Community paediatrics in Israel: the ‘Goshen’ model for change

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The emerging science in early childhood development challenges past paradigms of health care. There is consideration within the profession of paediatrics, and health care more broadly, of how to make systems of care more responsive to the developmental and social needs of young children and their families. Some countries have physician-centric models, either general physicians or paediatricians, while others rely on nurses. There is increasing recognition that the goal of any model should be parent-professional partnership that puts families at the center, elicits and responds to family needs, anticipates and supports families with developmental transitions, and fits within a seamless system of services and supports.

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confidence: 99%

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confidence: 99%

Improving preventive and health promotion care for children

Inkelas

Oberklaid

2018

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“…A related study assessing the knowledge of Israeli pediatricians in child development topics that was published in 2010, reported higher general scores (~ 70 %) compared to our results. However, this study had fewer respondents and included fewer questions [ 15 ]. Additionally, the questions were multiple choice which are arguably easier to answer.…”

Section: Discussionmentioning

confidence: 99%

“…Comparable attempts are being made to face these challenges in Israel. The recently launched “Goshen Project” [ 15 ] is directed at strengthening the training of residents and senior pediatricians in developmental, behavioral, and psychosocial areas [ 11 ], but it is neither mandatory nor widely implemented so that few pediatric residents actually benefit from it. Since the pediatric residency in Israel is longer than in the US (4.5 years compared to 3 years), extending it in order to increase the exposure to community pediatrics is also not a practical option.…”

Section: Discussionmentioning

confidence: 99%

Failure of Israeli pediatric residency curricula to cover child development and special education issues: results of a national survey on levels of knowledge

Latzer

Grossman

Sachs

et al. 2021

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Background There is an increasing prevalence of developmental difficulties among Israeli children. We aimed to assess whether pediatricians are equipped to diagnose and manage them. Methods We assessed the knowledge of basic child development issues and availability of services and content of special education systems among a randomly selected national sample of residents and senior Israeli pediatricians. This was done via an 70-itemed survey developed especially for this study which consisted of seven main subjects: developmental milestones, global developmental delay, autism spectrum disorder, attention deficit hyperactivity disorder, protocol for referring to a child development institute, availability and facilities of special education systems, and medical conditions associated with developmental delay. Results A total of 310 pediatricians (an 86 % usable response rate) participated. The total median knowledge score was 32.1 % (IQR 17.8–53.5 %). Knowledge was significantly better among senior pediatricians (p < .001), those working in an office-based setting (p < .001), and those who were parents (p < .001) or had a family history of a developmental condition (p = .003). Most responders (94 %) felt that their resident training in child development was inadequate, and that they do not have sufficient access to resources and guidelines about child development and special education systems (80 %). Conclusions The gap in knowledge on topics of child development and special education systems among Israeli pediatricians stems from inadequacies in the current curricula of pediatric residencies. The alarmingly low scores of our survey on these issues call for prompt revamping of the syllabus to include them.

“…This differs from findings in other countries where well child care is provided by physicians [ 16 – 18 ]. This may be a reflection of the current hospital-based training of Israel’s pediatricians and their lack of exposure to developmental and behavioral pediatrics [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

The role of the physician in Israel’s maternal child health clinics: surveys of professional and parental perceptions

Stein‐Zamir

Shoob

Zimmerman

2017

BackgroundPreventative health services are a pediatric health care cornerstone, which strives to promote health and prevent illness and injury. In Israel, Maternal Child Health Clinics (MCHC) provide these well child services for ages 0–6 years. MCHC care includes physician visits; however, the physician’s role is not well defined. The study purpose was to provide a basis for setting policies that determine the role of physicians in the provision of MCHC services. To get broad input we included MCHC stakeholders - parents, MCHC physicians, non-MCHC physicians and MCHC nurses, specifically to obtain insights regarding the MCHC physician role and to characterize the stakeholder demographics, service utilization, and practice patterns.MethodsProfessional groups completed self-administered written questionnaires (n = 398). Parents were interviewed during MCHC visits using a structured questionnaire (n = 1052). All provided demographic data, service characteristics and agreement with ten potential MCHC physician roles - Physical Examination, Abnormal Health Condition Detection, Developmental Screening, Anticipatory Guidance, Parent-Child Interaction Counseling, MCHC Staff Advice, Children-at-Risk Detection, Growth Surveillance, Vaccination Counseling, and Inter-physician Communication.ResultsThe study findings seem to indicate a true shortage of MCHC physicians. The median age of MCHC physicians was significantly higher than both non-MCHC physicians and MCHC nurses. There was agreement among stakeholders regarding some roles (Physical Examination, Developmental Screening and Detection of Abnormal Health Conditions) but not others. Most parents reported having at least one MCHC physician encounter. Parents who did not visit the physician were younger and had fewer children.ConclusionsStakeholders view MCHC physicians as integral to MCHC care. Roles traditionally regarded as part of primary prevention were less likely to be attributed to physicians than screening roles considered secondary prevention.Updating and standardization of the MCHC physician role is needed along with a national strategy to recruit and train MCHC physicians.to ensure optimal pediatric preventive health care in Israel.