REVISION OF CURRICULUM IN A PEDIATRIC CLERKSHIP ADAPTED TO MULTIPLE COMMUNITY SITES

Background: The growing recognition of the need for primary care physi cians, despite the declining numbers of medical graduates choosing the se careers, has led medical schools to evaluate the focus of their ins truction. Many have blamed traditional academic medical centers for th is problem and called for fundamental reforms designed to encourage pr imary care. Description: In 1992 our multiple campus, community-based medical school instituted 4 major curricular changes to the required 8 -week pediatric experiences for 3rd-year medical students. These chang es were designed to increase emphasis on skills, knowledge, and attitu des required for general pediatrics. Interventions included definition of core learning topics, increased ambulatory teaching, revision of l ogbook requirements, and development of an independent learning/proble m-solving exercise and examination. Evaluation: Outcome measures inclu ded scores from the USMLE pediatric shelf exam, evaluation by clinical preceptors, graded written patient records, and performance on a stru ctured oral examination based on the clinical problem-solving exercise . There were significant difference in student performance on the stru ctured oral exam at 2 of the 6 geographically separated campuses. No o ther community differences were found. Relative to prior years, USMLE shelf exam scores increased at every campus, with a mean increase of 1 9 points. There were no student failures on the shelf exam, a decrease of 5% to 10%. Conclusion: Data from this offering of the revised cour se show improved student performance and satisfaction. Although the da ta are preliminary and from a single student class, these early result s are encouraging.