EDUCATION
A TEACHING
PROGRAM
IN COMMUNITY
PEDIATRICS
Kenneth D. Rogers, M.D.
Graduate School of Public Health, University of Pittsburgh
CONTRIBUTORS’
SECTION
336
T THE School of Medicine of the
Uni-versity of Pittsburgh, the Department
of Pediatrics has organized a series of field experiences intended to acquaint future physicians with programs and facilities out-side the confines of tile Medical Center
which are concerned directly or indirectly
Vitil the health and welfare of normal
and exceptional children. During their pediatric outpatient service, senior medi-cal students in groups of six to eight spend 6 half-days in community pediatric” train-ing. Each student is loaned a collection of selected reprints, booklets and mimeo-graphed material pertinent to the areas coy-ered ill the community experiences. They
are urged to read the appropriate material before eacil field trip in order that their observations may be meaningful and pro-ductive. Additional preparation is given at
the visit site by approximately an hour’s group discussion of the general area to be covered, specific items to be noted, and questions to be considered during the ex-penience. No attempt is made to coven all aspects of the program being viewed. In-formal discussion and interpretation are maintained by the instructor throughout the field trip.
Selection of field experiences has been based on: 1) their pertinency to pediatric training; 2) their teaching impact during brief exposure; and 3) their accessibility
and availability.
FIELD EXPERIENCES
Visit 1 : Elementary School
Students meet in a classroom of a 200-pupil elementary school located near the
ADDRESS: Pittsburgh 13, Pennsylvania.
Medical Center. Tile rationale of school health programs for making compulsory education safe and effective is explained and the appropriateness of health as one facet of general education is discussed. Tile different kinds and components of
school health programs are considered as
to tileir appropriateness and effectiveness in meeting certain problems of children.
Current laws and programs for school health in Pennsylvania are outlined and
tile role of the Iriate physician in relation to these programs is discussed.
Each member of the group is then as-signed to one of tile classrooms to observe teaching and Otller activities for 30 to 45 minutes. As physicians, they are asked to make judgments regarding tile “stress” of the school experience for children, health problems observable in the classroom, and
direct and indirect health education evident
in the curriculum. As adult citizens, they are invited to evaluate the general caliber of education being given as to its appro-pniateness in preparing children for the fu-tune.
The group reconvenes in the school
health room and briefly discusses classroom
observations. Tile final hour is spent in a description of the school health program at the school and includes demonstration and student practice with vision screening and
audiometry. These procedures are
pre-sented as having relatively high viekis for case finding when performed on presum-ably well children, and it is pointed out
tllat, unfortunately, they are often omitted in health appraisals by practicing physi-cians. Normal physical growth and
CONTRIBUTORS’ SECTION 337
nient of the school age child are also dis-cussed, using classroom observations made
by students as illustrative material.
Visit 2: School for Handicapped Children
Students meet in the instructor’s office for a discussion of the child with a handicap. Subjects covered are: definition of handi-capping, diagnostic groups, changing prob-bems, prevalence of various handicapping conditions, components of care and preven-tion, and programs for therapy and re-ilabilitation. After about an hour the group
goes by car to a school for children with neuromuscular handicaps (predominantly
cerebral palsy). The director of the school
discusses the program of the school and visits are made to various classrooms to observe activities. Cerebral palsy as a
mul-tiple handicap is discussed and the needs of children in addition to strict medical care are illustrated. Contrasts are drawn with tile children and program visited the pre-vious week. Children with handicaps
repre-sentative of major diagnostic categories are
brought to the physical therapy room and
students are given the opportunity to
ex-amine them. Medical management is dis-cussed at this time. Finally, the group drives to a sheltered workshop for handi-capped young adults and briefly observes their work. Discussion at this time concerns
tile future as adults of severely handicapped children and the needs for programs to pen-mit realization of their maximum potential.
Visit 3: High School
Students meet in the health suite of a suburban high school. Normal physical growth and development of the adolescent
are discussed and illustrated with slides.
Physical and emotional health problems
of presumably well adolescents are de-scnibed. Medical students then observe chil-dren as they pass through the halls between
classes for illustrations of the subjects
dis-cussed, e.g. the differences in rates of maturation of boys and girls; the disparity in levels of maturation among high school boys of the same age; prevalence of obesity,
defects of visual acuity and acne; etc. Stu-dents are assigned to one of the several classrooms for 30 to 45 minutes and asked to make observations similar to those made in the elementary school. Finally, students are invited to participate in the health ap-praisal of a normal adolescent male who serves as a model for these exercises. The limitations of the physical examination in health appraisal, the need for interest in emotional problems, the opportunities for health education present during the health
appraisal and the high yield of useful
in-formation given by the health inventory, vision and hearing screening tests are ii-lustrated.
Visit 4: Juvenile Court and Detention Home
During tile first hour at the Court, the group discusses the general problems of juvenile delinquency, foster care and
adop-tion-especialby from the viewpoint of the practicing physician. Following this, there
is a tour of the building for observation of detention, educational, and recreational facilities and programs. Special attention is given to the department housing young neglected and abandoned children. Here
students are invited to consider future prob-lems to be anticipated in this group and medical knowledge pertinent to their pre-vention. The final 1% hours are spent with the judge in the hearing room observing cases brought to the Court. Following cen-tam of the cases, the judge discusses with the students the problems seen and invites their comments.
Visit 5: Office of a Private Pediatrician
dis-338 COMMUNITY PEDIATRICS
cussions range far and wide and often con-sider such areas as medical economics and the role of the private physician in com-munity programs.
Visit 6: General Discussion
Students meet in the office of the instruc-ton to discuss the general scope of children’s health and welfare programs in our country, giving special attention to ways in which such programs are of interest and help to
practicing physicians. The collection, inter-pretation and usefulness of vital statistics concerning children and mothers are consid-ened. Two current health problems in the area of pediatrics-accidents and staphylo-coccal infections in newborn nurseries-are described and used to illustrate the fact that public health, clinical therapy and
labora-tony study are facets of health problems rather than separate entities.
DISCUSSION
In planning the program in community
pediatrics, certain pedagogic convictions
were held concerning class size, preparation
for field trips, content of experiences, con-tinuity of teacher-student relationships, and teacher qualifications.
Small group teaching seemed highly de-sirable because it facilitated observations and intensified experiences on field trips.
More importantly, small groups permitted
free discussions and questioning by students in areas not familiar to them and about which they sometimes had strong emotional attitudes.
Preparation by reading and preliminary discussion was considered vital for obtain-ing maximum effectiveness from field trip experiences. When students had been stimulated by preparation to develop ques-tions concerning the area being considered and when they had acquired sufficient background information to create a frame of reference, field observations became more meaningful.
Every effort was made in field trips to select only those experiences most effective for teaching and to reduce to a minimum
lengthy transportation time and miscellane-ous observations.
The same instructor taught each of the sessions (except the visit to the office of a private pediatrician). While this was not necessary, it was helpful from the stand-point of interrelating the sessions and build-ing a relationship with the students. It was necessary, however, that an instructor in pediatrics accompany each group of stu-dents on field trips, as personnel working within the observed programs could not be expected repeatedly to give time for instruction nor necessarily to be oriented towards the educational needs of medical students.
Because their values and interests are focused intensely on the clinical aspects of medicine, medical students tend to be more accepting of teaching by clinicians and of subject matter shown to be related to patient diagnosis and therapy. The fact that the instructor was a clinically qualified pediatrician enabled him to start discus-sions in areas of clinical interest and extend them into the preventive and rehabilitative aspects of the problems. By constantly con-rebating the observations made during the field visits to their significance and useful-ness in medical practice, material was validated in the eyes of the students as “real” medicine. Such positive acceptance of these community programs and other professional workers was consciously sought as a teaching goal.
As is true with all small group teaching, this program required a heavy investment of faculty time-i full day a week
through-out the year. No formal evaluation of the
effectiveness of the teaching program in community pediatrics was made. The field trips were well attended and favorably received. Two students requested precep-torships with the instructor in the area of
community pediatrics and several made
further inquiries into programs on their
own initiative.
corn-CONTRIBUTORS’ SECTION 339
monly expressed by this group concerned the importance of contact with the “reali-ties” of medical practice for students during
their training years. Both students and practitioners commented that their teaching contact in the setting of a private office was
more effective in many ways than that in the busy outpatient clinic of the hospital.
Spe-cifically, counselling of parents, physical
examination, and general management of patients were considered well taught in the private office.
NEW PUBLICATIONS RECEIVED
THE FOOT AND ANKLE : THEm INJURIEs,
Dis-EASES, DEFORMITIES AND DISABILITIES, 4th
Ed., Philip Lewin, M.D. Philadelphia, Lea
& Febiger, 1959, 612 pp., $14.00.
PRu’icIPLEs OF NuTRITIoN, Eva D. Wilson,
Katherine H. Fisher, and Mary E. Fuqua. New York, John Wiley & Sons, Inc., 1959,
483 pp., $5.95.
METABOLIC HoMEosTAsIs, Nathan B. Tabbot,
M.D., Robert H. Richie, M.D., John D. Crawford, M.D., and Edith S. Tagrin.
Cam-bridge, Massachusetts, Harvard University
Press, 1959, 132 pp.
PADmIscmR EKG-ATLAS, Wilhelm Heck, M.D., and Joachim Stoermer, M.D. Stuttgart, Georg Thieme Verlag, 1959, 230 pp., $18.55.
CIBA COLLECTION OF MEDICAL ILLUSTRATIONS:
PART I OF DIGESTIVC SYSTEM: UPPER
DI-GESTIVE TRACT, Vol. 3, Frank H. Netter,
M.D. Summit, New Jersey, Ciba Pharma-ceutical Products, Inc., 1959, 206 pp., $13.00.
-- AND EVERYTHING NICE, Vance Hyde. New
York, David McKay Company, Inc., 1959, 240 pp., $3.95.
NEUROLOGY OF INFANCY, Anatobe Dekaban, M.D., Ph.D. Baltimore, The Williams and
Wilkins Company, 1959, 388 pp.’ $12.00.
PRINCIPLES OF HUMAN PATHOLOGY, Edward B.
Smith, M.D., Parker R. Beamer, Ph.D., M.D., Frank Vellios, M.D., and Dale M.
Schulz, M.S., M.D. New York, Oxford
Uni-versity Press, 1959, 1,123 pp., $15.00.
BRITISH MEDICAL BULLETIN: SYMPOSIUM ON
CURRENT VIRUS RESEARCH, Vol. 15, No. 3.
London, The British Council, 1959, 75 pp.’
$3.25.
Tiw SURGICAL TREATMENT OF SC0LI0SI5, Louis
A. Goldstein, M.D. Springfield, Illinois,
Charles C Thomas, Publisher, 1959, 116 pp., $6.75.
MEDICAL DISCOVERIES: WHO AND WHEN,
J.
E.Schmidt, M.D. Springfield, Illinois, Charles
C Thomas, Publisher, 555 pp., $14.75.
DISTURBANCES IN GASTROINTESTINAL
M0TIL-ITY, Edited by
J.
Alfred Rider, M.D., and Hugo C. Moeller, M.D. Springfield, Illinois,Charles C Thomas, Publisher, 387 pp.,
