PubMed · 8640277
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1996-06-20. Physicians. Help wanted.. https://pubmed.ncbi.nlm.nih.gov/8640277/
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PURPOSE: The Liaison Committee on Medical Education mandates a core curriculum in primary care but does not specify its content or structure. In this study, we explored the question of whether primary care specialty or geographic location affects student learning and satisfaction. METHODS: From 1994 to 1996, 294 third-year medical students at one medical school in New York state were randomly assigned to multiple teaching sites for a required 5-week primary care clerkship. Independent predictor variables were primary care specialty of the preceptor (family medicine, medicine, pediatrics, or joint medicine and pediatrics) and geographic location of the site (urban, suburban, rural). Outcome measures included four areas of student satisfaction, one of patient volume, and two of student performance. RESULTS: Primary care specialty had no detectable association with the outcome measures, except for a lower rating of patient diversity in pediatric experiences (P <0.001). Geographic location of the site had a significant association with all measures of student satisfaction and patient volume (all P values <0.001). Students at rural sites rated the experience more highly and saw on average 15 more patients per rotation. Ratings of student satisfaction remained high after adjusting for patient volume. Primary care specialty and geographic location did not influence student performance in the clerkship or scores on standardized patient examination. CONCLUSIONS: Rural geographic location of teaching site, but not primary care specialty, was associated with higher student satisfaction. However, higher student satisfaction ratings did not correspond to better student performance. Provided that all sites meet the screening criteria for inclusion in a teaching program, these findings support the continued development of high-quality, heterogeneous, interdisciplinary, primary care experiences.
BACKGROUND: There have been no quantitative, longitudinal studies on the effect of Level 1 Trauma Center (TC) designation on a facility. The purpose of this study was to evaluate the impact of such designation. STUDY DESIGN: In September 1990, a 416-bed core affiliate hospital of the state medical school system was state-designated as the Level 1 TC for 6 counties. Data collected from five concurrent 1-year periods after TC designation included case number and acuity of condition, length of hospital and ICU stays, preventable death rates, financial coverage, and neurosurgery and orthopaedic volume. No registry data were available before TC designation. RESULTS: While the yearly number of cases remained stable, the overall severity of cases increased coincident with a 50% reduction in overtriage. The need for ICU services increased over 50%. Mean Injury Severity Score increased from 11.0 in year 1 to 13.8 in year 5. There was a 25% to 30% increase in severe neurosurgery injuries and in major orthopaedic trauma. There was no change in the "self-pay" financial category (12% to 16%) or the ratio of blunt to penetrating trauma (90:10). CONCLUSIONS: With Level 1 TC designation in a noninner city setting, planners can expect a shift to more severely injured patients, but should not expect an increase in nonpaying patients. Increases in severe injuries will continue to place strain on the ICU. Impact on neurosurgeons and orthopaedic surgeons mandates their support in TC planning.