Geriatrics program for medical students. II. Impact of two educational experiences on student attitudes.

In an innovative program in geriatrics for undergraduate medical students, the preliminary report concerned attitudes toward the aged among health care personnel. This follow-up report concerns the stability of, and changes in medical students' attitudes toward the aged after participation in one of the following types of geriatric educational experience: 1) a Family Practice clerkship, or 2) a selective course in Medical Humanities. Although both experiences resulted in positive changes in general attitudes, the one that emphasized empathy toward the elderly along with observation of healthy aged persons produced more positive feelings about rehabilitation potential. Implications for the geriatric training of physicians are discussed in the light of these findings.

Geriatrics program for medical students and family practice residents. I. Establishing attitudes toward the aged.

This report concerns the initiation of required experience in geriatrics for undergraduate medical students and a program of research designed to evaluate that experience. Through the use of questionnaires, an attempt was made to differentiate between attitudes toward the elderly and their rehabilitation potential as stated by medical students, family practice residents, and professional and nonprofessional nursing-home staff members. Important differences were found between professional and nonprofessional groups, but no significant differences among professionals. Implications for the training of professional and nonprofessional staff members are discussed, and further research plans specified.

Sex differences in student preference for family medicine.

Differences between male and female students at the University of Washington School of Medicine in their choices of family medicine specialization were examined over a ten-year period. Specialty choices during the second year of medical school were compared to later residency selections. Women showed a significantly stronger early preference for family practice but were less likely to select a family medicine residency than their male counterparts. Although the magnitude of the differences was modest, the possible decline in interest among a group of students who intuitively seem particularly suited to this specialty appears worthy of note. Possible implications of these findings are discussed.

Long-term evaluation of a substance abuse fellowship program in family medicine.

BACKGROUND: Faculty development fellowship programs provide avenues for physicians to develop careers in academic medicine. However, the long-term impact of these programs has not been evaluated. This paper examines the impact of an 18-month substance abuse faculty development fellowship administered by the Society of Teachers of Family Medicine (STFM) 7 years after the fellowship's completion. METHODS: Fellows were interviewed by telephone. Their CVs were examined to assess how their present substance abuse teaching, clinical, research, administrative, scholarly, and networking activities compared with those prior to the fellowship. RESULTS: Initially, fellows contributed modules to an STFM publication and increased substance abuse teaching in their home institutions. Seven years later, fellows reported increased activity in substance abuse teaching, clinical, administrative, and research activities over those prior to the fellowship and attributed these increases to the fellowship. Fellows' CVs reflected increased publications, presentations, and networking activities with each other, including the creation of the STFM Group on Substance Abuse. CONCLUSIONS: In a 7-year follow-up, STFM's substance abuse fellowship program met its original goals, strengthened the academic and professional achievements of the fellows, and fostered the development of several fellows as leaders within the substance abuse field.

Creating a substance abuse network in family medicine: lessons learned.

Family practice was one of several primary care specialties awarded federal contracts in 1985 to survey substance abuse training needs. Family medicine has since excelled in creating a viable substance abuse network. Key events were the sponsorship of a fellowship program, the formation of the Society of Teachers of Family Medicine (STFM) Substance Abuse Working Group, and the working group's pursuit of externally funded projects. Tangible measures of the network's success include collective funding exceeding $7.3 million, an increase in the number of substance abuse activities at annual STFM conferences, and a nearly four-fold growth in the group's membership and collaborative publications. Key factors underlying the vitality of the network that may be generalizable include: 1) initial emphasis on training family physician faculty; 2) making optimal use of the existing administrative channels within STFM; 3) acquisition of external funding; 4) some continuity of core persons working together; 5) active networking within and outside family medicine; and 6) promotion of individual success.

Efficacy of an alcoholism self-report questionnaire in a residency clinic.

The efficacy of the CAGE alcoholism screening test, when used as a part of a much larger health and social history questionnaire, was assessed in a family medicine residency clinic by retrospectively studying 155 charts of randomly selected adult patients. The rate of problem drinking, as determined by the CAGE, was then compared with the rate found in other studies using the CAGE questionnaire. The CAGE responses were also compared with other information in the patients' charts to assess how frequently this screening test might support a diagnosis of problem drinking. The incidence of problem drinking identified by the CAGE was 3.2 percent, compared with the expected 9.8 percent level (P = .0039). The CAGE questionnaire proved to be no better than a simple self-report of alcohol consumption (which demonstrated an incidence of 4 percent), and failed to identify two patients with histories of alcohol abuse as noted in their charts. CAGE, when used as a part of a larger health questionnaire, thus failed to identify the anticipated number of patients with drinking problems.

Alcoholism curriculum development: an examination of the process.

Alcoholism is one of several topics that may be integrated into family medicine clerkship teaching. This article focuses on the process of curriculum development in alcoholism. The process is traced from its beginnings in a third-year clerkship to its integration into the medical school curriculum and other areas of medical education. Strengths and pitfalls in this project are discussed. Enlisting community support and field testing newly developed strategies are emphasized as successful methods. Less successful in this project, though equally important, are faculty development and long-term evaluation. Recommendations for curriculum development in similar projects are made.

Evaluating students in family medicine using simulated patients.

Various techniques have been used to evaluate students in family medicine clerkships and electives. Multiple choice or essay questions have been used extensively but are not satisfactory in testing some of the affective areas considered important for future family physicians. At Southern Illinois University School of Medicine, the Department of Family Practice has evolved an evaluation system using simulated patients as well as traditional methods. Simulated patients have proved to be an excellent means of evaluating affective skills which are not easily tested by other techniques.

An analysis of the magnitude of clinical-reasoning deficiencies in one class.

Clinical-reasoning ability is indispensable to a good doctor, but students are generally expected to "pick it up" in the course of their clinical clerkships. Concern by the University of Washington School of Medicine that some students did not master the concepts of clinical reasoning led to the formation of an ad hoc committee whose retrospective study on the class of 1981 is reported here by the authors. Nineteen students (11 percent of the graduating class) who were repeatedly noted by faculty members to have problems with clinical reasoning throughout their clinical clerkships were identified as a result of this study.