Journal of Medical Education最新文献

Burnout among 67 residents in four family practice training programs was explored. The residents' scores on the emotional exhaustion, depersonalization, and lack of accomplishment subscales of the Maslach Burnout Inventory were used to assess burnout. These scores were examined in relation to situational and background measures, two personality instruments (the Millon Clinical Multiaxial Inventory and the Myers-Briggs Type Indicator), and to regrets about career decisions. Few significant relationships were found between the background and situational factors and the burnout scores, but numerous relationships were found among personality measures, burnout scores, and measures of regret. The pattern of these relationships indicates the importance of interpersonal comfort and skills in mitigating burnout. Although personality factors were more predictive than demographic and situational variables of the variability in burnout among residents in the sample, the variables shared across the sample--long hours, little time for leisure activities and social contact, and compulsive personality characteristics--may contribute to the moderate level of burnout shared by these residents.

In 1984 the student body at a midwestern medical school created an honor code and student honor council which supplemented the school's proctoring system. In consideration of recommending that the proctoring system be replaced by an honor system, the authors conducted a controlled experiment in which one trimester's behavioral science midterm and final examinations were unproctored and the midterm and final examinations in physiology and neuroscience were proctored. Using anonymous questionnaires, the authors discovered that significantly more students cheated and observed others cheating in behavioral science than in physiology or neuroscience examinations. Of 17 students who observed cheating, only two reported it, and they did so without providing the offenders' names.

Evaluating the physical and psychological constitution of elderly patients and their social and cultural environments requires skills that should be taught to all physicians in training. A survey was conducted among all accredited U.S. residency programs in family medicine to examine training in geriatrics. The teaching sites most commonly used by the responding programs were the family practice center (used by 96.4 percent), nursing home (81.9 percent), family medicine inpatient ward (62.4 percent), and home care service (HCS) (48.2 percent). The professional most frequently in contact with the resident during training at an HCS was the attending physician. Longitudinal rotations (that is, long-term rotations involving part of each week for months or years) in geriatrics were used more often than block rotations. The HCS rotations ranked highest in residents' evaluations were those in which the resident followed patients long-term and discussed problems and management with a multidisciplinary team. A combined rotation involving a family practice center, a family medicine inpatient ward, and a home care service is discussed as an alternative method of teaching geriatrics in family medicine.

Residents were surveyed about the characteristics and quality of their education before and twice after a new practice plan for faculty members was implemented at a county medical center. The residents assessed the impact of the practice plan on their training programs. Compared with the ratings before the plan began (1984), the responses one and two years (1985 and 1986) after institution of the plan were significantly more positive on three of nine characteristics: quality of staff, quality of supervision, and heterogeneity of patients. Contrary to concerns expressed by faculty members and residents prior to the plan, the 1985 and 1986 residents did not identify significant decline in the level of their patient care responsibility and opportunities for independent decision-making. One-third of the residents in 1985 and 1986, however, commented (usually negatively) about increased time required for attending rounds due to involvement of faculty members in ward care and documentation activities. These results suggest that changes in faculty organization to increase patient care reimbursement are not necessarily incompatible with maintaining and even improving graduate education.

Decreased availability of hospitalized patients for medical student education, a changing clinical environment in both hospital and outpatient settings, and the need for teaching the specific skills of primary ambulatory care mandate the development of outpatient-based clinical clerkships. A required third-year clerkship at Michigan State University College of Human Medicine combines a long-term structure and a defined curriculum with a wealth of clinical encounters. New approaches to the basic clinical education of medical students are needed to connect clinical resources, specialty expertise, and the special knowledge and skills needed for primary care. The clerkship described in the present paper represents a model for such clinical education.

A 57-item multiple choice test to assess physicians' knowledge of current approaches to diabetes management was devised by a multidisciplinary team that developed the test's case studies and questions. This test was revised based on critiques by diabetologists and other specialists at the Washington University Medical Center and its Diabetes Research and Training Center. A pilot test of the instrument was conducted with 95 residents from five accredited residency training programs and 17 medical students, and the results demonstrated consistent gaps in the respondents' knowledge in several major categories of diabetes management. The test was validated by administering it to 20 endocrinologists with known diabetes expertise and 16 nonspecialist family practice and internal medicine physicians. Analysis of these results revealed significant differences in test performance between the nonspecialists and experts. This initial body of data was used to refine the instrument further to the 56-item test presently being administered nationwide by the diabetes center to groups of family practice and internal medicine physicians and to residents and medical students.