Perceived must see pediatric conditions vs. actual clinical exposure during an undergraduate pediatrics clerkship

Undergraduate pediatric rotations aim to provide authentic exposure to core conditions. Programs often publish "must-see" lists, but student and doctor perceived priorities may not reflect real-world case-mix. We compared student/doctor perceived must-see topics with the diagnoses and presentations they actually encountered.

Cross-sectional comparison of a perception dataset (49 participants: 39 medical students and 10 doctors; 81 presentation-illness pairs, mean ± SEM on a 1-5 scale) and an electronic logbook of clinical encounters. Free-text logbook fields were normalized, segmented, and classified as presentations or diagnoses by the authors and were not independently reviewed. We computed documented diagnosis and presentation frequencies, mapped survey pairs to observed labels, and examined alignment using Spearman's rank correlation coefficient. Mapping coverage and discrepant priority-exposure patterns were summarized descriptively.

The logbook comprised 5,179 encounters. After normalization and mapping, 63% (51/81) of survey pairs had at least one documented match. Spearman's rank correlations were ρ = 0.713 for diagnosis pairs (n = 15, p = 0.003, 95% CI = 0.32-0.90) and ρ = 0.087 for presentation pairs (n = 11, p = 0.800, 95% CI = -0.54-0.65). Respiratory and gastrointestinal conditions were prominent in both datasets. No mapped logbook entry was found for innocent/pathologic heart murmur, but this may reflect limited exposure, documentation omission, or mapping/capture error rather than confirmed absence. Hydronephrosis was documented 12 times despite a perceived rank of 70.

The logbook documented frequent exposure to several common core conditions that students and doctors valued, while some high-priority items had few or no mapped entries. Because absence from a free-text logbook is not proof of no clinical exposure, structured chief-complaint and final-diagnosis fields, mapping validation, targeted simulation/virtual cases, and data-informed scheduling may improve both documentation and equitable curricular coverage.