'Minifellowship' in Pediatric Program

Sir.—Since 1981, pediatric training programs have had increased difficulty in providing adequate supervisory and consultative experience in patient care for third-year (PL-3) residents due to an expansion of the pediatric training requirement to a mandatory three years. This resulted in the elimination of the "pyramid system" and increased by approximately 30% to 50% the number of PL-3 residents in most large pediatric training programs. In programs with a fixed quantity of high-quality inpatient ward supervisory experience, this net increase of third-year general pediatric residents decreased the availability of supervisory time per PL-3 resident. As a result, PL-3 residents have less time for involvement in positions of major responsibility, eg, actively teaching junior residents, making management decisions, and supervising a patient care team. There is also less opportunity available for the PL-3 resident to interact as a teacher and adviser of less experienced residents, to expand working relationships with the