Journal Club | Pediatric Residents' Preparedness, Preceptor Crisis, and Building a Better Doctor with Dr. Rebecca Swan and Dr. Jessica Barnett

In this episode of Cumberland Conversations Journal Club, Dr. Lillard sits down with Dr. Rebecca Swan and Dr. Jessica Barnett to tackle some of the biggest challenges facing pediatric medical education today. From resident preparedness and the growing preceptor shortage to rethinking how we train the next generation of physicians, they explore the research behind these critical issues and share practical strategies to strengthen clinical teaching. 

Join the conversation as they discuss how educators can move beyond teaching medicine to building confident, compassionate, and resilient pediatricians ready for the future of healthcare. 

This episode's articles include the following:

The Community Preceptor Crisis: A Call to Action

Pediatric Residents' Preparedness and Training Satisfaction: 2015 to 2022

How to Build a Better Doctor 

If you have follow-up questions or comments based on the articles in this week’s journal club or have articles you would like Cumberland Conversations to review in the future, please email cpfnashville@gmail.com. Tune in, stay informed, and be part of the conversation! Don’t forget to subscribe so you never miss an episode!

Transcript

SPEAKER_03 0:00

Hey there, welcome to Cumberland Conversations. This is the place where we talk about the issues that matter most to you, your patients, and your community. We're diving into real conversations with real people, sharing insights you can actually use. Let's get the conversation started. Hey everybody, it's Rob Lillard, Medical Director of the Cumberland Pediatric Foundation. Welcoming you back to another episode of Cumberland Conversations, our podcast where we discuss everything that's going on in the world of pediatrics. And today we are doing a journal club with a little bit of a different take. We're going to talk about training the next generation of pediatricians. And it's an appropriate time to talk about this because we are recording this on July 1st, when all the new interns are starting fresh and having a great time today. So I am happy to be joined by Dr. Rebecca Swan, who is Vice Chair of Education for the Department of Pediatrics of Vanderbilt University Medical Center, and Jessica Garnea. Did I say that right? Yes. Okay, wonderful. Who is not working at the hospital today because you have graduated and you are off into the world of primary care uh here in Nashville, correct? Exactly. Children's study because we'll be. So we are looking forward to a conversation uh about where we are in today's training and workforce development for pediatrics in the future. So we pulled um several articles uh and we're just gonna walk through those and have a conversation uh about some of the challenges and where some of the positive things in the future training of pediatricians lies. And we want to start with an article that was in the November 2025 uh issue of Pediatrics uh titled The Community Preceptor Crisis and a Call to Action. We have seen this, especially in our community, as a little bit more of a challenge to find preceptors. And um, but the article makes it very clear, I think, that they are an essential part, especially having experience in the pediatric office, because there are some things that you just can't replicate in a hospital system. I think, Rebecca, would you agree with that?

SPEAKER_02 2:08

Absolutely. I think there's definitely differences in both what occurs in an academic-based continuity clinic, but certainly in order to see what actually goes on in a community setting, there's no better experience than actually working with a community preceptor.

SPEAKER_03 2:22

Right. And did you have that opportunity? I did, yes.

SPEAKER_01 2:26

Tell me about your We have our private practice elective that we can choose to go into. And with those, I was able to shadow an Academy Children's Clinic and get more of a feel of what it's like to be in one of the more community settings and how that runs different than our um like hospital-based clinic. Um I was really happy and excited to see how much more continuity there was able to be and just how close um a lot of the patients were with their providers, and really a very close-knit family feel that was highlighted in the community clinic in particular.

SPEAKER_03 3:06

Yeah, and and I agree with that. I think I still remember back even uh when I was in medical school at UAB, we had the opportunity, we went out in the community, and I worked in a small town in a family practice. And um obviously I didn't know I was gonna do pediatrics at the time, but it really I saw primary care as a whole new light because it was just you were everything to the patients, but also the standing in the community. I remember going to the lunch, you know, in the small town diner and things like that. Everybody just knew who everyone it was in that office, and so uh it was that sense of reward and meaning that uh that I think kind of led me down that path. And so, but the challenge is now. I mean, obviously the world has changed a lot. Uh, I've done this for a long time, and and what pediatrics was then and what it is now is totally different. Practices are in a very challenging environment in terms of schedule, in terms of cost. It it's almost it creates more barriers for a good educational experience. And so um, not to mention the fact just financially, I think it's a drain uh sometimes on practices to slow down and be able to teach. There's a there's a lot of emphasis on being as efficient as you can right now. Um so have y'all seen that as a problem as far as a finding, and I'm talking to you, Rebecca, I'm sorry, but uh assigning or finding preceptors, and what are your barriers that you're seeing?

SPEAKER_02 4:30

Yeah, I think that's true, and I think that's probably true at um from the both the you and me, so the medical student as well as for residents to find. And I think that's true not only in our community, but uh, you know, across the country, that's something we talk about in terms of finding preceptors. And generally, I think pediatricians enjoy teaching. I think that's one of the things that you know we enjoy. Obviously, we spend a lot of time teaching families and patients, so I think many of us are, you know, that education is something we love to do, but I think there are barriers to it. And so finding practices and providers who are able to provide those opportunities for our learners has become an issue. And it ties into giving experiences like Jessica had, but also to our students. Um, and we know that that all ties into, I think part of the conversation we'll eventually have, but how we influence our students to want to go into pediatrics is to make sure they're having those experiences and that they can see the joy that we have when we're actually practicing, in addition to understanding how practices work. So there's a multitude of reasons that we need to have preceptors, but there are many challenges that are highlighted in that article in terms of the the issues that come up with that.

SPEAKER_03 5:38

Aaron Powell Right. And and some of that, you know, is financial, obviously, but some of that is I think there are certain preceptors now that don't feel comfortable in that teaching role. And so how do we go about creating an environment where they're comfortable as teachers and preceptors? Is that something that y'all have talked about?

SPEAKER_02 5:56

Yeah, I think there's you know, I think providing um is it as easy as providing some faculty development, so some easy on-the-fly faculty development. It's always hard to know what the best way to deliver that is. Is it ways that we could do it over a lunchtime gathering where somebody comes in and provides that? There are CMEs that are virtual that they could join in, you know, the things that are offered on the main campus that they could, you know, participate in. It's it's um it there's not a one size fits all to provide that. Um, and certainly um I think trying to figure out the best way to deliver that would be important. Um, we've certainly have heard that, that that is one of the things that some providers feel uncomfortable, that they don't um know the best way to teach. Uh on the other side of that, I think one of the ways that many of the learners will say that they've learned the most is really by um watching what our providers do, that there is so much to be gained from the basics of communication skills and seeing how they examine children. And so some of it is not that the world has changed so much, it's that they just need the time with a provider to see how our provider provides care and works with a family. Right. There are some aspects that they need to understand in terms of the evaluation systems and those sorts of things, but many of our learners are just hungry to spend time with a provider taking care of families.

SPEAKER_03 7:22

You know, I think that's an excellent point because, and I don't know what your experience was, but I think there's so many students come in and residents for that matter want to come in and just say, let me see the patient and do learn the skills and things like that. But to Rebecca's point, there's a lot to be learned by just watching someone who's done this and being in the corner and seeing how they interact and just basic skills of how to make children comfortable or how to address patients' concerns when they're very anxious, be it for vaccines or other things. And so those sorts of skills just by watching are things that can feed into you. And it, I don't know, did you experience that?

SPEAKER_01 7:55

No, I couldn't agree more. Even I think in my last clinic, technically as a resident, I still would ask kind of the more experienced seasoned attendings how the there's always nuance with things, and how do I effectively explain with this without being too scary, but also not oversimplifying it and kind of brushing it under the rug. I want to convey the importance of something or um how to more seamlessly do a physical exam thing, like looking in ears. I feel like I can never uh get too much experience as far as like just seeing how different people do it, because it's can be chaotic every time. Um so yeah, even I think just the more observation and just kind of absorbing all of the expertise that people have built up over years of practice and trial and error has been invaluable, truly.

SPEAKER_03 8:55

I uh I was working with a student the other day. I was teaching pneumatic autoscopy. Have you ever did you have you learned that skill?

SPEAKER_01 9:02

I wouldn't say I'm confident in doing it myself, but I have seen it, yes.

SPEAKER_03 9:06

Yes, and it's it's something they're like, oh wow, that's really cool. When you can get it just right and they can see that eardrum move. It's it's and the other part of this, and I'm gonna jump ahead a little bit, I plan on talking about this later, but something that you get in the office that you can't really do inside a big system is learning how to run a practice too. Especially, this is more talking about residents and students, but if you're thinking about primary care, you know, how do you know what insurance to bill? How do you bill? How do you get that money in? How do you get it to the bank? All those sorts of things. And when I had residents uh in my office, um that you know, the setup is sometimes they would come out for several weeks at a time, if not over six months, you know, on certain days. And I would have them actually spend time in the office, uh the billing office and things like that, so they could learn, you know, even a check-in process. And uh, you know, how do you decide on an EMR and all those sorts of things? So there's a lot of things that I've again going back to the value of community preceptorships, and you know, obviously at CPF we're trying to advocate hard for our members to continue to provide uh good precepting experiences, and uh we're trying to recruit more. And I I think another great experience, I mentioned my experience being in a rural area. I mean, if we could find a way to get folks out into rural communities, there is a lot of great things to learn and see out there, and and um great teachers who are out there doing great things too. So I know it's difficult in today's environment. I I I can't get used to the fact that some people don't even have cars. They come and they just you know either bike or Uber, and it's like we can well, there's there's a little bit being left on the table, I think, when it comes to that. But uh so I I think this is all great stuff, and I want to kind of turn to the second article, um, and that was talking about residents in their program and their comfort level and preparedness to go into whatever, be it subspecial or things like that. And this article came out, also a pediatrics, in February of 2024, so a little bit older, but it looked at data over a period of, I believe it was close to 10 years, was it 2015, I believe, into through the pandemic and into 20 uh 22. Um, and they saw some interesting things, most notably the biggest declines in confidence were among those that wanted to enter primary care practice, and a confidence level that was at 68% fell to 42%. So I'm gonna ask you, as you're getting ready to start in primary care, do you have any reservations? Or do you feel tell me about what you felt like your training was like and uh since especially since you've been in a practice, do you feel walking in on day one you're ready to go?

SPEAKER_01 11:49

I mean, I think being a brand new graduate, I will not feel completely ready. Obviously, there's a lot that comes with time and experience. I think my continuity clinic experience was harder to get comfortable with at the beginning just because it's something that we do maybe once a week, um as opposed to a different rotation that you're on day in and day out, and you see kind of that comfortability build sooner. But I think towards the end of intern year and going into second and third year, I have become infinitely more comfortable in clinic. And since it is something that I'm going into, I think I put more time and effort into kind of streamlining my process and becoming more comfortable. Um with it's a little bit also of kind of ignorance is bliss. And starting out, I you don't know what you don't know, and then you spend more time just experiencing all the different questions out of left field. Um I'm like, I have not even thought about that. Let me look into it. And um there's just such a breadth of things that pediatricians just are on the front lines with kind of fielding and deciphering what the next best step is. Um and so I think I'm trying to go into it with a mindset of I don't have to know everything about everything. I need to know I think the bread and butter things, but also know what my resources are. So there's inevitably going to be things that I don't have the answers to, but knowing who to ask and where to look things up and continuing to develop kind of my knowledge over time rather than expecting myself to know everything day one, because that's just unrealistic.

SPEAKER_03 13:43

That is incredibly wise. I think you are well suited and well prepared because uh those are the sorts of things when they ask you, what do I do if my child won't keep on bucking buckling his car seat in the back. Those sorts of things. You're like, uh Yeah. And yeah, you just know you've got your resources. You've got your partners, you've got CPF, you've got you know, people that you trained with that you can fall back on and ask those questions. Somebody asked me once, when did you feel comfortable with every aspect of your practice? And I told them honestly, I think it took me at least 10 years after I graduated to say that I was comfortable, but you could throw anything at me, and I knew. Uh, but there was a lot of humility and a lot of uh, you know, just you relying on, like you said, your partners and and all your resources. When I came out of uh residency training, I had a great job opportunity offered to me in Dallas, Texas, uh Richardson, just north of Dallas. And I thought this was perfect. My mother-in-law lived, you know, five, ten minutes from this practice, and this gentleman was wonderful. I walked around, I said, This is it. And he said, Now, if you start, I'll hang around for a few months and then I'll head out the door. He was gonna hand me the keys to his practice, and I was gonna be in solo practice three months post-graduation. Can you imagine that? Wow. Um I ran as fast as I could. Um, because I really think, and and looking back, I mean, again, to your point, it there's a lot of learning to be done as you go, but I think I think your approach to it is wonderful. Uh, and and things have changed a lot, I think. Um, you know, when I came out, you know, spinal taps and all those things, those were the things that you knew you were probably gonna have to do, and then circumcisions and procedural stuff. There's a lot more of that in treating illness. And now with behavioral health and things like that, it's it's a whole different ball game. Uh, and maybe that has something to do with uh folks being less comfortable in primary care practice and what their exposures are. But um again, I think that dovetail dovetails back into the first article, which is we really need to get them outside and experience everything possible, uh, every environment of pediatrics and support them in that way. Rebecca, do you have anything to add to that?

SPEAKER_02 15:55

Yeah, I you know, I'm not necessarily surprised by this, to be totally honest. I think um we I was program director for 20 years um before I took on this current role, and we have surveyed um and this data has been available every year, and so it's not uncommon for this information to come out. And until the recent changes to the residency program, I would say we often train people to be very good hospitalists because they spent so much time within inpatient world.

SPEAKER_03 16:24

That was my day.

SPEAKER_02 16:25

Yeah, for sure. And um, when you go to a fellowship, even if you're not ready to be a fellow, you still have supervisors, right? You're not on your own. So when you go out to practice, and I always advise people, please don't go out in solo practice because you need mentorship, you know, you're nervous because you don't know what well, you both don't know what you don't know, and you know there's a lot of stuff out there that you don't know. Um we survey our uh graduates a year out. So um just to see similar questions, but after they've been out there a year. So what did we not prepare you for? Um and most of the things are the things that you would expect that they say if if they were in private practice. They wish they, you know, they feel like they've learned a lot about development, the things that you can't learn doing once a week continuity clinic. Gosh, they they've learned a lot about development, about mental health, about the things that you just need to learn a lot and the business of medicine, because it's the things you don't learn because it's very challenging to teach, because if you're in the middle of a residency where there's so many other things that you have to learn, it's hard to find an engaging way to really teach that. And I was the same way when I was a resident, way back when, like, you know, the economics of healthcare were not the top intriguing lecture that I wanted to hear. So but those have been very consistent on the feedback that we've gotten. So um I do think the ACG me changes have helped so that there's more time in outpatient subspecialties and they're trying to kind of pay more attention to mental health education and those sorts of things. But you're a hundred percent correct that I think more time with community preceptors will hopefully help a little bit of that.

SPEAKER_03 18:02

Well, I want to I want to maybe hear a little bit more about the changes in and the structure of programming, what we're doing, but specifically I would say what what are what do you think is the right approach to teach more of the business part of the medicine? Is there a way inside the curriculum we do that or do we leave that for our preceptors?

SPEAKER_02 18:20

Well, I mean, Jessica can you know chime in. I mean, I think there's some of it that's handled, so in in our clinic setting, we do teach how you bill and think through. And so they're responsible our residents are responsible for billing their own clinic visits within, but it's within the spectrum of our patient population, which is majority Medicaid, so that you are learning to understand the basics of that. But it doesn't delve into how you manage a business and the ins and outs of hiring, firing, looking through, getting approvals for things with different um insurance plans and those kinds of things. We do a few prior authors and those kind of things, but not a significant amount of those things. Um, we have a primary care interest group now, which is new in the last few years. And I think we've had a few speakers, you know, from the community come in and talk about those kind of topics. I think that works better because it's a motivated group who have specific questions that will, you know, when you're motivated and you have someone that's talking about it who lives it all the time, I think that helps. Um, I think having speakers come and talk to the whole residency as a group over lunch has not been effective just because it's just not effective. You know, it's a mixed in audience and distracted by other things and who has the best cookie in the box. Yeah, yeah, yeah. So I don't get a trade. That hasn't worked well. So um and then I think going out into you know a primary care elective, I think helps because you can sort of see it in action.

SPEAKER_03 19:46

So well, and we're trying to put together some structure here at CPF on whether it's lectures or things like that, some educational opportunities, because it's not just residents or even students. We're finding as we go in the community um where a lot of practices are struggling, and and that goes back to why a lot of practices are being purchased now, is um there's a lot of people out there in practice still that that need education. And um I was just before we walked into the the studio here, was looking at the uh AAP national meeting that's coming up and their uh practice management uh lectures and curriculum that's assigned, it's going to be excellent. So uh quick quick shout out for anybody listening. If you want to go to San Diego in October, it's gonna be a great conference. So um think about that. There's lots of things to be learned, plus a lot of networking. That's a lot that you can go into that meeting and meet a lot of people who can be mentors from afar, even. So don't just limit yourself. Uh the section of uh office and practice administration and office management is it's only $35 a year. It's a great resource for pediatricians across the country that are doing these sorts of things. And um I would recommend that to anybody in a heartbeat. But uh we've got lots of local pediatricians too that that are interested in teaching business that uh we would love to kind of connect with everybody. Um but uh getting back to the other part of that, tell me a little bit about how the curriculum has changed and and how we're addressing that.

SPEAKER_02 21:18

Um so the ACGME in 2025 uh mandated um just to kind of keep the details kind of at a higher level, two I would say significant changes. One was the implementation of behavioral health as a required curricular aspect. So which I think is for anyone who's currently practicing pediatrics understands that it's gotta be really a structured experience that's not just inpatient behavioral health, but inpatient and outpatient exposure to that. Um that is one module or one curricular rotation that's been added. And the other is exposure early on to outpatient subspecialty experience. Which has been a nice adjunct to what we do. Because I think, especially for residency programs that are based in a tertiary care hospital, like we are lucky to have in our community, it is very easy to train on mainly inpatient experiences, right? And then use electives to, with the elective time you have, and I think our residents get a fair amount of elective time, but then you've, you know, your electives are half a second year, essentially a third year, you're kind of figuring out what you want to do. Well, this allows interns and um to go to a variety of outpatient clinics in the subspecialties. So that's two things it does. One, it exposures you to them, which is nice for many of our subspecialties that are um don't have a lot of interest, but it's also if you're going to do primary care, you really see the aspects of the subspecialty that you really need to see. So a great example is cardiology. We have fabulous cardiologists, but our inpatient cardiology experience is really specific. Those are very critically ill, complex children. And so we need to take advantage of our outpatient cardiology, which is fabulous. So I think that's for an example of one change that I think has been great.

SPEAKER_03 23:09

You need to hear all those murmurs that you're going to hear in the exam room every day say, oh, that's normal. I can tell you that's normal, and we can wait and watch and all those sorts of things. So uh yeah, I think I think that's wonderful. So um, and you know, the other thing I think uh we wanted to go on to is the the the last article that we had um talked about. This is factors that influence medical students' career choice um into going into pediatrics. Because again, as we need to recruit more pediatricians, um I think it's an interesting look at why people are not choosing pediatrics. Um couple things that I took away, and they looked at, by the way, this was a group I should mention, this came out of the Journal of Pediatrics in February of 2024. Uh again, it was titled Factors Influencing Medical Students' Career Choice to Pursue Pediatrics. And uh when they did a study and they were able to get 426 respondents, uh, and these were fourth-year medical students, I believe, that had gone through the process of the interviews but had not yet gone through the match process. So it went, it was a questionnaire. And 15% of those uh had chosen pediatrics, uh, 40% had considered pediatrics but chosen another field, and then 45% were like, no way am I doing pediatrics. Um couple of interesting things. 42% of people who chose pediatrics knew before they even started that it was like a chosen, like I want to be a pediatrician. And I don't know if you see that necessarily any other field. Uh in fact, I think it was 22% who considered pediatrics and then switched to something else, and 9% uh of those who excuse me, 22% who never considered pediatrics, nine percent who switched. Um but they looked at a lot of the barriers uh of that, and not surprisingly, I should say, uh, is a large number of people who chose to go away from pediatrics mention earnings potential. Um and you know, that is not shocking to probably anybody who's listening to this podcast is that we are not the wealthiest doctors on the block. Um, but we knew that going in, right? And so um, but I think the other thing that shocked me was almost, I don't think I have the exact number in front of me, but uh almost half of those graduating now have $200,000 in debt. And so I think that is a significant barrier. And so um, you know, now we're getting into the world of politics and everything else that goes with that, but um I'll just go back and tell you that the years that we had Medicare parity for Medicaid payments were were some of the best times that pediatricians had. I mean, you felt valued, your your payments were up, but now those payments, especially for Medicaid, which is such a big part of it, especially a new pediatric practice, um doesn't exist. Um But the other factor besides payment, which is more difficult to deal with, people who chose pediatrics were heavily influenced by mentorship. Okay. And so I'm gonna turn to Jesse and say, first of all, did you, were you one of the 42% that knew you were gonna be a pediatrician from the get-go? I was, yes. I've been So what influenced you?

SPEAKER_01 26:29

Drawn? I don't I I can't even necessarily put my finger on it. Um I just knew I think even yeah, before medical school, and actually before medical school, I was a behavioral therapist for kids with autism, and I knew that I'd say that about you. Yeah, I enjoyed working with children, and I think it's just the joy and and just being at the pediatrics hospital is to me infinitely better than being at the adult hospital. I can't even explain it. The color, the the kind of emotions, the I know it's a difficult time, especially if you're in the hospital and and whatnot. Um, but I I don't know, I just I think so many uh pediatricians that are drawn to the field have the similar sense of just wanting to work with kids, knowing that they want to work with this population um from early on. And it's so interesting. My husband, who's also in medicine, he knew off the bat that he did not want to work with children. It's just that inherent uh you either kind of know or not for a lot of people, um, and choose to go into pediatrics despite be maybe making less than another specialty or whatnot. Um yeah, it's um I will say I I was part of the the percentage that knew early on.

SPEAKER_03 27:50

You said uh you were behavioral.

SPEAKER_01 27:51

I was a behavioral therapist. So for kids with autism doing um like ABA therapy. Uh-huh.

SPEAKER_03 27:57

Did you have a graduate degree in that before you started, went back to medical school?

SPEAKER_01 28:01

I not at that time. No, I got my graduate degree after.

SPEAKER_03 28:05

Okay. All right, that's outstanding. So again, it goes back to those exposures that that mold you. And and again, that goes back to I think having the examples uh laid out before you which we've you know we've got to continue to uh make sure we provide those early exposures. And speaking of that, uh I we had a great uh kind of change this year. Vanderbilt or development of Vanderbilt, I guess we'd say, it's 2025, actually, I think when the undergraduates at Vanderbilt started the Vanderbilt Pediatric Association. Is that how they yeah, so uh and I think you were involved in helping setting that up. And I've I've worked with uh one of the co-founders there and and mentored a little bit. And um tell me a little bit, did they come to you with this idea?

SPEAKER_02 28:52

So uh Vanderbilt certainly has um university certainly has uh pre-med advising, and this was a group at the same time that we were trying to at a department level um work on some other efforts to um increase opportunities for high school students in the community to get involved in research and shadowing, just to increase um interest in health care sort of across the board. I'm involved in some other ways. There's a pre-med book club and there's some other things that go on at Vanderbilt. Um, but they came to us and said they wanted to start a Vanderbilt Pediatric Association. And so two um Daisy Senior, who is the emergency medicine, PEEDs Emergency Medicine Fellowship Program Director, and Devon Pestacki, who's one of the associate program directors for the residency program. So the three of us worked with them to work on getting it approved as an official organization at Vanderbilt. And they have been phenomenal at kind of organizing to do both service in the community, which has been great. They've worked with a local elementary school doing some service activities, um, getting a variety of people to do presentations on a variety of uh career opportunities, everything from pediatric surgeons to child life to other ancillary services and sort of PEADs adjacent things, to just kind of broadly speaking. They've had fellows and residents come do panels. Um, they've been very active. And most recently, they've actually they connected with the um AAP and actually are also have developed a toolkit so other universities can develop it. And most recently, Duke universities actually developed their own um, I don't know what they're calling it, Duke Pediatric Association, which is may not be what they're calling it, but the same sort of activity, which isn't even Duke's finally recognizing that Vanderbilt is the leader in the field. Yes, exactly. So I think that's great because I think that um when in that article they were talking about modifiable factors to increase interest. And I think that um the the politics of changing reimbursement is I I'm gonna go out and say is probably outside the scope of this table. But things of helping increase exposure both at the university and before, increasing exposure in the early years of medical school, those are things, and in the clerkship are things that we can definitely make effort with. So that's a great place that you know increasing mentorship and preceptor show can make sense.

SPEAKER_03 31:20

And I will agree with you, it's outside the scope that we can change it, but it doesn't mean we can't talk about it. Oh, absolutely, absolutely that um, you know, I we tend to be nice people as pediatricians. We not don't like to be confrontational much of the time, but I think at some point we have to say the future of child health is important and it should be valued, and I think we need to continue saying that over and over again until somebody listens.

SPEAKER_02 31:58

Right.

SPEAKER_03 31:59

Um and and network, network, network with your, you know, know who your politicians and representatives are, and and maybe they listen, maybe they don't, but but the more they hear from us, the more it matters, I think. So absolutely. And and again, it goes back to experiences. And uh, you know, I wouldn't be here today if it weren't for the experiences I was given. Uh, even going back to college, um, you know, had a chance to volunteer at a hospital. But importantly, I had an opportunity to be an intern chaplain uh at a hospital, which was fascinating. And I I didn't know what to make of it, but uh, as as one of the uh preceptors said, this gets you over the fear of walking in and what's on the other side of the door. And it really did. You you learned everyone has a story, and everyone has a different background. And I think that was probably laid the groundwork for me going into primary care because it's like, oh, there's more than just what's in the textbook. And you you start to learn uh how important, and and and again, that goes into you know, ACEs and and uh you know, you know, trauma-based care and things like that, all the sorts of things that we have names for now. Back then we were just saying it's your story. And uh I think that's uh it's important that we get these or get in front of these students and get in front of the people and show them that what we do is very valuable. And um, you know, every pediatrician can tell you a story like this. But you know, I've been out of clinical, full-time clinical practice for a few years now, but uh ran into a patient while I was shopping. And uh, of course we swap stories, it was good to see them, got a couple hugs, but uh she finally almost kind of did bring me to tears when she said, you know, you don't know the difference you made when I had those two young kids. She says, I I was, you know, I didn't know what to do, and you were so helpful in walking me through it. And, you know, I told my children, I said, you know, we may not get the notoriety or the respect or whatever you want to call it. We definitely don't get the money. But I will walk out of this one day and know that I I helped people and I I made made a difference, and that's that's all I can ask. And so I think the same goes for when we talk about all these issues about medical education, is people did it for us and laid the groundwork for us, and we need to kind of make sure that we're we're laying the groundwork for them because uh I think the health of everyone in Tennessee and and and across the country depends on it. So I appreciate y'all sitting down to talk about this. Any any closing comments that you wanted to make, Jesse?

SPEAKER_01 34:28

I just agree wholeheartedly. I similarly uh kind of reflect back on my mentors and early on in medical school getting the exposure I think was crucial because not everybody had the opportunity, at least in my med school, to do specifically pediatric primary care as their continuity clinic one. And it was kind of a lottery system, so I was lucky enough to be able to do one of the pediatrics ones just because there was a lack of pediatric preceptors, even. Right. Um, so yeah, that exposure is just of the utmost importance. And um similarly to you, I recently had an encounter with a family that just really expressed a lot of appreciation. And um, it was a little bit sad when I was saying I was graduating and moving to a different clinic, and they were like, What's the clinic? I want to come, and and you have been just amazing for my kids here, and and I was able to at least sit tell them that I was staying in Nashville. So if they wanted to come, they were more than welcome to. And yeah, so it's we do it for the families, for the children, for these experiences, and even if the money is not as um as much of a draw as other fields, I think um it's uh uh necessary and um it's really worth it even in the end.

SPEAKER_03 35:53

I I would I wouldn't change a thing about what I've done. So Rebecca, do you want to close with anything?

SPEAKER_02 35:58

Well, I I think that um the role of a mentor and a preceptor cannot be um, you know, de-emphasized. I mean I think and that it's not there's not really specific training that we can't we can provide whatever people need, but I just think the presence of someone who's walking that walk, just showing a student and a trainee what that looks like and how much you enjoy what you do means more than people really realize. You don't have to be super trained in special skills, it's really just allowing someone to see you in doing what you're doing and how you interact with families and whatever we can provide. I'd love to, you know, work with you and CPF to see what we can do to help that because we know it really does matter. The earlier a student can see what pediatrics looks like, the better we have the chance of overcoming some of these other things so they can see what a joy really is to do what we do.

SPEAKER_03 36:53

Absolutely. Um and so for those of you listening, watching, uh, we would love to talk to you about the opportunity to be a preceptor or how you can get involved, or if you want to and you are facing some of those challenges we talked about, talk to us about that too, because we certainly want to have those discussions uh here. We want to have those discussions at Vanderbilt so we can continue to produce the quality of pediatricians and the people that will enjoy this career and like I said, change the lives of people uh throughout the state. So thank you for listening. Uh and if you have any questions about this episode or something you want to hear in future episodes, I always say reach out to us at cpfnashville at gmail.com. Uh your email will be forwarded to the right person, and we're happy to talk to you and correspond with you. So uh thank you again for listening and being with us, and until next time, take care.

SPEAKER_00 37:48

Thank you for joining Cumberland Conversations. We're proud to support the people who care for Tennessee's children. Don't forget to subscribe so you never miss an episode and stay connected with CPF for more tools, trainings, and community updates. Until next time, take care.