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June 2, 2008

Context (Place) Matters

Arch Pediatr Adolesc Med. 2008;162(6):584-586. doi:10.1001/archpedi.162.6.584

Former speaker of the US House of Representatives Thomas “Tip” O'Neill (1912-1994) is noted for saying, “All politics is local.” He could have been talking about clinical decision making and, by extension, medical education.

In their comparative study of training sites and residents' attitudes about neonatal resuscitation, Janvier and colleagues1 report a series of compelling links between site (4 neonatal residency programs in the province of Quebec, Canada) and willingness to resuscitate a depressed infant at 24, 25, 26, and 27 weeks of gestation.1 They also identify a “site effect” for medical knowledge (cerebral palsy prevalence), along with the finding that knowledge does not substantially increase with level of training.