Using standardized patient instructors to teach health promotion interviewing skills.

BACKGROUND: Medical students report knowledge, but inadequate skills, in health promotion and disease prevention (HPDP) technology. An established methodology using standardized patient instructors (SPIs) was adapted and tested for effectiveness in teaching HPDP. METHODS: Thirteen lay persons were trained and given profiles showing high cardiovascular risks. During their family medicine clerkship, 104 students engaged in one-to-one exercises with the SPIs. Half of these sessions were spent in the doctor-patient interview; in the other half, the SPI gave specific feedback using a validated scale. Encounters were videotaped. RESULTS: The students rated the SPI feedback as the program's most valuable aspect and the videotaping as the least valuable. The SPI feedback was rated valuable by 90%-96% of the students. The students also reported that the skills acquired were likely to be used, and they had learned "much" or "very much." As a group, students' self-assessments did not differ from the SPIs' assessments of the students. CONCLUSION: Lay SPIs are a powerful educational tool.

A point-source epidemic of leptospirosis. Description of cases, cause, and prevention.

Leptospirosis is a zoonotic disease that consists of fever, headache, myalgias, and multiple organ involvement, has varying clinical severity and morbidity, and can occur in epidemic form. Diagnosis is based on culture or serologic demonstration of recent infection. There is evidence that doxycycline therapy started early in the course of the disease favorably affects duration and severity. Antibiotic therapy is often initiated because of a strong suspicion of the disease, before bacteriologic or serologic confirmation of the diagnosis is completed. Public health measures play an important role in minimizing the incidence of leptospirosis.

The natural history of palpitations in a family practice.

A retrospective cohort study was conducted to assess whether palpitations are an independent risk factor for increased cardiac morbidity or mortality. A cohort of 109 patients with palpitations, seen over a five-year period in a primary care setting, was compared with an age- and sex-matched control cohort. Mean length of follow-up was 42 months. There was no statistically significant difference in incidence of morbidity or mortality (6.4 percent for the cohort with palpitations and 7.2 percent for the control cohort) between the two groups. This study suggests that palpitations are not an independent risk factor for increased cardiac morbidity or mortality.

Uses and safety of acyclovir in pregnancy.

Acyclovir, an antiviral nucleoside analogue, is a widely used agent highly specific for herpes simplex and varicella-zoster viruses. Unintended exposure to acyclovir early in pregnancy, which is not uncommon, may cause excessive maternal and physician anxiety. This drug has not been studied prospectively in large numbers of pregnant women and lacks the Food and Drug Administration's approval for gestational use unless benefits clearly outweigh potential fetal harm. However, data published since acyclovir became available do not indicate increased adverse effects related to its use in pregnancy, especially if prescribed in selected situations, such as disseminated primary herpes simplex infections or maternal varicella pneumonia. This article reports the impact of inadvertent acyclovir exposure on a woman during the first trimester of pregnancy and reviews the literature on acyclovir's pharmacology, safety profile, and potential uses during pregnancy.

Analysis of resident and attending physician interactions in family medicine.

Clinical teaching does not fit neatly into traditional teaching-learning models. The interaction between a resident and an attending physician is of particular interest because it has several functions including education, supervision, socialization, and quality control. The purpose of this study was to observe, classify, and record verbal teaching and learning behaviors in the resident-attending physician interaction. During a 12-month period, 125 observations of resident-attending physician interactions were recorded; the average length of the interactions was 4.27 minutes. The six most frequent resident verbal behaviors compared by postgraduate year level did not vary significantly. Only one of the six most frequent attending physician verbal behaviors varied significantly. In the average interaction of about 4 minutes, three fourths of the interaction was on patient care issues, leaving little time for teaching. There are many unanswered questions about the resident-attending physician interaction and its contribution to the training of a physician.