The longitudinal primary care clerkship at Harvard Medical School.

The primary care clerkship (PCC) at Harvard Medical School was established in 1997. The goals are to provide students with longitudinal experiences with patients and to include modern themes in the curriculum: managing illness and clinical relationships over time; finding the best available answers to clinical questions; preventing illness and promoting health; dealing with clinical uncertainty; getting the best outcomes with available resources; working in a health care team; and sharing decision making with patients. The PCC, a required course in the clinical years, meets one afternoon a week for nine months. Students spend three afternoons per month in primary care practices, where they see three to five patients per session and follow at least one patient ("longitudinal patient") over time. Classroom sessions, in both large- and small-group formats, promote a common educational philosophy and experience, and reinforce habits of problem-based learning established in the preclinical years. The students rated 74% of their preceptors excellent, especially praising their ability to facilitate and support good interpersonal relationships with patients, their ability to encourage students' independent evaluation of patients (as opposed to shadowing), and their enthusiasm for teaching. Students saw their longitudinal patients a mean of 4.8 times; 83% saw their patients at least three times. The PCC complements the curriculum of block clerkships in hospitals, and because the two are offered concurrently, students are required to come to terms with two substantially different cultures within medicine. Other medical schools are beginning to develop longitudinal clerkships to ensure that students have essential educational experiences that are difficult to achieve in block, hospital-based clerkships.

The teaching matrix: a tool for organizing teaching and promoting professional growth.

Despite barriers of limited time and lack of formal preparation for teaching, physician-teachers want to do a good job in the classroom. However, without appropriate feedback or self-reflection, physician-teachers have no systematic way to think about their role both in what students learn and in how well they understand important information. With this in mind, the authors developed a model, the Teaching Matrix, designed to encourage clinician-teachers to reflect on their teaching before, during, and after each teaching session. The Matrix helps teachers to address five central questions: Who am I teaching? What am I teaching? How will I teach it? How will I know if the students "got it"? And how will I improve my teaching for the next time? In this paper, the authors describe how the Teaching Matrix may be used as a tool for planning actions, as a "suggestion box" of ideas, advice, and questions, and, most importantly, as a guide to systematic reflection on teaching.

Pediatric Symptom Checklist: screening school-age children for psychosocial dysfunction.

The Pediatric Symptom Checklist (PSC) is a 35-item screening questionnaire that is completed by parents and designed to help pediatricians in outpatient practice identify school-age children with difficulties in psychosocial functioning. The current study assessed the validity of the PSC by screening 300 children in two pediatric practices, a middle-class group practice and an urban health maintenance organization. Validity was established by comparing the results of PSC screening of 48 children with in-depth interview assessments and pediatricians' ratings. Results indicate that the PSC has a specificity of 0.68 and a sensitivity of 0.95. The screening process was well accepted by parents and pediatricians. Several children whose pediatricians' ratings had indicated adequate functioning were identified by the PSC as having substantial psychosocial dysfunction and requiring further evaluation.