Teaching Clinical Genetics to Pediatric Residents in an Outpatient Setting: A Proposed Model

Abstract

The ambulatory care setting is one in which the pediatrician as a primary care provider excels in knowledge, skills, and effectiveness. He/she is particularly skilled in allaying the fears and concerns of parents as well as guiding them through complex care problems. Physician skills are heavily dependent on having a sufficient knowledge base in the various disciplines. In this new dawn of genetic medicine, our current methods of developing the resident's diagnostic and clinical management skills in genetics are not clearly defined. The fact that the half-life of the knowledge-base in applied clinical genetics is much shorter than in other fields provides an even greater challenge to the development of these teaching strategies. At this time, we have found very few programs with a well-developed model for teaching rudimentary diagnostic and management skills in clinical genetics for the pediatric resident-in-training. In any institution, the methods used to teach clinical genetic skills in a pediatric outpatient clinic must recognize the other teaching and service needs that are equally important to the program. We describe a protocol that is designed to develop the pediatric resident's skills and knowledge-base in clinical genetics while rotating through our outpatient clinics. There are two pathways whereby our residents develop their outpatient skills. In the morning clinics, three residents rotating in the Ambulatory Department are assigned to see faculty patients under their supervision, while in the afternoons, all the residents are assigned to their own patients in Continuity Care Clinic. The residents rotating on Ambulatory Care Service each month are assigned a specific case or topic in clinical genetics for which they will be responsible to develop the content of information sessions to the remainder of the resident staff at the beginning of their Continuity Care Clinic. Our intention is to develop a 36 month cycle of monthly topics with several of them repeated each year for the orientation of incoming house staff. An outpatient resource handbook in clinical genetics that the residents can refer to periodically will be developed from the monthly presentations and discussions and regularly updated. A testing instrument will be developed to allow residents to periodically check their knowledge base against faculty's expectations. Further, a survey questionnaire will be developed and administered to the resident staff anonymously on a yearly basis to judge the effectiveness of the teaching program.