Evaluation of a community-based pediatrics residency rotation using narrative analysis.

Purpose: To evaluate the extent to which a community pediatrics rotation in disadvantaged neighborhoods provided residents with a self-assessed change in knowledge, attitudes, and skills useful for improving the health of children at the community level.
Method: All pediatrics and medicine-pediatrics residents at the University of Rochester Medical Center participate in a two-week community-based rotation. At the end of each rotation, residents were asked to write a short essay on what they learned during the experience. An interdisciplinary team conducted a retrospective, qualitative analysis of residents' essays looking for recurring themes. Essays were also examined for narrative plot elements that would indicate a causal sequence of events indicating some transformation of the learner.
Results: Of the 25 essays reviewed, each gave evidence of at least one of three themes: increased knowledge of lives in poverty, renewed enthusiasm for advocacy, and increased skill in making referrals. Although many residents expressed initial skepticism of the value of a community rotation, none noted any negative final impression. The narrative structure of residents' essays also showed evidence of some transformation of the learner.
Conclusions: A community pediatrics rotation can be a successful educational experience for providing residents with knowledge of how pervasive poverty impacts children and families. Reported changes in attitudes and skills require further evaluation to demonstrate that they can be applied in practice.