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A Model for Medical Education

Amy M. Bernhardt, MEd; Madeline A. Dalton, PhD; James D. Sargent, MD; Marguerite M. Stevens, PhD

Arch Pediatr Adolesc Med. 2000;154:1258-1262.

Objective  To examine e-mail communication between student physicians and schoolchildren, in the context of a school-based tobacco prevention program, as a way to teach communication skills and model physician-patient interactions.

Design  Twenty medical students and pediatric residents were partnered with groups of children as part of HealthQuest, a tobacco prevention program implemented in 2 kindergarten through grade 12 Vermont schools. Medical students and residents acted as mentors for their group and provided support to the schoolchildren through e-mail and occasional site visits. E-mail messages were transmitted and stored in a Web server and monitored by preceptors. Content analysis of the messages was performed to identify emerging themes.

Results  During the 2-year intervention period, 1187 messages were exchanged between children, teachers, and the student physicians. Thirty-two percent (n = 383) of the messages involved tobacco, of which 54% addressed health effects; 23% were related to social influences of tobacco use, 15% to cessation by parents and others, and 7% to cessation by students. Other categories included nontobacco health issues (n = 135), personal questions (n = 294), and classroom information (n = 735). Many inquiries required medical students and residents to research their answers, and several required collaboration with preceptors, because the questions raised serious medical or psychosocial issues. With feedback, medical students and residents adjusted their responses so that they were appropriate for the developmental level of the children.

Conclusions  The e-mail component of this program provided important learning opportunities for student physicians in tobacco control, child development, communication skills, and developing a physician-patient relationship. This model also offers potential benefits for medically underserved pediatric populations.

From the Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center (Ms Bernhardt and Drs Dalton, Sargent, and Stevens); and the Departments of Pediatrics (Drs Dalton and Sargent), and Community and Family Medicine, Dartmouth Medical School (Dr Stevens), Lebanon, NH.

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