Showing papers in "Academic Medicine in 1995"

Teaching and Learning in Ambulatory Care Settings : A Thematic Review of the Literature

Abstract: A thematic review was conducted of the 1980–1994 research literature on teaching and learning in ambulatory care settings for both undergraduate and graduate medical education. Included in the review were 101 data-based research articles, along with other articles containing helpful recommendations

Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature

Abstract: This paper analyzes and synthesizes the literature on primary care specialty choice from 1987 through 1993. To improve the validity and usefulness of the conclusions drawn from the literature, the authors developed a model of medical student specialty choice to guide the synthesis, and used only high-quality research (a final total of 73 articles). They found that students predominantly enter medical school with a preference for primary care careers, but that this preference diminishes over time (particularly over the clinical clerkship years). Student characteristics associated with primary care career choice are: being female, older, and married; having a broad undergraduate background; having non-physician parents; having relatively low income expectations; being interested in diverse patients and health problems; and having less interest in prestige, high technology, and surgery. Other traits, such as value orientation, personality, or life situation, yet to be reliably measured, may actually be responsible for some of these associations. Two curricular experiences are associated with increases in the numbers of students choosing primary care: required family practice clerkships and longitudinal primary care experiences. Overall, the number of required weeks in family practice shows the strongest association. Students are influenced by the cultures of the institutions in which they train, and an important factor in this influence is the relative representation of academically credible, full-time primary care faculty within each institution's governance and everyday operation. In turn, the institutional culture and faculty composition are largely determined by each school's mission and funding sources--explaining, perhaps, the strong and consistent association frequently found between public schools and a greater output of primary care physicians. Factors that do not influence primary care specialty choice include early exposure to family practice faculty or to family practitioners in their own clinics, having a high family medicine faculty-to-student ratio, and student debt level, unless exceptionally high. Also, students view a lack of understanding of the specialties as a major impediment to their career decisions, and it appears they acquire distorted images of the primary care specialties as they learn within major academic settings. Strikingly few schools produce a majority of primary care graduates who enter family practice, general internal medicine, or general practice residencies or who actually practice as generalists. Even specially designed tracks seldom produce more than 60% primary care graduates. Twelve recommendations for strategies to increase the proportion of primary care physicians are provided.

What makes a tutor effective? A structural-equations modeling approach to learning in problem-based curricula.

Abstract: Purpose To test and further develop a causal model of the influence of tutor behaviors on student achievement and interest in the context of problem-based learning. Method Data from 524 tutorial groups involving students participating in the four-year undergraduate health sciences curriculum at the University of Limburg in 1992-93 were analyzed. The tutorial groups were guided by 261 tutors. Overall, 3,792 data records were studied, with each student participating in an average of 2.3 groups. Correlations among tutors' social-congruence, expertise-use, and cognitive-congruence behaviors, small-group functioning, and student' self-study time, intrinsic interest in subject matter, and level of achievement were analyzed using structural-equations modeling. This statistical technique allows the investigator to test causal hypotheses on correlational data by comparing the structure of data with a theoretical model. Results After minor adaptations, the hypothesized causal model of the effective tutor fitted the data extremely will. Each tutor's level of expertise use and social congruence not only directly affected his or her level of cognitive congruence but also affected other elements of the model. Level of social congruence influenced group functioning in a direct fashion, while expertise use had a slightly negative effect on the students' level of self-study time and a slightly positive effect on level of achievement. As hypothesized, the level of cognitive congruence influenced tutorial-group functioning. Level of group functioning affected self-study time and intrinsic interest. Finally, time spent on self-study influenced level of achievement. Conclusion The results suggest that subject-matter expertise; a commitment to students' learning and their lives in a personal, authentic way; and the ability to express oneself in the language used by the student are all determinants of learning in problem-based curricula. The theory of the effective tutor, presented in this article, merges two different perspectives prevalent in the literature. One perspective emphasizes the personal qualities of the tutor: his or her ability to communicate with students in an informal way, coupled with an empathic attitude that enables the tutor to encourage student learning by creating an atmosphere in which open exchange of ideas is facilitated. The other stresses the tutor's subject-matter knowledge as a determinant of learning. The data presented in this article suggest that what is needed, really, is much of both.

Developing key-feature problems and examinations to assess clinical decision-making skills.

Abstract: This article introduces the concept of a key feature and describes its function as the cornerstone of key-feature problems, a new problem format for the written assessment of clinical decision-making skills of medical trainees and practitioners. The rationale for using this problem format and the steps in problem and examination development--including issues of scoring and standard setting--are described. A key feature is defined as a critical step in the resolution of a clinical problem, and a key-feature problem consists of a clinical case scenario followed by questions that focus on only those critical steps. The questions can be presented to require examinees either to write in their responses or to select them from a list of options. For each question, examines can be instructed to supply or select whatever number of responses is appropriate to the clinical task being tested, and answer keys can comprise one or several responses. This problem format, with its focus on only the critical steps in problem resolution, and with its flexibility in question format and scoring keys, effectively addresses the psychometric considerations of content validity and test score reliability, and accommodates the complexity and configurations of actions often required in the resolution of clinical problems.

Medical ethics education: past, present, and future.

Abstract: This paper examines undergraduate medical ethics education in the United States during its 25-year history. Included is a brief description of early efforts in medical ethics education and a discussion of the traditional model of ethics teaching, which emphasizes the knowledge and cognitive skills necessary for ethical decision making. The authors also discuss alternatives to the traditional model that focus more directly on students' personal values, attitudes, and behavior. Current areas of consensus in the field are then explored. Finally, the authors identify three incipient trends in medical ethics education--toward increased emphasis on everyday ethics, student ethics, and macroethics. Throughout the paper, examples of specific courses and curricula are used to illustrate the modes and trends described.

The Medical Council of Canada's key features project: a more valid written examination of clinical decision-making skills

Abstract: In 1986 the Medical Council of Canada (MCC) commissioned a six-year research and development project to create a new, more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. At that time, the qualifying examination consisted of three booklets of multiple-choice questions and one booklet of patient management problems administered over a two-day period. All graduates of Canadian and foreign medical schools must pass this examination before practicing medicine anywhere in Canada except Quebec. The project was undertaken because (1) numerous studies do not support the use of patient management problems (PMPs) to assess clinical decision-making skills, and (2) research results on the characteristics of clinical decision-making skills offered guidance to develop new approaches to their assessment. In particular, research suggested that these skills are specific to the case or problem encountered and are contingent on the effective manipulation of a few elements of the problem that are crucial to its successful resolution--the problem's key features. The problems developed by this project focused only on the assessment of these key features. The project was implemented in three overlapping phases over a six-year period, 1986-1992, each containing a development component followed by a pilot test through which the research studies were carried out. The pilot tests were conducted by presenting sets of new key feature problems to classes of graduating students in medical schools across Canada.(ABSTRACT TRUNCATED AT 250 WORDS)

Shifting students and faculty to a PBL curriculum: attitudes changed and lessons learned.

Abstract: BACKGROUND. The University of Toronto Faculty of Medicine is implementing a new undergraduate curriculum that emphasizes active, self-directed learning. The aims of this study were to (1) evaluate shifts in students' attitudes after initial direct experience with problem-based learning (PBL), (2) de

Medical education and computer literacy: learning about, through, and with computers.

Abstract: The call for medical students to become literate in the uses of information technology has become a familiar refrain. Over ten years ago, the Association of American Medical College's GPEP Report recommended that medical schools incorporate into their curricula training in the use of such technology; however, in the intervening decade, discouragingly little progress has been made toward meeting this goal, even though the need for such changes has grown more compelling. The author contends that teaching medical students to be computer-literate will not only enable them to use information technology competently, but will foster their capacity for "termless learning," which involves the ability to assess the adequacy of one's knowledge, to efficiently redress identified deficiencies, and to direct one's ongoing learning well in a rapidly changing world. He contends that by exposing medical students early in their training to the vast profusion of electronic information resources, medical educators can help produce a generation of practitioners who have a different orientation toward knowledge and learning. The author then assesses three different approaches to computer-literacy training: learning about computers, learning through computers (i.e., using computers as tools for instructional delivery), and learning with computers (i.e., requiring students to use computers in their work on a day-to-day basis). He concludes that none of the approaches is sufficient unto itself, but learning with computers offers the most powerful means of fostering the forms of termless learning that students will need to practice medicine in the future.

Developing a "clinical presentation" curriculum at the University of Calgary.

Abstract: Currently, medical curricula are structured according to disciplines, body systems, or clinical problems. Beginning in 1988, the faculty of the University of Calgary Faculty of Medicine (U of C) carefully evaluated the advantages and disadvantages of each of these models in seeking to revise their school's curriculum. However, all three models fell short of a curricular structure based on current knowledge and principles of adult learning, clinical problem solving, community demands, and curriculum management. By 1991, the U of C had formulated a strategic plan for a revised curriculum structure based on the way patients present to physicians, and implementation of this plan has begun. In creating the new curriculum, 120 clinical presentations (e.g., "loss of consciousness/syncope") were defined and each was assigned to an individual or small group of faculty for development based on faculty expertise and interest. Terminal objectives (i.e., "what to do") were defined for each presentation to describe the appropriate clinical behaviors of a graduating physician. Experts developed schemes that outlined how they differentiated one cause (i.e., disease category) from another. The underlying enabling objectives (i.e., knowledge, skills, and attitudes) for reaching the terminal objectives for each clinical presentation were assigned as departmental responsibilities. A new administrative structure evolved in which there is a partnership between a centralized multidisciplinary curriculum committee and the departments. This new competency-based, clinical presentation curriculum is expected to significantly enhance students' development of clinical problem-solving skills and affirms the premise that prudent, continuous updating is essential for improving the quality of medical education.

The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: a review and quality assessment of the literature.

Abstract: The authors evaluated and reviewed the literature on the effects of medical school curricula, faculty role models, and federal biomedical research support on the specialty choices of U.S. medical students. All 275 articles on these subjects published from 1984 through 1993 were considered. An instrument was developed to assess the quality of the articles. A total of 85 articles met study criteria and were reviewed. The mean score achieved was 42.7% of the total possible points. Major educational reforms emphasizing primary care have resulted in significant increases in the percentages of graduates choosing generalist careers. Except for required clinical training in family practice, individual curriculum components have generally not been successful. Students and physicians often stated that faculty role models influenced specialty choices, and there is some evidence that faculty composition is related to students' career choices. There was a consistent inverse correlation between the amount of federal biomedical research support received and the percentage of a school's graduates choosing generalist careers. It is unknown whether this relationship is causative and, if so, how research funds affect specialty choices. The best strategies to enlarge the proportion of medical students choosing generalist careers include institutional reform to emphasize generalist training, increasing the size of generalist faculty, and requiring clinical training in family practice. The relationship of federal biomedical research support to the specialty choices of medical students needs to be studied further. Research on specialty choice could be improved by including a larger number of schools and students, studying trends over several years, and using validated measures and outcomes, control groups, and multivariate analyses. (ABSTRACT TRUNCATED AT 250 WORDS)

Attitudes and opinions of faculty tutors about problem-based learning.

Abstract: BACKGROUND. There has been little systematic attention to the opinions of faculty in evaluating problem-based learning (PBL). The purpose of this report is to describe the attitudes and opinions of tutors in PBL programs about the relative merits of PBL and traditional medical education, and to exam

A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study.

Abstract: PURPOSE To use a controlled, randomized design to assess the effect on patient satisfaction of an intensive psychosocial training program for residents. METHOD Twenty-six first-year residents, in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine, were randomly assigned during 1991 and 1992 to a control group or a one-month intensive training program. Experiential teaching focused on many psychosocial skills required in primary care. A 29-item questionnaire administered before and after the residents' training evaluated their patients' satisfaction regarding patient disclosure, physician empathy, confidence in physician, general satisfaction, and comparison of the physician with other physicians. Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training. RESULTS The patients of the trained residents expressed more confidence in their physicians (p = .01) and more general satisfaction (p = .02) than did the patients of controls. The effect of training on patient satisfaction with patient disclosure (p < .01) and physician empathy (p < .05) was greater for female than for male residents. CONCLUSION The intensive psychosocial training program for residents improved their patients' satisfaction.

Medical history in the undergraduate medical curriculum.

Abstract: The study of literature encourages the development of otherwise hard-to-teach clinical competencies. It provides access to the values and experiences of physicians, patients, and families; it calls for the exercise of skill in observation and interpretation, develops clinical imagination, and, especially through writing, preserves fluency in ordinary language and promotes clarity of observation, expression, and self-knowledge. Faculty in one-third of U.S. medical schools teach literature in courses that, although concentrated in the preclinical years, range from the first day of school, through residency programs. Once focused on the work of physician-authors and realist fiction about illness that encouraged moral reflection about the practice of medicine, literary study in medicine now encompasses a wide range of literature and narrative types, including the patient history and the clinical case. Literary study is intended not only to enrich students' moral education but also to increase their narrative competence, to foster a tolerance for the uncertainties of clinical practice, and to provide a grounding for empathic attention to patients. Literature may be included in medical humanities courses, and it may provide rich cases for ethics courses or introductions to the patient-physician relationship; it also may be the focus of small, elective, or selective courses, frequently on particular social issues or on the experience of illness. Reading, discussion, writing, and role-play rather than lectures are the methods employed; faculty include those with PhDs in literature and MDs who have strong interests in the contributions of literature to practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Reshaping the graduate education of scientists and engineers.

Abstract: The following article presents highlights of the findings and recommendations of the Committee on Science, Engineering, and Public Policy (COSEPUP) that were made public at a briefing earlier this year. The committee, composed of representatives from the National Academy of Sciences, National Academ

Preceptors' strategies for correcting residents in an ambulatory care medicine setting: a qualitative analysis.

Abstract: PURPOSE. To understand the interactional strategies preceptors use as they relate to and occasionally correct interns in a general internal medicine teaching clinic. METHOD. An observational, cohort study was carried out from May 1990 through May 1993 of the precepting conversations between 11 pairs

Professional networks: the influence of colleagues on the academic success of faculty.

Abstract: BackgroundSuccessful higher education faculty, those who get promoted and tenured, who get recognized for contributions, who produce more and significant research, frequently consult colleagues. This article summarizes what is known about colleague relationships with the hope of stimulating further

Using faculty and student perceptions of group dynamics to develop recommendations for PBL training.

Abstract: BACKGROUND. In training faculty as tutors for problem-based learning (PBL), certain aspects (domains) of teaching methodology are highlighted in the medical education literature. These are content, cognitive processing, and group dynamics. The authors contend that the amounts of attention given to t

Physician-patient partnership in managing chronic illness.

Abstract: No abstract available.

A systematic approach to conducting a non-statistical meta-analysis of research literature

Abstract: Literature analyses and syntheses are becoming increasingly important as a means of periodically bringing coherence to a research area, contributing new knowledge revealed by integrating single studies, and quickly informing scientists of the state of the field. As a result, there is a need for appr

Influence of Medical School Curriculum on Primary Care Specialty Choice: Analysis and Synthesis of the Literature.

Abstract: There is a growing consensus that the proportion of primary care physicians in the United States is inadequate to meet health care needs. Many graduating medical students continue to choose to subspecialize. The literature on curriculum and specialty choice is fraught with confounders and a lack of

Withdrawal and extended leave during residency training: results of a national survey.

Abstract: BackgroundAlthough national figures for medical student withdrawal and extended leave have long been reported, similar data have not been available for residents in training.MethodData for this study came from the American Medical Association survey of the 1991–92 residency year, in which pr

Gender Comparisons of Young Physicians' Perceptions of Their Medical Education, Professional Life, and Practice: A Follow-Up Study of Jefferson Medical College Graduates.

Abstract: PURPOSE: To obtain information from a group of young physicians and compare men and women on their evaluations of selected areas of the medical school curriculum, their perceptions of issues related to medical practice and professional life, and their specialty choices, professional activities, and research productivity. METHOD: In 1992, a questionnaire was mailed to 1,076 physicians who had graduated from Jefferson Medical College between 1982 and 1986. The responses of men and women were compared using multivariate and univariate analyses of variance, t-tests, chi-square, and median test. RESULTS: Completed questionnaires were returned by 667 graduates (530 men and 137 women). The curriculum areas of interpersonal skills, disease prevention, medical ethics, and economics of health care were rated by both men and women as being the most important in medical training. Conversely, research methodology and statistics received the lowest ratings. Women, in general, valued psychosocial aspects of medical care higher than did men. Among the areas of perceived problems related to practice, lack of leisure time received the highest ratings (as being the greatest problem) and interpersonal interactions received the lowest ratings (as being the least problem) from both men and women. The men were more concerned than the women about the areas of patient chart and documentation, malpractice litigation, physician oversupply, peer review, and interaction with patients. These differences remained when specialties and numbers of hours worked per week were held constant. Generally, the physicians reported satisfaction with their professional lives, but the men tended to be more satisfied than the women about their decisions to become physicians and in their perceptions of medicine as a rewarding career. The proportion of men employed full-time (99.4%) was significantly higher than that for women (84%). Women were more likely to practice general pediatrics, while men were more likely to practice surgery and surgical subspecialties. Full-time--employed women worked fewer hours per week (57) than men (63), and men reported more research productivity than women. CONCLUSION: The implications of the findings of numerous gender differences are discussed regarding the issues of physician workforce, types of care rendered by men and women, and possible changes in the national health care system.

Cost analysis of objective structured clinical examinations

Abstract: Background The costs of objective structured clinical examinations (OSCEs) and other patient-centered examinations have not been well established. The published literature contains cost estimates ranging from $21 to over $1,000 per examinee. This wide range in cost estimates is due in part to both a lack of a consistent definition as to what should be included as an expense and a lack of understanding of how these expenses can be minimized. Method In 1993-94 the authors conducted a literature review and defined and subcategorized costs related to the production and implementation of an OSCE into costs for personnel, standardized patients (SPs), and administration. An analysis was undertaken of how each of the subcategory costs can be minimized. Results Costs for physicians, patient trainers, support personnel, and data analysis are negligible if the personnel who perform these duties do so as part of their overall academic responsibilities. Costs for SPs can be minimized by developing a cadre of experienced patients as well as professional personnel who participate in a comprehensive program in which SPs are used in both teaching and evaluative modes. This contributes to the development of a psychometrically valid OSCE with a minimum number of stations and decreased costs. Administrative costs are fixed and not amenable to significant cost saving. A detailed cost analysis of a comprehensive OSCE given at the end of an Introduction to Clinical Medicine course at one institution is presented, illustrating the practical aspects of these cost-containment methods. Conclusion Based on these considerations it appears financially feasible for an individual academic institution to develop and implement an OSCE.

Use of an objective structured clinical examination to determine clinical competence.

Abstract: PURPOSE. To describe the performance of second-year internal medicine residents on an objective structured clinical examination (OSCE) and to analyze the role of the OSCE in the evaluation of clinical competence. METHOD. In 1993–94, 51 second-year residents in an internal medicine training program a

Quality assurance in medical education

Abstract: Many people have an interest in the quality of medical education. Students have the right to as good an education as possible, and the public has the right to well-educated and well-trained general physicians and specialists. Therefore, a medical school or faculty must ensure its quality and is accountable for the quality of the training it provides. This paper emphasizes that the best way to ensure quality is by continuous attention to it. Quality depends not on measurement instruments and tools but rather on the spread of quality awareness among faculty, staff, and students. A tool for safeguarding quality is the design of a well-functioning quality assessment system, based on two pillars: a system of internal quality control and external assessment by peers. The connection between the internal and external assessments is the self-evaluation by the school. On the one side, this self-evaluation is a critical self-analysis and an agenda for improvement. On the other side, it contains information for the external reviewers. The peer review also provides input for the process of improvement.

A standardized-patient assessment of a continuing medical education program to improve physicians' cancer-control clinical skills.

Abstract: Background Although continuing medical education (CME) has long been used to inform physicians and teach specific skills, its efficacy in many areas is not well established. This randomized controlled trial assessed the effects of differing educational techniques on the cancer-control skills of 57 physicians. Method The CME program was part of the Cancer Prevention in Community Practice Project in Hanover, New Hampshire, and was implemented in 1988. The program used several methods in its presentation, including interactive small-group discussion, role playing, videotaped clinical encounters, lecture presentations, and trigger tapes. Measurements included cross-sectional observations made by unannounced standardized patients (SPs) who, one year after the CME program, assessed 25 physicians who had participated in the program and 32 physicians who had not. To measure consistency in the SPs' performances and accuracy in assessing the physicians' performances, most interactions were audiotaped using a hidden microphone. Pearson chi-square, Fisher exact two-tailed test, and kappa coefficients were used for analysis. Results Significantly higher ratings were found for the CME physicians in two areas: breast cancer risk-factor determination (determined maternal history: 80% versus 52%, p = .03; determined age at first period: 16% versus 0%, p = .02), and smoking cessation counseling (providing written material: 32% versus 9%, p = .03). The CME physicians were rated higher on all 19 study variables in the target areas of early detection of breast cancer and smoking cessation. The results show that the physicians' performance were better in those areas where the CME program had used performance-based learning, such as role playing or viewing and discussing a videotaped role-play encounter. Conclusion The educational techniques that rehearsed or portrayed clinical applications seem to have increased the physicians' performances of cancer-control clinical activities. The standardized-patient instrument seems to be particularly useful in evaluating interventions that address specific skills training.

Validity of three clinical performance assessments of internal medicine clerks

Abstract: PURPOSE: To analyze the construct validity of three methods to assess the clinical performances of internal medicine clerks. METHOD: A multitrait-multimethod (MTMM) study was conducted at the Case Western Reserve University School of Medicine to determine the convergent and divergent validity of a clinical evaluation form (CEF) completed by faculty and residents, an objective structured clinical examination (OSCE), and the medicine subject test of the National Board of Medical Examiners. Three traits were involved in the analysis: clinical skills, knowledge, and personal characteristics. A correlation matrix was computed for 410 third-year students who completed the clerkship between August 1988 and July 1991. RESULTS: There was a significant (p < .01) convergence of the four correlations that assessed the same traits by using different methods. However, the four convergent correlations were of moderate magnitude (ranging from .29 to .47). Divergent validity was assessed by comparing the magnitudes of the convergence correlations with the magnitudes of correlations among unrelated assessments (i.e., different traits by different methods). Seven of nine possible coefficients were smaller than the convergent coefficients, suggesting evidence of divergent validity. A significant CEF method effect was identified. CONCLUSION: There was convergent validity and some evidence of divergent validity with a significant method effect. The findings were similar for correlations corrected for attenuation. Four conclusions were reached: (1) the reliability of the OSCE must be improved, (2) the CEF ratings must be redesigned to further discriminate among the specific traits assessed, (3) additional methods to assess personal characteristics must be instituted, and (4) several assessment methods should be used to evaluate individual student performances.

Are the teachers teaching? Measuring the educational activities of clinical faculty

Abstract: As the teaching activities of medical school faculty are given greater emphasis, medical schools must find a way to recognize and reward excellence in teaching. In order to properly evaluate teaching, the authors developed an instrument for measuring the various teaching activities of their faculty. The Relative Value Scale in Teaching weights all teaching activities according to labor intensity, preparation time, level of responsibility, and educational value. The scale quantifies levels of teaching and allows comparison among diverse teaching activities. This complements qualitative measures of teaching and can enhance participation in educational programs as well as recognition of educators.

Turning interns into senior residents: preparing residents for their teaching and leadership roles.

Abstract: To assist new senior residents with their transition from internship to ward-team leadership, a practical teaching course has been implemented at the University of Washington that integrates the residents' roles as teachers and team supervisors. Residents develop leadership and problem-solving skills by discussing sample cases and videotaped vignettes of typical situations they will encounter. Teaching skills are practiced through small-group role-plays, which illustrate brief teaching opportunities in patient care. Residents learn managerial techniques, including how to clarify goals and expectations with team members, to conduct work rounds efficiently, to provide ongoing feedback as well as formal evaluation, and to develop criteria for grading. Emphasis is also given to residents' communication with attending physicians and ways residents can increase the attending physicians' effectiveness on the teams. Residents learn to teach and direct medical students, to refine case presentations, and to include students as valued team members. Because residency stresses can lead to coping problems, residents are taught to recognize burn-out, depression, and signs of substance abuse. Residents have been overwhelmingly positive in their evaluations of and responses to the teaching course. By working to develop problem-solving and teaching skills prior to undertaking their new responsibilities, residents are better prepared to be ward-team leaders. Factors in developing such a teaching course for residents are reviewed.

Content validation of key features on a national examination of clinical decision-making skills.

Abstract: Key features (KFs) represent the critical, or essential, steps in the identification and management of a clinical problem. KFs for 59 clinical problems were defined by members of a test committee for the Medical Council of Canada as part of their efforts to create a more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. In order to evaluate the content validity of KFs that the test committee had defined for the examination, 99 physicians from outside the committee, who came from clerkship programs at all 16 of Canada's medical schools, participated in three studies conducted in 1991. The first study was retrospective and was designed to find the degree of agreement or disagreement that the outside physicians had with the KFs already defined for each problem by the committee members. The second study was prospective and was to compare the KFs generated de novo by the participants with those already defined by the committee members. The third study was to gather the outside physicians' opinions of the frequencies with which graduating students in Canada are exposed to the 59 problems used in the retrospective and prospective studies. Almost all the KFs defined by the test committee were corroborated by the outside physicians, 92% in the retrospective study and 94% in the prospective one.(ABSTRACT TRUNCATED AT 250 WORDS)