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Biomedical subjects

Scott M Wright

Publications and source records attributed to Scott M Wright.

At least 37 records · Page 2Linked to original sources
PubMed2004

Conference attendance and performance on the in-training examination in internal medicine.

The objective of this study was to describe the relationship between attendance at conferences during residency training and residents' performance on the In-Training Examination (ITE) in Internal Medicine. Nineteen house officers participated in the study. Conference attendance records were retrospectively reviewed for the one-year period preceding the ITE (pre-ITE), and in the three-month period after house officers received their ITE scores (post-ITE). After receiving their scores, participants completed a questionnaire asking about study habits and opinions about conferences. Attendance was taken at 126/165 (76.4%) conferences pre-ITE and 32/42 (76.2%) conferences post-ITE. House officers attended a mean of 35% (range, 10-59) of the conferences pre-ITE and 32% (range, 9-75) post-ITE (p = 0.365). There was no correlation between prior conference attendance and ITE scores (Spearman correlation coefficient -0.230, p = 0.34), and no correlation between score and conference attendance post-ITE (Spearman correlation coefficient 0.174, p = 0.48). Participation in clinical rotations also failed to influence ITE scores in that content area (all p > 0.05). The findings of this study suggest conference attendance does not influence ITE scores. Medical educators may need to rethink and study how best to impart medical knowledge.

Adult↗
PubMed2004

Faculty development in teaching skills: an intensive longitudinal model.

Although reflection contributes to the personal growth of clinician-educators and is important for effective teaching, few teaching skills programs report its use. The Johns Hopkins Faculty Development Program in Teaching Skills, first implemented in 1987 as a theoretically grounded, longitudinal model for faculty development of clinician-educators, comprises a set of conditions intended to promote reflective learning. This paper describes the program and reports evaluation results for 98 participants and a comparison group of 112 nonparticipants between 1988 and 1996. Participants met with facilitators weekly for nine months for 3.5 hours, in stable groups of four to six individuals. Educational methods used across seven content areas emphasized relationships and collaboration, and included information provision, experiential learning with reflection, and personal awareness sessions. A pre-post evaluation design with comparison group measured changes in self-assessed teaching and professional skills, teaching enjoyment, and learning effectiveness. A post-only evaluation design appraised overall program quality, educational methods, facilitation, learning environment, and perceived impact of participation. Program participants had significantly greater pre-post-change scores than nonparticipants for all 14 outcomes (p <.05). Multiple regression modeling indicated that program participation was associated with pre-post improvement in all outcomes except administration skills, controlling for all participant and nonparticipant baseline characteristics (p <.05). All measured programmatic characteristics were highly rated by participants. Experiential methods with reflection were rated significantly higher than information-provision and personal awareness sessions (p <.001). Evaluation results demonstrate a positive impact of this alternative approach to faculty development on clinician-educator perceptions of their attitudes and behaviors towards learners and colleagues.

Adult↗
PubMed2004

Educational research at Johns Hopkins University School of Medicine: a grassroots development.

The Divisions of General Internal Medicine at Johns Hopkins University School of Medicine have been a rich source of educational research. To better understand the facilitators and barriers to educational research within the divisions, the authors reviewed published educational research from the divisions published between 1995-2004 and examined the history, leadership decisions, and sentinel events that have allowed educational scholarship within the divisions to grow. The authors' analysis suggests a grassroots model of programmatic growth that includes a growing cadre of clinician-educator scholars, effective mentorship, a faculty development program, access to learners, access to research expertise, protected time for scholarship, some funding, and an institutional culture that stimulates scholarship. A medical education fellowship was integral to the model; fellows were first authors for 47% of reviewed manuscripts. Extramural funding has helped build an infrastructure that supports educational scholarship; however, only 12% of the publications have had extramural funding. Protected time for faculty is the characteristic of this model most at risk. While there has been a move toward more institutional support of educational research, it is clear that further growth in the educational research program will require noninstitutional resources.

Baltimore↗
PubMed2004

Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals.

Methemoglobin is a form of hemoglobin that does not bind oxygen. When its concentration is elevated in red blood cells, functional anemia and tissue hypoxia may occur. We performed a retrospective case series to describe the cases of acquired methemoglobinemia (methemoglobin level >2%) detected and the clinical circumstances under which they occurred at 2 tertiary care hospitals and affiliated outpatient clinics over 28 months. We surveyed co-oximetry laboratory data to identify patients with methemoglobinemia. We reviewed these patients' medical records to extract the clinical information and context. One hundred thirty-eight cases of acquired methemoglobinemia were detected over the 28 months. There was no gender predisposition, and the condition occurred over a wide range of ages (patients aged 4 days to 86 years). Cases occurred in many areas of the hospital, including outpatient clinics. One fatality and 3 near-fatalities were directly attributable to methemoglobinemia. Dapsone was the most common etiology of acquired methemoglobinemia, accounting for 42% of all cases. The mean peak methemoglobin level among these individuals was 7.6%. In 5 of the patients with the most severely elevated levels, 20% benzocaine spray (Hurricaine Topical Anesthetic spray, Beutlich Pharmaceuticals, Waukegan, IL) was the etiology, associated with a mean peak methemoglobin level of 43.8%. Eleven pediatric patients developed methemoglobinemia either from exogenous exposure, such as drugs, or due to serious illness, such as gastrointestinal infections with dehydration. Almost all (94%) patients with methemoglobinemia were anemic. Drugs that cause acquired methemoglobinemia are ubiquitous in both the hospital and the outpatient setting. Acquired methemoglobinemia is a treatable condition that causes significant morbidity and even mortality. We hope that a heightened awareness of methemoglobinemia will result in improved recognition and treatment. Primary prevention efforts have the potential to reduce the morbidity and mortality associated with this condition.

Adolescent↗
PubMed2004

Clinician-teachers' self-assessments versus learners' perceptions.

Understanding how clinician-teachers' self-assessments compare to learners' impressions can serve to help educators place each of these evaluations in the appropriate context. Past participants of the Johns Hopkins Faculty Development Program and other physician-teachers were surveyed in 2002 regarding their teaching skills and behaviors. We surveyed their learners to compare teacher and learner assessments of teaching proficiency, behaviors, enjoyment, and career satisfaction. In each area, learners' ratings were statistically significantly higher than their teachers' self-ratings. Though it is unclear whether teachers' or learners' assessments are a more accurate reflection of the truth, the more positive learner ratings should promote self-confidence in clinician-educators regarding their teaching abilities.

Faculty, Medical↗
PubMed2004

Writing more informative letters of reference.

Writing a meaningful and valuable letter of reference is not an easy task. Several factors influence the quality of any letter of reference. First, the accuracy and reliability of the writer's impressions and judgment depend on how well he knows the individual being described. Second, the writer's frame of reference, which is determined by the number of persons at the same level that he has worked with, will impact the context and significance of his beliefs and estimations. Third, the letter-writing skills of the person composing the letter will naturally affect the letter. To support the other components of a candidate's application, a letter of reference should provide specific examples of how an individual's behavior or attitude compares to a reference group and should assess "intangibles" that are hard to glean from a curriculum vitae or from test scores. This report offers suggestions that should help physicians write more informative letters of reference.

Correspondence as Topic↗
PubMed2004

Motivating factors for academic physicians within departments of medicine.

OBJECTIVE: To understand what motivates academic physicians at a time when physician dissatisfaction is prevalent. SUBJECTS AND METHODS: Of a cohort of 480 physician faculty members (identified from the Association of American Medical Colleges faculty roster) hired at the assistant professor level, 183 were monitored prospectively for a characterization of their success in achieving promotion. In mid-2001, follow-up data were collected about the factors that physicians described as motivating in their work. We conducted this study to understand the differences in motivators between clinician-educators and cliniclan-investigators and between male and female physicians, as well as to validate a previously used instrument developed to assess motivation and occupational values. RESULTS: Of 183 physicians monitored, 144 (79%) responded to an interim follow-up questionnaire. Factor analysis revealed that physicians' occupational motivators could be grouped statistically into 3 factors: self-expression, helping others, and extrinsic rewards. Compared with clinician-educators, clinician-investigators were more motivated in their current work by having the ability to express themselves (composite factor score, 4.30 vs 3.84; P<.001). Clinician-investigators also rated 4 of the 6 items within the factor of self-expression as being significantly stronger motivators for them than did the clinician-educators. Compared with male physicians, female physicians Indicated they were more motivated by helping others (composite factor score, 4.18 vs 3.89; P=.03). CONCLUSIONS: Factors that motivate physicians appear to be different for clinician-investigators and clinician-educators as well as for male and female physicians. Understanding the inspiration for physicians may help medical leadership to better motivate and relate to their physician workforce.

Faculty, Medical↗
PubMed2003

Minimal prevalence of authorship misrepresentation among internal medicine residency applicants: do previous estimates of "misrepresentation" represent insufficient case finding?.

BACKGROUND: High rates of authorship misrepresentation have been documented among medical trainees. OBJECTIVE: To assess misrepresentation among internal medicine residency applicants while comparing searches used by previous authors (searches 1 and 2) to a more comprehensive strategy (search 3). DESIGN: Review of 497 residency applications. SETTING: Two university-based internal medicine residency programs. MEASUREMENTS: Search 1 was limited to MEDLINE. Search 2 added Current Contents, Science Citation Index, and BIOSIS and included searching journals by hand. Search 3 added seven other databases and contacts to librarians, editors, and coauthors. RESULTS: 224 applicants reported 634 articles; 630 (99%) were verified. The number of applicants with misrepresented citations varied depending on the search used (56 applicants [25%] in search 1 vs. 34 applicants [15%] in search 2 vs. 4 applicants [1.8%] in search 3). CONCLUSIONS: Using a comprehensive search, we found substantially less misrepresentation than had been reported. Previous studies probably overestimated the magnitude of the problem.

Adult↗
PubMed2003

Promotion criteria for clinician-educators.

OBJECTIVE: Department of medicine chairs have a critical role in the promotion of clinician-educators. Our primary objective was to determine how chairs viewed: 1) the importance of specific areas of clinician-educator performance in promotion decisions; and 2) the importance and quality of information on available measures of performance. A secondary objective was to compare the views of department chairs with those of promotion and tenure committee chairs. METHODS: In October 1997, a questionnaire was mailed to all department chairs in the United States and Canada asking them to rate the importance of 11 areas of clinician-educators' performance in evaluating them for promotion. We also asked them to rate 36 measures of performance. We compared their responses to a similar 1996 survey administered to promotion committee chairs. RESULTS: One hundred fourteen of 139 department chairs (82%) responded to the survey. When considering a clinician-educator for promotion, department chairs view teaching skills and clinical skills as the most important areas of performance, as did the promotion committee chairs. Of the measures used to evaluate teaching performance, teaching awards were considered most important and rated as a high-quality measure. When evaluating a clinician-educator's clinical skills, peer and trainee evaluation were considered as the most important measures of performance, but these were rated low in quality. Patient satisfaction and objective outcome measures also were viewed as important measures that needed improvement. Promotion committee chairs placed more emphasis on productivity in publications and external grant support when compared to department chairs. CONCLUSION: It is reassuring that both department chairs and promotion committee chairs value teaching skills and clinical skills as the most important areas of a clinician-educator's performance when evaluating for promotion. However, differences in opinion regarding the importance of several performance measures and the need for improved quality measures may represent barriers to the timely promotion of clinician-educators.

Academic Medical Centers↗
PubMed2003

What do academic primary care physicians want in an electronic journal?

To determine the interest of academic general internists and family physicians in specific features of electronic journal publications, we surveyed 350 physicians, 175 randomly selected from each of 2 medical societies: the Society of General Internal Medicine, and the Society of Teachers of Family Medicine. The response rate was 70%. Most general internists and family physicians used online journals sometimes or often. Most general internists and family physicians reported moderate to high interest in having links from original articles, reviews, or editorials to listed references (77% to 89% of internists and 65% to 81% of family physicians) and electronic medical reference texts (73% to 78% of internists and 65% to 83% of family physicians). Less than 25% of both groups reported moderate to high interest in having links to initiate dialog with other readers or to communicate comments to the author or editor. General internists were more likely than were family physicians to have moderate to high interest in having links to appendices and supportive material (e.g., 66% of general internists versus 46% of family physicians for original articles; P < .05) and less likely to have moderate to high interest in links to health-related web sites (44% of general internists versus 69% of family physicians for original articles; P < .05). We conclude that academic general internists and family physicians have strong but not identical interests in specific features of electronic publication that primary care-oriented journals should consider.

Academic Medical Centers↗
PubMed2003

Looking forward to promotion: characteristics of participants in the Prospective Study of Promotion in Academia.

OBJECTIVES: To determine what clinician-educators consider important for promotion, and what support they find helpful and useful for success. DESIGN: Cross-sectional study. SETTING: Eighty academic medical centers in the United States. PARTICIPANTS: One hundred eighty-three participants of the Prospective Study of Promotion in Academia comprising assistant professors in departments of medicine from 80 different medical schools in 35 states. MEASUREMENTS: Differences between clinician-educators' and clinician-investigators' work activities, promotion preparedness, and faculty support needs. RESULTS: One hundred seven (58%) of the faculty were clinician-educators (CEs), and 63 (34%) were clinician-investigators (CIs); the remaining 13 fit neither category. Participants had been in their faculty position for 4.7 years. Ninety-eight percent of CIs reported a publication expectation for promotion, and 75% of CEs also reported such an expectation. More CIs had career mentors available than CEs (68% vs 32%, P <.001). Seventy-nine percent of CIs indicated >10% protected scholarly work time, compared to only 35% of CEs (P <.001). Fifty-three percent of CIs as compared to 32% of CEs (P <.01) meet more often than yearly with their chief/chair for performance review, and more CIs have seen written promotion guidelines (72% vs 51%, P <.01). Clinician educators believed out of 11 job performance areas, research, written scholarship, and reputation were the 3 most important factors that would determine the success of their application for promotion. Both CEs and CIs sense that CIs are more likely get promoted (82% vs 79%). CONCLUSIONS: Clinician educators are less familiar with promotion guidelines, meet less often with superiors for performance review, and have less protected time than CI colleagues. There is dissonance between CEs' beliefs and previously published data from promotion committee chairs in the importance given to specific aspects of job performance.

Academic Medical Centers↗
PubMed2003

A systematic review of resident research curricula.

PURPOSE: To review in a systematic manner the published curricula for training house officers in research. METHOD: Articles were identified by searching the Medline, Educational Resources Information Center, and Science Citation Index databases, educational Web sites, and bibliographies of captured articles, and by contacting experts who had developed resident research curricula. Demographic information, curriculum development steps, educational strategies, evaluation methods, and outcomes were abstracted. RESULTS: The search identified 41 articles describing curricula. The most common curricular objectives were to increase house officers' research productivity and improve their critical appraisal skills. Only one curriculum was designed with the goal of producing academic physicians. Among many instructional methods, conducting research projects, exposing learners to role models or mentors, and providing house officers with multiple opportunities to present their work were common. Only 27 articles (66%) articulated goals or objectives, and 11 included (27%) needs assessments. Evaluation methods were often rudimentary, frequently limited to learners' self-assessments or authors' anecdotal reports. Five (12%) reported pre-post-intervention testing of learners' knowledge. No curricula were evaluated as prospective pretest-posttest controlled trials. A minority of articles reported costs, obstacles encountered, or modifications made in the curriculum. CONCLUSION: Successful educational interventions should incorporate needs assessments, clearly defined learning objectives, and evaluation methods. While many curricula for resident research exist, the lack of detailed developmental information and meaningful evaluations hinders educators interested in adopting these curricula.

Attitude of Health Personnel↗
PubMed2003

Serving as a physician role model for a diverse population of medical learners.

PURPOSE: Medical learners look to role models to better understand the values, attitudes, behaviors, and ethics of the medical profession. This study examined issues related to physicians serving as role models for diverse medical learners. METHOD: Between September and November 2000, in-depth semi-structured 30-minute interviews were conducted with 29 highly regarded role models, as judged by medical house officers at two large teaching hospitals in Baltimore, Maryland. Interview transcripts were independently coded and compared for agreement. Content analysis identified several major categories of themes that were examined and conceptually organized. RESULTS: The informants identified issues that relate to role modeling for diverse medical learners. Subcategories under the domain of similarity facilitates role modeling included learners prefer role models similar to them, role modeling is easier when the learner resembles the teacher, and minority physicians may be better role models for minority learners. Under the domain role modeling when physician-teachers and learners are different were the subcategories extra effort may be necessary, success promotes and inspires confidence, and role modeling across diversity is an achievable objective that should be pursued. The final domain, approaches to differences between physician-teachers and learners, encompassed embrace diversity, act as a consultant and refer when necessary, and minimize and disregard all differences. CONCLUSIONS: The results of this study should draw attention to these issues and may serve as a stimulus for teaching physicians to consider a broader range of options for successful interactions with medical learners who are different from them.

Adult↗
PubMed2003

Re-examining the value of medical grand rounds.

PURPOSE: To study medical grand rounds, the cornerstone of a department of medicine's educational programs. METHOD: Between April and June 2001, a questionnaire was sent to chairs of departments of medicine at the 389 U.S. hospitals with medicine residency programs accredited by the Accreditation Council for Graduate Medical Education. Data were collected on the objectives and attendance, educational structure, perceived quality, and costs of medical grand rounds. RESULTS: Three hundred questionnaires were returned (77%). Grand rounds were offered by 97% of departments and accredited for continuing medical education in 96% of hospitals. The most important objectives were to educate, showcase faculty role models, and promote a collegial atmosphere. Patients were present at grand rounds less than 3% of the time. Grand rounds were predominantly lecture based; only 10% were clinical case presentations or interactive workshops/small groups, the formats proven most effective for facilitating adult learning and a humanistic approach to patients. Curricular tenets of needs assessment, program evaluation, and knowledge assessment were performed in only 73%, 59%, and 17% of programs, respectively. University hospitals were less likely to incorporate these principles (p <.01). Although respondents attested to the high quality of grand rounds, many potential attendees missed more than half the sessions. Grand rounds were the most expensive conference in 78% of departments, with the pharmaceutical industry providing the majority of the funding. CONCLUSIONS: Medical grand rounds are costly and often do not take into account learners' needs. Departments of medicine should reevaluate their commitment to grand rounds.

Clinical Medicine↗