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The generalist/cardiovascular specialist: a proposal for a new training track.

The economic forces that are reshaping the delivery of health care in the United States have led to intense examination of the appropriate roles for specialists and generalists. Resolving this issue has profound implications for the future of U.S. health care and for the economic health of academic training centers and individual physicians. The issues are particularly intense in cardiovascular care, a field that has had dramatic success in the application of new diagnostic and therapeutic technology and rapid growth in specialist practitioners but is now under pressure to shrink its ranks. A new generalist/cardiovascular specialist training track and a parallel reduction in the number of standard fellowship training positions in cardiovascular disease may be a partial solution. The first 2 years of the proposed 5-year program would consist of training in internal medicine, the final 2 would consist of training in cardiovascular disease, and the middle year would be a flexible combination of the two. Graduates would be Board eligible in internal medicine but would have enhanced competency in cardiovascular disease. This plan may improve the balance between generalists and specialists, improve the quality of primary and specialized cardiovascular care, and strengthen departments of medicine and academic training centers while facing new economic realities.

Cardiology↗

Fellowship training in academic general internal medicine: a curriculum survey.

OBJECTIVE: To determine whether current fellowships in general internal medicine (FGIM) meet the perceived needs and objectives of physicians entering careers in academic internal medicine. DESIGN: A modified Delphi method yielded the 18 curricular elements included in the mailed survey. Participants outlined both actual and ideal fellowship experiences by rating the degree of emphasis of each curricular element on a Likert scale. Respondents then prioritized elements by rank-ordering them on perceived importance. Current job descriptions and opinions on related issues in FGIM were collected. PARTICIPANTS: Potential fellows, current fellows, and recent graduates were surveyed. Individuals were identified through the Society of General Internal Medicine associates' mailing list and solicitation of program directors. Nonfellow associates served as the proxy group for potential fellows. MEASUREMENTS AND MAIN RESULTS: 579 surveys were mailed; 348 (60%) responses were received, of which 288 (50%) were suitable for analysis. Of all respondents, 38% were current fellows and 40% were recent graduates. When asked to prioritize educational needs during fellowship training, respondents ranked research methodology, ambulatory medicine, critical review of the literature, epidemiology, biostatistics, teaching skills, medical consultation, grant writing, preventive medicine, and design of educational curriculum as the top ten. Only minor deviations in rank order were found between graduates and nongraduates. Mean Likert scale scores for degree of emphasis of each curricular element in graduates' actual fellowships were compared with mean scores for graduates' ideal fellowship descriptions. High-priority elements that were perceived as adequately emphasized included research methodology, critical analysis of the literature, epidemiology, and biostatistics. High-priority elements that were perceived as inadequately emphasized included ambulatory medicine, teaching skills, medical consultation, grant writing, preventive medicine, and design of educational curricula. CONCLUSIONS: FGIM largely meet the expectations of their fellows for preparation for research responsibilities. However, several curricular elements concerned with preparation for future clinical and teaching responsibilities are perceived by graduates as underemphasized. These areas deserve increased emphasis during fellowship training to better prepare fellows for their future roles in academic general internal medicine.

Adult↗

Supporting whistleblowers in academic medicine: training and respecting the courage of professional conscience.

Conflicts between the ethical values of an organisation and the ethical values of the employees of that organisation can often lead to conflict. When the ethical values of the employee are considerably higher than those of the organisation the potential for catastrophic results is enormous. In recent years several high profile cases have exposed organisations with ethical weaknesses. Academic medical institutions have exhibited such weaknesses and when exposed their employees have almost invariably been vindicated by objective inquiry. The mechanisms that work to produce such low ethical standards in what should be exemplary organisations are well documented and have been highlighted recently. The contribution of elements of medical training in eroding ethical standards of medical students have also been emphasised recently and strategies proposed to reduce or reverse this process. The ability to rapidly change the ethical and professional culture of graduate medical trainees may help to deal with some of the perceived problems of declining ethical standards in academic medicine.

Academic Medical Centers↗

Research and research training in academic radiology departments. A survey of department chairmen.

We surveyed 121 chairmen of academic radiology departments to assess how these departments select and educate their residents and fellows in research. Eighty-six chairmen responded (71%). The majority of their programs select at least some of their trainees for their potential as researchers and nearly all encourage trainees to perform research. The more the selection process focuses on research, the greater the percentage of residents and fellows that participate in research during training. Nonetheless, only about one-third of residents and half of the fellows perform and publish research. Only half the programs offer formal research seminars and few trainees opt for additional research training. These results may relate to the relatively small percentage of faculty performing prospective clinical and laboratory research. These findings are disappointing in the light of previous results suggesting that performing research, publication, and formal research education during training correlate highly with the development of successful research careers. Chairmen could increase the likelihood of trainees choosing research careers and being successful in publishing research by providing early exposure to research experiences and providing formalized research training.

Academic Medical Centers↗

What do semi-illiterate adults know about 2-digit Arabic numbers?

Brazilian semi-illiterates (n=19) with 1 to 4 years of academic training compared 2-digit Arabic numbers. Like competent readers, semi-illiterates responded faster and more accurately when the larger number also had the larger unit digit (unit-decade compatibility). Even semi-illiterates with minimal academic training were sensitive to the unit-decade compatibility on number comparison. Probably semi-illiterates derive their ability to automatically activate unit-decade segmentation directly from the oral/verbal number representation. Interestingly, processing speed had an effect on two-digit number comparison. Faster participants showed a smaller or even inverted unit-decade compatibility. Processing speed reflects increased automatization of number segmentation and better selection of the decade-digits for comparison, what eliminates the semantic interference of units. In line with previous research, our data suggest that unit-decade segmentation plays a pervasive role in Arabic number comparison.

Adolescent↗

[Looking for the physicians that our countries need: emphasis on communication and training of academics].

Changes in physicians education and practice induce, nowadays persistent modifications in program's curricula and contents and in learning methodologies, in almost all medical schools and countries. In many of these, and in Chile, this process shows some peculiarities due to the unusual proliferation of medical schools and their differing proposals about the profile of the professional training based on epidemiological considerations and teaching resources. The institutional initiatives leading to reforms, have defined quality and pertinence of these programs and profiles, as it has been the case of the curricular renewal in the University of Chile School of Medicine. Relevant to this reform have been: 1) the introduction of communication skills, pursuing to increase humanistic contents, to improve patient doctor relationship and to accomplish the actual goals of medicine, and 2) capacitating the faculty in the proper disciplines and competencies, for better application of new knowledge and teaching tools to improve learning of the health professionals. Prospective evaluation of these changes will allow us to assess, with best evidence, its definitive role, that is momentarily availed by student's satisfaction.

Chile↗

Implications of a diagnosis of anorexia nervosa in a ballet school.

Competitive pressures to achieve a slim body shape may be of importance in the etiology of eating disorders in ballet dancers. This study examines the presence of anorexia nervosa-like symptoms in a group of 49 female ballet students (mean age = 18.9 years, SD +/- 1.9). All students were assessed for certain physical (weight and height) and psychological (Eating Attitude Test [EAT]) indices at the start of their academic training year. Thereafter, all subjects who presented with anorexia nervosa-like symptoms (EAT > or = 30, and/or with current secondary amenorrhea or primary amenorrhea if aged 16 years or over) at the initial assessment, were invited for a semistructured interview (Morgan-Russel scales) to determine their diagnostic status. Another aim of the study was to assess the prognostic implications of a diagnosis of anorexia nervosa in this sample. All subjects previously interviewed were invited for a follow-up assessment at 10 months. Anorexia nervosa could be diagnosed in 2 students (4.1%), whilst another 4 students (8.2%) presented with "partial syndrome" anorexia nervosa. All diagnosed students managed to complete their academic training year. The development and implications of a diagnosis of anorexia nervosa in the ballet students are discussed.

Adolescent↗

[Relations hip between placental weight and age, family characteristics, parity and activity of the mother as well as the weight or maturity and sex of the newborn infant]?1?H.

An investigation of the correlation of the placental weights of 500 unselected live-born babies delivered after a gestation period of 33 weeks at the minimum and 42 weeks at the maximum, respectively, with age, family status parity, and mother's occupation, as well as with the weight, maturity, and sex of the neonates yielded the following results: 1. Between primiparae, secundiparae, and multiparae, working and housewife mothers, workers, farmerettes, women doing other jobs, and academically trained women, eutrophic mature and hypertrophic mature neonates, and newly born male and female babies there was observed a roughly similar frequency of the generally accepted "normal weight of placenta" of 400 g to 600 g and no significance of minor differences in frequency, respectively. 2. The high incidence of mothers aged 20 and less in the "normal placental weight group" of 400 g to 600 g compared to 21- to 30-year-old and 31- to 35-year-old mothers was not found to be significant. 3. The high incidence of unmarried mothers in the "normal placental weight group" of 400 g to 600 g compared to married mothers is not significant, the higher incidence of premature labor in unmarried women being due possibly, not to the weight of placenta, but rather primiparity, age under 20, and social class. 4. The higher frequency in the placental weight group up to and including 400 g of married compared to unmarried mothers, primiparae compared to secundiparae, primiparae and secundiparae compared to multiparae, working mothers compared to housewife mothers, and workers and farmerettes compared to both women doing other types of jobs and academically trained women was not found to be significant.

Birth Weight↗

Training of academic staff in obstetrics and gynaecology in the USA.

As we enter a new century and millennium, departments of obstetrics and gynaecology in American medical schools face a number of challenges. Of primary concern among these is the relative dearth of physician-scientists to explore and connect the basic mechanisms and clinical aspects of the diseases of women. This report reviews some aspects of three programmes designed to educate such investigators: The Reproductive Scientist Development Program, The American Gynecological and Obstetrical Society--American Association of Obstetricians and Gynecologists Foundation Fellowship Program and the Women's Reproductive Health Research Career Development Centers. Based on a decade of experience with the first two of these programmes, the prospects for the relatively new third programme are promising. Nonetheless, the need for and opportunities for obstetrician-gynaecologist reproductive scientists far exceed the supply.

Education, Medical, Graduate↗