Reprinted with permission of AAP News, December 2004

A quarter century of learning PREP, PIR educational programs keep pediatricians current

by Sheryl Cash
Correspondent

Editor's note: This is another in a series of year-long articles commemorating the Academy's 75th anniversary.

Twenty-five years ago, the Academy created a historic educational program to help pediatricians maintain and enhance knowledge and prepare for a then-voluntary competency exam.

Today, the Pediatrics Review and Education Program (PREP) The Curriculum, Pediatrics in Review (PIR) journal and PREP Self-Assessment (SA) are the gold standard for ongoing pediatric education, with a national enrollment of 35,000. In the United States, the Self-Assessment and PIR components work in conjunction with a mandatory American Board of Pediatrics (ABP) Maintenance of Certification exam, now required every seven years for pediatricians certified after 1988. Internationally, PIR is available in six languages with a worldwide circulation of more than 60,000.
"The program is considered by both residents and practicing pediatricians all over the world as one of the very best ways they have of staying up-to-date and keeping current in pediatrics," said AAP Executive Director Errol R. Alden, M.D., FAAP.

"PREP was born ahead of its time," said Mary Ellen Rimsza, M.D., FAAP, PREP SA editor. "Today, the boards of the professional organizations recognize that assessment is essential if a physician is going to maintain competency."

PREP The Curriculum was designed to meet two AAP objectives, said Robert J. Haggerty, M.D., FAAP, PIR editor and founder: to help pediatricians maintain and acquire new abilities and to set priorities for their own professional advancement.
Its origins, said Dr. Haggerty, are rooted in the Academy's ongoing commitment to educating pediatricians as a primary means of improving child health services and, ultimately, child health.

PREP SA first appeared in early 1980. By fall of its first year, more than 8,000 pediatricians had registered. PIR debuted in July 1979, with Dr. Haggerty as editor and James McKay, M.D., FAAP, and Jerold Lucey, M.D., FAAP, as associate editors. Floyd Helwig, M.D., FAAP, was the initial editor of PREP SA, to be succeeded by O.J. Sahler, M.D., FAAP, Kathleen Woodin, M.D., FAAP, and now Dr. Rimsza.
In the early 1980s, a grant from Abbott Laboratories (now parent of Ross Products) allowed Latin American distribution of PIR and the beginning of a resident distribution, initially limited to PL-2s.

Now, a grant from Ross Products Division, Abbott Laboratories, supports distribution of PIR to all pediatric residents in the United States and Canada. The Academy supports distribution of PREP SA and the content specifications and PREP study guide booklet.

PREP SA is available in a variety of formats - in print, on CD-ROM and online via PediaLink (www.pedialink. org).

PIR is mailed to subscribers each month. The journal has been available on the Internet (www.pedsin review.org) since 1999 and offers interactive CME testing and an online credit summary report.

The components serve pediatricians in meeting requirements for the Program for Maintenance of Certification in Pediatrics. PREP SA fulfills Part Two: Evidence of Lifelong Learning and Self-Assessment, while both PREP SA and PIR assist physicians in preparing for the secure examination.

"If you read the journal diligently for five years and do the self assessment examination, you are going to cover the broad spectrum of pediatric medicine," said Lawrence Nazarian, M.D., FAAP, PIR associate editor since 1989, who will succeed the retiring Dr. Haggerty as editor in January.

PREP SA and the content of PIR are based on more than 3,500 content specifications that constitute the core of the ABP's Maintenance of Certification examination.
"Today, at least half of all pediatricians are in the mandatory recertification program," said Dr. Haggerty. "Nowadays, we promote the concept of life-long learning," added Dr. Rimsza. "This involves using a number of different educational approaches, depending on your preferences and learning styles."

"PIR is geared toward the practitioner," said Dr. Nazarian. "Many of today's journals are 'new science' journals - with the latest articles and late-breaking research. But I think it's more difficult for a busy practitioner to get information from these types of journals. There's so much information and a lot of it is just coming out in research and is not immediately relevant in practice.

"PIR brings the practitioner up to speed, providing tried-and- true information that is as current as possible in a way that is readable and palatable," said Dr. Nazarian. "That's important to people who come home after a long day at the office. With PIR they're making good use of their time."

Over the next few years, PREP The Curriculum hopes to add much more evidence-based material "as we have more and more literature available," said Dr. Rimsza. "Through an evidence-based approach, you systematically review all the pertinent research studies and decide on the quality of the research to support a particular approach. "We don't want the information to be based on one person's opinion," said Dr. Rimsza. "We need to look at the quality of the research as well as the results."

Dr. Nazarian said changes are under way for PIR, "although we don't want to disrupt the basic approach that has worked so well over the past 25 years."

Improving online capabilities for PIR, including new audio/visual features, and the expansion of special departments and sections "that teach in different ways" will greatly assist pediatricians, said Dr. Nazarian."We would also like to expand into other countries," said Dr. Nazarian. Currently, PIR has Spanish, Italian, Hungarian, Polish and Portuguese editions, as well as an English version distributed in India.

Dr. Haggerty said he is confident that PREP The Curriculum and PIR will continue to evolve to meet the new health advances and threats to child health. "The effects of maternal illness and depression, smoking and obesity, these are all new problems that have arisen in the past 10 years," said Dr. Haggerty. "Who knows what the next ones will be? PIR will respond to them and be the educational vehicle for practicing pediatricians."

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