What’s in a Doctor’s Bag? Maria O. Stanislaw, DO Marshfield Clinic, PGY2 Marshfield, WI Advocacy Advocacy is the pursuit of influencing outcomes that directly affect people’s current lives. Marshfield Clinic’s Pediatrics Residency program requires an advocacy or research project before graduation. My project is called What’s in a Doctor’s Bag? The Summer Day by Mary Oliver “Tell me, what is it you plan to do with your one wild and precious life?” Walk a Mile in their Shoes Threatening Uncomfortable Restricted movement Separated from parents Viewed as a punishment Undressing in-front of strangers Memories of shots, gagging, forcibly restrained… Routine visits have potential to produce stress 1990. Goldberg, L.; Gaynard, L.; and Wolfer, J. Helping Children Cope with health-care procedures. Contemporary Pediatrics, March. 141-160. Poof!!! Be Gone Prelogical thinking prevails between 2 and 6 yo. Children use their immediate spatial and temporal cues to determine their reality Doctor visits can be viewed as a punishment implemented by a villain (the doctor) By introducing children to medicine in a nonthreatening manner, we can remove some of their misconceived perceptions. 2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215. What are the goals? Don’t Worry, Be Happy Take the unknown out of the well child visits 41 mothers with toddlers routine immunizations If children were informed before immunizations, the shots were less distressing They had the chance of using selforiented strategies rather than avoidant coping strategies. 2008. Favez, N. and Reichert, M. Toddler’ Adjustment to the Stress of Immunizations. Early Child Development v178 n1 p49-64. Practice Makes Perfect Make believe medical consultation for preschoolers reduces anxiety when visiting doctors. 2000. Jessee, Peggy; Wilson, Heidi. Childhood Education. Vol 76, issue 4, p215. Proactive approach to health Decrease barriers to healthcare Invested interest in their own health Up-to-date on immunizations Well child visits Early career choices Studies show that career aspiration can begin as early as elementary school It’s never to early to spark an interest in a medical career 2000. Jessee, Peggy; Wilson, Heidi. Childhood ducation. Vol 76, issue 4, p215. Have fun! Play is a medium to learn about the world- Piaget, Erickson Switch form passive observer to active participant Conquer fears 1988. Oremland, E. Mastering development and critical experiences through play and other expressive behaviors in childhood. Children’s Health Care, 16 (3), p150-156. My Plan Target population: Head Start to 3th grade Rural Wisconsin children 20 minute presentation covering the basics Split into small groups Typical medical equipment in a well child visit Name, function Identify body parts Hands-on approach Children are sent home with an encouraging flyer for parents to read and discuss Overall Goals Encourage, guide, ask questions, answer questions, respond to concerns and have some fun… Outcomes No formal measure Plenty of smiles and hugs Positive feedback from parents Reminder about why I’m in primary care Long-term Plans 1 1/2 years in Marshfield Continue the program until my graduation and then set up a similar program at my future practice site Future plans: To include surrounding small towns Perception is Everything A study in rural Ireland focused on how the process of health visits in homes and schools changed parents’ perceptions medical care Parental perceptions of being supported were exemplified by: Increased confidence in infant care Reduced anxiety Increases in knowledge A sense of personal competence in parenting practices Reduced isolation McIntosh, Jean. The process of health visiting and its contribution to parental support in the starting well demonstration project. Health and Social Care in the Community 15(1), 77-85. “The specific leadership of pediatricians is often key in overcoming political and cultural barriers.” Grason, Holly. Pediatrician led community child health initiatives. Pediatrics vol 103 No. 6. June 1999. How can you repeat this project? What do you advocate for? Where is your passion? Does your residency have a similar project requirement? What simple thing can you do TODAY that will have positive outcome on TOMORROW? “What do you plan to do with your one wild and precious life?” Thank you for your time. Any questions?