Let's go shopping: a tool for pediatric resident education.

Residency training is designed to allow trainees to develop the clinical skills and the knowledge base necessary to practice their specialty independently.1 Most pediatric residency programs have been hospital-based, usually in tertiary care institutions. Even required primary care continuity experiences are often based within urban hospital clinics. As a result, pediatric residency graduates have good preparation to care for critically ill children or children with special needs, but may be less prepared to care for generally healthy children or to answer the practical questions that will comprise the bulk of a primary care pediatrician’s practice. In fact, many pediatric residents complete training without exposure to many of the practical aspects of primary care and community pediatrics.2–4 It is difficult to teach residents many key aspects of community and ambulatory pediatrics effectively. Certain issues and skills require active, hands-on involvement. Participatory teaching formats have equal or more efficacy than traditional didactic lectures in many instances and are wellreceived by the learners.5–7 The participatory format particularly enhances practical skill and knowledge acquisition. There are many practical aspects of primary care and community pediatrics that cannot be taught in a lecture and might be more appropriately taught through hands-on involvement. Many of these involve issues dealt with regularly by parents, such as administering unpleasant tasting medication. Physicians may be unaware that such an issue can create an obstacle for parents. Another issue for parents, especially new or inexperienced parents, relates to the purchase of items needed for routine care of healthy infants (such as car seats and formulas) or items to help with minor acute illness (such as thermometers and humidifiers). Parents who receive little guidance in item selection can find this a perplexing and frustrating experience. Families who are financially disadvantaged or who live in an underserved area may face the additional barriers of inadequate finances or lack of transportation to stores not readily accessible. Pediatricians, including pediatric residents, should understand the cost, accessibility, and convenience of use for items that they recommend to parents; however, unless they are themselves parents, many pediatricians lack this understanding. This type of practical information is rarely taught in a traditional residency curriculum. We introduced a resident “shopping trip” to our ambulatory curriculum in the academic years 1996–1997 and 1997–1998. The purpose of the shopping trip was to provide residents with an experience simulating that of a new parent attempting to purchase items necessary for infant care. We initially assessed resident knowledge regarding the prices of commonly used child care items, such as diapers, infant formula, and commonly used overthe-counter (OTC) medications, via a written pretest asking residents to price items. Residents were then assigned to a focused shopping trip, either during the ambulatory rotation or the continuity clinic, looking for items such as routine and unusual infant formulas, car seats, OTC medications (generic and brand name items), and disposable diapers (see Table 1). Store locations were not specified, so residents generally chose stores convenient to their homes. Residents then took a posttest, both within 1 month of going on the shopping trip, and again at least 6 months after the shopping trip. Objective gains in knowledge regarding prices were assessed by asking residents to price the same items that were on the pretest. Residents were also asked to evaluate the experience. Over a 24-month period, 59 pediatric residents completed all components of the study. Because the shopping trip was introduced into the intern curriculum, interns comprised the majority (79.7%) of the participating residents. Only 4 (6.8%) of the residents were parents at the time that they went on the shopping trip. Residents demonstrated a 20.7% improvement in knowledge of the costs of the items after the shopping trips; after 6 months, there was some decrease of knowledge, but it was still 12.4% improved from baseline. Twenty-four percent of residents found that items were less accessible than expected, 82% found that the variety of choices offered made it difficult to choose, and 71% found that items were, From the *Department of General Pediatrics and Adolescent Medicine, Children’s National Medical Center, Washington, DC; and ‡Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC. The results from this article were presented in part at the Ambulatory Pediatric Association meeting; May 3, 1999; San Francisco, CA. Received for publication Nov 22, 1999; accepted Feb 23, 2000. Reprint requests to (R.Y.M.) Department of General Pediatrics and Adolescent Medicine, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010. E-mail: [email protected] PEDIATRICS (ISSN 0031 4005). Copyright © 2000 by the American Academy of Pediatrics.