small, 24.9%; medium, 25.9%; and large, 29.9%; small vs medium, P<.001; small vs large, P = .07). The proportion of medical discharges for asthma increased with residency size (small, 6.5%; medium, 7.4%; and large, 9.3%; small vs medium and large, P<.001).

Conclusion  Large variations in inpatient illness severity and diagnostic diversity were seen across programs, but program size was found to be a poor indicator of inpatient learning opportunities.

From the Center for the Evaluative Clinical Sciences and the Departments of Community and Family Medicine (Ms Jennings and Drs Thompson and Goodman) and Pediatrics (Drs Thompson, Stashwick, and Goodman), Dartmouth Medical School, Hanover, NH; and the Dartmouth-Hitchcock Alliance, Lebanon, NH (Mr Townsend).