Writing for publication in medical education in high impact journals.

BACKGROUND: One of the key priorities of a scholarly teacher is to demonstrate the ability to contribute to the advancement of knowledge, and transformation of new knowledge into applications that can be of value to the profession and the teaching/learning community. However, successful contribution to a scholarly activity such as publication is challenging particularly when academics lack confidence in their writing skills. AIM: The aim of this article is to highlight keys for successful publication in medical education. METHODS: We reviewed the current literature, recent medical education proceedings, and Association of Medical Education in Europe (AMEE) Guides and explored the basic principles for creating a scholarly publication. We have also reflected on our collective long experience as reviewers to educational, scientific, and clinical journals as well as our roles on editorial boards of medical education and scientific journals. RESULTS: Using the methods described, we have developed the following twelve tips: (1) Start with the end of mind, (2) Sharpen your idea, (3) Select the right journal, (4) Discuss authorship, (5) Adhere to ethical principles, (6) Prepare the manuscript, (7) Avoid common mistakes, (8) See it from the reviewer's eyes, (9) Prepare a cover letter, (10) Respond to the editor's and reviewers' reports, (11) Don't be discouraged by rejection, and (12) Reflect on your experience. CONCLUSIONS: Writing for publication in medical education, particularly in journals with high impact ratings, is a challenging task. However, becoming passionate about your contention, and working on transforming your idea into a published work necessitates self-regulation, resilience, visualization of outcomes, and implementing scholarly approaches. Overcoming challenges and focusing on your goal can be reached if these tips are applied.

Consultation for asthma: results of a generalist survey.

BACKGROUND: There are few studies that examine referral patterns for asthma and few studies that examine the referring physicians' reasons for consultation. OBJECTIVE: The purpose of this study was to survey generalist physicians on their referral patterns for adult patients with asthma. METHODS: We mailed a questionnaire to all the staff (faculty) in the Department of Family Medicine and the Division of Community Internal Medicine at the Mayo Clinic in Rochester, Minnesota. There were 37 completed questionnaires (18 family medicine and 19 internal medicine) out of a total of 58 for a response rate of 64%. The survey asked what were reasons for consultation, whether allergists or pulmonologists were preferred, and the characteristics of a good consultation. RESULTS: We asked respondents to indicate "how often you consult a specialist for an adult asthma patient" for a variety of clinical indications. The percentage responding "always" (for the top five indications) were if the patient requests one (46%), for allergen immunotherapy (38%), for single life-threatening attack (27%), for allergy testing (14%), and for steroid-dependent asthma or poorly controlled asthma (11%). Twenty-seven percent of respondents generally consulted allergists only, 22% generally consulted pulmonologists only, 3% indicated both, while 46% had no preference. Respondents did express a preference for a pulmonologist when the reported reason for the consultation was diagnosis of asthma uncertain, chronic cough, asthma in smoker, exercise training, or for an allergist when the reported reason for consultation was allergy evaluation or immunotherapy. The respondents indicated that the top six characteristics of a good consultation were the following: clear recommendations, clinically appropriate recommendations, high patient satisfaction, including recommendations for future management scenarios, including educational content in the consultation, and calling the referring physician before requesting a secondary consultation. CONCLUSIONS: These results suggest that while consultation occurs often for severe or uncontrolled asthma, some asthma patients who may benefit from consultation may not be seeing the specialist. There were no systematic preferences for consultations with allergists versus pulmonologists for asthma although for some clinical indications pulmonologists or allergists were favored. Referring physicians value clear, clinically appropriate recommendations.

Use of an objective structured clinical examination to determine clinical competence.

PURPOSE: To describe the performance of second-year internal medicine residents on an objective structured clinical examination (OSCE) and to analyze the role of the OSCE in the evaluation of clinical competence. METHOD: In 1993-94, 51 second-year residents in an internal medicine training program at the Mayo Clinic participated in an OSCE. The OSCE was administered in four sessions, with 12 or 13 students in each session. The OSCE was composed of nine physical diagnosis stations, with two or three test-interpretation stations per session. Student's t-test and one-way analysis of variance were used to compare scores on the basis of the residents' gender, medical school training (international medical graduates versus those trained in the United States and Canada), and OSCE session. In addition, the residents' scores were correlated with scores on the American Board of Internal Medicine's in-training exam (ITE) and with the training program's clinical rotation scores (CRSs). RESULTS: The residents' scores were significantly higher for test interpretation stations than for physical diagnosis stations (p < .0001). There was no significant difference in average scores based on gender, medical school training, or OSCE session. The OSCE scores correlated with the ITE scores (r = .30) and the CRSs (r = .40). CONCLUSION: The OSCE's moderate correlation with the ITE and CRS suggests that the OSCE, which consists largely of physical diagnosis stations, may test a component of clinical skills not evaluated by the other measures. Thus, the OSCE is an important addition to the assessment of clinical competence.