Ambulatory Pediatrics Research Articles

AMBULATORY PEDIATRIC ASSOCIATION

The Ambulatory Pediatric Association (APA) held its 34th annual meeting in Seattle, Washington from May 2 to 5, 1994.1 Registrants participated in 31 workshops and 18 special interest groups. The Association of Ambulatory Pediatric Services held its first meeting in Swampscott, Massachusetts on May 2, 1960.2 Thirty-two pediatricians attended, most of whom were directors of pediatric outpatient departments (OPDs). The first Association of Ambulatory Pediatric Services scientific meeting was held at the Traymore Hotel in Atlantic City, New Jersey on May 3, 1961. Five of ten papers submitted were presented in one evening session. This essay describes the remarkable story of four decades of the APA and how this organization of over 1500 members became the recognized voice of ambulatory academic pediatrics.

Annual Meeting of the Ambulatory Pediatric Association

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue

1988 George Armstrong Award Lecture, Ambulatory Pediatric Association: Prophets, Disciples, and Honorable Schoolboys

Few who do research have any illusions that they alone, acting in isolation, are likely to accomplish much that is truly significant. We all build on the work of our prophets and our colleagues. Whatever contributions we may make will, however, almost certainly, pale by comparison with what we can expect our disciples to contribute. From the best and the brightest, those who are fortunate enough to be in the right place at the right time, we truly expect great things. But we can hope as well that all will discover some of the magic ingredients for research training and have the opportunity to transfer these to their successors.

Annual Meeting of the Ambulatory Pediatric Association

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue

Annual Meeting of the Ambulatory Pediatric Association

Annual Meeting of the Ambulatory Pediatric Association

A community outreach training program for pediatric residents and medical students.

In 1982 the Division of Community Pediatrics of the University of North Carolina at Chapel Hill began a new training program for all first-year pediatrics residents and fourth-year medical students taking an ambulatory pediatrics elective. The program was designed to introduce the trainees to community resources for children and increase their knowledge of the factors affecting children's development. During their regular hospital clinic rotations, the trainees spend approximately one-third of their time in program activities that involve 25 community agencies. Educational packets (consisting of books, journal articles, films, slides, videotapes, self-instruction materials, manuals for developmental tests, and/or agency materials) are provided for each program component. At the end of each one-month rotation of program activities, the trainees meet individually with the program director and coordinator to discuss the trainee's experiences and reactions and to identify strengths and weaknesses of the program components.

Annual Meeting of the Ambulatory Pediatric Association

Annual Meeting of the Ambulatory Pediatric Association

Therapeutic drug monitoring in Ambulatory pediatrics

Therapeutic drug monitoring in Ambulatory pediatrics

NEXT SLIDE, PLEASE

Ken was educated at Yale University, New Haven, Conn, where he received his BA degree, and The Johns Hopkins University, Baltimore, where he received his MD degree, consecutively, and then completed his residency education at Hopkins in 1976. He spent two years at the Centers for Disease Control, Atlanta, in the midst of his residency. When he had completed his formal training, he joined the faculty at Hopkins, where he rose to his current rank of associate professor in 1984. Ken is currently associate pediatrician-in-chief at Sinai Hospital, Baltimore. As such, he is medical director of the inpatient service and is heavily involved with the training program. Ken is active in a number of regional and national professional organizations and has been chairman of Region IV of the Ambulatory Pediatric Association. His interests are varied and include education, general pediatrics, infectious diseases, injury control, and girls' soccer! He is married

The status of research in ambulatory pediatrics.

To investigate the status of clinical research in ambulatory pediatrics and to characterize those environments that produce the most research activities and receive funding for research, a questionnaire survey was undertaken of all ambulatory pediatrics programs in the United States and Canada (N = 143). Our response rate was 68%. We found that divisions of ambulatory pediatrics that conduct clinical research have more faculty with formal research training, faculty with more time devoted to research endeavors, a designated research coordinator, research funding, and regular research seminars. Divisions of ambulatory pediatrics that have funding for research have more faculty with formal research training, fellows, a designated research coordinator, and regular research seminars. Funding for research is a more influential factor in producing clinical research than the number of faculty members in the division. The most frequently mentioned barrier to doing research was lack of time. Divisions of ambulatory pediatrics must continue to stress formal research training, faculty time set aside for research, and skills in grant writing if they hope to compete for academic recognition in the years ahead.

Annual Meeting of the Ambulatory Pediatric Association

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue

Primary Practice Experience and Academic Generalists-Reply

In Reply .—While I am in agreement with Dr Grossman's perspective on the mandate for some academic generalists in pediatrics, her letter suggests that she missed the point of the editorial. I implied that teaching is the primary work of teachers and that excellence in teaching springs out of extensive experience in practice, an experience that is highlighted by critical thinking and rigorous reflection. Perhaps we ask too much of our teachers in general pediatrics: to teach with wisdom, to conduct research that produces tenure while providing relevant new directions to the practitioner, and to administer programs in patient care and education. My argument suggests that, in the attempt to achieve all these objectives, teaching predictably falls short. More important, teaching ambulatory primary care pediatrics requires an ongoing clinical experience with a significant number of children and families through time. Mickey Mantle recently bemoaned his inability to teach

Pediatricians and mental health professionals. Patterns of collaboration and utilization.

We surveyed 1,089 fellows of the American Academy of Pediatrics regarding (1) their experiences with child psychiatrists during training, (2) their current utilization preferences and practice with psychiatrists and other mental health professionals, and (3) differences in responses between pediatricians who completed ambulatory pediatric and related training and other pediatricians with respect to the aforementioned questions. Of those pediatricians who had contact with psychiatrists during training, more than 68% remembered the psychiatrist as being helpful. There was a strong preference on the part of all respondents for referral to a "behaviorally oriented pediatrician" for selected psychosocial problems. The pediatricians trained in ambulatory pediatrics believed they were more competent to treat the psychosocial problems of their patients than did other pediatricians and indicated more collaborative activities with psychiatrists than did other pediatricians.

Publication of research presented at the pediatric meetings. Change in selection.

The adequacy of research presented in abstract form for presentation at scientific meetings remains a concern, as indicated by the proportion of such research appearing in scientific journals after peer review. This report examines the publication of research presented at the pediatrics meetings and the effect of a change in selection procedure for abstracts presented at the Ambulatory Pediatric Association meetings for the years 1979 and 1980. Throughout the period, about half of the presentations were published, usually in general pediatric journals, with an average time to publication of about 20 months. The change in selection procedure resulted in little change in the proportion published among either presentations or abstracts submitted but not selected for presentation, but it did lead to a reduction in time to publication. This experience suggests a mechanism for enhancing the timeliness of publication of research presented at scientific meetings without adversely affecting the process of selection.

Ambulatory Pediatrics

Ambulatory Pediatrics

Variability in the management of the febrile infant under 2 months of age

The management in the emergency department of febrile infants less than 2 months of age is influenced by the standard of practice in the community. We sought to determine if uniform practices existed across the United States. Individual academically based faculty from 154 (61%) United States pediatric residency programs responding to a questionnaire on the emergency department management of febrile infants less than 2 months of age showed great variability. Twenty-nine respondents reported written policies and 103 reported informal but defined guidelines for the evaluation and management of infants seen at their institutions. There was little consensus among the respondents as to the definition of fever in this age group. Those at institutions with formal policies reported using more laboratory tests in the evaluation. Respondents differed on the number and types of tests used and on antibiotic administration. University affiliation, type of population served, or presence of advanced training programs in ambulatory pediatrics were not related to the type of policy. The care of the young febrile infant varies greatly.

Academic General Pediatrics and the Practitioner

Teaching clinical medicine—like the practice of medicine—remains an art. Even in ambulatory pediatrics, where attempts have been made to provide objective analysis in clinical situations, teaching the prevention, detection, and treatment of childhood diseases is an art based on sound medical practice. Those physicians actively engaged in teaching medical students and residents recognize the complex process that occurs during teaching and learning in the clinical setting. EDUCATING THE EDUCATORS From an educator's point of view, we might ask, What is the source of training for teachers of primary care pediatrics? At a minimum, a degree in medicine and a pediatric residency leading to board certification are necessary prerequisites for the clinician teacher. Yet these are the same requirements for a practitioner of pediatrics! Perhaps the teacher of clinical medicine needs a fellowship in general pediatrics or (in 1984) experience in one of the programs in general academic pediatrics. These programs provide

Who Should Provide Primary Health Care to Children: Pediatricians or Family Medicine Physicians?

INTRODUCTION —Robert A. Hoekelman, MD This debate is one of a series entitled "Controversies in Child Health and Pediatric Practice." In 1978 and 1979, the Department of Pediatrics at the University of Rochester conducted 12 such debates, which were published in book form in 1981.1 It is interesting that of these 12 controversies, not one has been resolved. That may prove to be the case for the controversy presented in this debate, "Who should provide primary health care to children: pediatricians or family medicine physicians?" Our guest speakers are Dr Michael Klein and Dr James E. Strain. Dr Klein is Professor of Family Medicine and Assistant Professor of Pediatrics at McGill University School of Medicine. He is also Director of the Department of Family Medicine and of the Herzl Family Practice Center at the Sir Mortimer B. Davis Jewish General Hospital in Montreal. Dr Klein received his medical degree at Stanford University in 1966, and he was his class's recipient of the pediatric Harold K. Kaiser Award. Dr Klein served his internship at Bronx Municipal Hospital Center at Albert Einstein University and his pediatric residency at Montreal Children's Hospital. During his last year, he served as Senior Resident in Neonatology under Robert Usher at the Royal Victoria Hospital. He then became a fellow in biochemical genetics under Charles Scriver and the Chief Medical Resident at Montreal Children's Hospital under Mary Ellen Avery. In 1970, he came to Rochester as a Fellow in Ambulatory Pediatrics. Dr Klein's practice experience is extensive. He was the pediatric coordinator of the St Jacques Clinic in Montreal during the late 1960s and the medical director of the Westside Health Services in Rochester from 1971 to 1975, after which he assumed his current position.

Teaching and funding of primary care education in third-year clerkships.

The authors in this article describe a 12-week primary care elective for third-year medical students. The administrative and teaching resources of the Boston University School of Medicine, clinical sites at three Boston community health centers, and federal/state and private foundation funding are coordinated to provide a longitudinal, integrated experience in ambulatory pediatrics and medicine. A literature review revealed no prior medical student programs combining psychiatric, pediatric, and internal medicine teaching in a community setting. Case vignettes and questionnaire results indicate that the program has been a success at introducing students to primary care and the biopsychosocial model. The implications of bridging disciplines as well as academic and community health centers and providing funding resources are discussed. The authors recommend this integrative model for enhancing the development of future primary care physicians.

BOOK REVIEWS

Book reviewed in this article: Brain Tumors in Children, Principles of Diagnosis and Treatment: By Michael E. Cohen and Patricia Kressel Duffner Brain Tumors in the Young: Edited by Luis V. Amador Neurology of Hereditary Metabolic Diseases of Children: By Raymond D. Adams and Gilles Lyon Infectious Diseases of the Fetus and Newborn Infant, 2nd Edn.: Edited by Jack S. Remington and Jerome O. Klein Ambulatory Pediatrics III: Edited by Morris Green and Robert Haggerty Daily Living with a Handicapped Child: By Diana M. Millard Ultrasound in Obstetrics and Gynaecology: Recent Advances: Clinics in Obstetrics & Gynaecology Vol. 10 No. 3 Edited by Stuart Campbell Stuttering and Behavior Therapy: Current Status and Experimental Foundations: By Roger Ingham Computed Tomography of the Head and Spine (A Photographic Color Atlas): By H. N. Schnitzlein, Edith Wright Hartley, F. Reed Murtagh, Laurence Grundy and John T. Fargher