Selection of medical students for graduate training: pass/fail versus grades

We analyzed the performance of two cohorts of surgical residents: one from "pass/fail" and the other from "graded" medical schools. A performance index indicates that the group from graded schools performed significantly better (P less than 0.001). No resident from a pass/fail institution ranked above the 87th percentile, and this group accounted for 82 per cent of those ranking below the 15th percentile. A residency training program that seeks excellence among its trainees would do well to select preferentially students who apply from medical schools providing a specific class standing as part of the total evaluation of the student. It is suggested that the pass/fail controversy is symbolic of the erosion of standards that inevitably occurs when the university becomes involved in transient sociopolitical turmoil.     

Surveying graduates of one school to determine regional workforce demand.

PURPOSE: To study the demand for physician graduates from one school in one region of the country. The use of demand as a measure of potential regional variation should be of interest to medical educators and policymakers. METHOD: All residency graduates of the University of Washington School of Medicine between 1975 and 1995 (n = 3,824) were surveyed about their ability to gain employment in a timely manner and whether they were recruiting physicians for their practices. RESULTS: The response rate was 50.29%. A non-responder survey was done using a subsample (n = 200), with a 28% return. Over 95% of the graduates had found employment in their desired specialties and locations within two years of finishing their residencies. This was the same for graduates over all years. Approximately 30% of all practices of respondents within the Northwest region were recruiting for new physicians (26% of specialty practices and 34% of generalist practices were recruiting). There was no difference between recruitment in the urban and rural practices or between respondents to the initial survey and those responding to the follow up. CONCLUSIONS: Despite a significant oversupply of specialist physicians and at least a sufficient supply of generalist physicians nationally, there appears to be a strong demand for both specialists and generalists in the Northwest region of the country. This raises questions concerning the use of national averages to inform the education policies in specific regions of the country. More validated measures of demand are needed for future studies.     

Mandatory postgraduate medical training in Japan--present state of Nihon University as a private medical school

This is a time of considerable uncertainty about the future of the postgraduate medical education policy of the Japanese government. Strong and visionary academic leadership of laboratory physicians in private medical schools is needed. The medical schools must not only adapt to a changing health care system, but also maintain excellence in education, patient care, and clinical research. In Japan, tradition has it that the comparatively few faculty members at national medical schools are mostly promoted only on the basis of research in experimental medicine, therefore, young medical graduates are increasingly drawn to bench work or molecular medicine, not to clinical practice. Single-minded specialization tends to produce single track minds, which may lack balanced judgment in approaching the appropriateness of both investigation and management. For continuity of care and containment of costs, a year or two of general professional training after graduation preceded by a broad medical education is an invaluable investment. All medical graduates, whatever their intended or unintended final destination (even if not clinical), should spend more than six months in medicine and four or five months in surgery, at least half of each to be spent in the general disciplines, including responsibilities for acute emergency admissions. As certified laboratory physicians we must attempt to attract graduates into laboratory medicine by developing imaginative training programs including common laboratory procedures such as Gram's stain, Wright-Giemsa stain and point of care testing at the patient's bedside or in ambulatory clinics, not only in central clinical laboratories.     

Racial-ethnic background and specialty choice: a study of U.S. medical school graduates in 1987

This study used two Association of American Medical Colleges' questionnaires to determine whether there was a relationship between the racial-ethnic backgrounds and the specialty choices of a 1987 cohort of 11,136 U.S. medical school seniors, both prior to entering medical school and as they prepared for residency training. Their specialty preferences as premedical students were shown by their responses to the Premedical Student Questionnaire, administered when they registered for the Medical College Admission Test; their specialty choices at the end of their medical school training were shown by their responses to the Medical Student Graduation Questionnaire, which they completed shortly before graduation. Racial-ethnic backgrounds, self-recorded, were classified into black, other underrepresented minorities, Asian, other non-underrepresented minorities, and white. Specialties were clustered into primary care, medical specialties, surgical specialties, and supporting services. Before entering medical school, the students had similar specialty preferences regardless of background. As seniors in medical school, there was even greater convergence of specialty choices among the students of all backgrounds. Racial-ethnic background in itself appears not to have been a major factor influencing the senior medical students' specialty choices.     

The proposed educational reforms of the undergraduate medical school curriculum and the postgraduate clinical training system

Along with the rapid advances in the fields of life science and technology, the knowledge that the medical students are expected to acquire has expanded in many areas, and also many subjects have been subdivided into special fields, thus resulting in a situation in which the knowledge that doctors obtain at medical school is quickly becoming less uniform. Therefore, the introduction of a standardized medical school curriculum and postgraduate training systems has been discussed over the past several years. The Departments of Education and Technology and Welfare and Labor have started to draw up new curricula and systems in order to ensure the quality of the medical doctors licensed to practice medicine in Japan. These reforms require appropriate changes in the educational programs for such fields as clinical pathology and laboratory medicine on both the undergraduate and the postgraduate levels. This workshop has been organized to introduce the findings of both original and advanced trials being performed by medical schools and educational hospitals with different backgrounds. At first, the progress of these reforms is summarized in order for the participants to obtain a better understanding of the undergoing reforms.     

Predictive validity of a house-officer selection process at one medical school

This study explored the rank list generated by a process of evaluating applicants for a surgery residency; the process is a revision of an older process (pre-1982) used for that purpose. The study's aim was to learn whether the new process is more predictive of residents' performances in their first year than was the process it replaced and whether the rough rankings computed directly from ratings of applicants are more predictive than the final rankings determined in a meeting by the department faculty, who modify the rough rankings. The 1982-1986 rankings and performances of 32 first-year residents at the University of North Carolina at Chapel Hill School of Medicine were studied and compared with the rankings and performances of 77 applicants from 1976 and 1978-1979 under the previous system. Correlation analyses revealed that for the applicants studied, the rough rankings in the new and the previous systems were equally predictive of performances as measured by rating scales, but that the new system was more predictive of performances on the surgery in-training examination. However, all correlations were small. Finally, the rough rankings obtained under the new system were more predictive of the residents' later performances than were the faculty's final rankings.     

Distributed radiology clerkship for the core clinical year of medical school.

OBJECTIVE: The central role that diagnostic radiology has in the modern practice of medicine has not always been reflected in radiology's place in the curriculum. We developed a new radiology clerkship for undergraduate medical students during their core clinical year that was supported by Web technology. The assumptions underlying the design of the clerkship were that radiology is best learned from radiologists and that students are most receptive to learning radiology when it is related to concurrent patient care experiences. DESCRIPTION: Beginning in May 2000, a required radiology clerkship experience was incorporated into the core clinical year at Wake Forest University School of Medicine. The core clinical year was organized into three 16-week blocks of clerkships. Two or four independent half-day radiology tutorial sessions were included with each clerkship block, and attended by all students in the block (approximately 35 students), regardless of their specific clerkship assignments. There were ten different radiology tutorials, each given three times during the year as students rotated through the clerkship blocks. Thus, each student attended a radiology tutorial session every four to eight weeks during the year. The topics covered during the tutorials were correlated with the content of the clerkship blocks and included adult and pediatric chest radiology, adult and pediatric abdominal radiology, body CT, neuroradiology, obstetric ultrasound, gynecologic ultrasound, osteoporosis, adult and pediatric fractures, mammography, and cervical spine trauma. The tutorials included pre- and post-test, lectures, case presentations, and sometimes tours of the radiology department. The educational emphasis was on pragmatic case-based learning exercises, development of verbal and visual vocabulary, and learning when and where to seek more information. To provide continuity and organization, Web-based curriculum materials were designed and implemented as a component of the clerkship. The home page of the Web site provided the schedule, faculty names, attendance and grading policies, course overview, and links to individual tutorials. The pages for individual tutorials included educational objectives, glossary of radiology terminology relevant to the subject, lecture slides and handouts, and teaching cases. All students had laptop computers and access to the academic network, but did not use them during the actual tutorial sessions. DISCUSSION: Implementation of the radiology clerkship required extensive negotiation with directors of other clerkships so that students could be released from their other responsibilities in order to attend the radiology tutorials. The radiology clerkship format has proven to be complex in its administration, with faculty and students on different schedules commuting to the radiology lecture hall from various locations. Extensive use of e-mail and communication via the Web site have been instrumental in reminding faculty and students of upcoming sessions. Preliminary evaluations have indicated that students liked the radiology sessions and learned a great deal, but disliked the scheduling and the lack of continuity. An evaluation of the curriculum and its components is ongoing.     

Status of the clinical laboratory in the mandatory postgraduate medical training system. (1) Report from a laboratory technologist

According to a new system for postgraduate clinical training, 33 medical trainees have been accepted for the past two years at Osaka General Medical Center. Before practicing clinical medicine in each division by a super-rotated table, orientation is scheduled for 5 days to master the basic systems indispensable to the hospital. In this orientation, training in laboratory medicine is performed for 7 hours (3.5 hours for 2 days). Trainees are divided into 4 groups and learn emergency tests of chemistry, hematology and urinalysis, blood transfusion, physiology and microbiology for 60 min each. Laboratory technologists instruct the trainees to gain the basic skills. The main contents are blood gas measuring in chemistry, sample preparation in hematology and urinalysis, taking each other's ECG, ordering blood products for transfusion, serologic study of infectious diseases, and Gram stain in microbiology. Although it is difficult to find time for routine analysis and instructing trainees in the clinical laboratory, it is a suitable opportunity for revision, also for laboratory technologists, and for communication to discuss clinical matters.     

Audit of work at a medical centre for the homeless over one year

An audit of one years' work at a voluntary health care service for the homeless involving doctors, a chiropodist, nurses and social workers was carried out. It was found that although certain health problems are more common among the homeless than in the general population, the range resembles that in any general practice. However, registration with general practitioners was much less common among the homeless than in the general population, and a high proportion of referrals to hospital did not lead to appropriate treatment. The value of a special primary health care service for the homeless is discussed.     

Self-reported competency ratings of graduates of a problem-based medical curriculum.

PURPOSE: To study the self-reports of professional competencies by graduates of a problem-based medical curriculum. METHOD: All graduates from a medical school and a faculty of health sciences with a problem-based curriculum were sent a questionnaire asking them to compare their own performances in 19 domains with those of colleagues trained at schools with conventional curricula. RESULTS: Overall, alumni of the medical school rated themselves as better than colleagues who were trained at schools with conventional curricula for cooperation skills, problem-solving skills, skills relevant to running meetings, and the ability to work independently. There was no difference for possession of general academic knowledge and writing reports or articles. The self-reported ratings of better competencies were maintained after correcting the data for self-overestimation. CONCLUSION: The problem-based medical curriculum appears to contribute to the development of professional competencies. Further study is needed, however, to control for the effect of selection bias and respondents' emotional commitment to their alma mater.     

Student health in various periods of a year from one birthday to the following one

Human health varies in different seasons. There is an individual yearly health cycle (IYHC). The authors examined variations in working capacity (WC), stress inclination (SI), immunity (salivary IgA), biological age (BA), and integral health index (IHI) in 157 apparently healthy students in different months and terms of an individual year--from one birthday to the next one. SI was estimated by several methods. Variations in cardiac rhythm, mathematical problem solution-induced changes in cardiac rhythm and blood pressure, colour preferences (after Lusher), anxiety (after Taylor) and the number of nerve rings of the iris. In young men, the second term of IVHC, i.e. months 4 to 6 of their birthday, was the best for health and the fourth term was the worst. In the last term (months 10 to 12), the mean IHI was 30% lower than that in the second term; elevated blood pressure was found in 30.3% of the students, WC and salivary IgA showed the lowest values and SI and BA did the highest ones. In the girls, these changes were less pronounced and the first term was the best. The association of these individual yearly health variations with birth stress described by H. Lagercrantz and T. Slotkin (1986) is discussed.     

Evaluating the clinical skills of foreign medical school graduates participating in an internship preparation program

In the fall of 1986, the Ministry of Health of the province of Ontario, Canada, implemented a special 36-week internship preparation program for graduates of foreign medical schools. The program accepts 24 candidates per year and is offered at the five Ontario medical schools. At the time of this study, two cohorts of participants had completed the program. As part of the evaluation process, each participant was administered a battery of the same Objective Structured Clinical Examination-type test stations, prior to and on completion of the pre-internship experience. Repeating the same examination permitted investigation of the predictive and construct validities of the clinical skills tests, as well as the stability of the validity and high reliability estimates that emerged from the testing of the first cohort. The results provide convincing evidence of the testing approach's predictive and construct validity and reliability.     

Medical students' exposure to pharmaceutical industry marketing: a survey at one U.S. medical school.

PURPOSE: While much is known about the interactions between the pharmaceutical industry and physicians, very little is known about pharmaceutical marketing directed toward medical students. This study sought to characterize the extent and forms of medical students' exposure to pharmaceutical industry marketing. METHOD: In 2001-02, an anonymous, 17-item questionnaire was distributed to 165 preclinical and 116 clinical students at the University of Minnesota Medical School-Twin Cities. The main outcome measures were the number and forms of exposures to pharmaceutical industry marketing reported by medical students and whether students had discussed these exposures with teachers or advisors. Preclinical and clinical students were compared using chi(2) analysis (p < .05). RESULTS: One hundred fourteen (69.1%) preclinical students and 107 (92.2%) clinical students responded. Nearly all students reported at least one exposure to pharmaceutical industry marketing. Seventy-six (71.7%) clinical students compared to 38 (33.3%) preclinical students recalled over 20 exposures (p < .005). Clinical students were more likely to have received a free meal (p < .01), textbook (p < .005), pocket text (p < .005), or trinket (p < .005) than were their preclinical colleagues. Most students (68.2%) had not discussed pharmaceutical marketing with an instructor or advisor; 59 (55.7%) clinical students as compared to 87 (80.6%) preclinical students recalled no such discussion (p < .005). CONCLUSION: Medical students have extensive exposure to pharmaceutical industry marketing during their early years of training. Given existing evidence that such exposure influences physicians' practice and prescribing patterns, the authors propose that medical school curricula include formal instruction to prepare students to critically assess these contacts.     

医学院校研究生学位管理系统的开发和应用

开发和应用研究生学位管理系统作为研究生管理系统中的一个子模块,有利于优化工作流程,实现科学管理,提高办公效率。本文简要介绍了该系统的设计原则、管理权限设置及主要功能模块,并总结了该系统的特点和应用的意义。