The Minnesota Rural Physician Associate Program for medical students

The Rural Physician Associate Program (RPAP) at the University of Minnesota Medical School is a clinical education experience for third-year students that lasts nine to 12 months. In 1970 the Minnesota legislature required the medical school faculty to find an educational method to redistribute physicians into the medically underserved rural areas of Minnesota or lose state funds for the medical school. After 16 years of the program, all 87 counties in Minnesota have an acceptable ratio of general physicians for the first time in the state's history. RPAP students work directly with and are supervised by general physicians practicing in rural areas; these preceptors have an average age of 40 years, are board-certified, and have 12 years of clinical experience. They give their teaching services and a $2,500 stipend to the student; the state provides $7,000 to the student with no obligation that the student practice in rural Minnesota after training. The preceptors, RPAP staff members, and visiting university faculty members provide 50, 30, and 20 percent, respectively, of a student's grades for the program; the student receives six months of credit for the program. As of 1986, 57 percent of the former RPAP students in practice were practicing in rural communities, with a majority in Minnesota and a majority in towns with populations less than 10,000.     

员工帮助计划在中青年慢性病管理中的应用

目的通过员工帮助计划(简称EAP)在企业员工慢性病管理中的应用,分析EAP在此类人群管理中的成效,探讨中青年慢性病管理模式。方法采取与企事业单位高层领导签订EAP协议的方法,建立职工健康档案;通过健康体检与问卷调查,全面筛查出慢性病人群,调查出健康知识知晓率、健康行为形成率和幸福指数;然后采取开展健康教育与健康促进活动以及一系列企业员工心理援助等措施;一年后再次进行健康体检和问卷调查,进行统计分析与比较。结果全体员工血压、血糖、血脂和BMI等数值超标人数明显下降,健康知识知晓率、健康行为形成率和员工幸福指数明显提高,企业管理更加人性化与和谐。结论员工帮助计划在防控中青年慢性病、提高员工健康水平和幸福指数方面具有显著成效。     

Evaluation of a child health associate program.

The staff of the University of Colorado Child Health Associate Program critically reviewed the effectiveness of the program's structure and content during an intensive two-day seminar. The review was conducted through workshops involving participants representing students, graduates, faculty, employers, funding agencies, university administrators, and educational consultants. The agenda for the evaluation included workshops on specific topics such as basic and clinical sciences, psychosocial skills, and proficiency testing. Information obtained provided extremely valuable data which were used to improve the program.     

The impact of a physician's warning on recovery after alcoholism treatment.

OBJECTIVE--To study whether alcoholic workers had seen physicians during the year they were identified by their company, whether they recalled physicians' warnings about drinking, and whether such warnings affected outcomes 2 years later. DESIGN--Workers were interviewed at intake and 2 years later: subgroups who did and did not see physicians and who did and did not recall warnings were compared. SETTING--A company-union employee assistance program. PARTICIPANTS--Two hundred problem drinkers, newly identified on the job, predominantly male, blue-collar workers. OUTCOMES--Drinking, drunkenness, average daily alcohol consumption, and impairment score. RESULTS--Among the 200 participants, 74% saw physicians in the index year; only 22% recalled warnings. Recall of a warning was associated with liver disease, continued drinking while ill, supervisors' job warnings, older age, and marijuana use. Two years later, those warned were more likely to be abstaining, and sober, and were less impaired. CONCLUSIONS--Recalling a physician's warning at intake into alcoholism treatment was associated with better prognosis 2 years later. However, among this group of employees whose drinking was serious enough to be identified on the job, fewer than a quarter recalled physicians' warnings, even though more than three quarters had seen physicians in the year preceding intake.     

An AAMC pilot study by 10 medical schools of clinical evaluation of students

In 1979 the Association of American Medical Colleges (AAMC) began a Clinical Evaluation Program. In the first phase of the program, AAMC staff members interviewed more than 500 persons in approximately 40 medical schools and solicited responses from clerkship coordinators in six specialties on the problems encountered in evaluating students' clinical performance. These results were published in 1983. The second phase of the program, which is reported on in the present paper, consisted of developing a set of self-assessment instruments in clinical evaluation and testing these instruments by 10 pilot schools. Clinical faculty members and clerkship coordinators in the pilot schools and residents at affiliated hospitals who worked with the students were asked to identify the problems they faced in evaluating students' clinical performance, and these responses were analyzed in terms of the respondents' specialties. The problems identified by the highest percentages of clinical faculty members and residents were: inadequate guidelines for handling problem students, failure to act on negative evaluations, lack of information about problems that students bring with them into clerkships, and faculty members' unwillingness to record negative evaluations. A rank-ordering of these responses on problems showed that different specialties considered different problems to be severe. In rating difficulties in evaluating problem students, the respondents reported that the type of problem student most frequently encountered was one who cannot focus on what is important. Rank-ordering of these responses showed that each type of problem student poses different evaluation difficulties in each specialty. The respondents also identified the problems they had with the evaluation forms used in their departments.     

Organizing an academic nursing home. Impacts on institutionalized elderly

In March 1984, a program for an academic nursing home was established at the Sepulveda Veterans Administration Medical Center. The program was designed to improve care of nursing home patients, provide interdisciplinary training for medical house staff and allied health students, and stimulate research. Geriatric faculty physicians were appointed, medical house staff were assigned as primary physicians to groups of patients, and geriatric nurse practitioners were hired to provide day-to-day care. A two-phase evaluation of the impact of the academic nursing home on patient care was conducted. Beneficial developments associated with the program in concurrent comparison with the standard nursing home unit included a significant decrease in patient transfers to the acute-care hospital and significant improvements in functional status, patient satisfaction, and morale. A trend toward improved survival was nonsignificant. Longer-term follow-up revealed a significantly increased rate of discharge for patients completing long-term rehabilitation. Overall, the costs of nursing home care were only minimally increased by the program. Results suggest that programs like the academic nursing home can lead to improved process and outcomes of nursing home care.     

A committee on well-being of medical students and house staff

A committee on well-being of medical students and house staff was established in a university medical center to address some of the socioemotional aspects of medical education and training. The overall goal was to influence the learning climate in ways that would enhance positively the educational experience. Several problem areas were identified. They included poor communication, stressful effects of medical education both on self and on relationships, a need for advocacy, and a lack of support for house staff members. A series of programs were designed and implemented in response to these issues. With institutional support, a committee on well-being may serve as an effective approach in alleviating some of the stresses of the medical training process.     

Faculty and house staff members as role models

In the fall of 1986 approximately 100 faculty members, community physicians, house staff members, and students associated with Indiana University School of Medicine participated in a conference on "Teachers as Role Models: The Impact on the Learning Process." Small-group discussions allowed the participants to define and discuss the impact of role-modeling in medical education. It was anticipated by the organizers that after the conference the participants would be more cognizant of their influence as role models and would be motivated to become better role models and support good role-modeling. A synopsis of the conference indicates that the participants identified both the positive and negative impact of role-modeling and concluded that medical educational programs should use positive role-modeling as a teaching tool to instill within students the desire to gain new knowledge and to apply that knowledge as medical professionals.     

高等医学院校本科应用心理学专业培养方案的研究与实践

近年来开设应用心理学专业的高等医学院校越来越多,制定科学的专业培养方案是各有关高校亟待解决的问题,但目前尚无各单位认同的权威性的培养方案。本文根据齐齐哈尔医学院4年来本科应用心理学专业的办学实践和对国内外有关文献的研究,提出了高等医学院校本科应用心理学专业的培养方案,以供医学院校开办本科应用心理学专业参考。     

Development of an internal medicine clerkship by a department of medicine

In this report, the author summarizes the creation and evolution of an internal medicine clerkship in three large teaching hospitals undergoing transition from affiliated hospitals to the university hospitals of a new medical school. The creation of the clerkship has had major effects on the perceptions of both the residents and the faculty of their roles as teachers and evaluators. The methods felt to be particularly successful in facilitating the transition of the hospitals are emphasized: a preceptorship for medical students, monthly grading conferences for students, and evaluations by the students of the clerkship, the house staff, and the faculty.     

A 'firm' system for graduate training in general internal medicine.

The faculty of the Department of Medicine at Cleveland Metropolitan General Hospital has responded to the challenge of fostering general internal medicine in a graduate training program by organizing a "firm" system of medical care which has appealed to academic internists with broad interests in clinical medicine. This firm system consists of four medical teams which care for distinct patient populations, closely integrating their outpatient and inpatient care. The firms are made up of all the house staff in training in internal medicine together with senior and junior faculty members who are directors for the firms. Medical students in general medicine are also assigned to firms. This firm system is relatively simple to understand and establish and is readily applicable to other academic departments with general medical responsibilities.     

Summer research program for medical students

The decrease in the number of physician investigators is a serious national problem. Direct participation in research by medical students is widely regarded as a valuable component of medical education and as a stimulus to a career in research. A voluntary summer research program was implemented at the Medical College of Ohio at Toledo with student participation exceeding 20 percent for the classes entering in 1980 and 1981 and reaching 40 percent for the freshman class that entered in 1982. The research program was planned along with implementation of a new four-year curriculum. First-year students were encouraged to participate in research projects during the summer between their first and second year. Interested students were matched with faculty members by mutual agreement. An evaluation of the program based on publications and presentations by medical students and on responses of students and faculty members to a questionnaire was made.     

Alcohol-related disease in hospital patients

Ninety medical records of patients with an alcohol-related diagnosis who were admitted to a major city teaching hospital over a 12-month period were reviewed to assess the ways in which the problem had been recognized and managed by hospital staff members. The overall frequency of an alcohol-related diagnosis of 1.8% suggested an under-reporting of this medical problem. Those patients who were identified were, in general, well managed, but patients with less obvious and permanent clinical problems, such as non-dependent abuse of alcohol or acute alcoholic intoxication, were more likely to have minimal or no attention directed to the drinking problem. Our review suggests that medically trained staff members identify significant organ damage readily. It also suggested that more attention needs to be directed to the education of medical students and staff members in the recognition of the early stages of alcohol dependency and misuse, so that its more serious complications might be minimized by effective intervention.     

Comparing recommended sanctions for lapses of academic integrity as measured by Dundee Polyprofessionalism Inventory I: Academic integrity from a Saudi and a UK medical school

Background

There are varying perceptions about professionalism and academic integrity, both being influenced by regional, cultural, contextual and religious factors worldwide. Very few studies have compared the variations in understanding about academic integrity among medical faculty and students. This study explored the existing understanding of academic integrity in a Saudi and a UK medical school.

Institution-wide program for impaired residents at a major teaching hospital

An institution-wide program for residents impaired by alcohol, other drugs, or emotional problems was established in 1983 at the Medical College of Wisconsin Affiliated Hospitals. The goal of the program was to help impaired house staff members to continue their training in a nonpunitive environment. An approach to reviewing allegations of impairment and a legal agreement between the hospital and the recovering resident were implemented. Because no residents were reported for impairment during its first two years, the program's emphasis was shifted from an investigative to an educational, assistive role. Major problems in carrying out the program have been the program's lack of authority to ensure cooperation by program directors and by impaired residents; a widespread unfamiliarity with intervention procedures despite efforts to inform residents, their spouses, faculty members, and administrators about the program; and misconceptions that the program is punitive. Further impediments are lack of a budget to provide educational activities, inadequate socializing between the faculty and the house staff that would enable faculty members to recognize early signs of impairment; and inadequate health insurance coverage for long-term treatment.     

对医学本科毕业生教育目标的认知调查与分析

为探讨医学本科生毕业时应具备哪些基本知识、医疗技能和医德修养,用毕业生终期目标（TheExitObjectivesSurvey,EOS）评估表,调查了192位师生,统计分析了90条项目,其中师生一致（75％赞成）认为必要的有38条（42％）,以及四川大学华西临床医学院与美国华盛顿大学之间、师生之间认识的差异,并讨论其含义和影响因素。希望调查结果可供规划医学生毕业前教育内容的参考,为今后随着社会发展、科技进步和医疗改革的现状,调整传统的教育模式,制定一套层次分明、切实可行的教育目标体系。     

Arizona's three-year medical curriculum: a postmortem.

The College of Medicine at the University of Arizona was among many medical schools instituting a course of study leading to graduation in three years. Students and faculty found the three-year program to be an unsatisfactory educational experience. Among the major problems were excessive intensity of classroom work, insufficient vacation time, and inadequate time to teach important basic science material. Objective measures of student performance demonstrated no differences between graduates of the new program and students graduating from a traditional four-year curriculum. A process of curriculum review involving students, faculty, and administrators ultimately resulted in several curricular improvements and establishment of a new four-year program.     

医学生内科学泌尿系统疾病英语教学的实践与体会

医学教育国际化的要求,使得医学专业英语教学越来越受到重视。华中科技大学同济医学院附属同济医院肾内科,近年来承担了五年制、六年制、七年制、八年制学生和留学生的双语教学及全英语教学任务,根据各学制学生英语教学的特点和要求,在理论授课、PBL、临床见习和实习中实施了不同程度的英语教学,总结经验,有助于提高双语教学质量。     

Development of a campus-based satellite medicine clinic

The clinical facilities of many American medical schools are geographically separate from the main campuses of their parent universities. Traditionally, medical schools and teaching hospitals have made little effort to attract university faculty and staff members as patients. Academic medical centers have tried various strategies to maintain, expand, and broaden the patient population necessary for medical education, clinical research, and fiscal solvency. The University of California, San Diego, School of Medicine has established a campus-based ambulatory clinic to encourage university faculty and staff members to seek care from medical school physicians and to use its teaching hospital several miles away. This approach may be applicable to other institutions where the hospital and the major university campus are located at different sites.