European School of Internal Medicine (ESIM) in Brighton: experiences and reflections

The European School of Internal Medicine (ESIM) is a meeting aimed at young physicians training in internal medicine throughout Europe. Since 1998 the school has been held annually, and in this report we reflect on our experiences during the recent school in Brighton in July 2010. The school combined a broad mix of lectures, workshops and case presentations covering a variety of rare diseases, and both faculty and residents participated with noticeable enthusiasm, making this a special experience for all of us. The school also provided an opportunity to compare and discuss topical professional issues in internal medicine in Europe and was a memorable social gathering for physicians who share a strong interest in internal medicine.     

Variation in Internal Medicine Residency Clinic Practices: Assessing Practice Environments and Quality of Care

Background  Few studies have systematically and rigorously examined the quality of care provided in educational practice sites. Objective  The objectives of this study were to (1) describe the patient population cared for by trainees in internal medicine residency clinics; (2) assess the quality of preventive cardiology care provided to these patients; (3) characterize the practice-based systems that currently exist in internal medicine residency clinics; and (4) examine the relationships between quality, practice-based systems, and features of the program: size, type of program, and presence of an electronic medical record. Design  This is a cross-sectional observational study. Setting  This study was conducted in 15 Internal Medicine residency programs (23 sites) throughout the USA. Participants  The participants included site champions at residency programs and 709 residents. Measurements  Abstracted charts provided data about patient demographics, coronary heart disease risk factors, processes of care, and clinical outcomes. Patients completed surveys regarding satisfaction. Site teams completed a practice systems survey. Results  Chart abstraction of 4,783 patients showed substantial variability across sites. On average, patients had between 3 and 4 of the 9 potential risk factors for coronary heart disease, and approximately 21% had at least 1 important barrier of care. Patients received an average of 57% (range, 30–77%) of the appropriate interventions. Reported satisfaction with care was high. Sites with an electronic medical record showed better overall information management (81% vs 27%) and better modes of communication (79% vs 43%). Conclusions  This study has provided insight into the current state of practice in residency sites including aspects of the practice environment and quality of preventive cardiology care delivered. Substantial heterogeneity among the training sites exists. Continuous measurement of the quality of care provided and a better understanding of the training environment in which this care is delivered are important goals for delivering high quality patient care.     

Internal medicine residency redesign: proposal of the Internal Medicine Working Group

Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside. Key factors for new emphasis include patient-centered small group teaching, greater incorporation of clinical epidemiology and health services research, and better schedule control for trainees. Because previous proposals were weakened by lack of evidence, we propose to organize the Cooperative Educational Studies Group, a pool of training programs that will collect a common data set describing their programs, design interventions to be tested rigorously in multi-methodological approaches, and at the same time produce knowledge about high-quality practice.     

《中华内科杂志》2005-2011年载文被引分析

目的 应用文献计量学方法研究《中华内科杂志》2005至2011年载文的学术水平.方法 利用中国科学引文数据库(CSCD)提供的资料和数据,检索《中华内科杂志》2005至2011年载文被引用情况.结果 2005-2011年《中华内科杂志》共刊出文章2809篇,其中832篇(29.62％)被引用,共1993次.共有14位论文作者的文章总被引频次≥10次.被引文章作者来自全国25个省、市、自治区,其中北京(341篇)、上海(87篇)、广东(64篇)、江苏(45篇)、浙江(43篇)位居前列.对被引论文作者的所在机构进行统计,中国医学科学院北京协和医学院北京协和医院(205次)、北京大学人民医院(77次)、解放军总医院(76次)居前3位.结论 《中华内科杂志》近年来发表了一批高水平的学术论文,在促进医学学术交流方面起到了良好作用.     

《中华内科杂志》被引频次的影响因素分析

目的 分析发表于《中华内科杂志》2008-2010年所有学术性文章的属性和被引情况,以探讨影响《中华内科杂志》影响因子(IF)的因素.方法 检索并套录中国生物医学期刊引文数据库(CMCI)中收录的《中华内科杂志》 2008-2010年的所有文献,手工统计文献各相关因素并进行分层比较.结果 《中华内科杂志》3年共发表1164篇学术性文献,篇均参考文献9.95条,总被引频次为1029次,其中篇均被引0.93次/篇,面均被引0.31次/面,零被引文献736篇,占发文总数的63.2％.论著类、纯临床类的文献有较好的引文产出.在基金资助方面,无基金资助的研究比有基金支持者有更好的产出.血液病学、心血管病学、胃肠病学是统计年中发文量最多的3个专业,而内科领域亚专业中的重症医学、急诊医学和肾脏病学发文量最少;虽然各学科间引文情况存在固有差异,但仅就引用绝对值看,引文产出较好的是神经/精神病学(篇均被引0.73次)、心血管病学(0.65次)和胃肠病学(0.54次),而血液病学、基础医学和风湿病学对IF的贡献相对不足.结论 加强优秀论文的组稿和宣传力度,减少零被引文献的数量,扩大显示度,提供更快捷和便利的文献阅读方式是编辑部下一步工作的重点.     

Associations Between United States Medical Licensing Examination (USMLE) and Internal Medicine In-Training Examination (IM-ITE) Scores

Background  Little is known about the associations of previous standardized examination scores with scores on subsequent standardized examinations used to assess medical knowledge in internal medicine residencies. Objective  To examine associations of previous standardized test scores on subsequent standardized test scores. Design  Retrospective cohort study. Participants  One hundred ninety-five internal medicine residents. Methods  Bivariate associations of United States Medical Licensing Examination (USMLE) Steps and Internal Medicine In-Training Examination (IM-ITE) scores were determined. Random effects analysis adjusting for repeated administrations of the IM-ITE and other variables known or hypothesized to affect IM-ITE score allowed for discrimination of associations of individual USMLE Step scores on IM-ITE scores. Results  In bivariate associations, USMLE scores explained 17% to 27% of the variance in IME-ITE scores, and previous IM-ITE scores explained 66% of the variance in subsequent IM-ITE scores. Regression coefficients (95% CI) for adjusted associations of each USMLE Step with IM-ITE scores were USMLE-1 0.19 (0.12, 0.27), USMLE-2 0.23 (0.17, 0.30), and USMLE-3 0.19 (0.09, 0.29). Conclusions  No single USMLE Step is more strongly associated with IM-ITE scores than the others. Because previous IM-ITE scores are strongly associated with subsequent IM-ITE scores, appropriate modeling, such as random effects methods, should be used to account for previous IM-ITE administrations in studies for which IM-ITE score is an outcome.     

Acute Medicine: Triage, timing and teaching in the context of medical emergency admissions

Acute Medicine has been recognized as a sub-specialty of General Internal Medicine in the UK for 6 years. Acute Medicine aims to streamline diagnostic processes and treatment decisions for patients presenting with an acute illness in Internal Medicine in order to improve safety, patient experience and resource utilization. Acute Physicians are specialists in Acute Medicine. Co-location of patients in Acute Medical Units helps to rationalize logistical processes and supports training of junior doctors in supervised management of both life-threatening and complex medical emergencies. Research is needed to formally evaluate the impact of the format of service delivery on clinical outcomes and length of hospital stay for patients with comparable sickness profiles.     

2000-2004年中华内科杂志载文被引分析

中华内科杂志为中华医学会主办的内科专业学术期刊,重点报道内科领域领先的科研成果和临床诊疗经验以及对内科临床有指导作用且与内科临床密切结合的基础理论研究。是国家科技部“中国科技论文统计源期刊”(中国科技类核心期刊),分别被国际知名数据库《美国医学索引》(IM/MEDLI     

Politics and Graduate Medical Education in Internal Medicine: A Dynamic Landscape

The promotion of change and growth within medical education is oftentimes the result of a complex mix of societal, cultural and economic forces. Graduate medical education in internal medicine is not immune to these forces. Several entities and organizations can be identified as having a major influence on internal medicine training and graduate medical education as a whole. We have reviewed how this is effectively accomplished through these entities and organizations. The result is a constantly changing and dynamic landscape for internal medicine training.     

循证医学与经验医学的区别

从4个方面论述了循证医学与经验医学的区别，主要是评价结果的指标不同，循证医学更重视以满意的终点指标为主要评价指标：其次是证据的来源不同，循证医学倡导的是慎重、准确而明智地应用目前所能获得的最佳证据，即RCT结果；此外，对研究方法的要求不同，循证医学强调的是采用RCT方法，对大样本病例进行系统观察和评价；最后是对样本量的要求不同，循证医学要求证据的获得是基于大样本、多中心、大规模的临床试验。循证医学从根本上克服经验医学模式下的无序医疗，向着有序医疗的目标迈进。