Prevention practices of family medicine clerkship preceptors in North Carolina.

PURPOSE: Before implementing a new prevention curriculum, the authors assessed the prevention practices and attitudes of community family physicians in North Carolina who precepted third-year family medicine clerkship students. METHOD: An 18-item questionnaire was mailed to 165 preceptors during the 1995-96 academic year. The questionnaire explored the preceptors' levels of preparation to counsel patients, the types of prevention services they offered, and their levels of success in modifying patients' behaviors. The survey was re-sent to non-respondents. RESULTS: The response rate was 70% (n = 112); of these 75% were men and 55% had graduated after 1987. Over 60% of the preceptors "almost always" offered services in smoking cessation, exercise, diet and nutrition, and age-specific services (range 62-86%). Over 50% felt "very prepared" to counsel patients regarding smoking cessation, sexually transmitted diseases, depression, exercise, alcohol use, and age-specific services (range 53-74%). However, the preceptors in this study felt pessimistic about their success in getting patients to change their behaviors. Preceptors who had graduated more recently offered more preventive services for smoking cessation, alcohol use, and illicit drugs than did earlier graduates. DISCUSSION: Although North Carolina preceptors were pessimistic about their success in changing patients' behaviors regarding prevention, they were confident about their knowledge and skills to provide these services. This information was used to modify a prevention curriculum for third-year medical students.

A pre-admission program for underrepresented minority and disadvantaged students: application, acceptance, graduation rates and timeliness of graduating from medical school.

PURPOSE: To determine whether students' performances in a pre-admission program predicted whether participants would (1) apply to medical school, (2) get accepted, and (3) graduate. METHOD: Using prospectively collected data from participants in the University of North Carolina at Chapel Hill's Medical Education Development Program (MEDP) and data from the Association of American Colleges Student and Applicant Information Management System, the author identified 371 underrepresented minority (URM) students who were full-time participants and completed the program between 1984 and 1989, prior to their acceptance into medical school. Logistic regression analysis was used to determine whether MEDP performance significantly predicted (after statistically controlling for traditional predictors of these outcomes) the proportions of URM participants who applied to medical school and were accepted, the timeliness of graduating, and the proportion graduating. Odds ratios with 95% confidence intervals were calculated to determine the associations between the independent and outcome variables. RESULTS: In separate logistic regression models, MEDP performance predicted the study's outcomes after statistically controlling for traditional predictors with 95% confidence intervals. CONCLUSIONS: Pre-admission programs with similar outcomes can improve the diversity of the physician workforce and the access to health care for underrepresented minority and economically disadvantaged populations.

Preadmissions programs and enrollment of underrepresented minority students before and during successful challenges to affirmative action.

The association between the percent change in first-year and total underrepresented minority student enrollment and the presence of preadmission programs at Liaison Committee on Medical Education (LCME) accredited medical schools was assessed before and during successful legal and legislative challenges to affirmative action. The percent change in under-represented minority student enrollment was determined by comparing enrollment data for the academic years 1993-94 and 1996-97. Schools were categorized as having either a negative or positive percent change in their enrollment of underrepresented minority students. Logistic regression was used to determine the association of the percent change in under-represented minority student enrollment and the presence of a preadmission program while controlling for schools' financial support and the presence of postbaccalaureate programs. Fifty-six percent of the included medical schools had preadmission programs. Schools with a positive percent change were significantly more likely to have preadmission programs compared with schools with a negative percent change. There was no association between the presence of preadmission programs and the percent change in total enrollment. These results indicate that the presence of preadmission programs is positively associated with increases in first-year underrepresented minority student enrollment during the successful challenges to affirmative actions.

Do pre-admission programs make a difference in the enrollment of underrepresented-minority students at U.S. medical schools?

PURPOSE: To assess the association between the presence of pre-admission programs directed at underrepresented minority (URM) students at medical schools accredited by the Liaison Committee on Medical Education (LCME) and the first-year and total enrollments of URM students during the 1993-94 academic year. METHOD: The authors ranked 119 LCME-accredited medical schools by the percentages of their first-year classes and total enrollments made up of URM students. They then compared the schools in three ways: (1) schools ranking above versus below the median in terms of numbers of URM students; (2) the top 25% versus the lower 75%; and (3) the top 25% versus the lowest 25%. Logistic regression was used to determine the association between the presence of pre-admission programs and URM enrollment. RESULTS: Fifty-six percent of the medical schools had pre-admission programs. For both first-year and total enrollments, each comparison showed that schools ranked as having higher percentages of URM students (above the mean and in the top 25%) were more likely to have pre-admission programs than were the schools ranked lower (below the mean, lower 75%, and lowest 25%). CONCLUSION: This study suggests that the presence of pre-admission programs is positively associated with enrollment of URM students at U.S. medical schools.

Participation in a premedical summer program for underrepresented-minority students as a predictor of academic performance in the first three years of medical school: two studies.

PURPOSE: To determine whether the performances of underrepresented minority students in the Medical Education and Development Program (MEDP) at the University of North Carolina Chapel Hill (UNC-CH) School of Medicine (a structured, nine-week summer premedical program that simulates the medical school's first year curriculum) predicted their academic performances in the first three years of medical school. METHOD: These two studies looked separately at the predictive value of students' rankings (top quarter or top half) within their MEDP cohorts. The first study involved 165 students who had participated in the MEDP from 1981 to 1990 and who then matriculated at UNC-CH. Using backward elimination logistic regression models, the author determined whether those rankings and other, more traditional academic performance predictors predicted three types of academic difficulty during the first two years of medical school: (1) required participation in summer review; (2) deceleration; and (3) dismissal. The predictive validity of each regression model was assessed by calculating the sensitivity and the positive predictive value. The second study involved 135 students who had participated in the MEDP from 1981 to 1990 and who had finished their third-year clinical clerkships at UNC-CH. Forty-four of those students had taken the National Board of Medical Examiners (NBME) Part II examination. Using Spearman correlations, the Student t test, and the chi-square test, the author determined the simple relationships among MEDP ranking, traditional premedical academic predictors, and third-year clinical performance (as measured by clerkship grades and NBME scores). The author determined the best predictors of third-year clinical performance using stepwise backward-elimination linear regression models. RESULTS: In both studies, a student's ranking within his or her MEDP cohort was the strongest, if not the only, predictor of medical school academic performance. CONCLUSION: These studies suggest that structured summer premedical programs such as UNC-CH's MEDP are quite good at determining whether participants will be able to handle the academic rigors of medical school.

Monitoring students' clinical experiences during a third-year family medicine clerkship.

PURPOSE: To demonstrate the importance of monitoring the clinical experiences and types of supervision that students receive in physicians' offices, in order to ensure quality control during a required clerkship. METHOD: In a documentation system introduced in 1991-92, third-year students in the family medicine clerkship at the University of North Carolina at Chapel Hill School of Medicine were asked to complete an optical scan card for every patient they saw. The card information consisted of demographic data, patient continuity, medical problems, types of histories and physical examinations, patient education issues, primary care procedures, and type of supervision. The data were collected from 293 students placed in 63 practices from December 1991 through November 1993. RESULTS: Hypertension, health maintenance, and upper respiratory infection were the most frequently recorded medical problems. Although the students obtained adequate experience performing focused histories and physicals, their experiences with certain physical examinations (breast, rectal, and genital) were inconsistent. Patterns of supervision by the preceptors varied among practices. CONCLUSION: Although the validity of the data has not been assessed, previous literature and other information indicate that the documentation system successfully described the students' clinical experiences. The benefits of implementing such a monitoring system include highlighting the students' lack of certain experiences and making comparisons across sites in order to encourage change among preceptors.

The effects of certain student and institutional characteristics on minority medical student specialty choice.

This article investigates the possible effects of minority status, presence of a Minority Affairs Office or Student National Medical Association (SNMA) Chapter, level of indebtedness, and number of years (4 to 5) to complete medical school on specialty choice of minority medical students. The 5-year experiences of 20 medical schools in the southern region (including three in Puerto Rico) were examined via a questionnaire. Information was sought for African Americans, Afro-Caribbean, Mexican American, other minority, and nonminority students. Minority graduates entered the specialities of internal medicine, pediatrics, and family medicine in far greater numbers than any other speciality. Also, the percentage of minorities who entered these fields was greater than the percentage of non-minorities. Conversely, minorities were significantly underrepresented in the surgical subspecialties and radiology. Additional study is needed to further examine the medical school experience for indications of why the clustering in primary care specialities occurs. Moreover, while most schools had some kind of minority affairs organization, few were active in the writing of the Dean's letter. Other suggestions to assure adequate minority representation across specialties include early exposure to the different specialties and subspecialties for minority students, a mentorship program with practicing physicians, and stronger recruitment of minorities into underrepresented specialties.

Assessing correlations between black and white students' perceptions of the medical school learning environment, their academic performances, and their well-being.

From 1982 to 1985, first-year students at a medical school were invited to participate in a longitudinal study that assessed the correlations between their perceptions of the learning environment, their academic performances, and their perceptions of their own well-being. Differences between black and white medical students' perceptions of the medical school's learning environment and the predictors of their academic success and mental and social well-being were determined at the end of their first year. Black and white students had similar perceptions of the learning environment's quality. Black students experienced more stress but found more support from faculty, class advisors, and administrators. Although black and white students shared some predictors of academic performance and well-being, there were important differences that should be considered when resources are developed to assist students with their academic performance and the maintenance of their social and mental well-being.

Expectations versus reality, social support, and the well-being of medical students.

This longitudinal study of medical students assessed the relationship between their mental and social well-being, the discrepancy between their expectations and the reality of the learning environment, and social support, after controlling for baseline characteristics that may affect students' perceptions. Finding, at the end of the first year, that the quality of the learning environment was better than expected was positively associated with social well-being but negatively associated with mental well-being. Finding less stress than expected was positively associated with both mental and social well-being. Social support had only a direct positive association with social well-being. There was a suggestion, although it was not statistically significant, of a negative association between social support and mental well-being and a positive interaction between social support and students' perception of the environment's quality. These findings suggest that stressors and mediators of stress may show specificity for health outcomes.

Effect of a major curriculum revision on students' perceptions of well-being.

The impact of a major curriculum revision on students' perceptions of the quality of the medical school learning environment, social supports, and their own mental and social well-being was determined. First-year students' perceptions one year before the curriculum revision were compared with first-year students' perceptions two years after the introduction of the new curriculum. In the new curriculum, students reported better overall quality of the learning environment (p = .019), a trend toward fewer stresses (p = .091), no difference in social supports (p = .721), better mental well-being (p = .043), and a trend toward better social well-being (p = .099). Students at a comparison school that did not undergo curriculum revision did not have more favorable perceptions during the study period. The findings suggest that well-considered and well-executed efforts to improve the quality of a medical school's learning environment can be successful and can raise students' perceptions of their overall well-being.

Transcutaneous electrical nerve stimulation and postoperative use of narcotic analgesics.

Transcutaneous electrical nerve stimulation (TENS) has been reported to reduce the use of narcotic analgesic medication for pain relief in the postoperative period. This study compares the use of narcotic analgesics and the occurrence of postoperative complications in 205 patients who underwent gastric bypass surgery for control of obesity. Seventy-four patients used TENS for postoperative pain relief. The control group comprised 131 patients who did not use TENS. There were no statistically significant differences in the use of narcotic analgesic medication and the occurrence of postoperative complications between the experimental group and the control group.

Social supports, perceived stress, and health: the black experience in medical school--a preliminary study.

Black medical students perceived significantly more stressors than white medical students in a predominantly white medical school environment (P=0.001). Black medical students perceived fewer social supports than white medical students, but not significantly fewer (P=0.224). There was no significant difference between mean systolic and diastolic blood pressure levels for the low and high stress groups (P=0.302 and 0.844, respectively). The total degree of perceived stressors did not predict systolic and diastolic blood pressure when controlling for potential confounders (0.050.25 and 0.1