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PubMed1978

Evaluation of medical students during a clinical clerkship in internal medicine.

During a three-month clinical clerkship in medicine 175 medical students were evaluated. A proficiency assessment process was developed which included preceptor evaluation of on-the-job performance as well as independent oral and written examinations. Analysis of data from this study disclosed small correlations among the three measurements of clinical competence. Ratings by preceptors, based on direct observations of students, also showed a large intrastudent variation. Although the individual clinical ratings had low reliability, averages taken over a period of time were more consistent. These data have importance not only in the assessment of the clinical competence of medical students but also in other areas of granting medical credentials and certification.

Clinical Competence↗

PubMed1978

Academic and personal predictors of clinical success in medical school.

Admissions interview data and college academic credentials of five classes of University of Missouri-Columbia medical students were evaluated as possible predictors of clinical success. Those students who were judged by admissions interviewers to have high levels of maturity, nonacademic achievement motivation or rapport were approximately two to three times as likely to receive outstanding internship recommendations as those without such personal characteristics. Under-graduate grade-point average had a smaller but nevertheless significant relationship with clinical success as measured by internship letters. These data suggest that additional emphasis during selection upon applicants' personal characteristics would have enhanced the clinical success of these students.

Achievement↗

PubMed1988

Comparison of performances of students in programs at LSU Medical School in Shreveport.

The purpose of the study reported here was to evaluate the performance of graduates of the accelerated six-year (combined B.S.-M.D. degree) program and compare it with that of graduates following the regular curriculum at the Louisiana State University School of Medicine in Shreveport. Cumulative medical school grade-point averages, scores on the Federation Licensing Examination, and failure rates for the two groups were compared; by these criteria, the six-year graduates performed adequately but not as well as expected from their high school credentials (the basis for their entry into the accelerated program). Advantages and disadvantages of the six-year program are discussed with respect to the students, the medical school, and the undergraduate college of LSU at Shreveport.

Curriculum↗

PubMed1991

Residency directors' assessments of which selection criteria best predict the performances of foreign-born foreign medical graduates during internal medicine residencies.

In the summer of 1990, 102 directors of internal medicine residency programs from nine areas of the country with the largest numbers of foreign-born foreign medical graduates (FFMGs) were surveyed by mail to determine what criteria used to select FFMGs for residency positions best predicted performance. The directors felt that the most important predictors were performance on the Foreign Medical Graduate Examination in the Medical Sciences or the National Board of Medical Examiners examinations; performance during the interview; and postgraduate clinical experience in the United States. Recent graduation from medical school was felt to be a better predictor than postgraduate clinical experience in a foreign country. Seventy-three percent of the directors found letters of recommendation from a foreign country to be useless. The author suggests the results of this study may be useful to residency programs in evaluating FFMG applicants and to FFMGs in assessing their own credentials.

Attitude of Health Personnel↗

PubMed1992

The Jefferson-Penn State B.S.-M.D. program: a 26-year experience.

Since the 1960s a number of physicians have completed both their baccalaureate and their M.D. degrees in six or fewer years. In this longitudinal study the authors track the academic performances, clinical ratings, and career follow-up data of 659 students in one of these accelerated programs, the Jefferson Medical College-Pennsylvania State University B.S.-M.D. program, from entering years 1964 through 1989. The medical school performances, clinical performances in residencies, and rates of board certification and faculty appointment of the accelerated students compared favorably with those of a control group of medical students with similar high school credentials who had followed a four-year baccalaureate program. The authors conclude that a carefully chosen group of students can achieve high academic standards in an accelerated medical school program, graduate as younger physicians able to perform well in postgraduate training, and go on to highly productive careers in medicine.

Achievement↗

PubMed1994

Retraining the subspecialist for a primary care career: four possible pathways.

The degree to which a reformed U.S. health care system relies on an adequate supply of primary care physicians will determine the urgency of change in the composition of the medical workforce. In many areas of the United States, the demand for primary care physicians, particularly in managed care settings, far exceeds the supply. In contrast, reports of reduced practice opportunities for medical and surgical subspecialists in the same settings are increasing. As opportunities for and incomes of primary care physicians are enhanced, some medical subspecialists may seek retraining in primary care. This article provides a context for understanding the development of physician retraining programs, examines precedents for retraining physicians, describes four possible pathways through which medical subspecialists might acquire primary care training, and emphasizes the importance of defining the scope of practice and necessary skills for providing primary care. Obstacles to retraining appear to be economic (Who will pay? Is the cost worth the benefit?) and jurisdictional (Who will define core competencies? Who will credential programs and trainees?). The current absence of demand for such retraining programs suggests either that marketplace-induced changes will not take place or that the notion of a primary care provider shortage and an oversupply of medical subspecialists is overstated. The inclusion of physician retraining programs in proposed health reform legislation suggests that policymakers are convinced that such programs offer one viable solution to the nation's medical workforce needs.

Certification↗

PubMed1996

Identifying qualified underrepresented-minority students who otherwise appear to be at academic risk.

PURPOSE: To determine whether an academically intense program simulating six weeks of medical school could identify underrepresented-minority students at apparent academic risk who might actually have the time-management and other skills needed to succeed in medical school. METHOD: In the summer of 1995, 16 premedical students from minorities underrepresented in medicine participated in a six-course, six-week program at the Chicago College of Osteopathic Medicine. Academic credentials prior to participation in the program and performances in the program were compared for students subsequently offered or denied admission to the Chicago College of Osteopathic Medicine. Statistical methods included use of Student's t-test and Pearson correlation coefficients. RESULTS: Of the 16 participants, eight passed at least five courses and were accepted for early admission to the medical school; seven failed two or more courses and were denied admission; and one did not complete the program. The accepted and denied groups could be distinguished statistically by their overall performances in the program, and their performances in four of the six courses, but not by their performances prior to the program: the accepted students had a mean grade-point average of 2.68, SEM, 0.07, versus 2.66, SEM, 0.07, for the denied students, and a mean total Medical College Admission Test score of 16.2, SEM, 0.5, versus 17.0, SEM, 0.7. CONCLUSION: Programs such as the one at the Chicago College of Osteopathic Medicine might be relatively inexpensive ways for medical schools and underrepresented-minority students at apparent academic risk to learn whether the students are, nevertheless, prepared to succeed academically in medical school.

Chicago↗

PubMed1997

Internal medicine residents' assessment of the subspecialty fellowship application process.

PURPOSE: The application process for fellowships in internal medicine subspecialties begins approximately 18 to 24 months before the start of training, requiring residents to decide on a career by the beginning of their second year of residency. The authors surveyed the internal medicine residents at Mount Sinai Hospital to assess their attitudes toward the fellowship application process. METHOD: A survey instrument was designed and given to all 121 residents in 1994-95. The instrument surveyed the residents' career plans and the timing of their decisions, inquired about the effect on their residency of applying for a fellowship, and asked the residents to assess and comment on the timing of the fellowship application process. RESULTS: In all, 80% (97) of the residents responded. Nearly two-thirds intended to apply for fellowship training; however, 17% of the first-year residents had changed their minds about their fellowship plans, and 50% of the second- and third-year residents had changed career plans. Whereas 79% of the first-year residents intended to apply "on time" during their second year, only 29% of the second-year residents intended to do so; 25% of the third-year residents planned to delay entry into a fellowship. Nearly two-thirds of the first- and second-year residents felt uncomfortable making an informed fellowship decision in their second year. In all, 60% of the residents felt they had to do research in order to get a competitive fellowship, and 68% said they had to change their assigned residency schedule to "get credentials" for fellowship applications. The consensus of nearly all the residents was that the timing of fellowship applications was much too early and should be moved to the middle of the third year. CONCLUSION: As the current system of applying for medical fellowships is generally experienced negatively by residents, the authors recommend that the process be moved to the middle of the third year and that medical schools, residency programs, and fellowship training programs reconsider the entire fellowship application process.

Attitude of Health Personnel↗

PubMed1997

Retraining specialist physicians for primary care practice.

Managed care has led to unprecedented changes in the market forces in medicine. As a result, many physicians not in primary care will find it difficult to sustain their practices, and many of them who attempt to change to primary care careers will find themselves unprepared. Rather than CME or GME, a better response is retraining programs designed for these trainees' needs, which provide credentials that are valued by MCOs and develop expertise in primary care practice in MCO settings. MCOs and academic medical centers have an important opportunity to collaborate in serving the medical profession and meeting the primary care needs of the United States.

Certification↗

PubMed1997

A decade's experience at Tufts with a four-year combined curriculum in medicine and public health.

The absence of a good working relationship between medicine and public health is a cardinal feature of the health care system in the United States. Nowhere has the "uneasy alliance" between proponents of care for the individual versus those who advocate greater attention to the health needs of the population been more apparent than within medical schools. This article chronicles ten years of experience at the Tufts University School of Medicine where, for a limited number of students, the Combined MD-MPH (Master of Public Health) Program has been created and sustained and continues to produce professionals trained and credentialed in both public health and medicine. The four-year program has graduated over 75 students and provides a medical-school-based model that combines education in medicine with a comprehensive, prevention-oriented, population-based approach to health. The Program is described, and experience-based suggestions are offered for medical schools interested in developing training opportunities that address both the care of the individual patient and the care of populations. The Tufts experience shows that a four-year program that combines rigorous education in medicine and public health does not require drastic changes in medical school admission policy or major revisions in curricula. The introduction of combined MD-MPH programs can better serve the changing needs of medical practitioners and their patients while also fostering the health of the public.

Adult↗

PubMed1998

Reforming the structure and management of academic medical centers: case studies of ten institutions.

The authors describe a variety of strategies that academic medical centers (AMCs) are using to preserve their missions in the face of changing demands and declining resources. The report is based on comparative studies of ten centers conducted by the authors in 1997 and 1998. (AMCs are defined as medical schools and their owned or closely affiliated clinical facilities.) The studies show that the kinds of reforms that AMCs are making in the conduct of their missions and the results they are aiming for are often characteristic of successful organizations described by experts in organizational change and management. The major reforms found included balancing planning and opportunism; developing new approaches for faculty participation in governance; experimenting with the organization of core functions; listening to the customer; aligning incentives; creating a sense of urgency for change; and reducing the emphasis on paper credentials when recruiting for management positions. While these findings are encouraging, it seems clear that AMCs will need to change and adapt at an ever-increasing rate. Competitive pressures will require them to continuously improve the ways they achieve all their missions. New technologies such as informatics will threaten AMCs' near-monopoly in teaching and research. The new environment will require rapid decision making, the setting aside of traditional professional or departmental structures when they inhibit efficiency or quality, and more effective communication with external publics. How well AMCs can maintain their commitment to core values while adopting new methods in pursuit of those values will determine their futures.

Academic Medical Centers↗

PubMed1999

Postbaccalaureate Medical/Dental Education Preparatory Program (MEDPREP) at Southern Illinois University School of Medicine.

Between 1972 and 1998, the state and federally funded Medical/Dental Education Preparatory Program (MEDPREP) at Southern Illinois University School of Medicine served approximately 900 qualified minority and disadvantaged students, in an effort to increase the number of underrepresented-minority (URM) students accepted into and retained in health professions schools. To help students improve their application credentials, this post-baccalaureate program establishes high expectations for student progress, designs individual curricula, offers extensive academic and personal counseling, has its own teaching faculty, and operates in a specially equipped, designated facility. This supportive educational environment has demonstrated success. By 1998 over 500 MEDPREP students had been accepted into medical or other health professions schools, and 86% of them had graduated or were scheduled to graduate. And while the number of new URM entrants to medical schools declined nationwide from 1995 to 1997, 70 URM students from MEDPREP matriculated to 28 different allopathic medical schools, eight entered three different osteopathic medical schools, and two entered dental schools. Recent data indicate that the score changes of Medical College Admission Test (MCAT) repeaters who were MEDPREP students were larger than those of all MCAT repeaters reported by the Association of American Medical Colleges (AAMC). In fact, the MEDPREP repeaters' score changes were two to nearly six times greater than the overall changes reported by the AAMC. These gains suggest that a carefully designed, long-term post-baccalaureate intervention such as MEDPREP can increase the pool of qualified URM and disadvantaged students accepted into and retained in health professions schools.

Adult↗

PubMed2001

A structured interview for medical school admission, Phase 1: initial procedures and results.

PURPOSE: Despite their widespread use, medical school admission interviews often are unstructured and lack reliability. This report describes the development of a structured admission interview designed to eliminate bias and provide valid information for selecting medical students, with preliminary information about the interview's reliability and validity. METHOD: After screening applications, 490 applicants to a public medical school residency program were interviewed by two faculty members using a structured interview format. Interview scores were compiled and correlated with undergraduate grade-point averages (GPAs); Medical College Admission Test (MCAT) scores; Iowa Evaluation Form (IEF) scores, an in-house evaluation of applicants' noncognitive abilities; and eventual admissions status. RESULTS: Interrater agreement was good; the percentages of rater pairs whose scores differed by one point or less ranged from 87% to 98%. Scores on the structured interview revealed low to moderate correlations with other admission criteria: 10 (p < 0.05) for cumulative GPA, 0.18 (p < 0.01) for MCAT Biological Science, 0.08 (p > 0.05) MCAT Physical Science, and 0.10 (p < 0.05) MCAT Verbal Reasoning. None of the correlations between the overall interview scores and the IEF scores reached statistical significance (p = 0.05). Higher overall scores on the structured interview did predict a greater likelihood of being accepted into the medical school and the interview score accounted for 20% of the incremental variance in admission status beyond GPA, MCAT, and IEF scores. CONCLUSIONS: The moderate-to-low correlations with other admission criteria suggest that the interview provided information about candidate credentials not obtained from other sources and accounted for a substantial proportion of the variance in admission status. This finding supports the considerable time and resources required to develop a structured interview for medical student admissions. Final judgment on the validity and utility of this interview should be made after follow-up performance data have been obtained and analyzed.

Educational Measurement↗

PubMed2001

Critical issues in PhD training for biomedical scientists.

The rapidly changing world of modern biomedical research is raising important new issues for traditional PhD training programs and is creating concern among young PhD scientists about their futures. Specifically, the United States is producing substantially more biomedical PhDs than can be accommodated in professional positions that truly require the PhD as a credential. The "surplus" PhD population is being relegated to poorly paid, unstable, and increasingly unsatisfying jobs. In addition, many current graduate and postdoctoral training programs may not be adequately preparing young scientists for the more complex, more quantitative biological science of the future. Finally, many current graduate training programs are not attracting a sufficient portion of the most talented young people in the nation. To ameliorate these problems in the training and early career paths of basic biomedical scientists, the authors make specific recommendations, such as urging (1) that graduate trainees should be supported exclusively by competitive individual fellowships, training grants, or institutional funds and not by RO1s or similar research awards; (2) that graduate and postdoctoral stipends be increased so that they provide a reasonable living wage; and (3) that research-intensive academic institutions create a career path for biomedical PhDs other than that designed for the traditional tenure-track, grant-funded principal investigator and faculty member. They conclude that it is in the interest of faculty and institutions to make these and other drastic changes because the current system is both inherently unfair and self-destructive.

Biomedical Technology↗

PubMed2002

Integrative medical education: development and implementation of a comprehensive curriculum at the University of Arizona.

Dissatisfaction with the U.S. health care system is increasing despite impressive technologic advances. This dissatisfaction is one factor that has led patients to seek out complementary and alternative medicine (CAM) and led medical schools to start teaching CAM. This paper focuses on the University of Arizona's approach to developing and implementing a comprehensive curriculum in integrative medicine. Integrative medicine is defined much more broadly than CAM. It is healing-oriented medicine that reemphasizes the relationship between patient and physician, and integrates the best of complementary and alternative medicine with the best of conventional medicine. Since its inception in 1996, the Program in Integrative Medicine (PIM) has grown to include a two-year residential fellowship that educates four fellows each year, a distance learning associate fellowship that educates 50 physicians each year, medical student and resident rotations, continuing medical and professional education, an NIH-supported research department, and an active outreach program to facilitate the international development of integrative medicine. The paper describes the PIM curriculum, educational programs, clinical education, goals, and results. Future strategies for assessing competency and credentialing professionals are suggested.

Arizona↗

PubMed2003

Assessing personal qualities in medical school admissions.

The authors analyze the challenges to using academic measures (MCAT scores and GPAs) as thresholds for admissions and, for applicants exceeding the threshold, using personal qualities for admission decisions; review the literature on using the medical school interview and other admission data to assess personal qualities of applicants; identify challenges of developing better methods of assessing personal qualities; and propose a unified system for assessment. The authors discuss three challenges to using the threshold approach: institutional self-interest, inertia, and philosophical and historical factors. Institutional self-interest arises from the potential for admitting students with lower academic credentials, which could negatively influence indicators used to rank medical schools. Inertia can make introducing a new system complex. Philosophical and historical factors are those that tend to value maximizing academic measures. The literature identifies up to 87 different personal qualities relevant to the practice of medicine, and selecting the most salient of these that can be practically measured is a challenging task. The challenges to developing better personal quality measures include selecting and operationally defining the most important qualities, measuring the qualities in a cost-effective manner, and overcoming "cunning" adversaries who, with the incentive and resourcefulness, can potentially invalidate such measures. The authors discuss potential methods of measuring personal qualities and propose a unified system of assessment that would pool resources from certification and recertification efforts to develop competencies across the continuum with a dynamic, integrated approach to assessment.

College Admission Test↗

PubMed2006

Characteristics, roles, and responsibilities of the Designated Institutional Official (DIO) position in graduate medical education.

PURPOSE: In 1998, the Accreditation Council for Graduate Medical Education (ACGME) added the stipulation that each institution providing graduate medical education (GME) have a Designated Institutional Official (DIO). Little is known about the effect of new accreditation requirements on GME practice and outcomes. The authors conducted a cross-sectional survey designed to provide descriptive data about DIOs and to validate a DIO Responsibility Scale (DIORS). METHOD: DIOs were identified by the ACGME. The following delivery strategy was used to administer the survey from January 2004 to May 2004: prenotice letter; survey with self-addressed, stamped return envelope and cover letter; thank-you/reminder postcard; and replacement survey with new cover letter and self-addressed, stamped return envelope. RESULTS: Completed surveys were received from 243 of 363 DIOs (66.9%). Responses indicated wide ranges in DIO titles, report titles, time spent accomplishing responsibilities, DIO-specific salaries, credentials, and Graduate Medical Education Committee reporting arrangements. DIOs reported confusion or overlap between DIO and program director roles (72.0%), decreasing funding for GME (50.6%), and inadequate support staff (25.1%). The 11-item DIO Responsibility Scale demonstrated a Cronbach alpha of .86 and a statistically significant relationship to five variables selected to establish construct validity. CONCLUSIONS: The wide variability in DIO characteristics found in this study supports the premise that the DIO role is underdeveloped. The authors established the reliability and validity of the DIORS, which now may be used in future research of the DIO role. The data from this study may be used by DIOs and institutions to develop the role further, improve DIO performance, and create more useful job descriptions.

Accreditation↗

PubMed1996

Advanced practice roles for nurses in tomorrow's healthcare systems.

Advanced practice nurses (APNs) have traditionally been a diverse group in terms of titles, education, credentials, and roles. The classification of APN usually encompasses the nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). NP, CRNA, and CNM roles have been more clearly delineated than the CNS roles. In light of healthcare reform, the CNS roles have been critically reviewed and analyzed. Attempts have been made to clarify responsibilities and outcomes, and to quantify the financial impact of this role. In this article, seven APN roles clearly defined in terms of minimal qualifications and competencies critical to accomplishment of the duties, responsibilities, and expected outcomes are presented. Comparison of competency requirements are also presented. The roles presented are designed to facilitate healthcare institutions in meeting the demands for serving patients with increasingly complex needs, as well as cost-containment goals.

Certification↗