Sir.—In the July 1986 PEDIATRIC FORUM, a letter from Dr R. L. Williams1 pointed out in poignant detail the challenge we face in training young, enthusiastic physicians for entry into the world of primary care pediatrics. He stated, with apparent surprise at the concept, that "the community standards dictate that only subspecialists are qualified to perform certain procedures."
It is scandalous that a highly skilled resident, on June 30 of the last year of three or more years or rigorous training in hospital-based pediatrics, is expected to take responsibility for controlling the ventilator, placing a chest tube, reading an electrocardiogram, and aspirating a sample of bone marrow only to find that, a day later, on July 1 of his first year of private practice, such procedures are considered outside his or her level of competence. To add insult to injury, this often occurs in the very institution in
Cash R. Training for Life After Residency. Am J Dis Child. 1987;141(1):12. doi:10.1001/archpedi.1987.04460010012005