FINANCING PEDIATRIC EDUCATION IN COMMUNITY SETTINGS

Increasingly, hospital-based pediatric outpatient departments are reco gnized as settings that attempt to combine two critical, but not alway s compatible, mandates: (1) education of medical students and pediatri c residents in outpatient pediatrics, and (2) service, often with inad equate resources, to a socially highrisk population with a disproporti onately high prevalence of social, family, and psychological dysfuncti on, Coexistence of these two mandates has raised a number of concerns, because pediatric ambulatory care education and training have histori cally been based almost exclusively in a hospital setting. Trainees of ten get a false impression of the types of problems they will be deali ng with in pediatric primary care and of how an efficient pediatric pr actice is managed, In addition, they often are supervised by full-time faculty who have little if any experience in community settings and w ho practice only part time or not at all, These problems have led to a widespread desire to train pediatric residents outside the hospital, in settings that more closely approximate the places in which they wil l practice in the future. Residency programs that address this issue a lso provide residents with the opportunity to be trained by seasoned p ractitioners whose primary professional responsibility Is the outpatie nt care of children. To date, little has been written about the cost o r the financing of such educational efforts. This article summarizes w hat is known about the casts. We also attempt to specify the costs tha t should be anticipated for the various components and steps involved in devising and implementing pediatric community-based educational pro grams and to describe potential sources of funding for such programs.