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The essence of these case-based discussions is “a small
group experience that promotes
free exchange of ideas and provides for a continuing relationship
with resource faculty and
other group members” (Fishman et al., 1997). In 1989,
these rounds originated out of an
increasing emphasis on the mental-health aspects of primary
care for children and
adolescents. Postgraduate collaborative office rounds with community
pediatricians continue
with support from the U.S. Maternal and Child Health Bureau
in a dozen sites across the
country. Jointly led by a pediatrician and child and adolescent
psychiatrist, these study groups, which emphasize the practical
challenges confronted in the community, have been well
received (Schwam and Maloney, 1997; Thomasgard and Collins,
1998).
Fishman et al. (1997) noted that that the potential of collaborative
office rounds “may be
more fully realized by applying this approach more widely…A
natural extension would be to
explore the applicability of this approach to new situations
and withdifferent group
compositions.” The Collaboration Essentials program
is the extension of the collaborative
office rounds concept to a residency training program level.
While there is a long history of
joint teaching endeavors, this program is unique in bringing
together trainees from both
disciplines in a format that enhances communication, models
collaboration in case
management, and establishes new linkages. Presently, there
are no training programs in the country that bring pediatric
and child/adolescent psychiatry residents together in a similar
format.
Case-based Teaching Vignettes
Case-based teaching was selected for the content of the rounds
used in the Collaboration
Essentials program because case discussions are more effective
in promoting critical
thinking and analysis (Barnes et al. 1994a; Barnes et al.,
1994b).With support from The
Maternal and Child Health Bureau and The Genentech Foundation
for Growth and
Development, Knight et al. (2001) developed for pediatric
residents a standardized case-
based curriculum on child growth, development, behavior, and
adolescent medicine that incorporated the Bright Futures (Green
and Palfrey 2000) health supervision guidelines.
They developed a series of illustrative clinical cases with
accompanying written educational information, which appeared
promising for teaching pediatric
residents (Knight et al., 2001).
For the Collaboration Essentials program, it was critical
to have specific cases that met
the following collaborative office rounds objectives: 1) to
enhance understanding of
psychosocial aspects of child development, disorders, and
disability and increase
practitioners’ ability to help children and families
deal with these issues; 2) to expand
power to discriminate between transient disturbances and more
serious psychiatric
disorders which require referral; 3) to promote collaboration
between pediatricians
and child psychiatrists; and 4) to facilitate a more comprehensive
approach to health.
For this manual, pediatricians and child and adolescent psychiatrists
jointly wrote three
new clinical cases. (See individual cases in following sections.)
These cases have been
selected to illustrate a range of problems, including depression,
substance abuse, and
somatoform illness, that residents from both disciplines are
likely to confront.
Group Participants
A Collaboration Essentials group should have 6-15 participants,
including both pediatric
and psychiatry residents. Pediatric trainees can range from
interns through senior
residents and specialty fellows. Child and adolescent psychiatry
residents are
recommended, although general psychiatry residents and other
mental health trainees
or staff can participate. Triple board residents (i.e., pediatrics,
psychiatry, and child
psychiatry) as well as some child neurology residents are
also suitable participants.
A child psychiatrist and a pediatrician facilitate each group.
The facilitators should
maximize student interaction as well as encourage residents
to learn from one another
by: 1) maximizing student-to-student interaction and participating
as equal members
of the group; 2) meeting the group members at their level
and encouraging advanced
students to teach others; 3) asking questions to keep the
discussion going; and 4)
trusting the group to find the answers, as there is no single
best answer to questions
posed (Blaschke et al., 2002). Facilitators are told that
the program is designed for the
residents to learn to collaborate at the clinical crossroads,
rather than to learn one
subject in expert depth. (See Appendix 1 for more specific
guidelines for facilitators).
Group Format
There are two recommended formats for running a Collaboration
Essentials rounds.
The rounds comprise three cases, each of which requires 60
minutes for adequate
discussion. The first format requires a minimum of one 4-5
hour block, in which the
trainees are exempt from their usual duties, so that all three
cases can be discussed.
It generally includes at least one 10-15 minute break midway
through the block. The
rounds can be paired with either a lunch or a snack to allow
social connection among
the participants. There might also be a short didactic talk
on a topic common to both
participating disciplines.
The second format requires separate 1-hour sessions over
the course of a 3-6 month
period. These hours must be protected time, so that the trainees
may focus on the
case discussion without distraction. In this format, the program
is embedded within
the ongoing teaching schedule in the training programs. Continuity
of group membership
and leadership across these sessions is important.
In each format above, all case handouts should be provided
to the group facilitators at
the beginning of each case discussion. The cases are designed
to facilitate discussion
through the following format: 1) distribute first part of
case and have participants read
aloud; 2) discuss participants’ thoughts about the case
based upon this information;
3) hand out second part of case and indicated handouts; 4)
discussion and thoughts
continue with this additional information, 5) give out final
part of case and indicated
handouts, and 6) finish case discussion. The participants
can be given notebooks to
organize the written material provided to them. The Facilitators
Guide that accompanies
each case is intended to provide facilitators with ideas and
thoughts on each case and
is not given to the participants. |
