Selective medical examinations for school entrants: the way forward.

Systematic review of the school entry medical examination

“…9 12 13 19 Three studies showed that social and demographic characteristics appeared to influence the number of children selected, and both the number and type of problems identified 79 18 Many studies included in this review failed to provide any information concerning the characteristics of the school(s) in which the children being tested were located, and it was therefore difficult to assess the extent to which these factors might have influenced the outcome of the SEM examination.…”

“…9 12 13 15-17 19 The use of retrospective recording of data in the remaining five studies raises questions concerning the validity of the data.…”

“…Selection by class review. Criteria for selection include: records of preschool surveillance missing/incomplete; request by parent/teacher/ professional; SENs; clarification of known medical condition Retrospective observational  study 494 primary   school entrants from 10 schools 96% of children seenThe ‘routine’ SEM is an   outdated concept and that its abolition would allow more time for more important aspects of educational medicine • Schools not described • Retrospective recording  of data • Screening tests, uptake   rate, and conditions not clearly defined • Condition not reported   by need for identification; new problems; action taken • Referral and recall   criteria not clearly defined • No follow up after  referral • No follow up of whole  cohort Richman and Miles13 Type of SEM: selective Selective: all children   interviewed by school nurse and screened for height, weight, hearing and vision defects. Selection by class review.…”

School nursing: history, present practice and possibilities reviewed

“…While several more recent sinall-sccJe studies and personal reviews have explored the work undertaken by school nurses (e g Whitmore et al 1982a, Whitmore et al 1982b, Staunton 1983, Johnstone 1986), Thurmott's (1976 exploratory survey of the school nursing service m an English county m 1973 remains the most detailed empincal aneJysis of the work undertaken by school nurses However, her sample consisted of 58 genenc health visitors who undertook school health duties as part of their role and the data was collected by means of queshonnaires requiring recall of the previous week's work activities Since that survey, others have documented the value of school nurses m the held of health surveillance and saeenmg (Whitmore et al 1982a, Whyte 1984, Kennedy 1988, Leff 1989 There is a contmumg debate about the value of regular school medicals for apparently 'healthy' children In 1976 the Court Report (DHSS 1976) advocated a more selective approach to target those with the greatest health needs However, the Committee also recommended that universal rouhne health surveillance should be undertaken by school nurses Whitmore & Bax (1990) have suggested that up until the middle of the 1980s 90% of distnct health authonties favoured rouhne medical examination of 5year-olds However, today the need for routine medical examinations for school entrants is under review On the basis of a smaU study of two sdtools in North Kensington, London, {n = 52 children), Richman & Miles (1990) have argued that universal health mterviews by the school nurse are more appropnate as children with problems benefit from the extra medical time available to them Indeed, Kennedy's (1988) audit of school health records of 1033 children m Newtonabbey, Northem Ireland, revealed that routine medicals yield only a few new health problems and that most could have been detected by saeerung tests performed by the school nurse Lucas (1980) also had similar findings The results of a retrospective study (Smith et al 1989) of school medical records of 100 children bom m 1981 also demonstrated that the 5-year school medical was unnecessary, providing stnct cntena for the selection for exammahon by a school doctor were followed However, Jones & Gordon's (1992) survey found that the majonty (78%) of teachers value the school entry medical exammation and Jones et al (1989) found a high number of previously undetected problems revealed by pre-school medical examinations m Macdesfield Health Authonty R(Hitine medical checks Whitmore & Bax (1990) are strong supporters of routine medical checks of all school entrants drawmg upon the evidence of an audit of school health records m 12 pnmary schools m Paddmgton, London (n = 351 children) and have argued that a selective rather than a universal approach will undermine an effective surveillance of the health needs of children at school Although they recognize the manpower implications, they are unpersuaded by Ha...…”

School Nurses: Constraints and Opportunities for the Future

“…They are based on an initial screening process, where interviewing and questionnaires are used to supplement existing records, but selection criteria vary considerably (Richman and Miles, 1990). In some districts, such as Mid-Glamorgan (James, 1990) pilot schemes have demonstrated the feasibility of health visitors performing school entrance screening, but where caseloads are already high, they may experience severe disruption to their own work if they are asked to provide this additional service.…”