Educating pediatric residents in community settings

Teaching culturally competent healthcare in neonatal-perinatal medicine

Disparities in maternal and infant health care and outcomes exist despite advances in prenatal, perinatal, and neonatal care. In this article, the graduate medical educational goals to ensure that trainees in Neonatal-Perinatal Medicine have the knowledge, skills, and attitudes required for practicing culturally competent care are described. A framework for curriculum development, teaching, and learner evaluation for cultural competence will also be discussed. Included in this discussion are the educational objectives of preparing specialists in Neonatal-Perinatal Medicine to provide appropriate medical management to neonates, identify existing disparities in perinatal and neonatal care, and develop quality improvement initiatives to achieve equity in delivery of care.

Pediatric education in office settings

Pediatric training in community office-based settings has been demonstrated to be an effective means of providing "real-world" experiences to students and residents. Although it is often challenging with regards to addressing logistic and conceptual issues, such training provides important practical experiences that may prove critical to the future practice of not only primary care pediatrics but also pediatric subspecialty care. It also may be the key to enhancing the interaction between the two.

Evaluation and comparison of a 1-month versus a 2-week community pediatrics and advocacy rotation for pediatric residents

This prospective study was conducted to assess the effects of a 4-week community pediatrics and advocacy rotation with a unique project (Curriculum A), a 2-week community pediatrics rotation with advocacy training and unique project throughout residency (Curriculum B), or no curriculum exposure on residents' attitudes, perceived competence, knowledge, and behaviors. A 27-item questionnaire was used to assess attitudes, competence, and knowledge. Examination of residents' patients' use of Early Intervention services during the 5-year period after curricula introduction assessed behaviors. Seventy percent of questionnaires distributed over several years were completed by 105 of 111 eligible residents. Residents exposed to Curriculum A or B demonstrated improved competence and knowledge but no significant increase in positive attitudes toward community pediatrics and advocacy. Residents' patients' use of Early Intervention services increased 65% during the 5-year period after curriculum introduction. No significant differences in outcome measures were observed between Curriculum A and Curriculum B.

Pediatricians advocating for children: an annotated bibliography

PURPOSE OF REVIEW

Pediatricians have for many years been strong advocates for the health and safety of children. This article reviews the health literature to provide a historical perspective of advocacy efforts of pediatricians and examples of advocacy for patients at the bedside, in the community, and through local, state, and federal legislation, as well as policymaking. Studying these advocacy activities and incorporating them into pediatric practice and education of residents will surely result in stronger, healthier, safer, and happier children and families.

RECENT FINDINGS

Some of the cited works relate to pediatric advocacy in general, and some relate to advocacy for specific pediatric topics. Also, articles relating to the education of medical students and pediatric residents are reviewed; they may be of benefit to educators who develop advocacy curriculum.

SUMMARY

A review of the MEDLINE literature database from 1966 through October 2003 was performed looking for the terms advocacy (child advocacy, consumer advocacy, legislative advocacy, patient advocacy), as well as advocacy education and training, and was limited to children from birth through 18 years. The titles and many of the abstracts of 4580 articles were reviewed, and 104 articles were read in full. From these, 68 were selected for review here; they were thought to be of particular interest to practicing pediatricians and pediatric educators.

Primary care pediatrics in Italy: eighteen years of clinical care, research, and teaching under a national health service system

This article reviews how Italian National Health Service (NHS) pediatricians have tried to fulfill the obligations of modern primary care providers in a managed care environment, with special reference to the experience of the Veneto region in Italy and compares this situation with the present changes of the health system in the United States. Italian NHS primary care pediatricians work independently in their offices, providing acute and chronic patients to all children 0 to 14 years old: NHS primary care physicians, including 7000 pediatricians, contract directly with the government for the care of patients through a capitated reimbursement system. Twenty-nine independent associations of community pediatricians have been formed with the primary goal to pursue research and education in primary care pediatrics, in addition to traditional care. Several multicenter collaborative research studies at the national level have been organized and four university residency programs are training their residents in community-based pediatricians' offices also, giving priority to activities specific to ambulatory practice and follow the suggestion of an Italian work group on ambulatory pediatric training. The NHS has allowed the Italian pediatrician to focus on patient care and education rather than business. Computerization has been applied to the practice of medicine through the development of electronic medical records, particularly in the Veneto region. This technology allows combining effective clinical care with outcome researches and facilitates continuing medical education and residents' training programs. Italian primary care NHS pediatricians have tried to identify and address patient's needs as well as the needs of a primary care provider in a managed care system. Recent and possible future modifications in the health system in the United States and in Italy need to be examined to learn from similarities and differences.