Scholarship in the medical faculty from the university perspective: retaining academic values.

Academic medicine and research universities have enjoyed a close relationship that has strengthened both, spawning an era of discovery and scholarship in medicine that has earned the U.S. academic medical enterprise a high level of public trust and a deserved leadership position in the world. However, changes in the financing of medical care and in the organization of health care delivery have dramatically affected the medical school-university partnership. The growing emphasis on delivery of clinical services and the concomitant decrease in time for tenured and clinician-educator faculty to teach and do scholarly work jeopardizes both the potential for continued discovery and the education of the next generation of medical scholars. The background of the medical school-university relationship and the factors leading to the development of clinician-educator faculty tracks are reviewed, and recent trends that impact faculty scholarship are discussed. Both tenure-track and clinician-educator medical faculty, as members of the broader university community, should expect from their university colleagues a continued demand for scholarship and educational activity that reflects the underlying philosophy of the parent university. As a corollary, the university, through its medical school, must provide these faculty the time and the financial support necessary to fulfill their academic mission. The size of the clinician-educator faculty should be determined by the academic needs of the medical school rather than by the service demands of its associated health care delivery system. To accomplish this, academic medical centers will have to develop cadres of associated or clinical faculty whose primary focus is on the practice of medicine.

American Academy of Dermatology guidelines of care. Development and process.

Medical practice guidelines are being developed at an accelerating pace, in all areas of medicine, for a wide range of uses. The field of practice guideline development is not new, but a number of important economic and health care issues have renewed interest in their creation. In 1987, in response to many of these issues, the American Academy of Dermatology took a leadership role and began a process designed to develop guidelines for disease entities treated by dermatologists. The result was a set of clinical practice guidelines and the most comprehensive dermatology guideline development processes to date. Herein we describe the guideline development process in its current, refined form and discuss some of its unique and important characteristics. New applications of guidelines, outside of clinical practice improvement, have made their development controversial. Nevertheless, it is important for the medical profession to lead in this effort, and the American Academy of Dermatology continues to explore ways to refine and update its guidelines to reflect the latest medical science and technology.

Patch testing for contact dermatitis.

Patch testing is perhaps not an exact science, but it is the best method available for identifying and confirming contact sensitivity. Illustrated step-by-step instructions for the procedure are presented, with helpful hints to avoid some of the pitfalls.

Self-blame and adjustment to breast cancer.

PURPOSE: To examine the relationship between self-blame and illness adjustment in women with breast cancer. DESIGN: Descriptive, correlational design. SETTING: Outpatient facilities of two metropolitan medical centers. SAMPLE: 234 women diagnosed with stage I or II breast cancer. METHODS: Structured and semistructured interviews using the Psychosocial Adjustment to Illness Scale (PAIS), the Global Adjustment to Illness Scale (GAIS), an attributions and blame interview, and several questions about control over the cause and course of the cancer. MAIN RESEARCH VARIABLES: Self-blame, controllability, and adjustment to illness. FINDINGS: 39% of the sample reported some self-blame. Analysis of variance indicated that subjects with high levels of self-blame had poorer scores on the PAIS and GAIS. CONCLUSIONS: The findings indicate the need for further study of the self-blame/adjustment relationship. Researchers must clarify the characteristics that compromise adjustment in patients with breast cancer. IMPLICATIONS FOR NURSING PRACTICE: The findings support the importance of assessing self-blame and providing information to discourage its use by patients with breast cancer.

Adjustment to breast cancer using downward comparison.

Downward comparison is a cognitive process that is used when events such as illness threaten a person's self-esteem. The afflicted person feels better about his/her situation when he/she compares himself/herself with another whose condition is worse. This study identified the presence of downward comparison in 195 women with recently diagnosed breast cancer and determined the impact of such comparison on adjustment. The results indicate evidence of downward comparison. In comparison to others with breast cancer, most patients indicated they thought that they were better in regard to physical condition, coping, medical condition, and life experience. Clinicians should assess for the presence of downward comparison at the time of diagnosis or when there is any change in the treatment plan that may be threatening to a patient. Future research of downward comparison and its relationship to self-esteem is indicated.