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.

Longitudinal analysis of a multisite clerkship.

Monitoring the quality of well-established multisite clerkships can be aided by the use of trend analysis and graphic-oriented presentations. Five years of data on student performance, experience, and perceptions are reported for an obstetrics and gynecology clerkship offered at eight geographically dispersed sites. Of the five measures of student performance, two (final written and oral examinations) showed major changes. Trends also appeared in student participation in deliveries and student ratings of teaching over time. The results of these analyses were communicated to faculty at each site and used to make improvements in the clerkship. The implications and use of these longitudinal evaluation procedures are discussed.

Characteristics of the initial medical interview associated with patient satisfaction and understanding.

This study examines the relationship between selected interview characteristics, particularly physicians' verbal behaviors, and levels of patient satisfaction and understanding. Twenty-nine initial patient interviews by 11 physicians at the University of Washington Hospital Family Medical Center were videotaped and rated using a modified Bales' technique. Questionnaires provided measures of patient satisfaction and understanding. Results of correlation analysis indicate that higher patient satisfaction was associated with greater interview length, increases in the proportional time spent by the physician in presenting information and discussing prevention, and shorter chart review times. Increased patient understanding was associated with increases in the proportional time spent presenting both information and opinions, close physical proximity, and reduced chart review time. Implications of the results are discussed as well as methodological issues relating to further research.

Can continuity of medical care be taught?

The health sciences literature indicates that although continuity often has been shown to be associated with a number of favorable outcomes, the concept is as yet poorly conceptualized and difficult to quantify. In this paper the authors describe an approach to teaching continuity developed at the University of Washington. Beginning in 1973--74 second-year students in an elective family medicine preceptorship were placed with practicing family physicians one-half day per week for a complete academic year. The medical care of a few families was closely followed by each student throughout the period. Required written reports of each student's longitudinal-care experiences were analyzed to identify student-perceived benefits of extended patient contact. Three-fourths of the students over a two-year period were judged to have experienced important aspects of continuity. Results suggest that the teaching program described is a viable means for teaching students to recognize, appreciate, and employ approaches to patient care available only in settings characterized by continuity.

Evaluation of clinical training in the community.

An evaluation approach is presented that is designed to deal with the complex educational problems associated with community-based teaching. Such problems include using instructors with limited training in teaching, ensuring comparability of student experiences, monitoring students' performance in dispersed settings, and maintaining adequate communications among involved parties. The approach is based on a careful delineation of information needs and data sources followed by the design and strategic combination of evaluation instruments in order to promote efficiency in data collection. An application of the approach is described for an undergraduate clerkship in family medicine taught at multiple sites at the University of Washington School of Medicine. Nine instruments are described for eliciting information from four sources to satisfy the needs of five groups associated with the course. Sample results are presented suggesting that the approach is effective and may prove useful to others involved with teaching in dispersed settings.

Early ambulatory experience in the undergraduate education of family physicians.

A number of benefits have been claimed for early ambulatory experience in the training of family physicians, although few practical examples have been reported. This paper describes an approach to the education of first and second year medical students interested in family medicine which places heavy emphasis on community-based ambulatory care. During the first year, an elective introductory preceptorship permits students to participate in the office practice of a family physician in a limited role. Seminars are offered concurrently to provide integrating principles and perspective. In the second year, a nine-month-long continuity clerkship is offered in which students gain intimate contact with a small panel of families and practice the skills of primary care in the offices of family physicians. Clinical experience is accompanied by weekly seminars and integrated with elements of the required curriculum. Selected evaluation data are presented, which attest to the achievement of course objectives and provide support for the claim that this approach is beneficial to students seeking careers in primary care.

Student/patient contact--do the patients mind?

This paper reports the results of a survey of patients in both a community clinic and a large HMO hospital to assess: 1) Attitudes toward the presence of students during patient care, and 2) The effects of student training on patient attitudes and satisfaction. It was found that the overwhelming majority of patients in both settings reported high satisfaction and favorable attitudes, and that previous student contact was associated with more favorable attitudes toward the presence of medical students.