From physician-centered to community-oriented perspectives on health care: assessing the efficacy of community-based training.

PURPOSE To understand the influence of a community-based child advocacy block rotation on the perspectives of first-year pediatric residents and whether this influence persists. METHOD The authors conducted semistructured interviews to assess the impact of the training program on pediatrics residents' perspectives regarding child advocacy and their understanding of the role of the community members and community-based assets in child advocacy. Three cohorts of first-year residents at the University of California, Davis, participated in the two-week community collaborative rotation from 2000 03. Two cohorts of 23 first-year residents were interviewed. In 2003, the first cohort of nine third-year residents was re-interviewed to assess long-term impact. Interviews were conducted before and after residents' experiences with community collaboratives. Transcripts of interviews were reviewed using an iterative process, and a coding system was applied using a qualitative software program. RESULTS Comparison of pre- and postrotation interview data showed that residents' conceptions of advocacy shifted from ideas about being a pediatrician for the community to being a pediatrician in the community. This change in definition reflected a view of the pediatrician as facilitator, a community asset, rather than as a central administrator of child health affairs. This shift persisted through the completion of residency. CONCLUSIONS These findings suggest that substantive interaction in a community collaborative can provide a starting point for residents to reconceptualize their role as pediatrician, for understanding the diverse contexts characteristic of children's circumstances, and for identifying and using community-based assets for improving child health. Definition changes persisted through residency and may influence residents' future behavior in clinical practice.