title: Residency exposures and anticipated future involvement in community settings.
abstract: OBJECTIVE
  To assess how exposures to community activities in residency impact anticipated future involvement in community child health settings.
  
  
  METHODS
  Prospective cohort study of pediatric residents from 10 programs (12 sites) who completed training between 2003 and 2009. Residents reported annual participation for ≥ 8 days in each of 7 community activities (eg, community settings, child health advocacy) in the prior year. At the start and end of residency, residents reported anticipated involvement in 10 years in 8 community settings (eg, school, shelter). Anticipated involvement was dichotomized: moderate/substantial ("high") versus none/limited ("low"). Logistic regression modeled whether residency exposures independently influenced anticipated future involvement at the end of residency.
  
  
  RESULTS
  A total of 683 residents completed surveys at the start and end of residency (66.8% participation). More than half of trainees reported ≥ 8 days' of involvement in community settings (65.6%) or child health advocacy (53.6%) in residency. Fewer anticipated high involvement in at least 1 community setting at the end of residency than at the start (65.5% vs 85.6%, P < .001). Participation in each community activity mediated but did not moderate relations between anticipated involvement at the start and end of residency. In multivariate models, exposure to community settings in residency was associated with anticipated involvement at end of residency (adjusted odds ratio 1.5; 95% confidence interval 1.2, 2.0). No other residency exposures were associated.
  
  
  CONCLUSIONS
  Residents who anticipate high involvement in community pediatrics at the start of residency participate in related opportunities in training. Exposure to community settings during residency may encourage community involvement after training.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Electronic address: mgoldsh1@jhu.edu.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Goldshore
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Barry S
authors.initials: BS
authors.lastname: Solomon
authors.affiliation: Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Ind.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Downs
authors.affiliation: Assembly Member, California Legislature, Sacramento, Calif.
authors.forename: Richard
authors.initials: R
authors.lastname: Pan
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Minkovitz
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002662:Child Health Services; D002675:Child, Preschool; D003153:Community Health Services; D003154:Community Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D016015:Logistic Models; D008297:Male; D010372:Pediatrics / Q000193:education*; D010820:Physicians / Q000523:psychology; D015397:Program Evaluation; D011446:Prospective Studies; D014481:United States
keywords: community health services; education; graduate; graduate medical education; medical; pediatrics/education