by Debra Katz, M.D.
(article published in APA Medical Student Newsletter, Volume 13, Issue 2, Fall 2004)

"What led you to triple board training?" is a question applicants get asked everywhere they interview. As the residency training director of the Triple Board (TB) program at the University of Kentucky, I hear a variety of answers and wanted to share some perspectives on what TB training is, what issues an applicant should consider before applying and what types of careers might be possible as a TB-trained physician.

Triple Board programs combine training in three specialties in five years: Pediatrics, General Psychiatry and Child and Adolescent Psychiatry. Residents are board eligible in all three specialties at the end of training and are able to practice any of the three specialties alone or in combination. Students who want to do TB training love their Pediatrics and Psychiatry rotations equally and often struggle with how to give one up in making a specialty choice. Then they discover TB! A number of issues confront the prospective TB applicant once they begin to consider this career path.

1. Indecision or commitment: Is the decision to do TB a compromise for career indecision in medical school or based on a true commitment to both fields? TB applicants will often say, "I just couldn?t give up Peds or Psych" but the reasons behind this statement may be very different. Students who cannot make up their minds between Peds and Psych and students who have concerns about the stigma of doing a psychiatry residency should work with their advisers to understand what the factors are in their career choice. Students who discover that training in both Peds and Psych fits with their long-term career goals are much better served by a TB program.
2. Thriving on the pace and on transitions: TB residents have to become competent in three specialties in far less time than the resident doing training in a traditional way. Pediatrics training in a TB program is accomplished in two years instead of three, adult psychiatry in eighteen months instead of three or four years and child and adolescent psychiatry in eighteen months instead of two years. TB applicants should be people who are able to learn independently and with breaks in continuity. As one TB resident says, "I love going from the working in the NICU to working with chronically mentally ill patients at the state hospital." TB residents generally thrive on the change of pace in what they do and do not feel intimidated by having to master a diverse set of skills over five years.
3. Career possibilities: TB residents are committed to children and desire a comprehensive, holistic perspective in their training. Seeing families and children in crisis in a medical setting and following children in a pediatric continuity clinic give TB residents a perspective on children that psychiatry residents do not get. Many TBers discover that they enjoy seeing adults as well and often integrate some adult psychiatry into their practices. The career possibilities of TB residents are just as diverse as the reasons for doing the training. Here are a few:
4. Applying: There are only ten TB programs in the country with approximately 22 positions offered yearly. Geography and personal circumstances may limit the number of programs to which an applicant would want to apply . Because of the limited number of positions, obtaining a position may be competitive. All TB applicants should submit back-up applications, generally in Pediatrics or Psychiatry programs. Applicants may want to apply to a Psychiatry or Pediatrics program at the same institution as a TB program. Let the programs know this in advance of the interview process so schedules can be planned accordingly.
   • Working as part of a multispecialty pediatrics group as both a pediatrician and psychiatrist
   • Working in an acute care psychiatric hospital and managing both medical and psychiatric problems (e.g., on eating disorders units)
   • Working in community mental health or private practice and maintaining an office-based pediatrics continuity practice
   • Working in a hospital setting as a consultation-liaison physician and interfacing with pediatricians regarding medically ill children
   • Working in an inpatient or outpatient setting with chronically ill children (e.g., children with cancer, diabetes, cystic fibrosis) or maltreated children (e.g., being part of a multidisciplinary team that evaluates cases of abuse or neglect)
   • Doing research as some former TB-trained physicians have on topics such as ADHD, autism and infant psychiatry

Making a decision to do TB training is a process that evolves over time. It is wise to seek out TB residents to talk to and to make contact with program directors of TB programs. Most of us are happy to answer e-mails from interested students and will quickly put you in contact with TB residents. Consider doing an acting internship or spending a few days at a program in which you are very interested. Once you have sorted through all the issues involved in TB training and have decided to apply, you will join the ranks of an amazing group of people with awe-inspiring energy and commitment to children.

Visit AACAP's Triple Board Residency Training section for more information.