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Medical student attitudes about quality of care and training of minority persons.

Ninety-five first year medical students agreed that there was differential medical treatment of minority vs majority persons. Implicated reasons for this phenomenon were lack of personal treatment of members of minorities, distrust of medical workers by minority members, and majority perceptions that minority persons are not good patients. Integrated treatment and training facilities, preferential academic treatment, special training for majority students, and philosophy of medical care are discussed in terms of improving medical care for all.

Black or African American↗

Presidential address. Fatti Maschii Parole Femine.

The current role of the Society of Surgical Oncology has demonstrated leadership in the field of surgical oncology in both word and deed, as exemplified by the motto of the State of Maryland, adopted from the 1632 family seal of Lord Baltimore, "Fatti Maschii Parole Femine." The current emphasis on the need for clinical research on human cancers, and the education of surgeons in all aspects of various cancers is well founded in the writings and the addresses of Dr. James Ewing, the Society's founder. Our goals as a society for the next decade have been precisely defined and, as in all important national programs, made current and interfaced with corresponding priorities of the American Cancer Society and the National Cancer Institute. The Society, in three project areas, is: (1) assessing current progress in surgical oncology, as well as future manpower needs; (2) studying on a comprehensive basis the surgical practices in cancer patient management; and (3) surveying academic centers concerning the nature of current education and training of academic surgeons in clinical research. The Training Committee currently reviews and recognizes 2-year postresidency multidisciplinary training at several institutions, and the James Ewing Foundation has expanded its fiscal support of educational activities. This annual meeting marks an historic first signified by the conjoint sessions being held with other international surgical oncology societies.

Education, Medical, Graduate↗

Surgery in developing countries: essential training in residency.

HYPOTHESIS: A surgical elective in a developing country setting is an essential new component in academic residency training. DESIGN: A survey of residents and faculty within the Department of Surgery at the University of California-San Francisco, and a collaborative program piloted between the Department of Surgery at the University of California-San Francisco and Makerere University in Kampala, Uganda, including a 6-week clinical elective. SETTING: Mulago and Nsambya hospitals in Kampala, Uganda. PARTICIPANTS: Two residents and three faculty advisors at the University of California-San Francisco. INTERVENTION: Development of a 6-week pilot clinical surgical elective. MAIN OUTCOME MEASURES: Assessment of the level of interest in international health in an academic surgery program; pathology and case variety, diagnostic methods, and surgical and anesthetic resources and techniques in a pilot developing country. RESULTS: Forty percent of residents enter residency with prior international health experience whereas 90% express interest in a developing country elective. Twenty-five percent of faculty participate in voluntary international surgical service and research projects. As a result of the survey and the level of interest in our program, two visits to Uganda were made and a residency elective rotation was successfully created. This resulted in exposure of residents to the educational benefits of learning in a resource-constrained setting: a broader scope of surgical conditions and pathology, greater reliance on history-taking and physical examination skills in a low-technology environment, and sociocultural aspects of care provision. Greater questions about global health equity, access to information, and the role of surgery in public health are raised along with potential challenges in international collaboration. CONCLUSIONS: A developing country surgical experience complements the academic mission of service, training, and research, and should be an essential component of surgical training programs. There is interest among residents and faculty in such a program as well as a need for greater commitment to north-south collaborations among academic surgical institutions and societies, as has been successfully implemented abroad. More generally, surgery is an integral part of public health and health systems development worldwide.

California↗

How a community-based organization and an academic health center are creating an effective partnership for training and service.

Community-academic partnerships in the training of doctors offer unique learning opportunities of great importance. Such partnerships can induce a paradigm shift such that physicians view community as a teaching resource and partner rather than as a passive recipient of services or solely as a placement site. The authors describe a model of a community-academic partnership in New York City, begun in 1995, in which, for training and service, pediatric residents are integrally involved in a community-based program. Principles adapted from the Community-Campus Partnerships for Health's principles of partnership provide a framework for portraying the essential elements of developing and maintaining the partnership. The authors explain the clashes that may arise between partners and show how the principles of partnership guide partnership members in working and learning within a setting that by its nature entails conflict and inequality. This report is based on the knowledge gained from the structured reflections of both members of this partnership: the residency program at a large academic health center and the community-based social service organization. Such partnerships provide the training ground for the development of physicians who understand the social and cultural determinants of health and constructively use community agencies' input in promoting child health and well-being. Within this framework, community-based organizations are not solely service providers but become educators of physicians-in-training who, with new knowledge gained through the partnership, more effectively contribute to the overall health of the communities they serve.

Academic Medical Centers↗

Resident selection and predictors of performance: can we be evidence based?

Selection of orthopaedic residents can be a difficult process; we have endeavored to make it more objective by developing a scoring methodology for screening applications. The purpose of this investigation is to determine if an academic score, using objective elements only, will discriminate among applicants and will correlate with outcomes. Applications to our orthopaedic residency program for 2004 and 2005 were assigned an academic score as a screening tool in the residency selection process. Data was analyzed for the entire group both by gender and whether the applicant had interviewed for the program. Additionally, the applications of program graduates over the past 5 years were retrospectively assigned academic scores, which were compared with outcomes of the training program. Academic scores for applicants formed a generally normal distribution, and residents training in the program generally had higher scores. The distribution of scores for female applicants was similar to male applicants; however, a greater percentage of female applicants interviewed for the program. Scores on the OITE and ABOS examinations tended to parallel academic scores, but faculty ratings of performance in the program showed no difference between those with high and low academic scores. Calculating academic scores makes the application screening process more objective but does not appear to correlate with outcomes of the training program.

Clinical Competence↗

The outcome of research training during surgical residency.

BACKGROUND/PURPOSE: The exposure to research during residency is currently an integral part of most academic surgical training programs. In this study, graduates of two surgical programs were surveyed to characterize their research experience and to determine the effects on their careers. METHODS: Between 1975 and 1990, 86 and 61 residents completed general surgical training programs at UCLA Medical Center and at Harbor-UCLA Medical Center, respectively. An anonymous survey was sent to each graduate regarding his research experience and current practice. RESULTS: Of the graduates who spent 2 years in research, 47% now hold academic positions, compared with 23% for those who spent less than 2 years (P = .18). When the graduates were segregated according to their desire to enter the laboratory, 49% of graduates who requested research time hold academic positions, whereas only 13% of those who would not request research are in academic positions (P = .01). CONCLUSIONS: Residents who strongly desire a period of research during surgical residency are also more productive in the laboratory. This information should be considered in selecting residents for research training in the current era of academic budget restriction and managed health care.

Attitude of Health Personnel↗