Pediatrician prescription: more environmental training needed. (Science Selections).

The importance of environmental exposures to children's health is well known to pediatricians, but they need more training in that area, according to a recent survey by Emory University researchers [EHP 110:823-827]. "There's a disparity between what pediatricians feel is important and what They feel equipped to handle," says coauthor Howard Frumkin. The survey of more than 250 randomly selected pediatricians in the state of Georgia found that, although less than one-fifth of pediatricians are trained in taking environmental histories, most believe data on environmental exposures are important for monitoring and maintaining children's health. More than half of the doctors surveyed report encountering a child who had been seriously and adversely affected by an environmental exposure.

The Emory team examined the pediatricians' attitudes, beliefs, and practices regarding children's environmental health by mail questionnaire. The team surveyed mainly private primary care pediatricians. Of those selected, roughly two-thirds practice in urban settings, one-third in rural areas.

According to the report, although interest in environmental health education may be high, training remains a low priority. The article cites recent studies revealing that one-quarter of medical schools offer no instruction in environmental medicine. And those that do offer an average of less than 10 hours of instruction over four years. Two-thirds of deans report "minimal" emphasis on environmental medicine. The trend is similar in residency programs.

What's more, physicians report a low level of self-confidence in taking environmental histories, discussing such exposures with parents, and finding appropriate diagnosis and treatment resources. Generally, the pediatricians also report having low expectations that they could take environmental histories that would yield useful information. This corresponds to what traditional human behavioral models would predict--that doctors who expect environmental histories to be a useful tool are more likely to feel more confident about taking them.

Clinicians who do routinely take environmental histories seldom probe into parents' exposures, the survey revealed. Moreover, the exposures physicians ask about are generally limited to lead and environmental tobacco smoke, according to earlier studies cited in the article. The survey did not address how frequently pediatricians may be misdiagnosing their patients as a result of failure to take a proper history or act appropriately on information supplied by a patient or parent.

Besides whether and how pediatricians take environmental histories, the researchers also collected information on training and information sources. The American Academy of Pediatrics stands out as the leading source of environmental health information. The pediatricians prefer newsletters and government publications over professional journals and Internet resources. However, pediatricians using the Internet rely on professional organization sites almost twice as often as commercial medical information portals, the survey found.

Nearly 90% of the physicians surveyed say they would like to learn more about children's environmental health hazards. At the same time, physicians see "few logistic barriers, such as time, effort, or cost, to incorporating the environmental history into their clinical visits," the researchers reported. Frumkin acknowledges, however, that the survey may overstate the pediatricians' enthusiasm, because the response rate of just 56% may indicate some selection bias toward physicians who are already eager to learn more about environmental health.

Still, the survey "provides a data-based argument for beefing up education," Frumkin says. He believes this could be helped by the creation nationwide of more Pediatric Environmental Health Specialty Units, which are funded by the Agency for Toxic Substances and Disease Registry. The handful of existing centers were set up in recent years to provide quality care for children and to increase the knowledge base of pediatric environmental medicine by providing a forum for sharing information, training, consultation, and clinical referrals.