Die Bedeutung der Sozialpädiatrie in der ärztlichen Ausbildung [Elektronische Ressource] : Erhebung bei Studierenden in England und Deutschland sowie bei niedergelassenen Kinder- und Jugendärzten in Deutschland = The role of community paediatrics in paediatric medical education / vorgelegt von Isatta Lamboi (geb. Kamara)

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• Publié par: justus-liebig-universitat_giessen
• Publié le: 01 janvier 2003
• Nombre de lectures: 21
• Langue: Deutsch

Extrait

Die Bedeutung der Sozialpädiatrie in der
ärztlichen Ausbildung

(Erhebung bei Studierenden in England und
Deutschland sowie bei niedergelassenen Kinder- und
Jugendärzten in Deutschland)


The role of Community Paediatrics in
Paediatric Medical Education

(A survey among students in England and Germany
and among German Office Paediatricians)



Inaugural-Dissertation
zur Erlangung des Grades eines Doktors der Medizin
des Fachbereichs Humanmedizin
der Justus-Liebig-Universität Gießen


vorgelegt von Isatta Lamboi
(geb. Kamara)

aus London (England)



Gießen 2002 2
Die Bedeutung der Sozialpädiatrie in der
ärztlichen Ausbildung

(Erhebung bei Studierenden in England und
Deutschland sowie bei niedergelassenen Kinder- und
Jugendärzten in Deutschland)


The role of Community Paediatrics in
Paediatric Medical Education

(A survey among students in England and Germany
and among German Office Paediatricians)



Inaugural-Dissertation
zur Erlangung des Grades eines Doktors der Medizin
des Fachbereichs Humanmedizin
der Justus-Liebig-Universität Gießen


vorgelegt von Isatta Lamboi
(geb. Kamara)

aus London (England)



Gießen 2002
3
Aus dem Medizinischen Zentrum für Kinderheilkunde
und Jugendmedizin
Abteilung Neuropädiatrie und Sozialpädiatrie


Leiter: Herr Prof. Dr. med. Bernd Neubauer
des Klinikums der Justus-Liebig-Universität Gießen











Gutachter: Herr Prof. Dr. med. Gehard Neuhäuser


Gutachter: Frau Prof Dr. Dr. Petra Netter



Tag der Disputation: 4. Dezember 2002

4














Für meine Familie















5
Contents

1. Introduction

1.1 Paediatrics At A Glance
1.2 What Is Community Paediatrics
1.3 Features Of Undergraduate Medical Education
1.4 The Study
1.4.1 Background
1.4.2 Aims and objectives


2. Method

2.1 Topic Representation In Paediatric Education
2.2 The Instruments
2.3 The Student Questionnaire
2.4 The Office Paediatrician Questionnaire
2.5 Data Analysis


3. Results

3.1 Paediatric Textbooks
3.2 Sample Characteristics
3.3 An Evaluation of Paediatric Medical Education
3.4 The Importance Accorded To Community
Paediatrics By Students
And German Office Paediatricians
3.5 Features Of Undergraduate Paediatrics
3.6 Community Paediatric Practice

6

4. Conclusions

4.1 Paediatric Textbooks
4.2 Respondents
4.3 Paediatric Medical Education
4.4 The Importance Accorded To Community
Paediatrics
4.5 Undergraduate Paediatrics
4.6 Community Paediatric Work


5. Discussion

5.1 Recommendations
5.2 Limitations And Further Work
5.3 Have the study’s aims been achieved?


6. References


7. Appendix
7
1. Introduction



1.1 Paediatrics at a glance


Paediatrics is defined as the branch of medicine concerned with
the care of children and young people. In general, this care
commences at birth, but as children mature at different rates,
there are no clear-cut guidelines as to when it should be
brought to an end. It may for example be thought appropriate
to extend care beyond the age of sixteen or eighteen, when an
adolescent who is well known to a paediatrician or hospital
department presents with a known problem and their continued
care can be more suitably provided in a familiar environment.
On the other hand, the care of a young person becoming
pregnant would more appropriately be handed over to health
care providers in adult medicine. Similarly, an adolescent
exhibiting symptoms of diabetes at the age of fourteen could be
cared for either by paediatricians or providers of adult
medicine: Here the choice would depend on the child’s level
of maturity and perhaps the level of care required. Conversely,
the care of a patient diagnosed with diabetes very early on in
life, may for the reasons mentioned above, extend beyond
adolescence.

The past fifty years have brought about an exponential rise in
basic medical knowledge with the development of highly
specialised areas of medicine. This is an experience shared not
only by Forbes; authors like Baum, O’Keefe and Roberton
have written similarly on this topic. The volume of knowledge
that students have to learn has increased to such a point that it
is now clear that a medical course cannot cover all areas in
detail. As such, it seems appropriate that the selection and
8
training of students should be changed, to generate a product
better equipped for the new millennium. The teaching
environment too requires some change, so that advantage can
be made of outpatient and community facilities. In this way,
students can be ensured a better balance between patient
clientele in hospitals and the community, the latter being of
particular importance, given the fact that many graduates will
become general practitioners (Forbes).

In spite of the inherent shortfalls associated with it, Germany
exhibits a clear distinction between Clinical Paediatrics,
involved with the diagnosis and therapy of childhood illnesses
and Community Paediatrics, whose roles lie in the prevention
and prophylaxis, surveillance, welfare and rehabilitation of
children.

In being the responsibility of the health service and financed by
the national health insurance (Gesetzliche
Krankenversicherung), Clinical Paediatrics differs from
Community Paediatrics. The latter is the task of the public
health service (Öffentlicher Gesundheitsdienst) or centres for
Community Paediatrics and the Community Paediatrics
department of children’s hospitals or the office paediatrician
(Hellbruegge and Pechstein 1991). However, as social factors
play an important role in literally all areas of Paediatrics,
Community Paediatrics cannot be seen as a sub-speciality of
paediatrics, but as an essential, interrelated element of it
(Nitsch 1979, Brodehl 1990). In this light, ‘Clinical
Community Paediatrics’ has developed in recent years, so that
the term Community Paediatrics is progressively used in
different ways.

Over the past fifteen years, it has become clear that the role of
Community Paediatrics in medical education has been
somewhat neglected. Steps to reverse this trend are mirrored in
9
recommendations of both the German Society for Paediatrics
(1989) and the American Academy of Paediatrics (1993).
Despite this, a survey conducted in 1999 among British,
German and Italian students showed that little has been done to
reverse this trend at undergraduate level (Davies, Kamara,
Indimeneo, Cutrera 1999). In view of the intense specialisation
that has occurred in Paediatrics over the past decade, it seems
crucial that Community Paediatrics be appropriately
represented, particularly at undergraduate level, so that the vital
competency it imparts is not lost.

Though their boundaries are not always apparent, the following
will attempt to describe paediatric topics that have a well-
established role in both undergraduate and postgraduate
medical education.

In no other stage of life is infant mortality as high as it is
during the Neonatal period. Alongside infections, immaturity,
intrauterine growth retardation / placenta insufficiency and
serious disorders of postnatal cardio-respiratory adaptation are
the most common causes of neonatal mortality. Over the past
ten years, infant mortality has halved in Germany, now
standing at six per thousand. This positive development can
partly be attributed to better supervision of at-risk pregnancies
and endangered premature / newborn babies.

Infectious Diseases are among the most frequent illnesses of
childhood. Illnesses accompanied by fever, contagious
diseases and questions on immunisations make up more than
50% of the clientele of office paediatricians. Modern Clinical
Infectiology works with the methods and basics of
Microbiology, Serology, Pharmacology and Immunology. In
addition, Epidemiology, Infection Control and Infection-
Immunology are necessary. As new Infectious Diseases are
still being discovered better methods of identification, rapid
10
diagnosis and therapy options are necessary in order to deal
with them adequately.

Respiratory Disorders are the most common reason for
presentation to a paediatrician. The clinical pictures are
characterised not only by pathogenic factors but also by age
de