Triple Board Frequently Asked Questions

How do I know Triple Board is for me?
Successful Triple Board applicants are interested in thinking about how medical, psychological, and environmental factors interact to shape children’s health and that of their families. They are passionate about providing quality medical care to children. They are motivated to work hard to achieve their goal of becoming a physician who can approach medical problems using training from multiple disciplines. To be successful in residency, they are flexible and can function well in a broad range of clinical settings- sometimes even in the same day!

What do most Triple Boarders do after training?
There really isn’t a typical triple board career path. As each new class graduates, new career paths are developed. Many pursue careers at the “intersections” between pediatrics and child psychiatry, such as mental health integration in primary care or subspecialty clinics, consult-liaison child psychiatry, developmental disabilities, emergency psychiatry, and more. Some choose to take on multiple roles and split time between positions in pediatrics and psychiatry. 

Some Triple Boarders choose to pursue careers in traditionally psychiatric settings where their pediatric skills and knowledge provide additional insight into normal development, understanding of children's medical illnesses and treatments and medication issues. Graduates treat children on consultation-liaison teams, inpatient child psychiatry units, outpatient private practice or mental health centers, forensic psychiatry, infant psychiatry and caring for patients with developmental disabilities.

Other Triple Boarders choose to practice in predominantly pediatric settings where their training provides a depth of understanding of children's and family's responses to psychosocial and medical stressors, developmental disabilities and the impact of psychiatric illnesses on individuals and their families. Triple Board graduates have pursued subspecialty training in child abuse, hematology-oncology, pediatric emergency medicine, adolescent medicine, and pediatric critical care. Some also treat general pediatric patients in private practice.

In all settings, triple boarders have developed unique and exciting career paths caring for children and their families.

Can I enter a Triple Board Program after intern year?
Residents may apply for positions in Triple Board programs for the PGY-2 year if they will have completed a PGY-1 year in categorical pediatrics but may not start Triple Board training beyond the PGY-2 year. Residents who have successfully completed a pediatrics residency may apply to a position in a Post Portal Pediatric program.

I’ve heard I’ll be a “jack of all trades, master of none”. Is that true?
It is quite true that Triple Board residents cannot do everything in the five years that their categorically trained colleagues do in the equivalent of 8-9 years. However, Triple Boarders have chosen their “specialty” early and tend to be quite focused learners. When they arrive, they know how to learn. Over the course of the residency, they expect and are expected to work harder than categorical residents. Although the content in each specialty is different, the skills of doctoring are consistent across specialties. Triple Boarders learn early how to be a doctor, and bring a valuable and unique perspective to each of the specialties they encounter.

Board scores show that Triple Board graduates do learn what they need to learn to be certified in each of the three disciplines and experience (and even some research) demonstrates they are as skilled clinicians as their colleagues.

Aren’t Triple Board Programs more difficult than categorical training?
Triple Board programs combine the essential components of 3 training programs that would usually last 8-9 years together into 5 years. Triple Board training is rigorous and requires motivation and hard work. Generally, Triple Board residents have less elective time than their categorical counterparts to ensure competence in the core rotations. Generally, the clinical experiences in each discipline help enhance the practice of the other disciplines. For residents with a clear sense of purpose of why they want to do Triple Board training, it is an exhilarating, if sometimes exhausting, process.

How is Triple Board training different from traditional child psychiatry training?
One of the biggest differences between Triple Board and child psychiatry training is the exposure to healthy children and families without psychopathology. Triple Boarders see children longitudinally for up to five years in a pediatric continuity clinic. They see the broad range of “normal” development, observe transient perturbations in development, and learn to apply a preventative approach to health care. As pediatricians, Triple Boarders are familiar with medical illnesses of their child psychiatry patients and also understand the experiences that accompany evaluation and treatment of acute and chronic illnesses. Finally, Triple Boarders meet healthy families under extreme stress in the emergency room, on inpatient units, and in intensive care settings and they learn to support family resilience and address susceptibility to stressors in the medical setting.

Traditionally trained Psychiatry residents have longer training experiences with adults (generally 3-4 years compared with 18 months), so often have had a broader range of rotations and more exposure to severe adult psychopathology. Training experiences in traditional Child Psychiatry Fellowship are slightly longer than Triple Boarders’ experiences with Child Psychiatry, but there are no systematic differences in the training content.

How is Triple Board training different from Developmental-Behavioral Pediatrics?
The two major differences between Triple Board and Developmental-Behavioral Pediatric training are the focus on therapy and training in adult psychiatry. Triple Boarders receive training in multiple therapeutic modalities, including behaviorally and psychodynamically oriented therapeutic approaches for individuals, families, and groups. Triple Board residents spend 18 months in adult psychiatry, where they learn to manage adult psychopathology therapeutically and pharmacologically. This training is quite useful when working with parents with mental health problems and understanding the long-term trajectory of mental illness. Developmental-behavioral pediatricians usually have more extensive training in informal and formal assessment of developmental disorders and are trained in behavioral, psychoeducational and psychopharmacological interventions for mild-moderate mental health concerns. There tends to be significant overlap in the patient populations and research interests of Developmental-behavioral pediatricians and Triple Boarders and collaboration can be quite fruitful for all.

I like children and psychiatry and I can’t decide what I want to do. Is triple board for me?
Triple Board training requires focus and dedication. Successful Triple Boarders have a sense of purpose that helps them focus on acquiring the knowledge base and skills they need to pursue their goals. Although career plans often change during the five years, Triple Boarders generally are able to define specific reasons that have motivated them to sign up for this challenging training program and ways that the training would support their career goals and interests.

How are Triple Board Programs regulated?
Triple Board programs are approved by the American Board of Pediatrics and the American Board of Psychiatry and Neurology (ABPN) at the time they are established. Once the program is established, the Accreditation Council for Graduate Medical Education (ACGME) accredits each of the component residency training programs (Pediatrics, General Psychiatry, and Child and Adolescent Psychiatry) and they must be continuously accredited by their respective Residency Review Committee. This system has been effective in ensuring quality training for triple board residents since 1986.