The impact of training in behavioral pediatrics: a study of 24 residency programs.

Three groups of residency programs were compared: 11 externally funded to provide mandatory behavioral training, seven not externally funded but providing mandatory training, and six controls not requiring training. At the beginning and end of 1980-1981, 569 residents (70%) completed questionnaires assessing attitudes regarding behavioral disorders, physical disorders, and "mixed" disorders (with physical and behavioral aspects). Behavioral knowledge was tested by 60 multiple-choice questions. Virtually all significant effects of program type occurred in the PL-2 year. For three attitudinal measures, "competence in management," "ability to advise parents," and "future relevance," only Funded residents demonstrated higher change scores for both behavioral and mixed disorders, relative to physical disorders; Funded and Not Funded residents were superior to Controls regarding behavioral disorders. For "knowledge of resources" and "facility interest," Not Funded change was superior to Control. Given higher Funded ratings initially, Not Funded ratings approximated Funded ratings by the end of the year. Regarding knowledge, Funded and Not Funded residents showed greater improvement than Controls. These data suggest that: changes in attitudes and knowledge are related to mandatory training; Funded programs generate the most consistent changes in both behavioral and "mixed" disorders; and the impact of training is most evident in the PL-2 year.