Northwestern University Medical School.
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Curriculum↗
Biomedical subjects
R H Curry
Publications and source records attributed to R H Curry.
Gauging the outcomes of change in a new medical curriculum: students' perceptions of progress toward educational goals.
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Analysis of Variance↗
Use of learning contracts in an office-based primary care clerkship.
OBJECTIVES: This paper describes implementation of the learner-centred learning goal within the primary care clerkship at a Midwestern, United States medical school. DESIGN: The learner-centred learning goal exercise was developed to tailor students' educational activities to their personal level of development and to enhance their commitment to life-long learning in medicine. In the learner-centred learning goal exercise, each student records three specific learning goals early in the primary care clerkship. Students record the methods by which they will pursue and document achievement of each goal. Attainment of the learner-centred learning goal is evaluated based on an oral presentation at the end of the clerkship. We compiled presented learning goals along with the corresponding grade. Students' ratings of the learner-centred learning goal exercise were also compiled. Evaluations and ratings were made on a 1-5 Likert scale, where 1 is the best rating and 5 is worst. SETTING: Department of Medicine, Northwestern University Medical School, Chicago, USA. SUBJECTS: One hundred and seventy-seven third- and fourth-year medical students who presented learner-centred learning goals between 1 July 1995 and 30 June 1996. RESULTS: Students rated pursuing their individual learning goals more worthwhile than most clerkship lectures but less worthwhile than the office experience. Several learning goals were chosen by a disproportionate number of students, potentially indicative of some perceived deficiencies elsewhere in the curriculum. Third-year students ranked the learner-centred learning goal exercise more favourably than fourth-year students (2.14 vs. 2. 51, P = 0.03). CONCLUSIONS: The learner-centred learning goal exercise is a feasible and well-received method within our primary care clerkship. Further study is required to determine whether the exercise promotes independent learning after formal medical school education is completed.
Clinical Clerkship↗
The evolving role of the acting internship in the medical school curriculum.
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Curriculum↗
The evolution of courses in professional skills and perspectives for medical students.
A number of medical schools substantially revised their curricula in response to the GPEP Report, issued by the Association of American Medical Colleges in 1984. One of the most important areas of change has been in the way students are introduced to the professional skills and perspectives they will need to practice clinical medicine. A number of schools have recently developed interdisciplinary courses to accomplish this goal. Such courses may differ in scheduling, format, and focus, but they share a commitment to broadening skills and perspectives through experiential learning and small-group work. Most of these courses span the entire first two years of the curriculum, and some extend into the third and fourth years, blurring the line between the "preclinical" and "clinical" years. The near-simultaneous, largely independent introduction of major courses of this type into the curricula of some medical schools has gone largely unreported in the literature. This overview article discusses the origins of these courses and reviews the scope of the curricula now in place. Among the most comprehensive programs are those at Northwestern University, Oregon Health Sciences University, the University of California, Los Angeles, and the University of Nebraska, each of which is described and discussed in the following papers.
Academic Medical Centers↗
Patient, physician & society: Northwestern University Medical School.
Northwestern University Medical School's Patient, Physician & Society (PPS) course was introduced in 1993 as part of a complete restructuring of the first- and second-year curriculum. The PPS course meets two afternoons per week throughout the first two years, with one afternoon focusing on the relationship between patients and physicians and the other on that between physicians and society. The course is designed to provide a comprehensive, integrated introduction to professional skills and perspectives. Fourteen distinct curricular units address personal and professional ethics, medical humanities, behavioral sciences, physician-patient communication, physical diagnosis and clinical reasoning, health services organization and financing, preventive medicine, and the health of vulnerable groups. Health promotion as a primary goal of medicine is an underlying theme throughout the course. Active and interactive learning formats afford many opportunities for personal reflection and discussion. The overall response to the course has been positive, and survey data indicate that students completing PPS report more progress toward the school's fundamental educational goals than do students who had progressed through the first two years before the new curriculum was introduced. Still, a number of students are clearly uncomfortable with educational strategies that give them responsibility for finding answers on their own. Contrasts between PPS and the basic science courses--in content, presentation, and evaluation--highlight the importance of coordinating and integrating the overall medical school curriculum. Plans for enhancing the course include focusing on faculty development and student evaluation, as well as explicitly extending PPS material into the clerkship years.
Curriculum↗
The future of medical school courses in professional skills and perspectives.
This article looks toward the future of medical school courses in professional skills and perspectives by addressing the extent to which they are a valid model for educating physicians of the 21st century, highlighting what medical educators can learn from the experiences at a sample of four medical schools, and suggesting ways to strengthen this curricular genre. Each of the four courses described in this special feature strives to provide exposure and experience in behavioral science, medical ethics, physician-patient communication, health promotion and disease prevention, physical examination, clinical reasoning, and health services and financing. It is likely that students who will be practicing medicine in the 21st century would also benefit from more attention to personal awareness and professional growth. Several lessons can be drawn from the experiences with these courses: although complex, they are directed by very small groups of faculty; they require large numbers of teaching faculty; it is difficult to establish equal footing with basic science courses; evaluation of students' progress is a major challenge; it is important to clearly articulate course components; the emphasis must extend beyond the first two years; and ongoing student and faculty input is essential. The authors suggest that conducting outcome assessments, creating a more humane culture of medical education, and supporting course faculty are key to a stable future for these courses and a solid education for the students.
Academic Medical Centers↗
Learner-centered strategies in clerkship education.
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Adult↗
"Sympathy for my body": breast cancer and mammography at two Atlanta clinics.
This article examines beliefs about breast cancer and mammograms among low-income urban black women. Our research indicates that women associate breast cancer with domestic violence, believing that bruises resulting from physical abuse which is not reported or given medical attention can later turn into cancer. Some women fear that in "mashing" the breast, mammograms cause "knots" or bruises that can become cancerous. Mothers and daughters were found to have extensive knowledge of, and sense of responsibility for, each other's health. This bond can be used to encourage use of cancer screening procedures. While women assert that one's health is ultimately in God's hands, their faith appears to motivate health-seeking behavior rather than promote a fatalistic or passive orientation.
Adult↗
An active-learning approach to basic clinical skills.
Within the context of comprehensive changes in the preclinical curriculum at Northwestern University Medical School, the authors sought to create an active-learning approach to teaching the basic clinical skills of communication, physical examination, and diagnostic reasoning. This approach is built upon the premise that repetitive practice using a structured database, which is emphasized in traditional curricula, is necessary but not sufficient for students' early development as clinicians, as it marginalizes essential areas of discourse and restricts students' understanding of the scope of the medical encounter. Accordingly, this clinical skills curriculum incorporates small-group, patient-instructor, and peer-observation formats to encourage critical thinking and reflection. The clinical skills units have been among the most popular aspects of Northwestern's new curriculum. Preliminary data suggest that the overall attitudes, knowledge, and clinical proficiency of students completing this curriculum compare favorably with those of students who progressed through the preclinical curriculum before the active-learning approach was introduced.
Clinical Competence↗
Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: the implications for a cancer screening program.
This paper examines cultural models for breast and cervical cancer among low-income African-American women over 40, in order to better understand how those models might affect cancer screening behavior. The study is part of The Community-Based Cancer Screening Project, which is sponsored by Emory University, Grady Memorial Hospital, and the American Cancer Society. The Screening Project attempts to increase the use of mammography, clinical and self-examination of the breast, and cervical Pap smear among women aged 40 or older in a predominantly African-American, low-income, low educational level population that is currently underserved by any screening activities. The study of cultural models of cancer within the project was prompted by the recognition that if screening programs targeted at specific, underserved, populations are to succeed, cultural as well as logistical barriers to screening must be overcome. Patients and clinicians must each understand how the other perceives cancer, its prevention, and its treatment. Only with this mutual understanding as a foundation, can physicians and their clients cooperate to improve cancer screening rates. Our research results indicate that the cancer models held by the patient population differ significantly from those held by clinicians. Women attending the clinics endure cancer screening tests that to them seem to serve only as heralds of a disease that will ultimately kill them. Most women doubt there is a cure for cancer, though some believe a person may live if the disease is caught in time.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
First-year residents' caring, medical knowledge, and clinical judgment in relation to laboratory utilization.
PURPOSE: To investigate first-year residents' levels of caring (concern for others' well-being), medical knowledge, and clinical judgment in relation to their levels of laboratory utilization. METHOD: Self-report questionnaires about caring, knowledge, and judgment were given in 1986-87 to 36 first-year residents in a three-year internal medicine residency program of the McGaw Medical Center of Northwestern University. Inpatient laboratory utilization data obtained from structured chart audits over a one-year period were used to construct comparable diagnosis- and severity-specific physician practice profiles, from which the residents received overall utilization scores for laboratory test charges. Statistical methods included Cronbach's alpha reliability coefficient and multiple regression analysis. RESULTS: The multiple regression analysis showed that medical knowledge was an independent predictor of increased laboratory utilization (standardized beta = .54, p < .04, partial R2 = .07); clinical judgment was an independent predictor of decreased utilization (standardized beta = -.53, p < .05, partial R2 = .06); and caring was unrelated to utilization (standardized beta = .15, ns, partial R2 = .01). CONCLUSION: The finding that clinical judgment was related to less laboratory utilization suggests that future research should investigate the decision-making concomitants of judgment to better understand its translation into resource utilization. It is possible that the relationship between medical knowledge and laboratory utilization is developmentally specific, and thus the knowledge of more experienced physicians, who would likely be more precise decision makers than first-year residents, may be related to decreased rather than increased utilization.
Chicago↗
Public hospitals and managed care.
Managed health care is used increasingly in the public and private sectors to control rising health-care costs and to assure quality of care. While current proposals for health-care reform promote even wider application of managed care as a component in cost control, the formal use of managed care by public hospitals has not been fully explored. This article identifies possible reasons for providing managed care within a public-hospital system, explores the implications of managed care for public hospitals and their patients, and addresses some of the barriers to implementing managed care in a traditional public-hospital setting.
Cost Control↗
U.S. residency directors' views of the importances of seven roles that pediatrics residents should master.
Pediatrics residency programs should define and evaluate for their residents and faculty the competencies that residents should acquire during their three years of training. This 1987 survey of 129 pediatrics residency directors sought data about the demographic characteristics of the programs and asked the program directors to what degree they agreed that seven roles (each comprising several competencies) of the general and ambulatory-care pediatrician were essential. There was strong agreement on the seven roles and no demonstrated association between these responses and the residency programs' university affiliations, types of facilities, ages, lengths of training, or geographic locations. The results of this survey may be useful in developing ways to document and evaluate residents' performances and define subspecialty objectives that are consistent with the seven basic roles.
Attitude of Health Personnel↗
Technology assessment and the evaluation of implanted medical devices.
Technology assessment is attracting new attention and funding as concern about costs and effectiveness of health care grows. This article provides a general overview of technology assessment and relates recent trends and future prospects specifically to the use and evaluation of implanted medical devices. In the next decade we may expect to see renewed interest in technology assessment as pressure to control health care costs continues and as a different focus of evaluation emerges that emphasizes patient preferences and quality of life in addition to traditional measures of safety, efficacy, and cost-effectiveness. These pressures and forces will act to increase the visibility and importance of proper assessment of medical technology, and the field may more nearly achieve its early promise as a tool to make medical care more rational.
Community Participation↗
A curriculum in palliative care for internal medicine housestaff: a pilot project.
Despite dramatic growth in the number of hospice programs over the past 15 years, palliative care skills and principles receive minimal attention in medical schools and residency training programs. Northwestern University Medical School and Northwestern Memorial Hospital have developed a program in palliative care education for internal medicine housestaff. Residents, working with a multidisciplinary team of hospice staff, have primary responsibility for the care of terminally ill patients in the home. An inpatient unit is available for acute care when needed. A formal lecture series on symptom management, accompanied by a bibliography and defined learning objectives, provides a guide to the clinical experience. Participating residents also attend seminars focusing on physicians' coping skills and attitudes toward death and dying. Evaluation of the program in its first year shows a definite perception of educational benefit by residents, and enthusiasm for continued involvement in palliative care.
Curriculum↗
A path analysis of medical school and residency performance. Implications for housestaff selection.
The selection and subsequent performance of 212 internal medicine residents was examined by factor analysis and path analysis. A three-factor solution accounted for most of the variance among the nine selection variables. These three factors, labeled Board Scores, Faculty Evaluations, and Academic Distinction, were then combined with in-training residency performance evaluations and composite scores on the ABIM certifying examination to produce a comprehensive path model of house staff selection and performance. The Academic Distinction factor emerged as the strongest predictor of residency performance,; the Faculty Evaluations factor was also a significant component of the model. Standardized test scores correlated poorly with clinical performance. The data suggest that increased attention to the content of letters of reference could substantially improve their predictive validity. Other means of reporting subjective evaluations may also be needed to increase the stature of non-cognitive attributes in house staff selection decisions.
Chicago↗
Comparative performance information in the dean's letter.
Comparative medical school performance information, including the presence of a summative "dean's code" statement, was identified by selective content analysis of 310 dean's letters. There was a significant increase in the report of comparative information over the ten year study period, and correlation with residency in-training evaluations showed that this information may be useful to housestaff selection committees.
Clinical Competence↗