Teaching the essentials of "well-child care": inspiring proficiency and passion.

Abstract

Before the pediatric clerkship, most medical students learn to take a patient history starting with the “chief complaint.” Upon encountering their first pediatric patients, students quickly recognize that they are not prepared to ask the appropriate follow-up questions when the chief complaint is “well-child visit.” In this article, we present a practical method for teaching medical students how to approach pediatric health supervision visits that build upon their existing clinical skills. Primary care pediatricians address the health care needs of each child in the context of their family and community. They acknowledge the important ways in which social and psychological determinants of health impact wellness. Clinical teachers of pediatrics can inspire future physicians to use patient-centered communication skills to address the needs and priorities of families by making explicit the different aspects of a pediatric health supervision visit that include the following: 1. Identifying patient and family concerns by practicing a structured communication strategy. 2. Using reliable resources to identify the established priorities for each age and access most up-to-date anticipatory guidance recommendations. 3. Delivering prioritized anticipatory guidance that is specific to each patient within his or her community. A useful strategy for approaching the conversation with parents and children is for students to: “Elicit and ask…then assess, prioritize, and advise.”1 Clinical preceptors should explain the importance of eliciting patient and family concerns by asking open-ended questions. Then, with feedback on their ability to assess the most important issues, preceptors ask students to prioritize which topics to address and then together, advise the family accordingly. Eliciting concerns through open-ended questions creates the essential foundation for the health supervision visit.2 Recent studies have demonstrated that using a patient-centered communication style with open-ended questions is not only time-effective but allows for greater adherence to the current standards for well-child … Address correspondence to Erin K. Balog, MD, CDR, MC, USN, Department of Pediatrics, Uniformed Services University of the Health Sciences. E-mail: erin.balog{at}usuhs.edu