Exploring instructional quality indicators in ambulatory medical settings: an ethnographic approach.

BACKGROUND AND OBJECTIVES: As medical education moves to community settings, the quality of learning is influenced by differences in the practice environment, organization, resources, patient case mix, and demographics. This ethnographic study identified experiences and processes that influence student learning in community-based practice settings. METHODS: Trained field researchers conducted participant observation in eight community teaching sites. Data were analyzed using a qualitative, grounded theory approach. RESULTS: Three dominant themes emerged: 1) the preceptor's role in situating learning opportunities, 2) the learner's role in transforming experience into learning, and 3) the practice organization as a classroom setting. The findings highlight the importance of exploiting learning opportunities and the contributions of other medical staff and patients in facilitating unique learning experiences. CONCLUSIONS: This research suggests the need to move beyond the typical student ratings of teacher effectiveness to consider and assess additional important factors and processes that affect instructional quality.

Faculty development for community-based physicians at the University of Massachusetts and SUNY-Buffalo.

Community-based faculty development (CBFD) is becoming increasingly important as medical education moves into the ambulatory/office-based setting CBFD provides preceptors with essential knowledge, skills, and attitudes directly related to teaching while providing a sense of identity as teachers to a diverse group of practitioners in a variety of settings. This article reviews the structure and function of successful community-based faculty development, using as examples programs from the University of Massachusetts Medical School and the State University of New York at Buffalo that were supported by The Robert Wood Johnson Foundation's Generalist Physician Initiative. After reviewing the literature on successful implementation of programs dedicated to community-based precepting, the authors investigate the educational concepts, instructional designs, and operational characteristics that are the framework for providing successful faculty development to community-based preceptors. They list rationales and examples of the educational methods used and compare structural components of the programs at both institutions. Last, they explore future directions in the rapidly changing medical education environment that need to be addressed in CBFD in the areas of outcome/program evaluation, comprehensive needs assessment, and regionalization.

Accessing information resources in preventive medicine: current practice and future trends.

This article describes the ways physicians in preventive medicine can access state-of-the-art computer and information technologies to keep abreast of the medical literature in order to provide outstanding care to their patients, engage in lifelong learning, and become adept at traversing the information superhighway.

Medical education and faculty development: a new role for the health sciences librarian.

This paper describes the roles and responsibilities of the associate director for medical education at the Primary Care Resource Center (PCRC), School of Medicine and Biomedical Sciences, State University of New York at Buffalo (UB). The PCRC was established to increase the number of UB medical school graduates who selected graduate medical education in the generalist disciplines. The associate director, who is a health sciences librarian, has established collaborative working relationships with primary care physicians in the clinical departments of family medicine, pediatrics, and internal medicine with the goal of improving the teaching effectiveness of faculty and residents. Another goal is to incorporate the use of computerized information technologies into clinical practice by training physicians and residents, at specially equipped ambulatory training sites, in how to access and manage information for the purpose of providing quality medical care. This has been accomplished in part through the provision of highly personalized instruction to participants. In addition to describing these activities, this paper examines how the duties of the associate director reflect the potential for long-term change in the roles and responsibilities of health sciences librarians, whether they work in a traditional or nontraditional setting.

Anatomic considerations in lumbar posterolateral percutaneous procedures.

STUDY DESIGN: Intervertebral foraminal anatomy of L2-S1 was investigated by the anatomic dissection of 96 foraminal levels in 12 human cadaveric spines. OBJECTIVES: The goal of this study was to determine the dimensions of the "safe zone" and a safe point of insertion in percutaneous intradiscal procedures and the largest safe working cannula diameter. SUMMARY OF BACKGROUND DATA: Working cannulas are used in percutaneous lumbar procedures. The dimensions of the safe zone of insertion and determination of the optimal cannula size based on these measurements and point of insertion are unclear from the literature. METHODS: Safe zone dimensions from L2-L3 to L5-S1 were determined as were two cannula diameters, C1 and C2. C1 was the maximal cannula size that can be placed within the safe zone. C2 is the maximal size allowable when the point of insertion lies in the midline of the pedicle. RESULTS: The average triangular safe zone was 18.9 mm wide and 12.3 mm high; the hypotenuse measured 23.0 mm. The maximum C1 diameter ranged 5.0-10.0 mm. The corresponding safe point of insertion lay along the medial one third of the pedicle. The maximum C2 diameter ranged 4.0-8.9 mm. The corresponding safe point of insertion lay in the midline of the pedicle. CONCLUSIONS: Either a 7.5-mm cannula placed in line with the medial one third of the pedicle or a 6.3-mm cannula located in the midline of the pedicle appears safe.

MEDLINE training for medical students integrated into the clinical curriculum.

This study was initiated in response to the availabilty of unlimited access to MEDLINE via the PaperChase interface at the host institution. The goal of the study was to analyse the usage of MEDLINE by medical students during their third-year clinical clerkship in paediatrics. This was achieved by first giving them a formal demonstration of MEDLINE and then longitudinally administering a structured questionnaire at several points during their paediatric clerkship. Since medical students were required to write a thesis for this clerkship, which included an analysis of the primary literature, there was an identified need for using the system. This study analyses the students' perceptions and searching activities after formal training and upon having unlimited access to MEDLINE.

Impact of end-user search training on pharmacy students: a four-year follow-up study.

The Alfred Taubman Medical Library at the University of Michigan has offered instruction in online literature searching to third-year pharmacy students as a component of the course "Drug Information and Scientific Literature Evaluation" since 1983. In the spring of 1989, a follow-up study was conducted to assess the impact of instruction on four classes of graduates. Of a pool of 151 graduates, 90 (60%) responded to a mailed questionnaire on their use of information and computerized literature searching. The respondents were divided into four subgroups: end-user searchers, users of intermediaries, end users who used intermediaries, and those who did not use computerized literature search systems. Seventy-two percent of the respondents used some type of computerized literature searching, and 42% performed their own searches. The four subgroups differed in general computer use, familiarity with MEDLINE search terminology, information use, reasons for using or not using literature searching, and characteristics of searches (i.e., type, time frame, amount, and frequency). Training in end-user search systems appears to have had an impact on the continued use of computerized literature searching several years after the formal educational program.

Techniques for accessing the medical literature. I. Currently available approaches.

Today physicians and scientists have a wide range of choices in their quest to locate both clinical and scientific information. This article describes the range of choices available to allergists and immunologists as they attempt to locate information on a subject and offers some simple suggestions for managing the increased body of biomedical information.

New roles for the medical librarian in an information management environment.

Over the course of the next twenty years libraries will be undergoing significant retooling so that they can move beyond their traditional roles and become the manager of the medical center's information network. As libraries automatic, the role of the medical librarian will change. To manage the change with ease librarians must begin now to equip themselves, their libraries and their clientele to function effectively in the new environment. Developing formalized instructional programs that link individuals to information and to systems that provide those individuals with personal memory extenders and lifelong learning supports will be among the librarian's top priorities.