Showing papers in "Academic Medicine in 1983"

Resident Performance and Sleep Deprivation: A Review.

Abstract: The literature on resident performance and sleep deprivation is reviewed. It is suggested that despite the urgent need for definitive work in the area, current research is sparse and inconclusive. It also is suggested that the research that does exist implies there are potentially severe negative effects from sleep deprivation on physicians-in-training. The present authors believe that justifications for sleep-depriving night call schedules remain untested and that the presence of sleep-depriving night call as part of residency training should be reevaluated.

Retention of cardiopulmonary resuscitation skills by medical students.

Abstract: Performance in and knowledge of cardiopulmonary resuscitation (CPR) were assessed in a group of preclinical medical students who had received CPR certification either two or three weeks (group 0), one year (group 1), or two years (group 2) prior to the study. Assessment, ventilation, compression, and complications caused by incorrect technique were evaluated. A written examination was also given. There was significantly higher rate of failure to perform adequate CPR by students in groups 1 and 2 when compared with group 0 (p less than .05). There was no significant difference between the failure rates of groups 1 and 2. The most frequent errors related to chest compression rate and an inability to adhere to the recommended single-rescuer compression-to-ventilation ratio. Written test scores were also higher in group 0 than either group 1 or 2 (p less than .001). Written examination scores were not reliable predictors of CPR skill in individual cases.

Characteristics of clinical information-searching: investigation using critical incident technique.

Abstract: A total of 293 medical students, residents, and physicians were surveyed concerning their everyday information needs and the resources used to address these needs. The results of this study were used to identify goals of information-searching education for medical students. The participants' heavy reliance on their personal libraries, their basing their first choice of resource on physical convenience, and their need to obtain information quickly document the need to educate students in organizing and maintaining personal libraries and reprint files. In this study, the authors found that familiarity with a resource is often the basis of the choice of the resource and identified different types of information needs. These results revealed the need to educate medical students to be able to use the characteristics of the information problem to tailor information-search strategy to retrieve information expeditiously from a variety of resources outside the personal library.

Six years of experience using patient instructors to teach interviewing skills.

Abstract: In 1974 a competency-based program was developed at the University of Arizona College of Medicine that used patient instructors (PIs) to evaluate interviewing skills objectively. PIs are nonphysicians who are taught to function in the multiple roles of patient, teacher, and evaluator. For each specialty area, objective evaluation instruments have been developed to measure the student's interviewing technique (interview process) and the amount of relevant historical information obtained from the patient (interview content). Data from the six most recent classes of second-year medical students demonstrate that: (a) there is a positive correlation between process and content scores; (b) students learn from their interviews with PIs; and (c) there is a positive relationship between the scores students obtain on their first interview with each of two different PIs in two different specialty areas. It is concluded that the PI program provides an effective way to teach interviewing skills to medical students.

Identification of medical student problems and comparison with those of other students.

Abstract: The perceived problems of 585 medical students were compared with those of 1,110 students in the other health sciences colleges at the same institution. Through the use of a 5-point Likert scale, the students were able to indicate the degree to which each of 83 problem items on an inventory was of concern to them. The inventory included items concerning problems with life situation and school environment, other people, behavior, and feelings. The medical students were found to have the same spectrum of perceived problems as the other students but complained of these problems significantly more intensely on 35 items. Married students as a group responded to the problem items with significantly less intensity than the single students. Analyses of subgroups by marital status, gender, age, and year in school are also reported.

The Question of Stress Among First-Year Medical Students.

Abstract: In a study reported in this article, the authors investigated the presence of stress in two successive classes of first-year medical students at a private midwestern medical school. Support groups, didactic sessions, and no-contact control conditions were used. Few differences in personality measures were found among the groups, and all group means were within the normal range. Support groups did not facilitate academic performance. The results bring into question the previously reported extent of chronic stress among students in the first year of medical school as well as the need for support groups in this population.

Increasing physicians' antismoking influence by applying an inexpensive feedback technique.

Abstract: Continuing medical education that ignores motivational and environmental determinants of continued skill use will have little impact. Physicians who were trained to give antismoking advice to patients did so effectively soon after training, but their performance deteriorated during the next nine months. A subsequent study showed that antismoking effectiveness is maintained for extended periods if advice-giving rates are monitored monthly and physicians receive immediate corrective feedback whenever their performance declines.

Effects of three types of lecture notes on medical student achievement.

Abstract: Two parallel studies were conducted with junior medical students to determine what influence the forms of lecture notes would have on learning. The three types of notes given to the students were: a comprehensive manuscript of the lecture containing text, tables, and figures; a partial handout which included some illustrations but required substantial annotation by the students; and a skeleton outline containing no data from the lecture. The students' knowledge about the subject was measured before the lecture, immediately after the lecture, two to four weeks later, and approximately three months later. The students' responses to questionnaires indicated a strong preference for very detained handouts as essential to preparation for examinations. By contract, the students' performances on tests generally were better for those who had received the partial or skeleton handout formats. This was particularly true for information presented during the last quarter of each lecture, when learning efficiency of the skeleton handout group increased while the other two handout groups exhibited learning fatigue. It was concluded that learning by medical students was improved when they recorded notes in class.

Peer review of teaching in medicine.

Abstract: The design, development, and implementation of procedures for peer review of teaching are described. Peer review is one component of a comprehensive system to evaluate and improve teaching in a school of medicine. Colleague observations and judgments are used to augment student/resident ratings of teaching for purposes of instructional improvement and academic promotions. School policies have standardized evaluation criteria and instrumentation while granting departments flexibility in conducting peer review. Three different departmental peer review committee structures and procedures are reviewed. With the emphasis upon improvement, faculty acceptance of peer review of teaching has been positive. Peer review reports have had a positive impact on academic promotions. The inherent strengths and limitations of peer review of teaching are discussed in relation to the literature and to the medical school environment.

Evaluating instruction in medical education.

Abstract: The component parts and development of a comprehensive system to evaluate and improve teaching in a school of medicine are described by the author in this paper. This system integrates quantitative measures of teaching (student/resident ratings of classroom and clinical teaching), descriptive documentation (faculty teaching load, innovations, and research on teaching), and qualitative judgments (peer review) on the full spectrum of instruction in medicine. Medical school policies have standardized evaluation criteria, instrumentation, and procedures while granting departments flexibility in conducting peer review. The results of two studies indicate that the evaluation system described here has had a positive impact both on the improvement of teaching and on academic promotions.

Educational contracts: a basis for effective clinical teaching.

Abstract: An educational contract is a negotiated agreement between a teacher and a learner. It addresses four elements: needs, expectations, roles, and content. Contracts should develop and evolve via explicit negotiation between the teacher and the learner. Research to validate the concept of the educational contract and to document its utility is important to understanding effective clinical teaching.

Relationship between performance in medical school and postgraduate competence.

Abstract: A sample of 441 graduates (between 1971 and 1981) of Jefferson Medical College in Philadelphia, Pennsylvania, who pursued their medical training in internal medicine, pediatrics, and obstetrics/gynecology was selected. It was hypothesized that the relationship between measures of academic achievement in medical school and measures of postgraduate performance would vary in different specialty programs. The hypothesis was confirmed by comparing graduates in the three specialties on grades in medical school, scores on the examinations of the National Board of Medical Examiners, and ratings in four areas of competence in the first postgraduate year (that is, medical knowledge, data-gathering skills, clinical judgement, and professional attitudes). It was also hypothesized that the strength of the relationship would vary at different levels of performance within the specialty programs. This was confirmed for some of the variables. The results indicate that inappropriate conclusions may be drawn about the relationship between performance before and after graduation from medical school if specialty differences and levels of performance are ignored.

A follow-up survey of drug abuse and alcoholism teaching in medical schools.

Abstract: The authors sent a questionnaire regarding the teaching of drug abuse and alcoholism to a stratified random sample of 40 U.S. medical schools, and 35 provided usable replies. The findings are summarized and are contrasted with replies received five years earlier from the same schools. During these five years, there were notable improvements in the teaching of these topics, as reflected by increases in required teaching hours, percentage of total required hours, number of elective courses offered, and number of affiliated clinical programs. The effect of the presence of a career teacher in the addictions is also evaluated.

A committee on well-being of medical students and house staff.

Abstract: A committee on well-being of medical students and house staff was established in a university medical center to address some of the socioemotional aspects of medical education and training. The overall goal was to influence the learning climate in ways that would enhance positively the educational experience. Several problem areas were identified. They included poor communication, stressful effects of medical education both on self and on relationships, a need for advocacy, and a lack of support for house staff members. A series of programs were designed and implemented in response to these issues. With institutional support, a committee on well-being may serve as an effective approach in alleviating some of the stresses of the medical training process.

Acceptance by private patients of resident involvement in their outpatient care.

Abstract: The attitudes of private patients toward resident participation in their ambulatory care were evaluated. Of 195 patients (29 percent) responding to 667 mailed prospective questionnaires, 143 (73 percent) stated that they would allow resident participation in their care. Satisfactory prior experiences with trainees was the most important factor predicting acceptance (p less than .0001) of resident participation. A majority of "accepting" respondents would allow the following limited delegation of responsibility to residents: history-taking, physical examination, and visit scheduling. The majority (71 percent) desired faculty consultation at every visit. A small, retrospective survey of resident-treated private patients revealed that 70 percent were fully satisfied, 20 percent partially satisfied, and 10 percent dissatisfied. Dissatisfaction by the patients was associated with not knowing beforehand that a trainee would participate in the health care delivery. The private patients usually accepted trainees for outpatient care if: (a) they had been informed in advance, (b) they had not had a prior unsatisfactory resident experience, and (c) the responsibility of the residents had been carefully delegated and the residents closely supervised.

A study of the information-seeking skills of medical students and physician faculty.

Abstract: In the research reported here, the authors compared (a) the abilities of third- and fourth-year students and physicians to solve problems requiring review of current literature with (b) the information-seeking procedures of the three groups in researching those problems. The subjects were given a patient care question to answer, and logs were maintained to document their information-seeking processes. The findings indicated no differences among the three groups in accurately solving patient care problems; a difference in information-seeking processes between third-year students and physicians; and no differences between third-year and fourth-year students or between physicians and fourth-year students in their approaches to seeking information. Mean scores indicated that all three groups need additional training on accessing the literature in making patient care decisions.

Baccalaureate Preparation for Medical School: Does Type of Degree Make a Difference?.

Abstract: Four groups of medical school matriculants (43 with a B.A. degree in social sciences, 68 with a B.A. degree in the humanities, 49 with a B.A. degree in science, and 40 with a B.S. degree in science) were studied. No significant difference was found among the four groups on yearly grade-point averages in medical school or on parts I, II, and III of the examinations of the National Board of Medical Examiners. Those with an undergraduate degree in the humanities considered leaving medical school more frequently than the others. A substantial proportion of medical students with an undergraduate major in the sciences and social sciences reported they would choose the humanities if they were once again high school seniors. Those with a science background were disproportionately more likely than the others to choose residencies in internal medicine and surgery, and those with undergraduate degrees in the humanities and social sciences were more likely to choose psychiatry residencies.

Dermatologic practice: implications for a primary care residency curriculum.

Abstract: The problems encountered, diagnostic procedures performed, and treatments prescribed in dermatology were studied in a primary care practice and in a dermatology clinic. Referrals from a primary care practice to a dermatology practice were analyzed. It was determined that nine disease categories accounted for more than 75 percent of the problems encountered in both settings. Only one diagnostic procedure was performed commonly in both the primary care and dermatology practices--skin scraping for fungal infection. Approximately 90 percent of the treatments prescribed in both settings fell within 13 categories. It is proposed that these findings be the basis for designing the curriculum in dermatology for residents in primary care medicine. The curriculum also should provide practical experience in dermatology and familiarity with selected, rarely encountered dermatologic conditions that have important therapeutic implications.

Adult immunization: the medical record design as a facilitator for physician compliance.

Abstract: A three-year prospective chart audit of a family practice residency program was performed to measure physician compliance in following the recommendations of an adult immunization program. Despite curriculum changes, performance self-evaluation, and reminders by faculty members to residents about the need for adult immunization, physician compliance was poor in the second year of the study. It was thought that components of the medical record might be improved to facilitate physician compliance in the adult immunization program. At the beginning of the third year of the audit, tetanus and pneumococcal vaccines were preprinted on the health maintenance inventory (HMI), but influenza was not. The chart design also was changed to put the HMI in a more prominent place. In the third year of the audit, physician compliance with tetanus and pneumococcus immunization improved significantly. The results of the chart review suggest that physician compliance with adult immunization programs can be improved with appropriate chart design.

Legal implications of clinical supervision of medical students and residents.

Abstract: When a medical student or resident has been involved in the care of a patient who claims to be injured as a result of that care, the student, resident, clinical faculty members, medical school, and affiliated health care institution may all be potential defendants in a lawsuit filed by the patient. The liability of the faculty member, school, and institution may arise out of the supervisory position they occupy regarding students and residents. In this article, the author examines the legal implications raised by these supervisory functions and explicates potential liabilities associated with such responsibilities.

Medical students' skills, attitudes, and behavior needed for literature reading.

Abstract: Skills, attitudes, confidence, and behavior needed for literature reading were studied in first- versus fourth-year medical students at George Washington University in Washington, D.C. Questions on diagnostic test skills were used for comparison. Anonymous questionnaires were completed by 114 first-year and 84 fourth-year students. Fourth-year students read considerably more literature than first-year students, valued reviews over original research, and placed more value on the journal's reputation. They had greater confidence and objective knowledge than first-year students on diagnostic test skills but not greater confidence or objective knowledge on literature reading skills. Most dramatic was their "lower" willingness to admit uncertainty, even when taking into account their level of knowledge. Less willingness to admit uncertainty on the part of fourth-year medical students than first-year students may reflect medical education's emphasis on specific answers and its failure to teach students how to analyze data and draw conclusions. A need exists for specific training in literature reading skills with preevaluations and postevaluations of skills, attitudes, and behavior.

Characteristics of highly rated family practice preceptors.

Abstract: Student ratings of teaching, though controversial, demonstrate high reliability and acceptable validity. The study on which this article is based attempted to define the aspects of the family medicine preceptor and his practice which are significantly associated with the medical student's assessment of the preceptor's teaching ability. Questionnaires were sent to preceptors at the University of Western Ontario, and their responses were compared with student ratings by means of t-tests, correlation coefficients, and multiple regression. Higher teaching ability ratings were given to preceptors in group practice and nonurban practice and to those delegating more responsibility to students and using medication lists. Multiple-regression analyses using questionnaire data plus teaching ability subscores accounted for 88.1 percent of variance in student assessments of their clinical teachers. Suggestions for selection of preceptors are presented, together with proposals for further research into clinical teaching by family practice preceptors.

Using the Perception-Reality Gap to Alter Prescribing Patterns.

Abstract: Thirty physicians in a university family medicine teaching practice were asked to estimate their rate of prescribing diazepam to six age/sex groupings of patients within their practice. Their actual prescribing rates as recorded by a computerized data collection system were not accurately perceived. After the physicians were informed of the gap between perceived and actual prescribing, significant changes in prescribing behavior occurred. Awareness of a perception-reality gap in primary care practice prescribing offers a method of continuing medical education that may significantly alter prescribing behavior in ways beneficial to patient care.

Effect of immediate student evaluations on a multi-instructor course.

Abstract: Immediate student feedback and peer evaluation by a single physician were used to evaluate and monitor an interdisciplinary multi-instructor course. Clinical Correlations with Pathology is taught during the second year of medical school by 50 instructors, each of whom has a limited exposure to sophomore medical students. The format of the course, in which the same students evaluate multiple lecturers in multiple content areas, provided a unique opportunity to demonstrate the reliability and validity of student evaluations. About one-half of the lectures were repeated by the same instructors the following year to the next class of medical students, who also evaluated all of the lectures. Comparison of two consecutive sophomore classes of medical students documented overall course improvement and showed higher ratings given to instructors who presented the same lecture both years. Student evaluation is a powerful technique that can result in positive changes leading toward course improvement.

Suicide management skills and the medical student.

Abstract: To determine the suicide management skills of medical students at different levels of training, 141 medical students were administered the Suicide Intervention Response Inventory (SIRI), a self-report instrument assessing skills in responding to the self-destructive patient. As predicted, third-year students having completed a course in medical interviewing scored higher on the SIRI than first-year students who had not. Additional improvement in suicide management skills was evidenced for third-year students who completed a six-week inpatient psychiatry rotation. Whether or not students believed that suicide was ethically acceptable in some circumstances had no impact on their ability to select an appropriate response to the self-destructive patient. Several additional findings are discussed, and the potential utility of the SIRI in evaluating medical student skills in this important area is highlighted.

Women as Physicians.

Abstract: Whatever qualities are ascribed to femininity and whether these are attributed to nature or to nurture, the characteristics women display as physicians are primarily determined by the impact of their professional education, by their socialization into medical roles, and by the organization of their practices. Women physicians more nearly resemble men physicians in professional attributes than they do other women in the population. Women merit more opportunities in medicine, both on grounds of equity and in order to enlarge the pool of medical talent. However, women, in themselves, are not likely to alter the perceived shortcomings of medical practice. For that to take place, it will be necessary to modify admission criteria, to broaden the narrow focus of medical education, and to change the reward systems which govern medical practice for both women and men.

Career development of female and male physicians.

Abstract: In this article, the authors compare the career development of female and male physicians who were graduated from medical school in 1960 and followed through 1976. Working with a sample matched for type and location of medical school and admission test scores, the authors analyzed the effects of achievement motivation, performance in medical school, peer evaluation, prestige of internship hospital, and family responsibilities on professional attainment. The findings indicate that the careers of male physicians build in a sustained way, with the input factors during and following medical school remaining consistent in their effects; in the careers of female physicians, factors crosscut each other, with some being positive and some negative in their effect on professional attainment. Family responsibility is not the only negative factor for women, and this indicates that other elements in career development that help men do not similarly contribute to the advancement of women physicians. A strong positive factor for women is prestige of internship hospital.