Trends in the Clinical Education of Medical Students: Implications for Pediatrics † 1916

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Medical schools are introducing significant changes in the curriculum in response to contemporary educational imperatives. As PHASE I of this study, the Association of American Medical Colleges (AAMC) evaluated the clinical curriculum (including site visits)in 23 U.S. medical schools with recent curricular innovations. The major trends observed were: (1)early clinical experiences in community office-based generalist settings (longitudinal preceptorships), (2) community-oriented/population-based experiences, and (3) integrated generalist clerkships (multispecialty clerkships) involving family medicine, internal medicine and pediatrics. The major educational objectives for these changes were to: (1) utilize ambulatory sites rather than inpatient wards (the most mature trend), (2) emphasize prevention/wellness rather than diagnosis/treatment, (3) include a population-based as well as individual patient focus, (4) develop generalist office-based continuity experiences by restructuring or complementing traditional block clerkships, and (5) also provide interdisciplinary experiences with other health care disciplines(least mature trend). Supporting educational principles included student-directed learning and and additional student assessments of skills, attitudes and values. Our analysis of these curricular trends identified continuity of care and integration (horizontal and vertical) as the most important achievements. As PHASE II of this study, the core curriculum developed by the Council on Medical Student Education in Pediatrics (COMSEP) was reviewed relative to these curricular trends and their implications for the discipline of pediatrics. Whereas the focus of the COMSEP objectives was related to the pediatric clerkship, the new trends dramatically blur the boundaries between preclinical and clinical education and provide multiple new opportunities for integrating pediatric-related content with basic sciences and with other core clinical specialties across the 4 years. Logistical and age-related limitations have often precluded inclusion of relevant child health content and participation by pediatric faculty in the overall curriculum. In summary, refining the clerkship-based COMSEP guidelines according to the new trends can extend clinical curricular opportunities for pediatrics beyond the traditional boundaries of the clerkship. The discipline of pediatrics will, as a consequence, be able to achieve full partnership in the planning, conduct and evaluation of the generalist clinical education of medical students relevant in any way to child health issues.