Journal of Medical Education最新文献

Numerous medical schools are beginning to plan single courses, separate curricular tracks, or entire curricula using problem-based, small-group methods. The use of these methods places a high demand on faculty members' time and support. In the present study, the authors examined the characteristics and beliefs of those faculty members who volunteered as tutors for problem-based teaching during the first two years of the New Pathway Project at Harvard Medical School. The results confirm several major conclusions of innovation research: that an individual's adoption of an innovation is heavily influenced by his or her perceived need for change and the benefits that might result from becoming involved in this change; that initial adopters tend to be oriented toward institutional colleagueship; and that personal contacts with colleagues play an essential role in their decision to participate. In addition, the desire to improve medical education emerged as a major motive for involvement in the problem-based curriculum.

Teaching by residents has long been recognized as essential to the education of interns and medical students, but how residents view their role as educators has not been examined in great detail. For this purpose a questionnaire was constructed and administered to 55 internal medicine residents at the McGaw Medical Center of Northwestern University. Responses indicate that the residents enjoyed teaching and considered it a critical component of their own experience and education. These residents' views appear unrelated to their previous teaching or academic backgrounds or to plans for an academic career. A number of variables correlated with teaching satisfaction. The teaching experience can be improved, the survey suggests, by lessening distractions and interruptions that occur during teaching sessions, freeing residents of some other obligations so that more time may be devoted to teaching, increasing faculty members' observation and guidance of teaching, and carefully structuring the content of the residents' teaching sessions.

Medical student and resident education at a hospital-operated pediatric primary care clinic (PPCC) was threatened by chronic financial deficits and by a state mandate that all patients receiving medical care through the state Aid to Families with Dependent Children program be enrolled in a health maintenance organization (HMO). To comply with the mandate, the PPCC was reorganized in 1984 as a faculty-operated prepaid group practice independent of the hospital. The new PPCC contracted with an HMO to provide care, with reimbursement based on capitation. The PPCC continues to serve the same patient population as before the reorganization, continues its teaching activities, and no longer has financial deficits. The experience at this clinic shows that converting to a faculty prepaid group practice can be cost-effective, promote efficiency, and improve faculty-hospital relations. Such a group practice is an appropriate organization for maintaining medical education programs while providing care in a capitation payment system.

To determine the adequacy of medical history documentation, investigators videotaped 26 clinical interviews performed by medical residents in ambulatory practice, and the contents of each videotape were compared with the corresponding entries in the medical record. The residents recorded a little over half of all medical history information observed on the videotapes. Medical issues were more often documented than psychosocial or health behaviors. The residents in their second postgraduate year had the best documentation practices regardless of their residency track (primary-care or traditional track). Also, no difference was noted between the performances of primary-care internal medicine residents and traditional internal medicine residents. For one-quarter of the patients, less than 40 percent of the information that was present on the videotapes was documented in their charts. The residents documented more-severe illnesses better than less-severe ones and documented the medical histories of older patients better than the histories of younger ones. The residents' records of health behavior and psychosocial concerns were less complete for women patients. To improve chart documentation, members of both the attending and the house staffs should review videotapes and corresponding medical records of clinical encounters to help them investigate factors causing inadequate chart-documentation.

The authors surveyed a national random sample of medical students (10 percent of the graduating class of 1985) to identify the ways in which the students obtained informed consent from their patients and to learn the students' views of certain issues concerning informed consent. The results showed that the students introduced themselves to patients using methods that the authors grouped by levels of forthrightness. Those students who introduced themselves as medical students differed in their views on selected informed consent issues from students who introduced themselves as physicians. In general, all the students were less forthright about their status when given the opportunity to perform invasive procedures. Student gender, type of patient, and type of hospital were statistically associated with the students' behavior, according to bivariate analysis. After multivariate regression analysis, however, only the actions of the students' role models (residents and attending physicians) remained significantly associated with the students' behavior. The authors conclude that because some aspects of student behavior are at odds with the requirements of informed consent, medical educators must scrutinize the ethical dimensions of the policies they establish.

With a decline in the proportion of medical students pursuing family practice careers, it is necessary to better understand the factors influencing their career decisions. The Fishbein model of attitude formation was used as a framework for developing a questionnaire to measure students' attitudes toward a career in family practice and the social support students perceived they had for that career. The questionnaire was administered to fourth-year-medical students a short time before residency match day. Both the attitude and social support scales had excellent psychometric characteristics. The usefulness of these scales in discriminating between career choices of family practice and other clinical careers was tested. The social support scale did not discriminate well, whereas the attitude scale discriminated quite well. The students who chose careers in family practice differed from students who chose other careers in 14 of 19 values about characteristics of family practice but differed from them in only two of 19 beliefs about family practice. The implications for advising medical students about careers in family practice are discussed.