The relationship between pediatric residency program size and inpatient illness severity and diversity

Background: A critical component of pediatric residency training is exposure to diverse and challenging hospitalized patients, yet little is known about the differences in pediatric inpatient educational experiences across residencies. Objective: To examine variations in inpatient illness severity and diagnostic diversity at the affiliated hospitals of small, medium, and large pediatric residencies. Design: A retrospective analysis of hospital discharges among children aged 0 to 18 years (excluding newborns) in a sample of pediatric residency programs within the University HealthSystems Consortium. Main Outcomes of Interest: The study compares the mean and median Diagnosis-Related Group (DRG) weights of hospital discharges (illness severity) as well as the percentage of discharges for the 5 most common diagnoses and the percentage of discharges for asthma (diagnostic diversity). Results: There was no relationship between mean and median medical DRG weights and residency size (mean DRG weight: small, 0.89; medium, 0.86; and large, 0.85 small vs medium, P=.29; small vs large, P=.23). Larger programs had surgical patients with more severe illness (mean DRG weight, small, 2.11; medium, 2.08; and large, 2.47; small vs medium, P=.85; small vs; large, P=.02) but less diagnostic diversity (small, 24.9%; medium, 25.9%; and large, 29.9%; small vs medium: P<.001; small vs large, P=.07). The proportion of medical discharges for asthma increased with residency size (small, 6.5%; medium, 7.4%; and large, 9.3%; small vs medium and large, P<.001). Conclusion: Large variations in inpatient illness severity and diagnostic diversity were seen across programs, but program size was found to be a poor indicator of inpatient learning opportunities.