Liaison Committee on Medical Education. Past successes, future challenges.
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Biomedical subjects
Publications and source records attributed to M R Schwarz.
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Telephone interviews were conducted with 500 primary care physicians, drawn from a stratified random sample of internists, family practitioners, pediatricians, general practitioners, and OB/GYN physicians. Respondents were asked to report their experience treating AIDS patients and to estimate the percentage of their patients they felt were at high risk for HIV infection. Nineteen questions designed to assess practices and attitudes towards AIDS and HIV-related issues were asked. Results suggest that physicians underestimate their patients' level of risk for HIV infection and are not taking adequate drug use and sexual histories. The level of concern for personal risk of infection was high, although a strong ethical obligation to treat HIV patients was expressed. Physicians also expressed support for mandatory reporting and contact tracing, although this diminished as contact with HIV patients increased.
Among medical leaders in other countries, there is a general perception that it is difficult at present for their citizens to get graduate medical education in the United States. In response to concern that current U.S. policies may be negatively affecting opportunities for international medical education, a task force recommendation of the Accreditation Council for Graduate Medical Education led to the founding of a managing structure through which to develop the International Medical Scholars Program (IMSP). IMSP is described as an organization that will be able to provide tailored opportunities for high-quality education, centralized matching, planning, and evaluation; certificates for recognition of program completion; mechanisms to ensure the return of participants to their home countries; and a system to record the careers of IMSP graduates in their home countries. Proposed eligibility requirements for foreign medical graduates and selection criteria for U.S. institutions are discussed, along with obligations and requirements of program participants, program content, and the recognition for completion of IMSP programs. Administrative considerations also are presented, including IMSP financing and evaluation plans.
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The development of a comprehensive examination at the end of the first year of medical school is discussed. The implications of the results for the evaluation of the WAMI Program in decentralized medical education are presented.
Evaluation of the community phase of a regionalized medical education in the states of Washington, Alsska, Montana and Idaho (WAMI) is producing data to suggest that peripheralization of medical education, including remote site clinical training, offers a viable alternative to traditional methods.
The results of the evaluation of the basic science curriculum in a regionalized medical education program in the states of Washington, Alaska, Montana, and Idaho (WAMI) are presented and discussed. The hypothesis that students taking the first quarter of basic science at universities remote from the Unversity of Washington School of Medicine (UWSM) will be no different in academic performance from those who remain at the UWSM is tested. The variables considered were student performance on (a) common tests in Anatomy/Histology, Biochemistry, Mechanisms of Physiology, and Epidemiology; (b) subsequent course work at the UWSM; and (c) the mini-tests and Part I of the examinations of the National Board of Medical Examiners. The developement of the common tests is described. Analysis of variance indicates that the null hypothesis cannot be rejected at the .05 level.
In mixed lymphocyte cultures prepared with thoracic duct lymphocytes from allogeneic rats, approximately 20 percent of all blast cells that appeared at the end of 72 hours of incubation had surface receptors for rabbit antibody to rat immunoglobulin.
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Rabbit anti-chicken gamma-globulin was labeled with 125I and then incubated with cells from the bursa, thymus, spleen, and bone marrow of 4- and 8-week old birds. The same procedure was carried out on 11-week-old agammaglobulinemic chickens. Autoradiography revealed that the majority of large, medium, and small bursal lymphocytes bind the antibodies while labeled lymphocytes of each type in the spleen and thymus never exceeded 11 or 4 percent, respectively. Labeled medium and small lymphocytes in the bone marrow increased from 4.2 and 1.7%, respectively, at 4 weeks of age, to 9.5 and 8.8%, respectively, at 8 weeks of age. Labeled lymphocytes of all sizes were completely absent in all tissues of agammaglobulinemic chicks, including the marrow. Therefore, the increase in frequency of labeled lymphocytes in the bone marrow with age may be a result of recruitment of cells from the bursa of Fabricius. The majority of lymphocytes in the bone marrow do not label. Therefore, lymphocytes from the bone marrow may be T cells, subsets of B cells, or neither T or B cells.
Tissue tolerance was induced in neonatal rats by the intravenous injection of bone marrow cells from adult allogeneic rat donors. After 6 to 8 weeks, lymphoid cells from rats in which tolerance had been induced were tested for mixed lymphocyte reactivity (MLR), 3H-uridine uptake, and the relationship of uridine incorporation to B and T lymphocytes. Lymph node (LN) and spleen (SPL) cells from the adult inoculated rats showed no reactivity in the MLR or normal lymphocyte transfer reaction (NLTRx), indicating that the animals were tolerant. After in vitro exposure to 3H-uridine, an abundance of small lymphocytes (SL) from these same tolerant rats were heavily labeled, in contrast to nontolerant controls, where relatively few SL were heavily labeled. In order to determine whether the heavily uridine-labeled cells were T cells or B cells, lymphoid cells from the LN and SPL of tolerant animals were exposed to either rabbit anti-AKR brain serum or rabbit anti-rat Ig conjugated with ferritin. The results showed that the heavily uridine-labeled SL of the tolerant rats were mainly Ig-positive cells.
By 7 weeks post-grafting, the number of small lymphocytes in the thoracic duct lymph (TDL) and blood of the thymus-grafted neonatally thymectomized adult rats had increased to 60% of the number of cells in sham controls, or 2-1/2 times thymectomized control values. This increasing consisted almost exclusively of long-lived, recirculating small lymphocytes and corresponded to a 60% recovery of cellular immunocompetence as measured by the mixed lymphocyte reaction (MLR). Associated with the return of cellular immunocompetence was an increased incorporation of 3H-uridine by the small lymphocytes. Cells from thymectomized animals grafted with lymph node fragments demonstrated no significant increase in lymphocyte numbers nor was there a return of immunocompetence as compared to thymectomized controls.