Guidelines for medical student education in community-based pediatric offices. American Academy of Pediatrics Council on Pediatric Education Subcommittee on Medical Student Curriculum.

The special constellation of knowledge, skills, and attitudes that are necessary to practice general pediatrics should be an integral part of the curriculum of all medical schools. Community-based pediatric educational experiences should be integrated into the medical school curriculum starting in the first year. The curriculum should be developed as a joint undertaking of clerkship directors and community pediatricians. Implementation of the curriculum requires ongoing faculty development to learn to use focused teaching, to establish educational objectives, and to adapt educational experiences to the unique characteristics of the office setting. Methods and techniques for the ongoing evaluation of the students' performance, and evaluating faculty members' abilities to implement an effective educational program must also be developed.

A program to develop residents as teachers.

Residents are recognized as important and influential teachers of medical students. Although they are expected to teach and evaluate students, few residents have been taught how, and most would like to receive training to develop and improve their skills as teachers. We developed a "Residents as Teachers" retreat based on our faculty development program for clinical preceptors. We focused on clinical precepting skills, including evaluation/feedback, and the ability to prepare and deliver a brief presentation. The program increased knowledge and skills and improved attitudes about teaching, as reflected in self-reports, observed performance, and medical student ratings. The retreat also provided a valuable social experience for residents. The program has been considered beneficial by residents, program faculty members, medical students, the student clerkship director, and the residents' primary care preceptors. The retreats form the centerpiece of our curriculum for residents as teachers and have become an annual tradition in the residency program.

Prediction of developmental outcome using a perinatal risk inventory.

An effective perinatal developmental screening that predicts developmental outcome of high-risk neonates is currently not available. One hundred twenty-five high-risk infants were evaluated prior to discharge from the neonatal intensive care unit using a newly developed perinatal risk inventory, family status index, and abbreviated neurobehavioral assessment scale. All infants had been evaluated using the Bayley Mental and Motor Scales of the Stanford-Binet. They were also evaluated by a pediatrician, audiologist, and ophthalmologist. Fifteen infants had been evaluated using 9-month Bayley Scales of Infant Development, 74 had been evaluated using the Bayley at 9 and 18 months, and 36 children had been assessed using the Stanford-Binet at 36 months. The total score of the perinatal risk inventory demonstrated a significant correlation with the infants' last score on the Bayley and Stanford-Binet (r = .55, P less than .001). The abbreviated neurobehavioral assessment scale correlated with the infants' IQ and developmental quotient score (r = .3, P less than .001); the family status index did not correlate well with the developmental outcome. Using a score of 10 on the perinatal risk inventory provided a sensitivity of 0.76, specificity of 0.79, positive predictive value of 0.475, and negative predictive value of 0.929. Twelve of the 13 infants with cerebral palsy were identified as being potentially developmentally abnormal prior to discharge. It appears that it is possible to predict the developmental outcome of high-risk neonates using a perinatal risk inventory.

The vulnerable child syndrome: fact and theory.

Studies which have evaluated parent-child relationships following a life-threatening event indicate that parents and children have subsequent interactional difficulties. This study sampled a group of 17 mothers who gave birth to a low birth weight infant (mean weight 1260 grams) and compared them to 17 mothers of normal infants matched for age, education and marital status. The mothers were studied at the infant's adjusted chronological age of 12 to 18 months. At that time all infants were developing normally as determined by the Denver Prescreening Questionnaire. The results indicated that mothers of low birth weight infants did not demonstrate any greater degree of depression or over-protection than their matched controls. The findings of this preliminary study suggest the need for reassessing the relationship between prematurity and other life-threatening events and the psychological sequelae associated with the vulnerable child syndrome. Previous studies are reviewed, and their methodologies are discussed.

A review and analysis of the effectiveness of early intervention programs.

A review was made of 27 studies describing early intervention for biologically impaired infants and young children. Although every study provided some type of documentation of outcome, most studies failed to meet common criteria for scientific research, such as specification of inclusion criteria, documentation of reliability, random assignment, and/or the use of control/contrast groups. Studies were grouped into four classifications on the basis of experimental design as follows: retrospective, prospective-no control group, prospective-control/contrast group, and prospective-random group assignment. A comparative analysis was made of the effectiveness of findings on the basis of statistical evidence and clinical support. Statistical procedures were used in 59% of the studies and statistical support for the effectiveness of early intervention was reported in 48% of the studies. Effectiveness on the basis of subjective, clinical conclusions was reported in 93% of the studies. Implications of the discrepancy between effectiveness based on statistical evidence and clinical conclusions are discussed.

School failure and deafness after "silent" congenital cytomegalovirus infection.

We found IgM antibody directed against cytomegalovirus in the umbilical-cord blood of 53 of 8644 newborns. Forty-four of the 53 had psychometric and pediatric evaluations at 3.5 to 7.0 years of age. The group's mean IQ was 102.5+/-22.4 (+/-S.D.), whereas in matched controls it was 111.7 (PC 0.025). Bilateral hearing loss was present in five of 40 children with antibody against cytomegalovirus and in one of 44 matched controls without antibody (P less than 0.1). Three of the antibody-positive children, however, had profound deafness, an abnormality that occurs once in approximately 1000 children. The predicted school failure rate, based on IQ, behavioral, neurologic and auditory test data, was 2.7 times that of matched socioeconomic controls and eight times that of randomly selected controls. We conclude that clinically inapparent congenital cytomegalovirus infection can adversely affect central-nervous-system development.