PATIENT CARE AND STUDENT LEARNING IN A PEDIATRIC CLINIC

Abstract

Every pediatrician who has taught or worked in university pediatric outpatient departments recognizes the syndrome presented by Duff et al. in this issue of Pediatrics. The diagnosis is clear: effective student teaching is not occurring. The etiology of this problem is complex and not so clear. Some of the causes are inappropriate patient selection for beginning students, lack of effective administrative organization to achieve even limited teaching objectives, and lack of appropriate techniques to diagnose and manage the complex sociomedical problems presented. As a result, student, faculty, and patient dissatisfaction is very high. Effective management of the syndrome is even less clear. As with most complex problems, a clearer definition of the goals is the first step to a solution. What do we want the student to learn? How to gather information from families with such complex social and medical difficulties? Skills in diagnosis and management of common or rare health problems? Change of attitudes? Until each ambulatory program defines its teaching objectives more clearly in behaviorally measurable terms, effective management of the disease "poor patient care and teaching" will continue to elude us. I would, however, suggest the following considerations: 1. The first direct patient experiences which students have in ambulatory settings should be with patients who present considerably less complex problems than those available in most of our outpatient departments, and there should be a wider social class selection for the student's initial experience. To achieve this will require either a different patient recruitment procedure or the use of different settings for such education.