In 1994, The Council on Pediatric Education Subcommittee on Medical Student Curriculum of the American Academy of Pediatrics developed a set of guidelines for successful, community-based ambulatory care settings in pediatric education.1 As the Council's guidelines stated that one important factor for developing a successful community program is to include well-trained, enthusiastic community faculty members as preceptors, one of the challenges which clerkship directors or administrators encounter is the recruitment and retention of community faculty members. The motivations and rewards of participating as clerkship preceptors have been discussed in several publications,2-5 which cited personal satisfaction as the main reason for participating and professional growth as the main benefit of participating in such a program. In Korea, little data are currently available regarding the impact of participating in a clerkship program, specifically on pediatricians.

Considering that most community-based pediatric offices in South Korea are run by private, board-certified practitioners, clerkship directors face challenges similar to those in other community clerkship programs, including pediatricians' concerns about balancing time between advising students and maintaining their own busy schedules, dealing with the gap between the latest medical information and real, "hands-on" practice, and concerns of patients or their parents from having medical students practicing on them. In 2004, Chonbuk National University (CBNU) Medical School in South Korea implemented its community-based pediatric clerkship with the participation of either 24 or 25 private pediatricians who shared similar concerns in student training.

Since the responses of community practitioners and the effects of the clerkship program on their practice could be crucial factors in developing and maintaining a successful program,1 we designed this study to examine the participants' responses and identify their needs. The following is the result of that survey.

Qualifications: Candidates for community clerkship teaching were limited to pediatricians in private practice, who had achieved their pediatric specialty certificate after 5 years of training in a teaching hospital. Each candidate was informed that the CBNU medical school would offer no specific incentives or rewards in exchange for participating in the clerkship program. Every year, either twenty-four or twenty-five pediatricians participated in the program, with a total number of 35 participants (24 males and 11 females) over the course of three years. The participating pediatricians had practiced 13.6 years on the average since acquiring their specialty certification.

The program operated every Wednesday from 2 p.m. to 7 p.m. from September to December. Each week, the practitioner had a third-year medical student in his or her office, with another student rotating in the following week. Each student rotated to four different clinics for a total of 20 hours.

Questionnaires were mailed to all thirty-five pediatricians who had participated in the CBNU Medical School pediatric clerkship for the previous three years, and each participant received a call to encourage respondence. The questionnaire covered the following five topics: The pediatrician's motivation to join and/or reasons to quit (if they had considered quitting); changes of stress levels which pediatricians might have felt in the process of supervising students; changes in their treatment procedures or attitudes as a result of the students' presence; responses of patients or their guardians in regard to have medical students treating them; and whether the doctors felt that they had been inspired to grow professionally by participating in the program. Respondents could choose only one answer for each question except for the question concerning 'motivation', where the participant could choose more than one. In addition, a space for additional comments was provided at the end of each question. Respondents were strongly encouraged to write additional information when they felt that their thoughts were not adequately expressed in the answers.

The returned questionnaires to the survey were coded and submitted anonymously to the researchers. Responses to each question and comments were analyzed and summarized.

A total of 31 pediatricians, 88.5% of those asked, replied to the questionnaire. Twenty-six out of thirty-one respondents (86.4%) had participated for three consecutive academic terms since 2004. Two respondents had participated for two terms, one from 2004 to 2006, and the other from 2005 to 2006. Three respondents had participated for one term, two in 2004 and one in 2006 (Table 1).

Since 2004, the pediatric department of CBNU Medical School in South Korea has asked all participants (third-year medical students and community pediatricians) to evaluate our clerkship program in community-based pediatric office settings. Although not included in this study, students have shown high levels of satisfaction from participating, citing advantages such as gaining the understanding of general pediatric practice, acquiring clinical problem-solving skills and practical pediatric knowledge, and feeling positive about choosing pediatrics as their career.6 The implications of pediatricians' evaluations on this program show that the community-based pediatric clerkship has a positive impact not only on students, but also on the pediatricians in private practices. Having the students in their clinics contributes to the pediatricians' intellectual stimulation, and observing students in their practice actually encourages the doctors to be more academically oriented, resulting in potentially better medical care to patients.

According to the community pediatricians, as long as the students' practice is limited to non-invasive procedures such as history taking and physical examinations, patients and their parents seemed to benefit from having more time to spend with medical authorities for more careful physical exams and receiving better explanations. Whether the physicians are initially aware of it, the presence of the students seems to motivate them to offer better quality services to the patients in several aspects.

Most journal articles about the effects of community-based clinical education focused on the students; few focused on community physicians and their practices. Although not originally intended, the results of the survey indicate that the program can work as a way of reeducating and developing the professionalism of community pediatricians. Once they recognize that they are serving as teachers, they tend to become more conscientious about following procedures correctly and completely. Teaching can occasionally be an effective way of learning.

In spite of several drawbacks, such as small sample size and short duration, results of the survey are very encouraging because they indicate that a community-based clerkship program can be an effective way to motivate pediatricians in the community to continue enhancing their medical education. It is hoped that future research on this topic may include exploring specifically which ways that pediatricians are affected by a clerkship program and examining which specific changes doctors made in their medical practices.