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Longitudinal study of medical students selected for admission to medical school by actuarial and committee methods.

This study evaluates a "mid period" follow-up evaluation of the outcomes of selection of medical students by customary committee review procedures versus actuarial selection. One-third of a freshman class was selected solely on the basis of a predictor index which was a previously validated, optimally weighted combination of scores on the Medical College Aptitude Test and the premedical grade-point average. The remaining two-thirds were selected by committee decision based on review of the total application file which, in addition to the aptitude test scores and academic record, included basic demographic data, information on extracurricular activities, avocational interests, work experience, letters of recommendation, personality test profiles, and interview impressions. In a previous study, it was reported that the two groups of students were undifferentiated with respect to their academic standing at the close of their sophomore year. In the present study, the actuarially selected and committee selected students were compared on class rank at the end of the junior year, total and subtest scores on part II of the National Board Examinations administered toward the close of their senior year, and type and location of internship, and practice or training status one year after graduation. The two groups were not reliably differentiated on any of these variables. Implications of the findings are discussed with respect to reliability, efficiency, and economy in the selection process and the function of the admissions committees with respect to borderline cases and issues of school policy and philosophy.

Attitude of Health Personnel↗

Characteristics of graduating medical students who were matched and unmatched to hospital training posts.

The purpose of this paper is to examine similarities and differences between graduating medical students who do and do not match through the National Internship and Resident Matching Programme (NIRMP). Data from graduates of 3- and 4-year undergraduate curricula were examined separately. A two way analysis of variance was used; the two independent variables were (1) whether the student was a 3- or 4-year medical graduate, and (2) the students' matched vs unmatched status. The dependent variables used in this study were in the following five categories: (1) demographic and academic performance upon entrance to medical school, (2) academic performance during medical school, (3) future practice preferences projected during medical school, (4) internship/residency choices, and (5) clinical performance during internship/residency. On the basis of the data presented, it is clear that there are few differences between matched and unmatched students that could be detected in over seventy-five measures examined. Within the unmatched group, however, the 3-year graduates differ in some respects from their 4-year colleagues. It is likely, therefore, that a different constellation of factors appears to be operating in these two unmatched groups but not within the matched groups.

Decision Making↗

The content of the medical curriculum at McMaster University: graduates' evaluation of their preparation for postgraduate training.

This paper describes McMaster University medical graduates' perceptions of how well their medical curriculum prepared them for postgraduate training. The graduates view their overall preparation for postgraduate work as sound. These perceptions were compared with independent assessments by internship supervisors for one graduated class. The graduates suggest their preparation for postgraduate work differs somewhat from fellow interns. Graduates reported feeling very well prepared compared to fellow postgraduate trainees in independent learning, self-evaluation and problem solving skills. They also judge their preparation in data gathering skills, behavioural science knowledge, ability to deal with social and emotional problems of patients, medical record keeping skills, preventive, follow-up and in-patient care as very good compared to peers. They identified two content areas, pharmacology and the basic medical sciences, as requiring more attention in the curriculum. These findings are discussed and related to the approach to medical education at McMaster University.

Curriculum↗

An evaluation of training in family health for medical students and internes in Sri Lanka.

The results of an evaluation of an integrated training programme in family health for medical students and intern medical officers in Sri Lanka are presented. The course objectives were translated into expected student competences in specific tasks and the responses of the internes obtained using a semi-structured questionnaire. While the course had reinforced the students' awareness and commitment on the need for actively promoting family health it had not provided the expected competences in many tasks to the level of confidence that was anticipated. A number of deficiencies in the training programme in medical school as well as during the medical internship become evident and these have been discussed with the respective authorities with a view to effecting satisfactory improvements.

Clinical Competence↗

Identification of simulated patients by interns in a casualty setting.

Fifty-four interns agreed to a study in which their clinical performance in an out-patient unit with standardized patients was recorded on videotape. In order to examine whether they could distinguish standardized from real patients, the interns were asked to note any patients who they thought might be simulating their complaints and report these to the researchers at the end of each 2-day period of study. Thirty-two of the interns were assessed again at the end of their internship, using the same clinical problems presented by different simulators. The consultations took place in the casualty department of a large urban hospital. At the beginning of the year there were 152 consultations with standardized patients and 328 consultations with appropriate genuine patients. Standardized patients were identified definitely as 'not genuine' in only 12 of the 152 consultations (sensitivity 7.8%) whereas 320 of the 328 genuine consultations were accepted by the interns as genuine (specificity 97.8%). When the level of confidence required to distinguish the two groups was reduced from 'definite' to 'probable', the number of correctly identified simulator consultations increased to 36/152 (27%) but the rate of misclassification of genuine patients also increased from 8 to 37 out of 328 consultations (11%). At the end of the year there were 81 consultations with standardized patients and 149 consultations with genuine patients. Identification rates were only slightly changed. We conclude that simulator identification is not a problem in applying standardized patients to evaluate the quality of care provided in a hospital casualty.

Clinical Competence↗

Development and implementation of an innovative intern training programme.

The quality of medical education during internship is a cause for concern. This paper describes a structured educational programme for interns that was based around learning modules, clinical attachments and bedside teaching. The programme was incorporated into the term rotation of interns within an Area Health Service, and evaluated. Learning modules were timetabled by a Programme Coordinator and interns were reminded to attend. Clinical attachments were organized by the interns from a list of willing supervisors. Attendance at timetabled learning modules averaged 67%, which was greater than the 27% attendance at clinical attachments. Both sessions received high ratings for quality and clinical relevance. This structured education programme was based upon adult learning methods and was both feasible and well received by interns. Intern training programmes need to be programmed into the working week to ensure attendance, and modified following evaluation by interns. Such programmes should be considered by all hospitals to which interns are allocated.

Australia↗

Pre-registration in historical perspective.

This essay examines the background and implementation of the statutory requirement that each medical graduate in Great Britain must spend a pre-registration year in hospital training before full registration can be effected. It looks briefly at the French and USA 'internship', and then describes the British situation before 1950, when a Medical Act made the pre-registration year compulsory. The Parliamentary Act was passed after full consultation with appropriate professional organizations and, despite various changes, still provides the basic structure of the first postgraduate year of medical training.

Education, Medical, Graduate↗

A structured assessment of newly qualified medical graduates.

INTRODUCTION: While there is extensive published experience with the assessment of procedural skills in undergraduate students, this is limited in newly qualified medical graduates at the time of entry to the pre-registration (internship) year. The few studies that have been published suggest that these skills are frequently deficient when objectively tested. We therefore chose to assess the competence of a group of South African medical graduates on entry to their pre-registration year. METHODS: A total of 58 graduates of South African medical schools were assessed. Each subject participated in a 7-station objective structured clinical examination (OSCE); 6 of these assessed individual competence in phlebotomy, intramuscular injection, female pelvic examination, bladder catheterisation, tracheal intubation and prescription writing, while competence in cardiopulmonary resuscitation was assessed in a seventh station in randomly allocated teams of 3 candidates. Candidates' opinions of their own competence was sought by questionnaire. RESULTS: There was a wide variation in competence between subjects and across the range of tasks studied. Mean scores ranged from 85.4% for phlebotomy to 55.3% for prescription writing. The average score across all stations was 67.5%, and no student obtained an overall cut-off score of 85% or more, which was established using a modified Angoff method. Subjects' assessment of their own performance was unduly optimistic; most believed that they had demonstrated competence despite clear shortcomings in technique. Objective scores for subjects who had been exposed to a structured skills laboratory programme were not significantly higher than for those who had not, although their self-assessed performance was indeed higher. DISCUSSION: Most of the South African medical graduates who participated in this study were unable to satisfactorily perform technical procedures appropriate to the house officer on entry to the pre-registration year. This is in line with the conclusions of the few studies published in other countries. We suggest that the learning outcomes of undergraduate medical programmes should include an explicit statement of the competencies required for practice in the pre-registration year, and that these should be adequately taught and rigorously assessed before graduation.

Cardiopulmonary Resuscitation↗

A literature review of "resident-as-teacher" curricula: do teaching courses make a difference?

OBJECTIVES: To examine the evaluation methods of resident teaching courses and to estimate the effectiveness of these teaching courses. DESIGN: We searched the literature from 1975 to May 2003 using the PubMed MESH terms internship and residency and teaching; 1,436 articles were identified and 77 contained information regarding teaching courses. Fourteen articles contained information regarding outcomes of resident teaching courses and were selected for intensive review. MAIN RESULTS: Five uncontrolled pre-post studies used resident self-reported teaching skills/behaviors as outcome measures; all reported some improvement in self-reported skills. Three uncontrolled pre-post studies examined live or videotaped resident teaching encounters and all revealed improvement in some teaching skills. One uncontrolled trial and three nonrandomized controlled trials used learner evaluations of resident teaching behaviors as outcomes and all revealed an improvement in ratings of residents after course participation. Four randomized controlled trials of resident teaching curricula are included in this review. One study did not show any quantitative benefit of a resident teaching course on performance on an objective structured teaching evaluation. Two studies assessing resident teaching evaluations before and after course participation showed conflicting results. One study noted improvements in resident teaching skills assessed through videotape analysis. CONCLUSIONS: Resident teaching courses improve resident self-assessed teaching behaviors and teaching confidence. Teaching courses are linked to improved student evaluations. Further studies must be completed to elucidate the best format, length, timing, and content of resident teaching courses and to determine whether they have an effect on learner performance.

Curriculum↗

The PRIME curriculum. Clinical research training during residency.

AIM: The Primary Medical Education (PRIME) program is an outpatient-based, internal medicine residency track nested within the University of California, San Francisco (UCSF) categorical medicine program. Primary Medical Education is based at the San Francisco Veteran's Affairs Medical Center (VAMC), 1 of 3 teaching hospitals at UCSF. The program accepts 8 UCSF medicine residents annually, who differentiate into PRIME after internship. In 2000, we implemented a novel research methods curriculum with the dual purposes of teaching basic epidemiology skills and providing mentored opportunities for clinical research projects during residency. SETTING: Single academic internal medicine program. PROGRAM DESCRIPTION: The PRIME curriculum utilizes didactic lecture, frequent journal clubs, work-in-progress sessions, and active mentoring to enable residents to "try out" a clinical research project during residency. PROGRAM EVALUATION: Among 32 residents in 4 years, 22 residents have produced 20 papers in peer-reviewed journals, 1 paper under review, and 2 book chapters. Their clinical evaluations are equivalent to other UCSF medicine residents. DISCUSSION: While learning skills in evidence-based medicine, residents can conduct high-quality research. Utilizing a collaboration of General Internal Medicine researchers and educators, our curriculum affords residents the opportunity to "try-out" clinical research as a potential future career choice.

Authorship↗

Teaching medical ethics: University of Nijmegen, The Netherlands.

During his internship the medical student often feels a basic need for ethical discussion. The department of medical ethics at the University of Nijmegen offers a monthly discussion in single clinical departments. The ethicist is then assisted by staff responsible for guiding the interns. These discussions, based on daily experience, aim at critical evaluation of ways the profession is being exercised. As such they form an essential counterpart to the more theoretical learning in classrooms and seminars during previous years. The method is rather flexible. Either an inventory of problems is made, followed by a selection and discussion of one problem. Or a discussion is initiated by an introduction by either staff or ethicist. The actual programme and its origin, the objectives and some of the problems of such a programme are presented in this article.

Curriculum↗

Shifts in attitudes among psychiatric residents: serial measures over 10 years.

Psychiatric residents completing their training in 1976, 1978, 1980, and 1986 were sent surveys on their attitudes toward treatment and training among a "dynamic-organic continuum." Their responses indicated decreasing antagonism toward the medical model and increasing endorsement of medical education, experience in neurology, and the internship as essential aspects of psychiatric education. The rankings of various treatment modalities for each of four disorders were remarkably stable across surveys. Except for megavitamin therapy, residents in 1986 were at least somewhat more likely to consider essential each of six therapies for each of the four disorders, indicating a general increase in therapeutic optimism.

Attitude of Health Personnel↗

Psychiatric resident dismissal: a national survey of training programs.

The authors report on a nationwide survey of psychiatric residency training directors who responded to a questionnaire designed to elicit information on the magnitude of the problem of unacceptable performance by residents. One hundred six program directors reported on 5,591 internship or residency positions from 1981 to 1985. A total of 184 residents (3.3%) were prematurely terminated or persuaded to resign; departmental deliberations were held on an additional 139 residents (2.5%). Reasons for dismissal and indications during the selection process that a trainee might prove problematic are discussed. A provocative finding was that 37% of terminated residents were accepted into other psychiatry training programs.

Career Choice↗

Women in U.S. psychiatric training.

OBJECTIVE: The number of women in psychiatric training is predicted to increase over time. This article aims to review and evaluate the existing literature on the topic and identify present areas of concern and recommend future areas for research. METHOD: A Medline search from 1964 to the present day was conducted. Literature on female physicians in psychiatry, internship and residency, career choices, and medical education was reviewed. RESULTS: Much has changed, for the better, to accommodate the needs of this population. The areas of role integration, career choices, and pregnancy remain issues of concern. These concerns will continue as the percentage of female physicians increases. CONCLUSIONS: The multiple issues surrounding the pregnant resident need to be formally addressed and recognized to avoid strain on all residents, patients and departmental systems. Political, social, and departmental issues need to be addressed to help female residents with role integration. Psychiatry should lead the way among medical specialties in advocating for excellent family leave policies and childcare. Academic psychiatry will have to use creative strategies to effectively recruit and maintain female faculty.

Career Choice↗

Career choice influences in Australian anaesthetists.

All female members and a randomly selected group of male members of the Australian Society of Anaesthetists (n = 488) were surveyed by questionnaire as part of a broader study of gender issues in anaesthesia. This paper reports on reasons for career choice and the importance of role models. Responses were received from 199 women and 98 men (60.9% of those surveyed), representing all States and one Territory. Most males (95.9%) and a majority of females (55.7%) worked full-time. Reasons for career choice varied with gender, with a significantly greater proportion of women (39.7%) than men (8.7%) choosing anaesthesia because of controllable hours, particularly the ability to work part-time. Experiences in anaesthesia during internship and residency were important for 19.1% of women and 14.1% of men, although very few mentioned undergraduate exposure. Other important factors in career choice were the application of physiology and pharmacology in patient care, practical and procedural aspects of practice, and chance. A majority of women (56%) and men (55%) named specific role models who were influential and encouraging in their choice. These results are similar to those of other studies.

Adult↗

The current status of psychological assessment training in graduate and professional schools.

Test-based psychological assessment is threatened by the policies of managed care organizations; however, research has demonstrated that test-based psychological assessment is quite valuable and economically justified when conducted by well-trained psychologists. This surfaces the question of the current status of graduate training in test-based psychological assessment. Results of this study indicate that clinical and counseling students currently receive almost equivalent training in test-based assessment. However, in a larger context, results indicate a lack of sound preparation in test-based assessment training for a large proportion of clinical and counseling students. These findings are discussed in terms of their implications for the field and, more specifically, for graduate and internship training.

Counseling↗

Geropsychology training in a VA nursing home setting.

There is a growing need for professional psychology training in nursing home settings, and nursing homes provide a rich environment for teaching geropsychology competencies. We describe the nursing home training component of our Department of Veterans Affairs (VA) Predoctoral Internship and Geropsychology Postdoctoral Fellowship programs. Our training objectives for Interns and Fellows include: increased exposure and interest in nursing home practice; increased competencies in assessment, intervention, and consultation in this setting; and increased confidence in the role of the psychologist in medically oriented, geriatric care settings. We describe the local VA nursing home training setting and our training model, including expected competencies, training activities, special issues in supervision, and evaluation of competencies. We have found group supervision and peer support to be an important component of our nursing home training program. The VA healthcare system allows great flexibility for psychologists to both provide psychological services and training in the nursing home setting.

Aged↗

Constructing 'expertness': a novice pharmacist's development of interactional competence in patient consultations.

It has been argued that being able to utilize expertise in discourse is as important as having expertise (C. Candlin and S. Candlin 2002). From a constructivist perspective, knowledgeability does not exist outside of social interaction: being expert involves performing knowledge and skills effectively in social practices (cf. Butler 1990; Lave and Wenger 1991). It is, then, crucial that novice professionals develop the interactional competence to construct themselves as experts in interaction. This study brings together perspectives from research on expert-lay communication, social interaction, and situated learning to examine how a pharmacy intern performed his professional knowledge in the practice of patient consultation over time. Using conversation analysis complemented by the interactional competence framework (Hall 1995; Young 2002), I demonstrate that as the novice pharmacist gained more experience over the course of one internship, he was able to employ professional knowledge in ways that were sensitive to the sequential organization of talk, and to share the patients' lifeworld perspectives (Mishler 1984) more effectively, thus successfully managing the transactional and interpersonal functions of the consultations. This study contributes to research on expert-lay interaction, particularly in pharmacy, and to the under-studied area of interactional competence development in the professions.

Community Pharmacy Services↗