Because injuries and illnesses occur among children, even in licensed child care facilities, parents need to be aware of existing hazards. We developed a questionnaire to assess parental knowledge of 16 health and safety features in their child's care facility. These health and safety features were identified by parents, in a pilot study, as being the most important features in a child care facility. This questionnaire was completed by 91 parents who use day care. Parents were well-educated employees of a health care institution. Our results indicate that even well-educated parents often do not check child care facilities for health and safety features. Parents tolerated a mean of 9.3% of 16 unsafe features and did not know the status of 22.4% of the features. Fifteen percent of the children has been removed from their child care facility because of health and safety concerns, 7.7% reported an injury. Our results suggest that it is important that physicians, during well child visits, include discussions about health and safety issues in the day care environment.

Study objectives. To demonstrate reliability of a method for evaluating pediatric resident performance of health supervision examinations of infants using real patients and to evaluate pediatric resident performance of health supervision examinations of infants before and after an educational intervention consisting of a 6-month ambulatory rotation combined with video-assisted review of resident performance of the examination. Design. Longitudinal cohort study in which all seond-year residents were enrolled. Residents' preintervention (baseline) videotapes were compared with postintervention videotapes. Each resident served as his or her own control. Setting. University hospital pediatric resident continuity clinic. Subjects. Sixteen second-year pediatric residents who were participating in a required 6-month ambulatory rotation. Method and main results. Reliability study: Using a 51-item instrument derived from the American Academy of Pediatrics Guidelines for Health Supervision, trained raters blind to the sequence and dates of the videotaped health supervision examinations independently rated 44 resident encounters (a minimum of two raters per tape) and achieved good interrater reliability (κ = 0.80). Intervention study: After a 6-month ambulatory rotation which included resident-faculty reviews of preintervention videotapes, residents showed a 14% mean improvement in performance scores for the examination (P < .05). Conclusions. The results indicate that videotaped health supervision examinations using real patients can be reliably evaluated by observational techniques in a continuity practice. A 6-month ambulatory block rotation coupled with video-assisted interactive review of examinations is associated with measurable improvement in resident performance on the postintervention test.

No abstract

has become an increasingly powerful tool for the medical practitioner, educator, and researcher. Videotapes, in particular, have become more available, acceptable, and useful, as well as affordable. In the academic medical setting, they are being used for evaluation and for education. Although videotapes will never duplicate the precision of the written word, their ability to provide multidimensional information on a realtime basis allows the learner to approximate the experience of &dquo;being there&dquo; and thus learn on multiple levelscognitive, sensory, and affective. Many people, especially children, can comprehend pictures accompanied by words more easily than the written word alone. Even for professionals, it is often easier to understand a new procedure more rapidly by watching it than by reading about it.Many videotapes are made every year that are potentially useful to the practicing pediatrician, but often their marketing is limited. Some videos, particularly those that review interesting case reports, lack the professional production values required for commercial use but are extremely valuable to the clinician. Others do not have a large enough potential market to repay the costs of professional advertising and distribution. Even if a videotape is being marketed, it is often difficult for the clinician to discern from advertisements alone whether it would be useful or how it could be used.To provide such information to pediatricians, Clinical Pediatrics begins in this issue an intermittent department called Media Reviews. Evaluations by at least two healthcare professionals will be incorporated into each review article written by the series editor. In some cases, a designated specialist will write the review. To be selected for review, a videotape or other program must meet specific criteria. First, it must be potentially useful to pediatricians themselves or as a teaching tool for medical students, residents, fellows, personnel, patients, or parents. Second, the reviewers must agree that the material is medically correct. Third, videotapes bearing commercial messages will be included only if they contain important information that is unavailable elsewhere.Ideally, technologic developments linking computers, videotapes, and other media devices will soon make multimedia programs available for medically related applications. We anticipate an explosion of computer/video material within the next five years. This department will evolve to keep readers informed about new programs suited to the pediatrician's diverse needs.Until now, peer review in the medical literature of methods of communication other than in printed form has been limited. This section will pair a brief synopsis of each program with a critique. The purpose is to enable clinicians to identify and obtain programs suited to their individual needs.Readers are invited to share their expectations for this section, explain how they are using it, and suggest ways to enhance its usefulness.