SOME UNCHANGING VALUES OF PEDIATRIC EDUCATION DURING A TIME OF CHANGING TECHNOLOGY AND PRACTICE

A few of the opportunities and difficulties of educating pediatric res idents in a particular community-based setting, the managed care organ ization, are discussed in this article. Some of these organizations ha ve deliberately recruited corporate employees with young families, off ering relatively complete coverage. Quality problems remain, however. Children may benefit, because managed care arrangements may reduce ove rdiagnosis and overtreatment, but children may also be deprived, parti cularly in Medicaid managed care programs, of needed, appropriate care . Pediatric faculties must be confident about the quality of care, the quality of teaching, and the opportunity for residents to develop int erpersonal skills before residents are placed in managed care settings . First, however, important, broader aspects of contemporary pediatric education are discussed. These essentials of contemporary pediatric e ducation apply in any setting, community based or not, and not only to physicians in training, but to those who are delivering ongoing care as well. A case study illustrates the impact of technologic advances o n medical diagnosis and management. Such advances may lead to the chan ce for better outcomes but also to confusion, including misperceptions about disease prevalence, the natural history of disease, and therape utic effectiveness. To meet patient needs and to provide a medically e ducated physician, the understanding of biology and disease that grows out of scientific advances must be balanced with the illness-related functions of the physician. Two approaches to this goal are suggested: (1) the epidemiologic and demographic anatomy of the health of popula tions and the socioeconomic kinetics of our society and its diverse va lue systems relevant to health care should be deliberately structured into all phases of medical education; and (2) the sites of the educati onal process should be diversified so that residents are placed, perha ps as much as half the time, in those settings in which most patients interact with physicians.