Pulmonary and Critical Care In-Service Training Examination Score as a Predictor of Board Certification Examination Performance.

RATIONALE: Most trainees in combined pulmonary and critical care medicine fellowship programs complete in-service training examinations (ITEs) that test knowledge in both disciplines. Whether ITE scores predict performance on the American Board of Internal Medicine Pulmonary Disease Certification Examination and Critical Care Medicine Certification Examination is unknown. OBJECTIVES: To determine whether pulmonary and critical care medicine ITE scores predict performance on subspecialty board certification examinations independently of trainee demographics, program director competency ratings, fellowship program characteristics, and prior medical knowledge assessments. METHODS: First- and second-year fellows who were enrolled in the study between 2008 and 2012 completed a questionnaire encompassing demographics and fellowship training characteristics. These data and ITE scores were matched to fellows' subsequent scores on subspecialty certification examinations, program director ratings, and previous scores on their American Board of Internal Medicine Internal Medicine Certification Examination. Multiple linear regression and logistic regression were used to identify independent predictors of subspecialty certification examination scores and likelihood of passing the examinations, respectively. MEASUREMENTS AND MAIN RESULTS: Of eligible fellows, 82.4% enrolled in the study. The ITE score for second-year fellows was matched to their certification examination scores, which yielded 1,484 physicians for pulmonary disease and 1,331 for critical care medicine. Second-year fellows' ITE scores (ß = 0.24, P < 0.001) and Internal Medicine Certification Examination scores (ß = 0.49, P < 0.001) were the strongest predictors of Pulmonary Disease Certification Examination scores, and were the only significant predictors of passing the examination (ITE odds ratio, 1.12 [95% confidence interval, 1.07-1.16]; Internal Medicine Certification Examination odds ratio, 1.01 [95% confidence interval, 1.01-1.02]). Similar results were obtained for predicting Critical Care Medicine Certification Examination scores and for passing the examination. The predictive value of ITE scores among first-year fellows on the subspecialty certification examinations was comparable to second-year fellows' ITE scores. CONCLUSIONS: The Pulmonary and Critical Care Medicine ITE score is an independent, and stronger, predictor of subspecialty certification examination performance than fellow demographics, program director competency ratings, and fellowship characteristics. These findings support the use of the ITE to identify the learning needs of fellows as they work toward subspecialty board certification.

Expanding assessments of translational research programs: supplementing metrics with value judgments.

The University of Washington (UW) Institute for Translational Health Sciences (ITHS), funded by a Clinical and Translational Sciences Award program, has supplemented its initial Kellogg Logic Model-based program evaluation with the eight judgment-based evaluative elements of the World Health Organization's (WHO) Health Services Assessment Model. This article describes the relationship between the two models, the rationale for the decision to supplement the evaluation with WHO evaluative elements, the value-added results of the WHO evaluative elements, and plans for further developing the WHO assessments.

New craniodental material of Pronothodectes gaoi Fox (Mammalia, "Plesiadapiformes") and relationships among members of Plesiadapidae.

Plesiadapidae are a family of Paleogene mammals thought to have phylogenetic affinities with modern Primates. We describe previously unpublished dentitions and the first skull and isolated petrosals of the plesiadapid Pronothodectes gaoi, collected from middle Tiffanian localities of the Paskapoo Formation in Alberta. Other species of Pronothodectes, traditionally considered the most basal members of the Plesiadapidae, occur at earlier, Torrejonian horizons in Montana, Wyoming, and Alberta. Classification of P. gaoi as a species of Pronothodectes has proved controversial; accordingly, we use the newly available samples and the more extensively preserved specimens to re-evaluate the generic affinities of this species. Included in our study are comparisons with craniodental material known for other plesiadapids and plesiadapiforms. Cladistic analysis of craniodental characters is used to assess the hypothesis that P. gaoi and other species in this genus are basal members of the Plesiadapidae. The new dental evidence confirms that P. gaoi lacks derived character states of other plesiadapids except for a variably present fissuring of the m3 hypoconulid. Moreover, several aspects of the cranium seem to be more primitive in P. gaoi (i.e., more like nonplesiadapid plesiadapiforms) than in later occurring plesiadapids, such as Plesiadapis tricuspidens and Plesiadapis cookei. Cladistic analysis of craniodental morphology supports a basal position of P. gaoi among species of Plesiadapidae, with the exception of other species of Pronothodectes. The basicranium of P. gaoi preserves a laterally placed bony canal for the internal carotid neurovascular system, suggesting that this was the ancestral condition for the family.

Complementary and Alternative Medicine (CAM) attitudes and competencies of nursing students and faculty: results of integrating CAM into the nursing curriculum.

As part of the National Center for Complementary and Alternative Medicine (CAM) R25 Education Grant Program, a faculty development program for integrating CAM into the nursing curriculum was instituted in 2003-2006. The Integrating CAM program was composed of a number of elements; the primary strategy included a series of 4-week didactic and experiential summer CAM "Camps," attended by 27 faculty members. Camps were designed to influence faculty integration of CAM material into course offerings. The Integrating CAM program was evaluated via a series of faculty and student surveys regarding CAM competencies, attitudes, and perceptions. For more than half of the faculty (out of the 43 who responded), the program yielded a moderate-to-strong influence on incorporation of CAM material into course content and moderate-to-great increases in both enthusiasm for CAM and perceived CAM knowledge gains. Students at all levels (undergraduate, master's, and doctoral; n = 184) reported that their courses contained CAM content; for 70% of students, their CAM knowledge increased; for 50% of students, level of CAM interest increased. Self-reported student CAM competencies were significantly greater in 2006-2007 (n = 191) than those in 2003-2004 (n = 143). Results support the strategy of broadly infusing the nursing curriculum with CAM content via faculty development.

Chinese nursing students' HIV/AIDS knowledge, attitudes, and practice intentions.

Nurses have important roles in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) treatment and educational programs. Chinese senior nursing students completed a survey on HIV/AIDS knowledge, attitudes, and practice intentions. A weak positive relationship between attitudes and practice intentions (r = .140, P = .036) was noted. No significant associations between knowledge levels, attitudes, and practice intentions were found. Although the majority exhibited adequate knowledge of basic HIV transmission mechanisms, many disconcerting misconceptions were evident. Although most were empathetic to people with HIV/AIDS, stigmatization of high-risk groups persisted. Improved patient care will require intensified educational efforts and more positive attitudes toward persons with HIV/AIDS.

Survey correlations: proficiency and adequacy of nutrition training of medical students.

OBJECTIVE: The majority of graduating US medical students reported inadequate nutrition training over the past decade. This trend could in part be due to the lack of valid measures to assess the relationship between adequacy of nutrition training and proficiency on nutrition topics deemed essential. The study's objective was to test the hypothesis that self-reported nutrition proficiency is positively correlated with the perceived adequacy (quality, quantity, coverage and importance) of nutrition training of University of Washington medical students. METHOD: Cross-sectional e-mail survey of 1st to 4th year medical students (n = 708), including a survey prompt and three e-mail follow-up measures. To reduce and interpret the survey data, principal components analysis was employed, followed by Varimax rotation with Kaiser normalization. To assess internal consistency reliability, alpha (alpha) of nutrition proficiency items and factors was determined. RESULTS: A 44.5% response rate was achieved (n = 315 respondents). The 31-item questionnaire was reduced to 6 factors, explaining 60.2% of the total variance (alpha = 0.947). Self reported nutrition proficiency was positively correlated with the perceived quality, quantity and coverage of nutrition training in all 6 essential nutrition factors or topics determined after factor analysis (P < 0.01). CONCLUSION: Quality and coverage may be effective gauges of adequacy of nutrition training and related nutrition proficiency in medical education. Current national medical education evaluation measures focus on the quantity of nutrition instruction. The lowest reported proficiency topics; nutrition and disease management, micronutrients and complementary and alternative medicine are recommended for particular curricular emphasis.

First evidence of a venom delivery apparatus in extinct mammals.

Numerous non-mammalian vertebrates have evolved lethal venoms to aid either in securing prey or as protection from predators, but modern mammals that use venoms in these ways are rare, including only the duck-billed platypus (Ornithorhynchus), the Caribbean Solenodon, and a few shrews (Soricidae) (Order Insectivora). Here we report evidence of a venom delivery apparatus in extinct mammals, documented by well-preserved specimens recovered from late Palaeocene rocks in Alberta, Canada. Although classified within Eutheria, these mammals are phylogenetically remote from modern Insectivora and have evolved specialized teeth as salivary venom delivery systems (VDSs) that differ markedly from one another and from those of Solenodon and shrews. Our discoveries therefore show that mammals have been much more flexible in the evolution of VDSs than previously believed, contradicting currently held notions that modern insectivorans are representative of the supposedly limited role of salivary venoms in mammalian history. Evidently, small predatory eutherians have paralleled colubroid snakes in evolving salivary venoms and their delivery systems several times independently.

Publications and extramural activities of general internal medicine and medicine subspecialty clinician-educators: a multicenter study.

PURPOSE: Generalist clinician-educators may have more difficulty than specialists satisfying common promotion criteria (peer-reviewed publication and extramural reputation). This study compared publication rates and participation in extramural activities among subspecialist and generalist clinician-educators, and sought to determine the views of clinician-educators on the use of publication and reputation in determining their promotion. METHOD: A cross-sectional questionnaire was delivered to 526 clinician-educators identified by the chairs at ten randomly selected U.S. medical schools in 2002. RESULTS: A total of 270 clinician-educators responded. Medicine subspecialist clinician-educators reported more peer-reviewed publications than did general internal medicine (GIM) faculty (mean 26.4 versus 10.2, p < .003). Independent predictors of having a greater number of peer-reviewed publications were subspecialty membership (p < .01), less time spent in clinic (p < .01), focus of scholarship (p = .01), academic rank (p < .01), higher quartile of National Institutes of Health funding received by respondent's department (p < .01), and years on faculty (p = .03). A greater proportion of GIM faculty reported spending most of their protected time on scholarly activities less amenable to publication (p = .05). A greater proportion of subspecialists felt peer-reviewed publication should be required for promotion (p < .01), but a minority of both groups felt this should necessarily entail original research. CONCLUSION: Subspecialist clinician-educators generate significantly more peer-reviewed publications than do their GIM colleagues. clinician-educators hold diverse views on the role of publication and reputation in determining their promotion.

Screening for depression in a primary care setting in Vietnam.

A Vietnamese Depression Scale (VDS) was developed in 1982 in the United States and has been used as a screening tool for depression and as the basis for a standardized interview to assess depression in the Vietnamese refugee populations. In this current study, the VDS was used in Ho Chi Minh City, Vietnam, to assess depression in patients who were already diagnosed with depression by Vietnamese psychiatrists and in patients presenting at a local primary care clinic. Of the 177 primary care clinic patients, 8.4% met the criteria for clinical depression based on the VDS. Results indicate a higher risk for depression among married and/or less than high school educated individuals. Discrepancies were found between the depression diagnosis by Vietnamese psychiatrists and VDS screening results. Among the participants interviewed who met the VDS criteria for depression, culture-specific phrases such as "desperate," "going crazy," and "low spirited and bored" were highly associated with symptoms of depression.

Comparison of scholarly productivity of general and subspecialty clinician-educators in internal medicine.

BACKGROUND: Peer-reviewed publications and extramural reputation are criteria used to evaluate clinician-educators for promotion. There is concern that these criteria may be disadvantageous to clinician-educators in generalist fields relative to their specialist counterparts. PURPOSE: To determine whether medicine subspecialists had more peer-reviewed publications and academic activities outside their home institution than general internal medicine (GIM) faculty, and to explore possible explanations for observed differences. METHOD: Cross-sectional survey of all clinician-educators in a department of medicine at a leading public U.S. medical school. The survey assessed clinical duties, publications, and professional activities. RESULTS: Seventy-one percent (42/59) of clinician-educator faculty responded. GIM clinician-educators spent fewer months on inpatient services (p = 0.01), but more time in clinic (p = 0.05). Specialist clinician-educators had more peer-reviewed publications (p = 0.003), but total publications since entering a clinician-educator track was similar (p > 0.2). After multiple linear regression, only academic rank (p = 0.001) and subspecialty membership (p = 0.005) remained significant predictors of peer-reviewed publication. GIM faculty reported spending more scholarly time on "activities unlikely to result in publication" (p < 0.01). A greater proportion of specialists served on extramural committees (72% vs. 41%, p = 0.05) and lectured outside their home institution in the preceding year (92% vs. 59%, p = 0.02). CONCLUSIONS: In this single-institution survey, specialist clinician-educators reported more peer-reviewed publications and greater participation in other reputation-enhancing activities than did GIM clinician-educators.

Physician informational needs in providing nutritional guidance to patients.

OBJECTIVES: This study's objective was to assess patient nutrition inquiries and related physician resources to identify the nutrition topics about which physicians most need information for patients and practice. METHODS: A survey was mailed to a 50% random sample of Washington Academy of Family Physicians (WAFP) members (n=778) to identify the top 10 patient nutrition inquiries that the physician would like to be better equipped to answer. The responding physicians' use of nutrition resources (journals, pamphlets, Web resources, toll-free numbers, and referrals to registered dietitians) was also recorded. RESULTS: A total of 306 (39.3%) physicians responded. The majority wanted more information on weight management (66.5%), followed by information on herbals, botanicals, and other complementary and alternative medicines (CAM) (36.4%) and vitamin and mineral supplements (24.4%). Other common nutrition inquiries for which respondents wanted more information included diet for prevention of disease, high protein-low carbohydrate diets, and childhood nutrition. A minority of respondents used nutrition Web resources and toll-free numbers. Nearly all respondents reported referring patients to registered dietitians. CONCLUSIONS: Physicians in our survey expressed a need for information on topics such as obesity, CAM, and life cycle and disease-specific diets. Medical nutrition educators should consider the educational needs of the practicing physician.

Attitudes of Chinese medical students toward the global minimum essential requirements established by the Institute for International Medical Education.

BACKGROUND: The Institute for International Medical Education has published "Global Minimum Essential Requirements (GMERs) in Medical Education." PURPOSE: This study examined attitudes of a sample of Chinese medical students toward the GMERs. METHODS: Matriculating and graduating West China School of Medicine Sichuan University medical students were administered parallel surveys during the 2001 to 2002 academic years. RESULTS: Both cohorts produced similar response profiles. The majority in both groups rated the 7 GMER domains as either important or very important for their medical education. Matriculating students rated professional values, attitudes, behavior, and ethics as most important, whereas graduating students valued clinical skills highest. Population health and health systems received the lowest importance ratings from both groups. Please note that this study was conducted before the SARS outbreak. As a result of the SARS experience, attitudes toward population health and health systems might have changed. CONCLUSION: Although medical students ascribe importance to the GMERs, efforts are needed to increase the perceived importance of the population health and health systems domain.

Self-reported nutrition proficiency is positively correlated with the perceived quality of nutrition training of family physicians in Washington State.

BACKGROUND: Despite concerted scientific, educational, and congressional calls to increase nutrition coverage in medicine for more than half a century, most graduating medical students report an inadequate quality and quantity of nutrition training. Furthermore, practicing physicians report a lack of confidence and related proficiency in nutrition counseling skills because of inadequate training. Assessment of nutrition proficiency and related training of practicing physicians may support the prioritization of nutrition topics to be included in medical education. OBJECTIVE: We tested the hypothesis that the perceived adequacy of nutrition training (quality and quantity) of family physicians in Washington State is positively correlated with self-reported nutrition proficiency in 5 nutrition factors determined after confirmatory factor analysis. DESIGN: A randomized mail survey method (n = 778 possible respondents), which involved one mass-mailing follow-up, was used. RESULTS: A 39.3% response rate was achieved (n = 306 respondents). The 31-item questionnaire was reduced to 5 factors, explaining 48.5% of the total variance (alpha = 0.916). Perceived quality (poor to excellent) of nutrition training was positively correlated with self-reported nutrition proficiency scores for all 5 factors (P < 0.01). No significant differences were noted between zip code or sex and mean nutrition proficiency scores for all 5 factors. CONCLUSION: The examination of correlations between perceived quality of education and self-reported proficiency may be a useful gauge of effectiveness of nutrition training in medicine. Prioritization of nutrition information based on proficiency levels, including information on complementary and alternative medicines and nutritional management of disease, merits further investigation.

Preparing graduates for the first year of residency: are medical schools meeting the need?

PURPOSE: Changes in graduate medical education associated with full implementation of the Balanced Budget Act of 1997 have required medical schools to review and revise their curricula. As limited funding increases pressures to streamline training, residencies will potentially expect an entry level of skill and competence that is greater than that which schools are currently providing. To determine whether medical school curricular requirements correlate with residency needs, this multidisciplinary pilot study investigated expectations and prerequisites for postgraduate specialty training. METHOD: A questionnaire about 100 skills and competencies expected of new first-year residents was sent to 50 U.S. residency directors from surgery, internal medicine, family medicine, pediatrics, and obstetrics-gynecology programs. Each director was asked to state expectations of a first-year resident's competence in each skill at entry to residency and after three months of training. Skills deemed most appropriately acquired in residency were also identified. Competencies included diagnosis, management, triage, interpretation of data, informatics and technology, record keeping, interpersonal communications, and manual skills. RESULTS: A total of 39 residency directors responded, including seven surgery, nine medicine, seven family medicine, eight pediatrics, and eight obstetrics-gynecology. In addition to physical examination skills, 13 competencies achieved more than 70% agreement as being entry-level skills. There was wide variability as to the relative importance of the remaining skills, with residency directors expecting to devote significant resources and time in early training to ensure competence. CONCLUSIONS: Medical schools should consider the expectations of their students' future residency directors when developing new curricula. Assuring students' competencies through focused curricular change should save both time and resources during residency.

Development and evaluation of public health informatics at University of Washington.

Public Health Informatics (PHI) education began at the University of Washington (UW) with a Summer Institute in 1995. The Biomedical and Health Informatics graduate program, which is housed in the School of Medicine, is an interdisciplinary, multi-school program. It demonstrates the UW's cooperative efforts in advancing informatics, encompassing the schools of public health, medicine, nursing, dentistry, pharmacy, information and graduate schools in computer science. This article provides an overview of the developmental milestones related to activities in PHI and describes the evaluation strategy and assessment plan for PHI training at the UW (http://phig.washington.edu).