Showing papers in "Academic Medicine in 1976"

Problems and concerns among medical students--1975.

Abstract: Students at the University of Colorado School of Medicine were surveyed using an inventory of problems and conerns relating to their personal and academic lives. Results were to provide a data base for improvement of their educational environment via the ecosystem design process. The survey revealed that chief among student conerns are a lack of personal freedom, excessive academic pressures, and feelings of dehumanization. A marked trend toward increasing difficulty with thoughts of having chosen the wrong profession is noted over the four class levels. The authors offer several hypotheses relating to the underlying conditions responsible for these findings and discuss their possible relation to the current malpractice insurance crisis.

The mystification of meaning: doctor-patient encounters.

Abstract: The symbolic and communicative aspects of illness and treatment are examined. A number of factors that complicate interpersonal communication are identified and found to exist in their most extreme form in medical settings. New directions in research and training are suggested that might prepare medical personnel to respond more sensitively and flexibly to the symbolic aspects of illness.

The accuracy of recording patient problems in family practice.

Abstract: In 1974 several studies were conducted on the validity of medical data recorded and computerized at family medical centers affiliated with the University of Western Ontario. Fifty-nine encounters were observed. An average of 2.54 somatic, emotional, or social problems were dealt with per encounter. The residents recorded an average of 1.51 problems and the observers 2.45. This difference is highly statistically significant (p less than .001). There was no significant statistical differences among the observers. The many questions this study raises may have a bearing on medical education, medical audit, research, medical computer systems, and perhaps even on quality of care since problem-solving is based on problem identification. Further studies and evaluation are needed.

A study of student attitudes toward a psychiatric clerkship.

Abstract: Sixty-seven third-year medical students at the University of Ottawa were interviewed at the beginning and end of a month-long clerkship in psychiatry. Two attitude categories were designated: "attitude-positive" (AP) differentiated subjects with positive clerkship expectations or attitudes for "attitude-negative" (AN) subjects who had negative expectations or attitudes. Differences between preclerkship APs and ANs are described. Postclerkship interviews revealed a general improvement in attitudes toward psychiatry and the psychiatric clerkship. Statistically significant differences were noted between postclerkship APs and ANs in the following: attitudes toward psychiatry, attainment of preclerkship objectives, reduction of anxiety levels, and nature of supervisory experiences. Postclerkship attitudes may be predicted to some extent prior to the clerkship. The potential for a negative postclerkship attitude may be modified by positive clerkship experiences. The importance of identifying students vulnerable to the stresses of psychiatric clerkship is emphasized.

Selecting a few residents from many applicants: a new way to be fair and efficient.

Abstract: Selection of residents from among the large number of qualified applicants is an annual task requiring a significant commitment of resources by teaching hospitals. A method based on sound principles of decision-making and utilizing a computer analysis for initial ranking of applicants was developed to improve the selection process. The result was satisfactory selection with significant savings of time and effort for the residency program faculty.

Training Medical Students in Interpersonal Relationship Skills.

Abstract: A review of the literature on training medical students in interviewing skills reveals a neglect of experimentally controlled studies as well as methods based on the most thoroughly researched approach to training, the Rogerian "core facilitative qualities." This paper reports a description and experimental evaluation of a training method designed to increase the student's comfort in dealing with emotionally intense material and to increase his skills in the core facilitative qualities. Comparison of the experimental and control groups reveals a training effect on the student's ability to recognize and communicate empathic understanding and on attitude and personality variables.

A Method for Defining Competency in Pediatrics.

Abstract: In 1972 the American Board of Pediatrics (ABP) initiated studies leading to a report which identifies the important components of competency needed in the practice of pediatrics. The development of the report involved a group process engaging ABP board members and examiners. The outcome has been (a) the delineation of a process for establishing definitions of competency in a medical discipline; (b) the development of a framework for specifying the abilities needed to perform the tasks required of pediatricians; (c) an elaboration of samples of pediatric subjects to which these abilities and tasks are relevant; and (d) the development of a basis for choice of methods to use for purposes of certification.

Effectiveness of an international health elective as measured by NBME Part II.

Abstract: A total of 434 third- and fourth- year medical students from 80 U.S. medical schools participate between 1968 and 1974 in Yugoslav or Israeli international fellowship programs sponsored by the Association of American Medical Colleges and the U.S. Public Health Service. Subsequently, the scores of these fellowship student on Part II of the examinations of the National Board of Medical Examiners (NBME) were compared with the scores of rejected applicants and with the national average to determine the cognitive impact of the fellowship experience on the participants. The results show that the international fellows scored significantly higher than the rejected applicants and the national average in only the preventive medicine/public health portion of the examination. The conclusion is drawn that the fellowship programs enhanced the participants' knowledge of preventive medicine and public health.

A conceptual framework for measuring clinical problem-solving.

Abstract: Most attempts to measure clinical competence start by modeling the clinician's problem-solving process. The conflicting data from studies built around this approach suggest the need for rethinking the underlying concepts. Presented is a conceptual framework for clinical competence which is a natural expansion of earlier approaches. The framework is based upon defining the domain in which the clinician functions as the starting point for measuring clinical competence. There are three dimensions to the framework-problem-solving process, clinical discipline, and context of care. The intersection of the dimensions defines the clinical practice domain to be measured. For each domain specific problems can be identified and clinicians asked to demonstrate competence in resolving them.

Systematic Instruction in Interpretive Aspects of Laboratory Medicine.

Abstract: It is increasingly important for physicians to develop competence in ordering and interpreting laboratory tests. A review of the literature revealed no formal discussion of systematic instruction in the interpretive aspects of laboratory medicine. The goals, organization, instructional approaches, and assessment of a course offering such instruction are described here. Students are expected to develop an algorithmic approach to ordering and interpreting laboratory tests in the course of diagnosing and managing clinical problems in the major areas of medicine. Instructional approaches include lectures, case problem-solving sessions, and independent study. There has been an exponential growth in the number of students electing to take this course. Students respond enthusiastically to most aspects of the course. They are rated significantly higher on appropriate criterion measures in subsequent clinical electives than students who have not had such formal instruction in laboratory medicine during the senior years.

Communicating Drug Information to Physicians.

Abstract: In this paper the authors present a review of the multitudinous studies of researchers who have attempted to identify the sources of drug information utilized by physicians. Consideration is given to both professional sources (for example, journal articles, colleagues, meetings, and pharmacists) and commercial sources (for example, detailmen, journal advertisements, mail advertisements, and samples). Also included is a discussion of the relationship between physicians' sources of drug information and their choice of drugs and of the relationship between the sources of information and the severity of the conditions being treated. The paper concludes with a brief review of some of the new sources of drug information being considered for utilization by the Food and Drug Administration.

What happens to creative medical students

Abstract: A psychometric index of creative potential was devised by relating test scores to ratings of creativity in samples of architects, engineers, mathematicians, psychologists, and research scientists. A correlation of .45 was obtained between scores on this index and the criterion ratings in the total initial sample of 350 men. The tests used to compute scores on the index were also available for 284 first-year medical students being studied as physicians in a longitudinal inquiry on speciality choice and location of practice. The mean creativity score of the medical students was higher than that for any of the other samples. Within the array of means for medical specialty groups, psychiatrists ranked first and internists second. Students who failed to complete medical school also scored high, suggesting that dropping out is not just a matter of poor academic potential or unsuitability for a career in medicine.

Relationships between clinical competence ratings and examination performance.

Abstract: Relationships between faculty ratings and performance on components of the National Board of Medical Examiners Certifying Examination for Primary Care Physician's Assistants were investigated. A factor analysis of the clinical competence rating form yielded three discrete factors. Results of tests of simple relationships between each rating factor and examination component indicated that four of the six examination components correlated significantly though modestly with at least one of the rating scale factors. The results of multiple regression analyses indicated complex relationships between each of two examination components and the set of rating factors. One implication is that faculty members are able to make discrete judgments about students on more than one dimension.

Graduate medical education viewed from the national intern and resident matching program.

Abstract: The total number of applicants for first-year programs in graduate medical education through the National Intern and Resident Matching Program in 1976 exceeded the number of positions offered for the second consecutive year. The number of positions available for U.S. medical school graduates in 1976 was approximately 1.22. Based on student preferences for their first-year graduate medical education programs, there were deficits in the number of openings offered in the primary care specialties and surfeits in medical and surgical subspecialties, pathology, psychiatry, and radiology.

Marital satisfaction as perceived by the medical student's spouse.

Abstract: This is a report of student marriages as perceived by spouses of medical students at the Southwestern Medical School, University of Texas Health Science Center at Dallas. Between August and November 1974 a questionnaire was sent to all spouses (239) of sophomore, junior, and senior students and 1974 graduates. The questionnaire examined: areas of stress within marriage, congruence between expected and actual behavior in the marital partner's role performance, and the spouse's attitudes toward marital counseling and whether a marital counseling service should be made available. Stress factors frequently cited were student's preoccupation due to school pressures, limited finances for recreation and nonessentials, student's inaccessibility due to school and loneliness. Most respondents stated satisfaction with their marriage; however, 38 percent indicated that their marriage could have benefited from counseling some time during medical school.

A model for the improvement of medical faculty lecturing.

Abstract: The development of a program designed to improve the teaching effectiveness of faculty members of a new Introductory Psychopathology course at the University of Washington School of Medicine is described. Two consultants from the Office of Research in Medical Education worked closely with the faculty in designing the evaluation program during the preparation of the course. The literature on lecture effectiveness is reviewed, as are existing instructional evaluation instruments. The integration of this information and the needs of the involved faculty produced a lecture observation schedule designed to facilitate the observation of a lecture and the immediate feedback which followed each of the 15 lectures evaluated. The process of using this instrument to assist the faculty in self-improvement is discussed. While the specific evaluation method described may not be appropriate for all situations, it may serve as a model for the development of similar programs in other settings.

The teaching of child psychiatry in U.S. medical schools: results of a survey.

Abstract: The major results of this survey are that most schools have special programs in child psychiatry and that these are distinct from the adult psychiatry course. The course content involves clinical evaluation of children, information on child development and psychopathology, assigned reading, and liaison with pediatrics. Most schools have full-time psychiatrists on their faculty, and the child psychiatry course is taught by child psychiatrists; but less than 20 percent of the psychiatric faculty are child psychiatrists in a majority of the schools in the country. Finally, although evaluation by students and faculty is common in most of the schools, only slightly more than one-third of the institutions gave grades in child psychiatry and slightly fewer than one-third gave examinations in this subject.

The Medical Polyclinic: An Approach to Conflicting Needs in a Teaching Hospital.

Abstract: University teaching hospitals have become increasingly aware of their responsibility to improve both the teaching of ambulatory care and the quality of care provided in their clinics. This paper describes how one department of medicine met this challenge by forming a "Medical Polyclinic." The majority of the department's faculty and house staff, at all academic and training levels, participate in a system of ambulatory care with the following objectives: each patient has a single physician whom he sees by appointment and who coordinates his care; all medical subspecialties are available in the same clinic session; the clinic is attractive and efficient. While these goals are not infrequently met in private group practices, they are unusual in a university teaching hospital, where faculty, house staff, students, and patients each have unique needs, not always compatible. The success and problems of the polyclinic approach are discussed.

Weiskotten survey, class of 1960: a profile of physician location and specialty choice.

Abstract: This survey is the eighth in a series which has included every fifth American medical school graduating class, starting with the class of 1915. The questionnaire design differed from previous Weiskotten studies and emphasized attitudes towards location information not contained in the American Medical Association Physician Masterfile. Traditional tabular comparisons are focused on contemporary locational policy needs. The findings and methodology of this study are generally similar to those of many earlier studies of both physician location and, in a very limited way, of specialty choice. The paper contains findings on certain characteristics of physicians who move their practice and those who do not. These characteristics have not been contrasted previously in this series.

A positive approach to the utilization of student feedback in medical education.

Abstract: Many of the problems related to the usability of student feedback in medical education are concerned with validity and reliability. In this paper the author presents a rationale and a systematic procedure for the construction, implementation, and analysis of student feedback data which will provide both valid and reliable information about specific areas of the educational process that are controllable by instructors. This information can then be combined with other factors and used for continuous improvement of the teaching/learning process.

The Socialization of a Medical School Faculty.

Abstract: The research reported here shows the processes which socialize M.D.s and Ph.D.s into academic roles in a medical school and the factors affecting their retention and attrition. Eighty-one percent (350) of the regular faculty of a midwestern university medical school provided career background data and information on their attitudes toward issues within their school and their perceived and preferred organizational goals, characteristics, and managerial styles. Sherlock and Morris' (1) paradigm was the theoretical framework. Principal findings include the greater importance of latent over manifest variables, the M.D.s' late decision to try an academic career, the high colleague acceptance of the new M.D. recruit, the greater adoption of university professoriat norms by the Ph.D.s, and the high goal agreement between basic science and clinical faculty.