PEDIATRICS Vol. 50 No. 6 December 1972, pp. 849-852
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NATURALISTIC OBSERVATIONS IN A PEDIATRIC OUTPATIENT CLINIC

Morris Green M.D.1

1 Department of Pediatrics, Indiana University Medical Center, 1100 West Michigan Street, Indianapolis, Indiana 46202

The naturalistic observations on life in the Yale Pediatric Clinic by Duff and his co-workers in this issue carry the potential of an important service to American pediatrics if their publication stimulates constructive change. Because their findings can be widely generalized throughout the nation and this is a time of rapid reinstitutionalization of health services, it would appear likely that this manuscript will stimulate thoughtful reaction from many groups. The paper by Duff et al. presents observations on a medical model of care that is not working adequately not just in New Haven but in other leading medical centers throughout the country. Since it has not worked in the past and it does not now, what is its future?

This paper demonstrates forcefully the need for a statement of objectives to be transmitted to the student, the instructor, the patient, and the hospital administrator. Such stated objectives and a regular evaluation of the extent to which they are being met should be a basic requirement for pediatric outpatient departments not only for educational purposes but also as a highly effective management tool. Another educational principle that needs to be invoked in situations such as described is that the educational challenge should be graduated according to the readiness of the student. The student preformance expected in a clinical situation should exceed, but only to a reasonable extent, his current level of ability to deliver such services. Undergraduate students generally do not have yet all the skills required to encompass simultaneously complex biomedical and psychosocial facets of health and disease, especially when the patients present, in such a high percentage of cases, extremely complex situations.