Revision of curriculum in a pediatric clerkship adapted to multiple community sites

Abstract

Background: The growing recognition of the need for primary care physicians, despite the declining numbers of medical graduates choosing these careers, has led medical schools to evaluate the focus of their instruction. Many have blamed traditional academic medical centers for this problem and called for fundamental reforms designed to encourage primary care. Description: In 1992 our multiple campus, community‐based medical school instituted 4 major curricular changes to the required 8‐week pediatric experiences for 3rd‐year medical students. These changes were designed to increase emphasis on skills, knowledge, and attitudes required for general pediatrics. Interventions included definition of core learning topics, increased ambulatory teaching, revision of logbook requirements, and development of an independent learning/problem‐solving exercise and examination. Evaluation: Outcome measures included scores from the USMLE pediatric shelf exam, evaluation by clinical preceptors, graded written patient records, and performance on a structured oral examination based on the clinical problem‐solving exercise. There were significant difference in student performance on the structured oral exam at 2 of the 6 geographically separated campuses. No other community differences were found. Relative to prior years, USMLE shelf exam scores increased at every campus, with a mean increase of 19 points. There were no student failures on the shelf exam, a decrease of 5% to 10%. Conclusion: Data from this offering of the revised course show improved student performance and satisfaction. Although the data are preliminary and from a single student class, these early results are encouraging.