A bush of wild roses, lovely but tangled and full of thorns is how I view the pediatric residency review committee’s new requirement of “structured educational experiences that prepare residents for the role of advocate for the health of children within the community.”1
The idea, of course, is wonderful. Who can argue with residents becoming familiar with how children function outside of clinical settings? And implementing aspects of this vision may even be feasible. For example, elsewhere in this issue of the ARCHIVES, Chamberlain and colleagues2 report favorably on the experiences of advocacy training at Stanford University in Palo Alto, Calif, the University of Miami in Miami, Fla, and the University of California, San Francisco. Protected time was carved out of existing block rotations for two 3-hour preparatory workshops, independent field work, and presentation of the projects to peers and faculty. Using tools introduced during the workshops, “each resident individually selected, developed, and implemented an advocacy project that reinforced advocacy knowledge and skills.”2 Wisely, in my opinion, the residents were free to follow their own interests. Ninety-nine residents at the 3 centers completed projects; 42% of these projects involved some form of disease prevention and/or health promotion. Ninety-three of the 99 participants expressed satisfaction with the experience. The sting of some thorns, though, were felt: the motivation of residents varied, there were limitations of resident and faculty time, and one cringes when imagining the yeoman effort expended by the 3 authors, each of whom was solely responsible for the programs in her or his own institution.