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Creating an effective learning experience for medical students in ambulatory pediatrics can be a problem. In a pilot study several strategies to improve learning were tested on 51 students during their eight-week basic pediatric clerkship. Each student spent half of this clerkship in the outpatient area. Thirty-six received a detailed list of cognitive and skill objectives at the beginning of their outpatient experience, and 18 of these also had structured individual teaching sessions with a staff pediatrician. The individual teaching sessions tended to improve performance in patient evaluation skills, but neither approach improved the attainment of factual knowledge or the students' evaluations of their outpatient experiences. Further study of the qualitative and quantitative aspects of various teaching technics is needed.

There have been few assessments of residency programs by graduates; therefore, to investigate a practical means of evaluating programs we asked former trainees to relate aspects of their training to present professional needs. Former residents in the Duke pediatric program from 1960 to 1972 were asked to evaluate various aspects of their training. The overall training program was rated favorably, as were most deficiencies were identified in ambulatory pediatric care, such as surgery, dermatology, psychiatry, and radiology. Analysis according to respondent's period of participation in the program and current professional activity revealed little variation in patterns of response. This survey method provides an inexpensive means of monitoring inadequacies in residency programs and provides data to initiate changes.

A symptom-oriented protocol for acute pharyngitis was evaluated in a busy general medical clinic staffed by physicians and graduate and student physician's assistants. We observed significantly improved performance by all providers in collection of medical data, utilization of laboratory tests,and appropriate use of antibiotics after introduction of the protocol. Patient charges were less when the protocol was used, but these savings were offset partially by the cost of audit. Compliance with and acceptance of the protocol differed among the various health providers, with physicians demonstrating significantly lower levels than nonphysicians. Patient-care protocols provide an effective means of monitoring the process of medical care, detecting weakness in supportive clinic services, and affording educational feedback for all health providers.