Educating future physicians for Ontario: phase II.

In 1990, a collaborative project was launched to determine what the people of Ontario expect of their physicians and how the programs that prepare future physicians should be changed in response. The project, called Educating Future Physicians for Ontario (EFPO), brought together the five Ontario medical schools, the Council of Ontario Faculties of Medicine (COFM); a nonprofit, charitable organization, Associated Medical Services (AMS); and the Ontario Ministry of Health. The first phase ran for five years and was described in the November 1998 issue of Academic Medicine. After an external review, the project was continued for a second phase (EFPO II) for four more years until December 1998; that second phase is the topic of this article. EFPO II (1) focused more on residents' education; (2) emphasized four of the EFPO I-created physician roles in project activities; (3) maintained the province-wide, inter-institutional medical education framework of phase I, but fostered greater involvement of the seven sites (five medical schools and two regional health centers) in project activities; (4) stressed five project components (e.g., needs assessment and community partnerships) and worked for collaboration among components at all sites; (5) enhanced the original EFPO I Fellowship Program by adding residents and community fellows to the existing fellowships and by initiating leadership development activities, all of which bode well for the future leadership of medical education in Ontario. Students and residents played a vital role in EPFO II. Most of EFPO II's objectives were met, but the overall view of external reviewers was that the project was less successful than EFPO I. For example, the impact on clinical education, especially residency education, was less than anticipated. On the other hand, the project helped encourage the wide adoption of the eight physician roles that originated in EFPO I and advanced faculty development and assessment activities based on these roles. A third phase of EFPO concerning continuing medical education was planned, but support was not available. However, one of the funders will continue to support the successful fellowship and leadership program and the provincial education network for the next three years. Overall, the two phases of EFPO substantially modified medical education in Ontario to make it more responsive to evolving social needs.     

Mentoring program for minority faculty at the University of Pennsylvania School of Medicine.

Research indicates that having a faculty mentor and being part of an active network of peers are critical ingredients of successful academic medicine careers. Minority physicians, however, often do not have mentors, and the problem is greatest for minority groups underrepresented in medicine. The University of Pennsylvania School of Medicine in 1994-1996 undertook to learn the extent of mentoring programs in its departments and divisions and to compare the experiences of underrepresented-minority faculty and others. The results were used to establish a system for mentoring and networking support for minority faculty members. Examining the reports of division and department heads on their formal mentoring programs, it was clear that these leaders considered a mentor essential for career development, but many reported having no systematic plan for mentors for junior faculty. In looking at the reported experiences of minority and non-minority assistant professors (matched for promotion track, department, appointment date, and, where possible, gender), it was found that approximately half of either group did not have mentors. As a result of this information, the school established a faculty development program to meet the faculty members' demonstrated needs: annual career development meetings with new minority faculty; assistance in identifying and assigning mentors; assistance in developing research skills; and monitoring of the retention of minority faculty. As experience with the program produces additional insights into the needs of minority faculty--and particularly of junior faculty--the program will be adjusted and expanded to meet these identified needs.     

Support programs for minority students at Ohio University College of Osteopathic Medicine.

The Ohio University College of Osteopathic Medicine ranks high among the nation's 19 osteopathic medical schools with respect to the percentage of underrepresented minorities (URMs) in the entering class. The college has strong recruitment and retention programs for URM and disadvantaged students. URM enrollment rose steadily from 11% in 1982-83 to 22% in 1997-98, despite the school's location in a rural, residential public university with few minorities as students or town residents. The college has six programs to support minority students through both undergraduate and medical school: the Summer Scholars Program (1983 to present), an intensive six-week summer program to prepare rising under-graduate seniors and recent graduates to apply to medical school; Academic Enrichment (1987 to present), to support first- and second-year medical students; the Prematriculation Program (1988 to present), an intensive six-week summer program for students who will matriculate in the college; Program ExCEL (1993 to present), a four-year program for undergraduates at Ohio University; the Summer Enrichment Program (1993 to present), an optional six-week program for students who will enter the premedical course at Ohio University; and the Post-baccalaureate Program (1993 to present), a year-long, individually tailored program for URM students who have applied to the medical college but have been rejected. The medical college first focused on supporting students already in the medical school curriculum, then expanded logically back through the undergraduate premedical programs, always targeting learning strategies and survival strategies, peer and faculty support, and mastery of the basic science content. The college plans to create an on-site MCAT preparation program and perhaps expand into secondary education.     

Conflict resolution at the University of Ottawa Faculty of Medicine: The Pelican and the sign of the triangle.

In 1997 the University of Ottawa Medical School adopted a conflict-resolution policy for informally dealing with complaints of abuse, harassment and intimidation, sexual harassment, and scientific misconduct or misappropriation of intellectual property. In collaboration with the university's Faculty of Law, general conflict-resolution workshops were given for faculty and administration and mediation training was provided to medical faculty designated "complaint officers" under the policy. In this article, the authors describe the policy and training and then analyze the first major incident arising after the policy's implementation: the publication of disrespectful misogynist material in The Pelican, a medical student society newsletter. The Pelican incident is used as a "lessons learned" case study both in terms of its multiple outcomes and as an opportunity to pinpoint some important policy and practical considerations that emerged in implementing a conflict-resolution policy. The article also describes the results of a learning environment survey conducted after the Pelican incident.     

Simulated minority admissions exercise at Louisiana State University School of Medicine: an evaluation.

The Louisiana State University (LSU) School of Medicine-New Orleans has been active in recruiting minority students to create a diverse medical student body. Recognizing the need to explore ways to assess minority applicants, over the past 10 years, LSU has offered Stimulated Minority Admissions Exercise (SMAE) workshops to its admission committee members. Participants in six of LSU''s SMAE workshops were asked to respond anonymously to an evaluation form immediately following the workshop. Sixty of the 64 participants responded. The overall evaluation of the workshops was positive. More than 80% of participants indicated that due to their participation in SMAE, they knew how to locate and assess application data particularly relevant to minority applicants. The results suggest that identifying variables that enhance minority student admission and retention is desirable.     

In the minority: black physicians in residency and their experiences

OBJECTIVE: To describe black residents' perceptions of the impact of race on medical training. MATERIALS AND METHODS: Open-ended interviews were conducted of black physicians in postgraduate year 22 who had graduated from U.S. medical schools and were enrolled in residency programs at one medical school. Using Grounded Theory tenets of qualitative research, data was culled for common themes through repeated readings; later, participants commented on themes from earlier interviews. RESULTS: Of 19 participants 10 were male, distributed evenly among medical and surgical fields. Four major themes emerged from the narratives: discrimination, differing expectations, social isolation and consequences. Participants' sense of being a highly visible minority permeated each theme. Overt discrimination was rare. Participants perceived blacks to be punished more harshly for the same transgression and expected to perform at lower levels than white counterparts. Participants' suspicion of racism as a motivation for individual and institutional behaviors was tempered by self-doubt. Social isolation from participants' white colleagues contrasted with connections experienced with black physicians, support staff and patients, and participants strongly desired black mentors. Consequences of these experiences varied greatly. CONCLUSIONS: Black physicians face complex social and emotional challenges during postgraduate training. Creating supportive networks and raising awareness of these issues may improve training experiences for black physicians.     

Educating social workers to meet the challenge of an aging urban population: a promising model.

As Americans live longer, they will require more health and social services to address the onset of acute and chronic conditions. The persistent changes in health care delivery and the increasingly diverse older adult population in urban settings, coupled with the high expectation for families to be responsible for home care needs, challenge social workers, who work alongside physicians, nurses, and other health care professionals, to provide services effectively. Because social workers are becoming more essential, social work education must increase the numbers of social workers with the knowledge and skills necessary for practice in the current U.S. health, mental health, and social service systems, particularly in caring for the aging populations in urban settings. A New York Academy of Medicine study identified the need for increased synergy between the two components of graduate social work education: the field experience and classroom instruction. One educational model, the Practicum Partnership Program, which is designed to better integrate field and classroom, is being tested at six sites. Early results from over 300 graduates are encouraging, with evidence that students' knowledge and skills regarding aging adults have increased, their satisfaction with the experience was very high, and those who were trained reflect the diversity of the population of older adults. The early success of this program suggests that innovative educational models that expose graduate social work students to diverse populations across the continuum of care are possible. Such models will be essential for the nation to be successful in producing a social work labor force qualified to meet the challenge of an aging urban population.     

The Urban Health Program to encourage minority enrollment at the University of Illinois at Chicago College of Medicine.

Since 1969, the University of Illinois at Chicago College of Medicine has worked to recruit, admit, and graduate a more diverse population of physicians. The state of Illinois ranks third in the nation in the number of African American residents, and fifth in the number of Latinos, and these groups together account for approximately 60% of Chicago's population. To attract applicants from these groups, the medical school created the Medical Opportunities Program and its successor, the Urban Health Program, to maximize this pool of applicants. Outreach activities at undergraduate colleges, in association with premedical organizations, identify underrepresented-minority (URM) students who should receive support in their applications. The organizations assist in monitoring the applications of URM candidates. Also, the medical college created academic and social support programs for its URM students: a prematriculation program, small-group review sessions for every major course in the first two years of the curriculum, help for second-year students preparing for the United States Medical Licensing Examination Step 1 and fourth-year students preparing for Step 2, and support for organizations for minority students. Over its 30 years, the program has had a substantial impact on the number of URM students entering the medical college, other medical schools, and other health professions. Over these years, the proportion of URM students in the medical college's overall enrollment rose from 10% to 23%. Also, a higher proportion of the college's URM graduates than its non-URM graduates practice in the Chicago area.     

Time management: a review for physicians.

This article reviews the basic concepts and techniques of time management as they relate to a medical lifestyle. Essential tools are described to help the physician reassess and sharpen skills for handling intensifying demands and constraints of juggling patient care, research, teaching, and family responsibilities. The historical background and principles of time management for three popular "best selling" techniques are critiqued. In addition, a fourth technique, or model, of time management is introduced for physician use.     

Attitudes and smoking habits of physicians at the Lagos University Teaching Hospital

The attitudes and smoking habits of 333 doctors at the Lagos University Teaching Hospital were studied. Sixty eight percent were nonsmokers, while 24 percent were currently smoking, and 8 percent were ex-smokers. Surgeons (26 percent) and obstetricians and gynecologists (24 percent) accounted for most of the current smokers.     

Medical education research at the University of Washington School of Medicine: lessons from the past and potential for the future.

Faculty in the Department of Medical Education and Biomedical Informatics at the University of Washington School of Medicine received over $1.2 million in direct grant and contract support in 2003. In this case study, the authors provide some of the history and background of the evolution of the department's structure and its role in providing leadership in medical education research at the university, as well as regionally, nationally, and internationally. The authors offer their observations and reflections on what has helped and hindered the department's success, and end with some predictions on medical education research in the future. The University of Washington's five-state regional WWAMI educational program, establishing a single medical school for the states of Washington, Wyoming, Alaska, Montana, and Idaho, has been an important environmental influence on the direction of the department's educational and research activities. External support has helped the department to create the Northwest Consortium for Clinical Performance Assessment, the Center for Medical Education Research, the Teaching Scholars Program, and a Biomedical and Health Informatics graduate and fellowship training program, as well as a number of international programs.     

Viewpoint: New physicians for a new century.

How to train competent and compassionate physicians has assumed a new urgency. The authors propose that these concerns be approached by radically restructuring the medical school curriculum in ways that place facts and skills within the context of ethics and values. Doing so will require that the positivist stance of medical education be coupled to strategies that deal with ambiguity and uncertainty, communication and empathy, and, most important, physician self-awareness. Achieving such balance will require fundamental change in medicine's education philosophy along five general lines: (1) assertion of medical ethics as the foundation of clinical medicine; (2) recognition of the central place of values in clinical decision making; (3) cultivation of the ethos of humane care; (4) selection of medical students with the dual capacities of strong cognitive skills and empathy; and (5) encouragement and support of faculty who can transmit the knowledge of clinical science coupled to the principles of humane care. Such changes are both timely and necessary. Although they will be difficult to accomplish, they offer an opportunity for medical educators to foster the development of physicians with the range attributes that this new century demands.     

Digital chest radiography at the University of Chicago: Present status and future plans

Storage-phosphor computed radiography and film digitization systems have been in routine clinical use at the University of Chicago for several years. During this time we have implemented numerous modifications including techniques for scatter reduction, image processing enhancements and display systems to improve the image quality and utility of these devices. We have also evaluated the image quality and functionality of digital systems relative to conventional screen-film radiography. In this paper, we review our experience and summarize our impressions. In addition, we summarize our plans for a rapid transition into picture archiving and communication systems, with hardcopy interpretation being phased out for most modalities over the next 2 to 5 years.     

Evaluation of a teaching workshop for residents at the University of Saskatchewan: a pilot study.

PURPOSE: The University of Saskatchewan College of Medicine in Saskatoon, Canada, has been running a two-day workshop for teachers since 1993 to which both faculty and residents had been invited. Although the design of the workshop is consistent with principles of adult learning, it was important to determine if the workshop effectively helped residents to acquire and then use key teaching skills in real-world situations where they were called on to organize and make presentations. METHOD: This study, conducted in 1998 and 1999 with residents only, used a randomized controlled experiment with third-party ratings of before and after videotaped teaching sessions done in actual performance settings. There were eight residents each in the control and intervention groups. RESULTS: The intervention group made statistically significant and positive changes in two key areas taught in the workshop and showed slight improvement in a third. The changes made by the residents in the intervention group were in presenting the opening "set" (41.4% absolute improvement) and the use of instructional objectives (11.5%). The "body" of their teaching sessions increased slightly (9.3%). The control group held relatively stable. CONCLUSION: While this study demonstrates that the workshop likely made a difference in the teaching performance of the intervention group, the small sample size (eight in each group) and the presence of confounding variables suggest that further research should be conducted.     

Bone mass in physicians: a Howard University Hospital pilot study

PURPOSE: This observational cross-sectional study was done to determine bone mass in physicians and to determine if variables, such as calcium intake and exercise, were related to their bone mass. METHODS: One-hundred physicians of different ethnicities (African, African American, Asian, Caribbean, and Hispanic) were studied. Using dual-energy x-ray absorptiometry (DEXA), bone mass (BMD) of the lumbar spine and hips was measured. A validated questionnaire was used to determine the daily calcium intake and exercise. Student t-test, logistic regression, and Pearson chi-square were used to analyze the data. RESULTS: The study population consisted of 52% men and 48% women, with a mean age of 42 years old and a body mass index of 18.5 to 39.9 kg/m2. Low BMD occurred in 68% of the physicians (osteoporosis in 12%, osteopenia in 56%). Low calcium intake was found in 71%-14% of whom had osteoporosis and 49% osteopenia. Two-thirds of the physicians had inadequate exercise; 57% of this group had decreased BMD (osteoporosis in 9%, osteopenia in 38%). There was no statistical significance between BMD and calcium intake or exercise. CONCLUSION: A high percentage of the physicians in this unique study had a reduced BMD. Most of the physicians with low BMD were less than 45 years of age. This study indicates the need to define BMD in a larger cohort of young, ethnically diverse clinicians, and other health workers.