Adam R. Weinstein,Geisel School of Medicine at Dartmouth,Hanover,NH,Roshini C. Pinto-Powell,Geisel School of Medicine at Dartmouth,Hanover,NH
Background: A focus of recent curricular reform has been early clinical exposure in medical training. On end-of-clerkship evaluations, close to one-quarter of our third year medical students felt the pre-clinical years did not prepare them well for their pediatric clerkship. In particular, one-third of students commented on the need for more experience with the pediatric physical exam. This perception has been reported by pediatric clerkship directors and medical students at multiple schools. We aimed to create a hands-on pediatric physical exam curriculum that would give our pre-clinical students practice to be successful at the start of their pediatrics clerkship.
Methods: In the 2014-2015 academic year we enhanced the pediatric clinical skills content in our On-Doctoring curriculum. We updated the syllabi covering each part of the physical exam to include pediatric content and enhanced a pediatric "toolbox" on our course platform to include information on the pediatric history, vital signs, health maintenance guidelines, and a slideshow and video covering the approach to the age-appropriate pediatric physical exam. Next, we collaborated with a local elementary school in which second year medical students were paired with a kindergartener or first grader to gain hands-on practice performing the pediatric physical exam while concurrently teaching the children about the human body. We report on medical student feedback for this session using mixed quantitative-qualitative methods, the latter through identifying emergent themes via an inductive approach. Two investigators coded each response independently prior to arriving at consensus themes. We also share the elementary educators' impressions.
Results: Our medical students believe the session was effective. Nearly 80% of students "agreed" that the session helped them feel more comfortable in the examination of children (79%), that it was helpful to have hand-on practice (77%), and that it improved their understanding of how to assess neurodevelopment in children (78%). Student comments about the session include themes such as, fun, exposure and practice are key, interacting in a comfortable setting helps reveal what children are like, and previous experience with children makes this less helpful. Student comments about new approaches they found helpful include, letting the child use exam tools, being playful and using games to interact, and explaining things in terms easily understood. Themes about what could be improved include, handouts, an experience with parents, more sessions like this, having varying ages of children to work with, and more time to debrief. Elementary educators felt medical students established a nice connection with the children, children were intrigued with their measurements, and children loved being both learners and teachers.
Discussion: The session enhanced practice with the pediatric exam and communication skills for our students. We plan to evaluate student perception of preparedness for the pediatrics clerkship in subsequent years.