This is an exercise in observation. The resident drives around the community, not getting out of the car or talking to people on the street, but simply making observations and taking notes. When the learner and teacher review the notes, opportunities may arise to discuss observational skills, as well as cultural biases and stereotypes.
The survey works like a scavenger hunt and asks learners to look for public transportation, community centers, types of houses and cars, and ethnic makeup of the community. (See box.)
“We as physicians take pride in what we do, and as we get older, we become interested in who is going to come along after us. It's not a matter of paying back, it's paying forward as well,” Dr. Fisch said.
With a little planning, pediatricians can pay forward through effective teaching in a practice setting.
Components of a Windshield Survey
A “windshield survey” involves approximately half a day with students or residents driving around the area where they are doing their community pediatrics rotation to acquaint themselves with the community and to hone their observational skills.
The survey prompts observations about various community features, including:
▸ Housing and zoning. Age, style, and upkeep of houses.
▸ Transportation. The types of automobiles and the extent of public transportation.
▸ Service centers. Are there community recreation areas, doctors' offices and dentists' offices, alternative medical care? What types of churches?
▸ Race/ethnicity. What are the demographics? Are there signs in languages other than English?
▸ Media. What types of newspapers are available? Are there many satellite dishes?
▸ Open space. How much open space is there, and what is it like? Are there green spaces or rubble-filled lots? Are there well-kept lawns and trees on sidewalks? Is the open space public or private, and who uses it?
▸ Stores. Where do residents of the community shop? Local markets, malls, or large chain stores such as Wal-Mart? Do they travel to their shopping destinations by car or public transportation?
▸ Politics. Are there campaign posters visible? Is there evidence of a predominant party affiliation?
▸ Boundaries. What signs show where neighborhoods begin and end? Are the boundaries natural, such as a change in terrain, or physical, such as a highway?
▸ Commons. Where do people in the community congregate? What groups seem to meet in certain places, such as schools, parks or 24-hour drugstores, at certain times?
▸ Street people. If you are out during the day, who do you see on the street? Mothers with babies? Teenagers? Homeless people? What animals do you see? Strays? Pedigreed pets? Watchdogs?
▸ Signs of decay. Which neighborhoods are on the way up or down? Are there piles of trash? Abandoned buildings? Construction projects?
▸ Health and morbidity. Is there evidence of acute or chronic diseases or conditions in the community? Alcoholism or drug addiction? How far is the nearest hospital from different parts of the community?
Adapted from work by Terry Mizrahi, Ph.D., of Hunter College School of Social Work, New York.