Characteristics of medical schools and their affiliated institutions

Survey data from a sample of 58 U.S. and six Canadian medical schools were used to describe the current network of medical schools and their affiliates. Results showed that each medical school in the study averaged over 11 affiliates. The largest percentages of affiliates reported were in the categories of "community" hospitals (that is, the nongovernmental, not-for-profit hospitals), Veterans Administration hospitals, and city hospitals. Characteristics of the medical schools, such as class size, ownership, year established, and the presence of a university hospital, were not related to either the number or the kind of affiliates. However, the sizes of the affiliated institutions were associated with the year the medical school was established, the presence of a university hospital, and the class size of the medical school.     

The teaching of cultural issues in U.S. and Canadian medical schools.

PURPOSE: Despite the importance of culture in health care and the rapid growth of ethnic diversity in the United States and Canada, little is known about the teaching of cultural issues in medical schools. The study goals, therefore, were to determine the number of U.S. and Canadian medical schools that have courses on cultural issues, and to examine the format, content, and timing of those courses. METHOD: The authors contacted the deans of students and/ or directors of courses on cultural issues at all 126 U.S. and all 16 Canadian medical schools. Using a cross-sectional telephone survey, they asked whether each school had a course on cultural sensitivity or multicultural issues and, if so, whether it was separate or contained within a larger course, when in the curriculum the course was taught, and which ethnic groups the course addressed. RESULTS: The response rates were 94% for both U.S. (118) and Canadian (15) schools. Very few schools (U.S. = 8%; and Canada = 0%) had separate courses specifically addressing cultural issues. Schools in both countries usually addressed cultural issues in one to three lectures as part of larger, mostly preclinical courses. Significantly more Canadian than U.S. schools provided no instruction on cultural issues (27% versus 8%; p = .04). Few schools taught about the specific cultural issues of the largest minority groups in their geographic areas: only 28% and 26% of U.S. schools taught about African American and Latino issues, respectively, and only two thirds of Canadian schools taught about either Asian or Native Canadian issues. Only 35% of U.S. schools addressed the cultural issues of the largest minority groups in their particular states. CONCLUSIONS: Most U.S. and Canadian medical schools provide inadequate instruction about cultural issues, especially the specific cultural aspects of large minority groups.     

Health education programs in U.S. medical schools.

To examine the status of teaching programs on health education in undergraduate medical education, the author in 1990-91 surveyed representatives of all 126 U.S. medical schools. Of the 97 institutions that responded, 63 (65%) offered instruction in patient education and 72 (74%) offered instruction in community health promotion. The responses indicated that a number of departments participated in instruction and that diverse methods of instruction and evaluation were used. Opinions of the representatives regarding the importance and adequacy of instruction in health education were quite favorable. The author concludes that more information is needed to determine the effectiveness of the instructional programs and their impact on the quality of medical care.     

Measuring contributions to the clinical mission of medical schools and teaching hospitals.

This is the final report of a panel convened as part of the Association of American Medical College's (AAMC's) Mission-based Management Program to examine the use of metrics (i.e., measures) in assessing faculty and departmental contributions to the clinical mission. The authors begin by focusing on methods employed to estimate clinical effort and calculate a "clinical full-time equivalent," a prerequisite to comparing productivity among faculty members and departments. They then identify commonly used metrics, including relative-value units, total patient-care gross charges, total net patient fee-for-service revenue, total volume per CPT (current procedural terminologies) code by service category and number of patients per physician, discussing their advantages and disadvantages. These measures reflect the "twin pillars" of measurement criteria, those based on financial or revenue information, and those based on measured activity. In addition, the authors urge that the assessment of quality of care become more highly developed and integrated into an institution's measurement criteria. The authors acknowledge the various ways users of clinical metrics can develop standards against which to benchmark performance. They identify organizations that are sources of information about external national standards, acknowledge various factors that confound the interpretation of productivity data, and urge schools to identify and measure secondary service indicators to assist with interpretation and provide a fuller picture of performance. Finally, they discuss other, non-patient-care, activities that contribute to the clinical mission, information about which should be incorporated into the overall assessment. In summary, the authors encourage the use of clinical productivity metrics as an integral part of a comprehensive evaluation process based upon clearly articulated and agreed-upon goals and objectives. When carefully designed, these measurement systems can provide critical information that will enable institutional leaders to recognize and reward faculty and departmental performance in fulfillment of the clinical mission.     

Diversification of U.S. medical schools via affirmative action implementation

Background

The diversification of medical school student and faculty bodies via race-conscious affirmative action policy is a societal and legal option for the U.S. Supreme Court has recently ruled its use constitutional. This paper investigates the implications of affirmative action, particularly race-conscious compared to race-blind admissions policy; explains how alternative programs are generally impractical; and provides a brief review of the history and legality of affirmative action in the United States.

Discussion

Selection based solely on academic qualifications such as GPA and MCAT scores does not achieve racial and ethnic diversity in medical school, nor does it adequately predict success as practicing physicians. However, race-conscious preference yields greater practice in underserved and often minority populations, furthers our biomedical research progression, augments health care for minority patients, and fosters an exceptional medical school environment where students are better able to serve an increasingly multicultural society.

Summary

The implementation of race-conscious affirmative action results in diversity in medicine. Such diversity has shown increased medical practice in underserved areas, thereby providing better health care for the American people.

     

Current practices in admission interviews at U.S. medical schools

Although the interview is widely used in the selection of applicants for admission to U.S. medical schools, little is known about current interview practices. The authors formulated a 46-item questionnaire concerning the interview process for medical school applicants, then in 1989 sent it to admission officials at all the 127 LCME-accredited schools in the United States. The questionnaire concerned the interview's status as a predictor; interviewers and interview structure; interviewer training; and the utility of interview data. Seventy-two percent of those sent the questionnaire completed and returned it. The responding admission officials indicated that the interview had two major purposes at their schools: as a means of assessing candidates' noncognitive skills and as a public relations tool. Most schools' interview processes were loosely to moderately structured, and interviewers received minimal training. It is concluded that the interview's role is primarily subjective and that it has a definite but imprecise influence on admission decisions.     

The teaching of complementary and alternative medicine in U.S. medical schools: a survey of course directors.

PURPOSE: The number of U.S. medical schools offering courses in complementary and alternative medicine (CAM) has risen sharply in recent years. This study gauged the current state of CAM instruction by gathering details about the specific topics being taught and the objectives behind the instruction. METHOD: Data were collected from questionnaires mailed to 123 CAM course directors at 74 U.S. medical schools. RESULTS: Questionnaires were returned by 73 course directors at 53 schools. The topics most often being taught were acupuncture (76.7%), herbs and botanicals (69.9%), meditation and relaxation (65.8%), spirituality/faith/prayer (64.4%), chiropractic (60.3%), homeopathy (57.5%), and nutrition and diets (50.7%). The amounts of instructional time devoted to individual CAM topics varied widely, but most received about two contact hours. The "typical" CAM course was sponsored by a clinical department as an elective, was most likely to be taught in the first or fourth year of medical school, and had fewer than 20 contact hours of instruction. Most of the courses (78.1%) were taught by individuals identified as being CAM practitioners or prescribes of CAM therapies. Few of the courses (17.8%) emphasized a scientific approach to the evaluation of CAM effectiveness. CONCLUSION: A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.     

Support services for homosexual students at U.S. medical schools

This study reports the results of a national survey conducted to assess current programs directed toward gay and lesbian medical students and to identify their perceptions, needs, and wishes. Support services are limited and those that do exist vary on the basis of class size, institutional affiliation, and geographic region. The topic of homosexuality is taught in most medical schools in a circumscribed way. Implications of the findings concern the medical education of all students, irrespective of their sexual orientations.     

The changing faces of promotion and tenure at U.S. medical schools

Faced with many potentially divisive questions related to tenure and promotion, leaders at medical schools have lacked an overview of examples of how other medical schools are adapting their faculty policies to reflect changing realities. This article reports results of a survey of U.S. medical school deans and of interviews with faculty affairs administrators regarding areas of change in faculty appointment, promotion, and tenure policies. Examples of adaptations are reported under the following headings: use of tenure; financial guarantees of tenure; criteria for award of tenure; probationary period; post-tenure review; advising faculty; clinician-educator tracks; and recruting women and minority faculty. Of these, the adaptation entailing the most activity and about which the most information was obtained concerns establishing a clinician-educator track. Numerous examples are provided of schools' evolutions of policies with regard to modifying titles of clinical-educators, defining promotion criteria, monitoring transfer between tracks, and defining contract periods, benefits, and privileges. The primary challenge for medical school administrators is to build sufficient flexibility into their promotion policies to show that the institution values the many different types of faculty needed, and at the same time to provide adequate security to essential faculty.     

How issues of professional liability are taught in U.S. medical schools

This study investigated how medicolegal issues--specifically those concerning professional liability--are treated in U.S. medical school education. The author mailed a questionnaire in mid-1989 to all 127 U.S. medical schools that were accredited at that time and to the five medical school campuses of the University of Illinois; 120 (90%) responded. Of these, 73 (61%) reported that they included topics about professional liability in their educational curricula. Twenty-three of the schools indicated that students' training had been "compromised or jeopardized" by the impact of physicians' concerns about medicolegal issues. Forty-seven of the schools had students who had been named in malpractice suits. The study shows that undergraduate medical education has been significantly affected by issues of professional liability. Relevant medicolegal content should be an integral part of medical school education.