Postgraduate pediatric education in Chile: challenges for training quality in an expanding system

Abstract

The training of pediatric specialists is essential to ensuring safe, comprehensive, and equitable health care for children and adolescents. In Chile, postgraduate education in pediatrics has expanded steadily over recent decades, as evidenced by the growing number of university programs and the increasing number of physicians in training. While this expansion has strengthened the pediatric health workforce, it has not always been accompanied by equivalent, systematic mechanisms to ensure the quality of training. The objective of this manuscript was to critically examine postgraduate education in pediatrics in Chile, focusing on the training capacity of residency programs, curricular organization, the role of clinical training sites and tutors, and mechanisms for graduate certification and quality assurance. The shortage of specialists, territorial distribution, and demographic context are included as complementary analytical elements, as they influence the design, functioning, and outcomes of the training system, rather than as central objects of analysis. From an educational perspective, we explore the tensions arising from the expansión of training places in settings where teaching capacity on clinical campuses and the availability of

teaching staff have not always increased in proportion. We also address the challenges related to the transition toward competency-based education, the influence of information technologies and artificial intelligence on clinical learning, and the risk of reductionist approaches that may favor procedural efficiency over reflective clinical reasoning. Based on comparative international experience, the analysis concludes that there are no universally applicable models, but rather quality principles that must be adapted to local contexts. Two main approaches are identified: centralized systems, characteristic of continental Europe, with structured national curricula and progressive

assessment; and Anglo-Saxon models based on independent program accreditation and standardized final certification. Both models offer relevant lessons for the Chilean context. Strengthening postgraduate education in pediatrics in Chile requires greater alignment between profesional roles, curricular design, program accreditation, and graduate certification. Ensuring excellence in pediatric training is not only an academic challenge but an ethical and public health responsibility fundamental to safeguarding the right to health for children and adolescents.