Gelişimsel Konuların Pediatri Asistanlarının Eğitim ve Klinik Uygulamalarındaki Yeri ve Etkileyen Faktörlerin Belirlenmesi

Yıl 2021, Cilt: 15 Sayı: 1, 59 - 64, 22.01.2021

Tuba Çelen Yoldaş Saliha Şenel Hatice Abuş Hüsniye Yücel Elif Özmert

https://doi.org/10.12956/tchd.723486

Öz

Amaç: Çocuk sağlığı ve hastalıkları uzmanlarının gelişimsel sorunları yönetmedeki yetkinliği, pediatri eğitimi sürecinde, bu alanda alınan eğitime bağlıdır. Ancak gelişmiş ülkelerde dahi çoğu çocuk sağlığı ve hastalıkları uzmanı çeşitli zorluklar nedeni ile gelişimsel konuları açmak ve yönetmekte zorlanmaktadırlar. Bu çalışmada pediatri asistanlarının eğitim ve klinik uygulamalarında gelişimsel konulara ne düzeyde yer verildiğinin değerlendirilmesi, karşılaşılan zorlukların belirlenmesi ve bu konuda yeni stratejilerin önerilmesi amaçlanmıştır.

Gereç ve Yöntemler: Bu çalışma, Gelişimsel Pediatri tarafından 1 Ocak-1 Mart 2020 tarihleri arasında üçüncü basamak bir sağlık merkezinde yürütülmüştür. Çocuk sağlığı ve hastalıkları uzmanlık eğitimi almakta olan 120 pediatri asistanına klinik uygulamalarında gelişimsel konulara yer verme, karşılaştıkları zorluklar ve ilişkili etmenleri içeren, çalışma ekibi tarafından hazırlanmış 10 soruluk bir anket uygulanmıştır.

Bulgular: Çocuk sağlığı ve hastalıkları uzmanlık eğitimi almakta olan asistanların çoğunun çocuk gelişimi ile ilgili yeterli bilgiye sahip olmadığını düşündüğü (%86), gelişimsel bir değerlendirme aracı kullanmadığı (%89) ve gelişimsel sorunların erken tanı ve tedavisinde çeşitli zorluklarla karşılaştıkları (%95) gösterildi. Süre kısıtlılığı (%91) bu zorlukların başında gelmekteydi. Bilgi kaynağının olmadığını belirtenlerin sıklığı %28’di. Asistanlık eğitimindeki süresi ile gelişimsel konulara yer verme arasında bir ilişki bulunmadı (p=0.980). Gelişimsel konulara yer verme kaynak varlığı ile ilişkiliyken, kaynak varlığı da gelişimsel konular hakkında eğitim almakla ilişkiliydi (p<0.05).

Sonuç: Gelişimsel konulara yer vermenin bilgi kaynağı varlığı ile kaynak varlığının da eğitim almakla ilişkili olduğu ve başlıca süre kısıtlılığı olmak üzere karşılaşılan pek çok zorluk gösterilmiştir. Gelişimsel sorunların erken tanı ve tedavisi konusunda sağlık sisteminin bütüncül bakış açısıyla eğitimi entegre ederek desteklemesi gerekmektedir. 

Anahtar Kelimeler

Pediatri eğitimi, Gelişimsel sorunlar, Pediatri asistanı

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Identification of the Place of Developmental Issues in the Educational and Clinical Practices of Pediatric Residents and Affecting Factors

Öz

Objective: The competence of pediatricians in managing developmental problems depends on the education in this field during their pediatrics residency training. However, even in developed countries, many pediatricians find it difficult to open up and manage developmental issues because of various barriers. In this study it is aimed to evaluate to what extent are developmental issues included in the training and clinical practices of pediatric residents, to identify the barriers encountered, and to develop new strategies in this regard.

Material and Methods: This study was conducted by Developmental Pediatrics between January 1 and March 1, 2020 in a tertiary training hospital. One hundred twenty pediatric residents were given a questionnaire with 10 items, prepared by the study team which included giving place to developmental issues in their clinical practice, the barriers they faced, and related factors.

Results: It was shown that most of the pediatric residents didn’t think they had sufficient information related to child development (86%), didn’t use a developmental screening test (89%), and faced various barriers in early diagnosis and treatment of developmental problems (95%). The time limitation (91%) ranked the first among these obstacles. The frequency of those who reported that they had no information source was 28%. No relationship was found between the duration of residency training and giving place to developmental issues (p = 0.980). While giving place to developmental issues was associated with having information resources (p = 0.001), having information resources was associated with receiving training about child development (p = 0.000).

Conclusion: Giving place to developmental issues was associated with having information resources and resource availability was also associated with receiving education, and many barriers encountered were shown, particularly the time limitation. The health system should be supported with a comprehensive perspective by integrating training about early diagnosis and treatment of developmental problems.

Anahtar Kelimeler

Pediatrics training, Developmental problems, Pediatric residents

Proje Numarası

yok

Kaynakça

• 1)Ertem IO, Pekcici EB, Gok CG, Ozbas S, Ozcebe H, Beyazova U. Addressing early childhood development in primary health care: experience from a middle-income country. J Dev Behav Pediatr. 2009;30(4):319-26.
• 2) Schor EL. The future pediatrician: promoting children's health and development. J Pediatr. 2007;151(5 Suppl): 11-6.
• 3) Boreman CD, Thomasgard MC, Fernandez SA, Coury DL. Resident training in developmental/behavioral pediatrics: where do we stand? Clin Pediatr (Phila). 2007;46(2):135-145.
• 4) Senecky Y, Inbar D, Diamond G, Grossman Z, Apter A, Kahan E. Pediatricians' satisfaction with their abilities to care for children with developmental, behavioral and psychosocial problems. Pediatr Int. 2007;49(4):472-8.
• 5) Rikhy S, Tough S, Trute B, Benzies K, Kehler H, Johnston DW. Gauging knowledge of developmental milestones among Albertan adults: a cross-sectional survey. BMC Public Health. 2010; 8;10(1):183.
• 6) Rhodes A, Sciberras E, Oberklaid F, South M, Davies S, Efron D. Unmet developmental, behavioral, and psychosocial needs in children attending pediatric outpatient clinics. J Dev Behav Pediatr. 2012;33(6):469-78.
• 7) Sand N, Silverstein M, Glascoe FP, Gupta VB, Tonniges TP, O'Connor KG. Pediatricians' reported practices regarding developmental screening: do guidelines work? Do they help? Pediatrics. 2005;116(1):174-9.
• 8) Garg A, Butz AM, Dworkin PH, Lewis RA, Thompson RE, Serwint JR. Improving the management of family psychosocial problems at low-income children's well-child care visits: the WE CARE Project. Pediatrics. 2007;120(3):547-58.
• 9) Thompson LA, Tuli SY, Saliba H, DiPietro M, Nackashi JA. Improving Developmental Screening in Pediatric Resident Education. Clin Pediatr (Phila). 2010;49(8):737-42. doi: 10.1177/0009922810363818. Epub 2010 Mar 31.
• 10) High PC, Klass P, Council on Early Childhood. Literacy promotion: an essential component of primary care pediatric practice. Pediatrics. 2014;134(2):404-9.
• 11) Reid Chassiakos YL, Radesky J, Christakis D, Moreno MA, Cross C; Councıl on Communıcatıons and Medıa. Children and Adolescents and Digital Media. Pediatrics. 2016;138(5).
• 12) Council on Children With Disabilities; Section on Developmental Behavioral Pediatrics; Bright Futures Steering Committee; Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics. 2006 Jul;118(1):405-20.
• 13) Williams N, Mughal S, Blair M. 'Is my child developing normally?': a critical review of web-based resources for parents. Dev Med Child Neurol. 2008;50(12):893-7.
• 14) Blanchard LT, Gurka MJ, Blackman JA Emotional, developmental, and behavioral health of American children and their families: a report from the 2003 National Survey of Children's Health. Pediatrics. 2006;117(6):e1202-12.
• 15) Yimgang DP, Albury RA, Leppert ML. Do Parental Concerns Predict Developmental and Behavioral Diagnoses in a Developmental Clinic? Clin Pediatr (Phila). 2017;56(3):263-267.
• 16) Garner AS, Shonkoff JP; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012;129(1). Available at: www. pediatrics.org/cgi/content/full/129/1/e224
• 17) Brown A; Council on Communications and Media. Media use by children younger than 2 years. Pediatrics. 2011;128(5):1040– 1045
• 18) Earls MF, Hay SS. Setting the stage for success: implementation of developmental and behavioral screening and surveillance in primary care practice—the North Carolina Assuring Better Child Health and Development (ABCD) Project. Pediatrics. 2006;118: e183–e188.
• 19) Shuval K, Berkovits E, Netzer D, et al. Evaluating the impact of an evidence-based medicine educational intervention on primary care doctors’ attitudes, knowledge and clinical behaviour: a controlled trial and before and after study. J Eval Clin Pract. 2007;13:581–598.
• 20) McCluskey A, Lovarini M. Providing education on evidence- based practice improved knowledge but did not change behaviour: a before and after study. BMC Med Educ. 2005;5:40.