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Chin NP, Aligne CA, Stronczek A, Shipley LJ, Kacrowski J: Evaluation of a Community-Based Pediatrics Residency Rotation Using Narrative Analysis. Acad Med. 2003;78:1266-1270. Reviewed by Randy Rockney, MD, Brown University

Chin NP, Aligne CA, Stronczek A, Shipley LJ, Kacrowski J: Evaluation of a Community-Based Pediatrics Residency Rotation Using Narrative Analysis. Acad Med. 2003;78:1266-1270.

Reviewed by Randy Rockney, MD, Brown University

All pediatrics and medicine-pediatrics residents at the University of Rochester Medical Center participate in a two-week community-based rotation called The Pediatric Links with the Community. Residents spend time at homeless shelters, settlement houses, soup kitchens and public schools with the hope of enhancing the residents' knowledge about community-oriented health care and expanding their understanding of community resources for poor and special-needs children. It is also hoped that such exposure will motivate the residents to assume partial responsibility for the health of children in their communities. These goals are in keeping with the American Academy of Pediatrics' Committee on Community Health Services' criteria for the practice of community pediatrics. The community pediatrician is expected to understand the sociocultural context of child health, be a committed advocate for children, and be skilled in linking families in need with appropriate community agencies and services. These are all skills that are not easily learned in an inpatient clinical setting. The effectiveness of such community experiences in achieving these recommenda-tions has not been studied. These authors used residents' self-reports in the form of short essays describing important experiences that they had had during their community rotations.

In a pilot phase, twenty-five essays selected for "the richness of the narratives and the eloquence in describing the impact of the experience on residents' learning" were analyzed by an interdisciplinary team of investigators from anthropology and public health as well as pediatrics. Three themes were identified: (1) increased knowledge regarding the lived experience of childhood poverty; (2) renewed enthusiasm for social advocacy; and (3) skill in how to refer needy families for special resources. In the study phase twenty-five additional essays were randomly selected and investigated for evidence of those same themes. In addition, the essays were examined to learn if the experience led to some transformation of the learner. Transformative learning is described as a process in which adult learners "pass through a discernible cycle of extraordinary experiences, emotional confu-sion, and reevaluation of formerly held values and beliefs." All of the essays in the study phase mentioned at least one of the three identified themes and all the essays in both the pilot and the study phase showed evidence of a transformative cycle of learning.

Comment: The overt object of the study was to assess whether a 2 week community pediatrics rotation achieved the goals and objectives formulated for that rotation. By the authors' criteria it certainly did. They do admit that the assessment cannot determine whether the rotation shaped or changed actual practice. Stated another way, this study could not measure if and to what extent "transformation," as defined above, is sustained as residents move from residency into practice.

Perhaps of more interest to us as educators, however, is the assessment tool used: qualitative analysis of learners' self-reported experiences of a particular curriculum. What is immediately evident is that such an approach can and perhaps should be applied to a lot of the experiences we as pediatric educators offer to our learners routinely: a brief NICU exposure, child abuse clinic, the inpatient wards, etc. We have to be open to the possibility, however, that transformative experiences can be in the negative as well as the positive direction.

(I agree with Randy, that the key point of this study is how to use qualitative research to measure the impact of an educational intervention. It also addresses areas competencies, that we may or may not overtly promote during our clerkships, namely working with the sociocultural aspects of a patient's care.

  1. Have you ever used qualitative methods to assess a program?

  2. Do you explicitly promote learning of "cultural competence" during your clerkship? If yes, what is it: seminar? Faculty explicitly developed for bedside teaching? Other?

Steve Miller)

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