BACKGROUND:Pediatricians spend a significant amount of time on the telephone but receive little formal training in telephone management skills. We found only two previous reports in the literature using a randomized controlled trial (RCT) that documented the effectiveness of a telephone management program for residents.METHODS:The goals of this pilot study were (1) to provide second year pediatric residents (PL-2s) an experimental telephone management educational program, using a standardized patient (SP); (2) to assess the PL-2s' affective skills and ability to address relevant content on a series of simulated telephone calls; and (3) to determine whether feedback to the experimental group would improve their telephone management skills.RESULTS:In this small pilot RCT using an SP intervention, no improvement was found in PL-2s' short-term or long-term telephone management skills.CONCLUSION:Further studies involving larger number of residents and revised study design are needed in planning effective approaches to teaching these important skills to pediatric residents in our training program.

The objective of this study was to determine whether medical students' clinical experiences in pediatrics impact on their performance on the National Board of Medical Examiners (NBME) pediatric subject test. The subjects were 118 George Washington University School of Medicine third-year medical students on their pediatric clerkship in the 1987-88 academic year. Students were instructed that they were expected to record prospectively major patient diagnoses based on their clinical experiences during the academic year. From these logs, the authors determined the four most common patient diagnoses the students recorded: (1) well baby/child;(2) neonates; (3) infectious diseases; and (4) trauma/poisoning. The authors examined the NBME pediatric subject test in 1987-88 and selected questions that reflected each of the four categories. We then sought statistical correlations of student examination performance and the clinical experiences they recorded. There were no statistically significant correlations between number of patients seen in a designated category and the NBME scares which assessed three of the four categories, the exception being the neonate. There were no statistical correlations between overall number of patients seen and the NBME subject test score. This study confirmed the authors' hypothesis that medical students' clinical experiences do nor appear to have an impact on their performance on the NBME pediatric subject rest. Using an objective, nationally standardized test such as the subject test as an end-of-clerkship evaluative tool measures some of the objectives of the clerkship, but it should not be used as the sole way to measure student performance.

OBJECTIVE To determine whether human immunodeficiency virus (HIV) counseling and testing has an effect on reducing subsequent risk behaviors in those tested, to evaluate stability in condom use over time, and to determine whether self-reported frequency of condom use relates to the incidence of sexually transmitted diseases (STDs). DESIGN Cohort study with 2-year follow-up. SETTING An urban adolescent-medicine clinic. PARTICIPANTS A random sample of 149 patients (118 female and 31 male adolescents) with a mean (+/- SD) age of 16.4 +/- 1.51 years were selected from a cohort of 500 patients at high risk for HIV infection. The patients had received a risk behavior questionnaire during pretest counseling for HIV testing. They were divided into 3 groups, identified by the letter F, S, or R, based on their self-report of frequency of condom use at enrollment: 24% used condoms frequently/always (F); 40%, sometimes (S); and 36%, rarely/never (R). One hundred twenty-six patients (85%) made return visits. INTERVENTION HIV counseling and testing. MAIN OUTCOME MEASURES Medical record documentation of STDs before and after HIV testing, and self-reported condom use frequency. RESULTS Before HIV testing, all 3 condom use groups had a similar frequency of STD visits per month. The number of STD visits per month did not decrease significantly in the posttest period for either the total group or each of the 3 subgroups. Also, most patients (F, 67%; S, 44%; R, 53%) in each of the 3 subgroups had shifted unfavorably to rarely/never (R) condom use within the month before their follow-up visit. Only 24% (8 patients) of those in the initial frequently/always (F) group reported continued frequent condom use. CONCLUSIONS As has been found in adult studies, single-dose interventions such as HIV counseling and testing did not seem to reduce HIV risk behaviors in our sample of high-risk adolescent patients. None of the 3 groups showed a significant decrease in STDs after HIV testing and counseling. Also, our adolescent patients reported widely varying condom use frequency over time, yet the incidence of STDs did not correlate with self-reported condom use.

Purpose: Many surveys of adolescent behavior are dependent on self-reported data. We sought to assess the accuracy of adolescent self-report of sexually transmitted diseases (STDs) and pregnancies.Methods: We randomly selected 149 (118 females, 31 males) adolescents to participate in this accuracy study. Follow-up questionnaires were administered to the 126 patients (99 females, 27 males) who returned after enrollment. Patients were asked about STDs and pregnancies during the follow-up period which ranged from 6 months to 1 year. All patient charts were reviewed to validate post-testing history.Results: Return visits were made by 126 patients (84%). Fifty-one (40%) denied having had an STD at all during the follow-up period but were found to have had at least one STD. Another 11 (9%) admitted having had an STD but had multiple STDs in excess of what they reported. Only 46% of the patients provided accurate information on the follow-up questionnaire. Of the 99 girls who returned for follow-up, the inaccurate patients (10%) consisted of 9 who reported no visits for a pregnancy but had a pregnancy documented in their charts and I who underreported her number of pregnancies. Reliability analysis of the accuracy of STD and pregnancy self-report for our patients showed kappas ranging from 0.185 to 0.413 (slight and fair to moderate, respectively). Pearson correlation coefficients were 0.3107 and 0.4364 for STD and pregnancy, respectively.Conclusions: Our patients' histories of visits for STDs and pregnancies are often not substantiated by review of their medical records. The reason for the inaccuracies in self-report of sexual behaviors is unclear. Further research in this area should be done. Physicians must confirm patient history concerning sexual practices through appropriate record review and medical evaluation. (C) Society for Adolescent Medicine.

The Feeding Scale provides a reliable rating of mother-infant/toddler interactions during a 20-minute feeding in a laboratory setting. The scale consists of 46 mother and infant behaviors, which are rated at the end of the feeding session. Observations of mother—infant interactions during two feedings separated by 2 weeks showed considerable stability. Five subscale scores are derived (1) Dyadic Reciprocity, (2) Dyadic Conflict, (3) Talk and Distraction, (4) Struggle for Control, and (5) Maternal Non-Contingency, Predictive validity of the Feeding Scale has been demonstrated and it discriminates between infants with and without feeding disorders as well as three diagnostic categories of feeding-disordered infants. The Feeding Scale can be used with infants and toddlers ranging in age from 1 month to 3 years. © 1997 Michigan Association for Infant Mental Health

Resurgence of neurosurgical intervention of obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus palsies, and 63% were mild. Forty-two infants required no long-term follow-up because they rated 1 or 2 on initial physical examination. Comparing first and last follow-up clinical findings of the remaining 149 patients, there was high agreement (correlation r= 0.81; P < 0.001). Pearson correlation of initial physical exam with electrodiagnosis at three intervals was relatively stable (r= 0.87, 0.88, 0.69). One hundred eight (72%) of the patients remained in their original severity groups. Thirty-three of 41 patients with discrepant follow-up scores improved by at least one category. Eight patients deteriorated. The natural pathophysiology and recovery of OBPP is presented.

A growing literature documents the deleterious effects of radiation therapy in children treated for malignant brain tumors. However, the clinical relevance of previous research has been limited by reliance on global IQ and achievement test scores. The present study of a sample of long-term survivors of medulloblastoma examined their cognitive and socioemotional functioning in depth with standardized psychologic measures. Participants' levels of intellectual functioning ranged from moderately mentally retarded to low average, with marked scatter across individual skills. Thirty-nine percent of participants had formal learning disabilities, with achievement substantially below their learning potential. In terms of specific areas of deficit, almost one half the patients tested (47%) showed considerable impairment in perceptual-motor coordination, fine-motor dexterity, attention and concentration, sequencing, and memory, particularly visual memory. More than one half of the sample (54%) was also described as displaying severe impairment in terms of maladaptive behaviors. Results are discussed in terms of the implications for special education, everyday skills, and psychosocial program development.

This study was conducted to determine male adolescent behavior, attitudes, and knowledge concerning the use of condoms. Subjects were 241 sexually active black adolescent males attending an inner-city adolescent medicine clinic who were surveyed using a structured interview technique. Factors associated with condom use included higher grade level, > or = 2 sexual partners in the past six months, communication about contraception with sexual partner(s), desire for sexually transmitted disease (STD) prevention when contracepting, and parental suggestion to use condoms. Variables not associated with condom use included older age, minimal level of knowledge about condom use, history of having impregnated a partner or of having contracted an STD, desire for pregnancy prevention, suggestion by friends to use condoms, or partner dissatisfaction with condoms. Using multivariate logistic regression analysis, the following variables in combination were able to correctly classify respondents as condom users or nonusers in 74% of cases: higher knowledge score, reported communication about contraception with one's partner(s), > or = 2 partners in the past six months, and higher socioeconomic status. These findings suggest that, for the study population, interventions directed toward improving knowledge about condoms, school achievement, and communication with parents and partners may be effective in increasing condom use.

Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school. Some recommmdations are made for curriculum changes based on the findings reported.

The majority of pediatric residents continue to choose a career in practice on completion of their training. Despite knowing residents' career preferences, many training programs have focused on inpatient tertiary care at the expense of primary care. Perhaps this reflects service needs and the significant technology and extensive information resulting in the growth of pediatric subspecialties. To determine the spectrum of didactic and clinical experiences pediatric training programs offer residents to prepare them for managing a practice, we conducted a survey of pediatric training program directors in 1988. Although the majority of residency programs have a practice management curriculum, the number of hours devoted to this area is minimal. In addition, a significant number of residents are not experiencing a community office rotation. This survey indicates the need to develop a practice management curriculum if trainees are to be prepared for choosing the right career and for being competitive in practice.