A pleasure to work with--an analysis of written comments on student evaluations.

OBJECTIVE: Studies assessing rating scales on student evaluations are available. However, there are no data related to the written comments on these evaluations. This study was designed to evaluate these comments. METHODS: A content analysis was performed on the narrative section of pediatric clerks' evaluations. Final evaluations were obtained from 10 outpatient clinical sites staffed by full-time faculty over 14 months. A coding dictionary containing 12 categories (7 linked to clinical skills) was used. RESULTS: One thousand seventeen comments on 227 evaluations were coded. The mean number of comments per evaluation was 4. Learner and personal characteristics were the largest categories. Normative comments, such as "good physical exam," as opposed to more specific comments, such as "complete presentation," predominated in all categories. CONCLUSIONS: Evaluation comments were infrequently related to basic clinical skills and were not often specific enough to lead to effective change in a student's performance. Faculty development is needed to make final evaluation comments more useful for students.

Advised follow-up after emergency treatment of adolescents with violence-related injuries.

OBJECTIVE: To compare the rate of advised medical follow-up for adolescents with violence-related, nonsuicidal injuries versus other complaints. DESIGN: Cross-sectional study. SETTING: Pediatric emergency department (ED). PATIENTS: All visits by adolescents, aged 13 to 18 years, during a one-week period from each season during 1992. MAIN OUTCOME MEASURES/RESULTS: Advised medical follow-up for patients sustaining violence-related injuries versus other complaints were compared. Four hundred twenty-six visits were reviewed; 351(82%) resulted in discharge from the ED. Sixty-eight (16%) were classified as violence-related, nonsuicidal. Male adolescents were more likely to sustain violence-related injuries (66% vs 34%, P < 0.01). There were no differences in admission rate or having a primary care provider (PCP) between the violence-related injury group and the group with other complaints. Adolescents with other complaints were twice as likely to have follow-up advised. Presence of PCP and older age were also positively associated with advised follow-up. CONCLUSION: Adolescents sustaining violence-related injuries were less likely to have follow-up advised at the time of their ED visit than were adolescents presenting with other complaints. Violently injured adolescents, at risk for recurrent violent injuries and psychosocial sequelae, were less likely to have follow-up advised at the time of their ED visit than were adolescents presenting with other complaints.

Do missed opportunities stay missed? A 6-month follow-up of missed vaccine opportunities in inner city Milwaukee children.

OBJECTIVES: To determine 1) the frequency of missed vaccine opportunities (VOs) in inner city children

Clinical teaching rounds. A case-oriented faculty development program.

OBJECTIVE: To improve clinical teaching with emphasis on improving provision of feedback through a faculty development series modeled on clinical rounds. METHOD: Seven 1-hour conferences were held for the pediatric faculty during the academic year 1994-1995. Clinical rounds were emulated, with a simulated learner functioning as the patient with a chief complaint of some instructional problem. The conferences progressed from discussion about teaching in a particular situation, to videotapes of clinical teaching, and finally to live clinical teaching. Evaluation of the conferences was assessed by attendance records, participants' evaluations of the conferences, and comparing student and resident evaluations of faculty who attended (i.e., those who attended > or = 2) with faculty who did not attend. Comparisons were made for the academic year before and after the conferences using paired t tests. RESULTS: Forty percent of the faculty attended 2 or more conferences. Mean conference ratings were 4.00 to 4.35, (1 is poor; 5, excellent). Faculty who attended had a significant improvement in ratings for feedback (P = .01) and overall teaching effectiveness (P = .04). Ratings for faculty who did not attend did not change. CONCLUSION: These conferences were well received by the faculty and are an effective way to improve clinical teaching.

Adolescent health care in a pediatric emergency department.

STUDY OBJECTIVE: We examined the use of the pediatric emergency department of an urban children's hospital by adolescents. This study included visits by all adolescents aged 13 to 18 years in a 1-week period from each season during 1992. RESULTS: The ED saw 426 adolescents, representing approximately 15% of the total ED visits. Fifty percent of these patients were male. More than half of the patients were black; a few were members of other minority groups. Eighteen percent had emergency, 60% urgent, and 21% nonurgent conditions. Forty-three percent of the patients came to the ED between 3 PM and 11 PM. Injuries accounted for 47% of male visits and 42% of female visits. Approximately half of the injuries resulted from violent events. Twenty-seven percent of the visits were for exacerbation of a chronic illness such as asthma or diabetes. The most common reason for adolescent female visits was gynecologic problems. Injury was the most common reason for adolescent male visits. Only 27% of the adolescents lived in a two-parent home. In 16% of the cases, the adolescents were treated without consent. Nineteen percent of the adolescents were uninsured, and nearly 50% were publicly insured. CONCLUSION: Issues of violence, consent, and insurance present problems for many adolescents in the pediatric ED. Injuries, particularly those related to violent events, are cause for many adolescent visits. ED staff members should develop plans to care for the complex psychosocial and medical problems of adolescents.