CHILDHOOD INJURY AND PEDIATRIC EDUCATION: A CRITIQUE

Abstract

The medical school, the school of engineering, the liberal arts college, and the high school all share a common problem today: the exponential growth of knowledge and the increasing complexity of contemporary society have caused numerous demands for further crowding their already crowded curriculums. Thus, there are those who believe that high school students "must" get driver education, that engineering students "must" learn something about the social sciences, that liberal-arts students "must" have a course in computer technology. Often these needs are "felt" by their proponents rather than demonstrated objectively, and often the proponents seem unaware that the subject matter they advocate might be acquired with equal or greater effectiveness outside a formal curriculum. The paper that follows, however, distinguishes itself in several ways from the hortatory pleadings characteristic of special-interest groups. To begin with, it demonstrates the cost-benefits of sound injury-control teaching in departments of pediatrics. Secondly, it points out that much needs to be done in the development of materials and methods before a demonstrably sound program can be proposed. (In both these respects the author provides a sharp contrast with the proponents of driver education, who have successfully lobbied into the American high school curriculum a program whose methods and materials have never been subjected to systematic evaluation and whose outcomes have been questioned by responsible research.) Lastly, the paper does not propose that the departments of pediatrics is the "ideal" or "inevitable" site for the teaching of injury control; rather, the responsibility for the program is seen as shared among many community institutions and agencies. The paper does not, unfortunately, address itself to the question of the role of the pediatrician in injury control, although this question needs to be answered before adequate materials and methods can be fully developed. Should the pediatrician's role be a purely preventive one? And, if so, should he focus his efforts on the patient and his family or on environmental hazards in the community as a whole or on the broad social, cultural, and technological factors found to be related to accidental injury in children? Should he be sufficiently trained in research methodology to carry on his own investigations or should he be taught to work with other specialists in an interdisciplinary context? A number of papers in this volume demonstrate the methodological inadequacies of even the most dedicated pediatrician. On the other hand, interdisciplinary research, despite the lip service which it constantly receives, is beset with problems and has produced few findings that can be incorporated into action programs or that offer clear guidelines for the teaching of injury control-in medical schools or elsewhere. As the paper makes clear, the student in a medical school today learns little to make him effective in reducing childhood injury. But, what, when, and how he is to be taught remain unanswered questions.