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H K Rabinowitz

Publications and source records attributed to H K Rabinowitz.

50 records · Page 3Linked to original sources
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Oral health care issues in HIV disease: developing a core curriculum for primary care physicians.

BACKGROUND: Given the high occurrence of oral manifestations in patients infected with human immunodeficiency virus (HIV), the relative ease in recognizing these manifestations on physical examination, and their potential impact on the health care and quality of life in these patients, it is critical to provide adequate training for primary care physicians in this area. METHODS: Based on a review of the published literature and the consensus of a national panel of primary care physicians and dentists with clinical and research expertise in this area, a core curriculum was developed for primary care physicians regarding oral health care issues in HIV disease. RESULTS AND CONCLUSIONS: We describe the process of developing the core curriculum of knowledge, skills, and attitudes regarding oral health care issues in HIV disease. The final curriculum is in a format that allows for easy accessibility and is organized in a manner that is clinically relevant for primary care physicians.

Clinical Competence↗
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The change in specialty preference by medical students over time: an analysis of students who prefer family medicine.

Over one third of U.S. medical school matriculants from the graduating class of 1983 had an original career interest in family practice, although there was a significant attrition by the time of medical school graduation. Perhaps of greater importance, however, was that students who entered medical school with an interest in family practice were almost three times as likely to choose family practice as a career than matriculants who were interested in other specialties (24.2% versus 8.4%, P less than .001).

Career Choice↗
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Student clinical experiences in family medicine: a comparison of clerkships and preceptorships.

Clerkships and preceptorships represent the two major clinical experiences in predoctoral family medicine education. Data was collected from 154 of 211 third year students from Jefferson Medical College during their required family medicine clerkship (residency-based), and compared with similar data from 12 of 20 senior Jefferson students on their elective family medicine preceptorships (private office based) (1984-85). Students on clerkships had fewer patient encounters than on preceptorships (127.6 vs. 320.0 per six week rotation). In addition, clerkship students saw more patients with trauma, vaginitis, and hypertension, although preceptorship students saw more patients with health maintenance, arteriosclerotic problems, lower respiratory infections, and dermatologic problems. These results suggest that medical students should be encouraged to participate in both a third year clerkship and a senior preceptorship, because they represent different and complimentary clinical experiences in family medicine.

Clinical Clerkship↗
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A comparison of the modified essay question and multiple choice question formats: their relationship to clinical performance.

The Department of Family Medicine at Jefferson Medical College has used the modified essay question as the final examination format for its required third-year clerkship since 1976. To compare the family medicine modified essay question format with the multiple choice question format used in the other five required junior clerkships, examination scores from 2,174 Jefferson graduates (1976-1985) were correlated with scores on the examinations of the National Board of Medical Examiners (NBME), ratings of clinical performance in the required third-year clerkships, and ratings on four global areas of postgraduate competence. Grades on the multiple choice examination in internal medicine consistently yielded the highest correlations with NBME scores and with postgraduate ratings of medical knowledge. Performance on the modified essay examination in family medicine had the lowest correlations in these areas. The family medicine scores, however, consistently yielded the highest correlations with overall third-year clinical performance and with postgraduate performance in the areas of data-gathering skills, clinical judgment, and professional attitudes. These results indicate that the modified essay question format may provide a different and important parameter in the evaluation of medical trainees.

Clinical Competence↗
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The relationship between medical student career choice and a required third-year family practice clerkship.

Family practice as a career choice has been related to a number of educational variables, including the presence of a required clinical clerkship. In order to determine whether or not the timing of the required clinical clerkship was also related to family practice residency selection, a study was undertaken to investigate the relationship between the required third-year family practice clerkship and family practice career choice. The results showed that students who attended medical schools with a required third-year clerkship in family practice were significantly more likely to enter family practice residency training (16.8%), than students who attended schools with a required fourth-year clerkship (14.5% P less than 0.05), or who attended a school with no required family practice clerkship (12.1%, P less than 0.001). These results support the recommendations of the STFM Task Force on Predoctoral Education that a required third-year clerkship in family practice is important in medical student career choice.

Career Choice↗
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Improving consistency in student evaluation at affiliated family practice centers.

The Department of Family Medicine at Jefferson Medical College has since 1974 been successful in administering a required third-year family medicine clerkship, providing students with a structured, didactic, and experiential curriculum in six affiliated family practice centers. Prior analysis (1976-1981) had indicated, however, that variation existed in evaluating similar students, depending on the clerkship training site, i.e., three sites graded students in a significantly different fashion than the three other sites. Utilizing these data to focus on the evaluation process, a comprehensive and specific six-point plan was developed to improve consistency in evaluations at the different training sites. This plan consisted of a yearly meeting of affiliate faculty, assigning predoctoral training administrative responsibility to one faculty member at each training site, increased telephone communication, affiliate-faculty attendance at the university site evaluation session, faculty rotation to spend time at other training sites, and financial reimbursement to the affiliate training sites. After intervention, analysis (1981-1983) indicated that five of the six clerkship sites now grade students in a consistent fashion, with only one affiliate using different grading standards. The intervention was therefore judged to be successful for five of the six training sites, allowing for better communication and more critical and consistent evaluation of medical students.

Clinical Clerkship↗
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The effect of a required residency based student clerkship on resident selection.

Over the past decade, the Department of Family Medicine at Jefferson Medical College has used a network of seven residency-based family practice centers each year to teach 223 third-year medical students in their required family medicine clerkship. A comparison of these affiliated residency programs with a control group of the other family medicine residency programs in Pennsylvania and Delaware (with minimal third-year teaching responsibilities) from 1976 to 1984 has shown that the affiliated programs had a significantly higher National Residency Matching Program (NRMP) fill rate (92% v. 77%), had a higher percentage of programs with fill rates above the national average (71% v. 41%), and filled their full complement of residents more often (82% v. 52%) than the control programs. This success in residency recruitment was due in part to the fact that the affiliated programs filled one-third of their positions with Jefferson graduates, three times the percentage found in the control programs. For family medicine residency programs, teaching third-year medical students in a required clerkship offers a major opportunity to improve their residency selection results in the NRMP.

Clinical Clerkship↗
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Influence of income, hours worked, and loan repayment on medical students' decision to pursue a primary care career.

OBJECTIVE: To assess the specialty plans of current fourth-year medical students and, for those not choosing primary care specialties, to investigate the potential effect that changes in key economic or lifestyle factors could have in attracting such students to primary care. DESIGN AND PARTICIPANTS: A survey study was sent to 901 fourth-year medical students in the 1993 graduating classes of six US medical schools. OUTCOME MEASURES: Comparisons were made between students choosing and not choosing primary care specialties. For the non-primary care students, we also evaluated whether alteration of income, hours worked, or loan repayment could attract them to primary care careers. RESULTS: Of the 688 responses (76% response rate), primary care specialties were chosen by 27% of the students and non-primary care specialties by 73%. One quarter (25%) of the non-primary care students indicated they would change to primary care for one of the following factors: income (10%), hours worked (11%), or loan repayment (4%). For students whose debt was $50,000 or greater, the loan repayment option became much more important than for students with lesser debt. In all, a total of 45% (n = 313) of the students indicated either they were planning to enter primary care (n = 188) or they would change to a primary care specialty (n = 125) with appropriate adjustments in income, hours worked, or loan repayment. CONCLUSION: Significant changes in economic and lifestyle factors could have a direct effect on the ability to attract students to primary care. Including such changes as part of health system reform, especially within the context of a supportive medical school environment, could enable the United States to approach a goal of graduating 50% generalist physicians.

Career Choice↗
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Alternate career choices of medical students: their relationship to choice of specialty.

BACKGROUND AND METHODS: To help identify additional information regarding why some individuals are more likely to enter certain medical specialties, we undertook a study to evaluate the relationship between a senior medical student's self-reported alternate career choice (ie, if he or she had not entered medicine), and that student's subsequent choice of a medical specialty. RESULTS: Students entering the specialties of pediatrics, family practice, obstetrics and gynecology, and emergency medicine were likely to have chosen alternate careers in the teaching, health care, humanities, arts, and nonprofessional areas. In contrast, students entering the specialties of anesthesiology, radiology, internal medicine, and surgery (general surgery or the surgical subspecialties) were more likely to have chosen alternate careers in engineering, research, science, business, law, and architecture. CONCLUSIONS: The alternate career choices of medical students may be related to their subsequent choice of medical specialty.

Career Choice↗