Patients' views of the medical education settingGlasser, M; Bazuin, C H
doi: 10.1097/00001888-198510000-00001pmid: 4045968
The results of a survey of 1,334 patients at three community health centers operated by the University of Illinois College of Medicine at Rockford are presented and discussed. The research was designed to begin to obtain a better understanding of the patient's views on the quality of care and medical students in the medical education setting. Patients in the study reported being attracted to the educational site for the same reasons they would go to a private physician, that is, location, advice of a friend, or dissatisfaction with their previous doctor. They also reported satisfaction with care in general and with the specific components of care at the health centers. However, the patients expressed different views of the medical student's role, and there were differences in the patients' preferences for a student or a faculty physician depending on their medical problem or condition. These views of the student's role and the patients' preferences of physicians were found to be related significantly to the patient's age, the patient's perception of his primary source of medical care, the patient's evaluation of the effect of medical schools on health care, and the patient's level of satisfaction with the care received.
Impact of undergraduate courses on medical student performance in basic sciencesCanaday, S D; Lancaster, C J
doi: 10.1097/00001888-198510000-00002pmid: 4045969
Many students planning to apply to medical school take undergraduate courses (for example, biochemistry, embryology, histology, and vertebrate anatomy) covering concepts that are taught within the medical school curriculum. Do these students perform better in similar courses in medical school than students without prior exposure? In the study reported here of 310 medical students, approximately 50 percent had taken biochemistry, 50 percent had taken a course dealing with vertebrate anatomy, 25 percent had taken embryology, and 25 percent had taken histology as undergraduates. In comparisons of the students with prior exposure to these courses and those without prior exposure, no statistical difference was noted in cumulative grade-point averages for the first year in medical school or in the students' scores in three of the four individual medical courses examined. In addition, there was no significant difference in the academic performances in the four courses between the students in the upper and the lower quartiles of the class. Implications regarding undergraduate preparation of medical school applicants are discussed.
Development and modification of a required family medicine clerkshipMichener, J L; Parkerson, G R; Munning, K A; Warburton, S W; Bobula, J A; Estes, E H
doi: 10.1097/00001888-198510000-00003pmid: 4045970
A new required clinical clerkship in family medicine at Duke University School of Medicine is described in terms of planning, implementation, and modification in response to students' evaluations. Seventy-five percent of the eight-week course involves direct clinical experience both in academic practices and community sites, and 25 percent is spent in small group seminars and workshops. Evaluations by students have been highest for the clinical experience, the clinical competence of the faculty, the teaching effectiveness of the faculty and house staff, and the overall learning experience. The ratings have been lowest for seminars, workshops, and required written projects. Several modifications made in the clerkship over a three-year period have raised the students' ratings to near their ratings of the five traditional clerkships. The data demonstrate that family medicine can be taught effectively as a core clinical rotation and can broaden the general education of medical students.
Spectrum of diseases for house staff education on a VA general medicine inpatient serviceFriedland, J A; Wu, L; Wray, N P
doi: 10.1097/00001888-198510000-00004pmid: 4045971
A significant portion of internal medicine residency training in the United States today occurs in general medicine sections of Veterans Administration hospitals. The authors studied the demographic, diagnostic, and prognostic characteristics of the patients treated by house staff members rotating through the general medical wards of the Houston, Texas, Veterans Administration (VA) Medical Center. In 2,131 admissions over 13 months, the most frequent primary causes of admissions included congestive heart failure, pneumonia, exacerbation of chronic obstructive lung disease, and malignancy. In 85 percent of the admissions, two or more chronic diseases were present. In 53 percent of admissions, the patients were deemed to be moderately or severely ill on admission. The data indicate that the residents' experience is representative of problems encountered by practicing internists and that VA hospitals make a significant contribution to internal medicine training and thus to the provision of health care for the nation.
Development of community-based health services for adolescents at risk for sociomedical problemsLear, J G; Foster, H W; Wylie, W G
doi: 10.1097/00001888-198510000-00005pmid: 4045972
Community-based service and training programs have been advocated as important for improving access to medical care for the poor as well as enhancing the ambulatory training setting for residents and medical students. In 1981 the Robert Wood Johnson Foundation provided funds to 20 teaching hospitals to support community-based, comprehensive health services to high-risk young people, that is, young people living in communities with high rates of sociomedical problems, such as adolescent pregnancy, drug abuse, alcohol abuse, accidents, homicide, suicide, and depression. In this article, the authors describe the experiences of these institutions in establishing off-campus clinics, concluding that high-risk adolescents need additional services and that teaching hospitals and communities can collaborate to provide these comprehensive services. They discuss issues of maintaining services after foundation grants end and the impact of recent financial restraints on continued support from teaching hospitals for off-campus activities.
A rural primary care pediatric residency programKairys, S; Newell, P
doi: 10.1097/00001888-198510000-00006pmid: 4045973
Rural primary care is often reported in the medical literature as frustrating, lonely, and nonrewarding. Many graduating residents who choose small town practice become quickly disenchanted with the life-style and leave for a more populous territory or subspecialty training. Opportunities to learn how to take advantage of rural settings and establish rewarding community practices are few. The Primary Care Pediatric Residency Program at the Dartmouth-Hitchcock Medical Center has developed a training program in rural primary care. Residents experience over a three-year period the many facets of rural practice and are introduced to community-oriented approaches to child health care. Selected rural pediatric practices within a 45-mile radius of the medical center serve as teaching laboratories in which residents develop the skills necessary to manage children's problems related to school, behavioral disorders, and chronic diseases.
A first-year, student-managed course to correlate basic sciences with clinical medicineSaffran, M; Yeasting, R A
doi: 10.1097/00001888-198510000-00007pmid: 4045974
A course for first-year medical students was designed to illustrate the correlation of the biochemistry and physiology content of the curriculum with clinical applications. The course included early exposure of the students to clinical problems; the use of patients in the classroom; joint teaching by clinical and basic science faculties; independent learning, reading, and evaluation of the literature; and the use of reading, writing, and communication skills. The course was begun in 1981 as a faculty-directed course, but responsibility for the course was gradually transferred to the students until the entire presentation, from introduction and interview of the patient to the correlation of the clinical application with the basic sciences, was carried out by the students.