An analysis of attrition from Canadian neurosurgery residency programs.

PURPOSE: To determine the magnitude of and reasons for attrition from neurosurgical residency programs in Canada. METHOD: Directors of the 13 Canadian neurosurgery residency programs were asked to complete questionnaires on their programs, magnitude of attrition, reasons for attrition, and selection criteria. Open-ended questions were assessed with content analysis and quantified with dual-scaling techniques. Similar questionnaires were sent to 30 residents who had completed training; six residents who had voluntarily withdrawn were interviewed. RESULTS: Twelve of the 13 directors (92%) responded. Forty-two residents voluntarily withdrew from residency training between 1980 and 1992; withdrawal rates grew during that period. The number of dismissals--approximately 1.8 per year--remained constant. Reasons for voluntary withdrawal focused on excessive workloads and unexpected residency demands, whereas reasons for dismissal related primarily to deficits in professional attitudes and behaviors such as interpersonal skills and ethics. In selecting residents, programs with low attrition rates gave more importance to a candidate's work ethic than did programs with high attrition rates. The low-attrition programs also gave more importance to the relationship developed with residents during training. CONCLUSION: These results suggest that voluntary attrition from neurosurgical residency is significant and is related to issues of lifestyle control. Dismissal is rarely related to cognitive or psychomotor deficits, but usually occurs for concerns about professionalism such as ethics and interpersonal skills and behaviors. Further studies are necessary to confirm these findings across specialties and countries.

Overview of recent literature on undergraduate ambulatory care education and a framework for future planning.

This study provides an interpretive overview of ambulatory care undergraduate education from 1979 to 1991 and identifies two major problems for medical education: (1) the difficulties inherent in the transfer of educational techniques from the hospital to the ambulatory care setting; and (2) the misuse of and lack of agreement on definitions of ambulatory care, primary care, and community-oriented primary care. The authors distinguish various types of ambulatory care and examine factors that differentiate ambulatory care and hospital sites for educating medical students, including the setting, program management, curriculum issues, evaluation, cost, faculty time, and space. Based on concepts and issues identified in the study, the authors propose a framework for planning future ambulatory care education and research.

Medical student training in the performance of diagnostic laboratory procedures.

A study was conducted to determine what diagnostic laboratory procedures medical students recalled being taught during pre-clerkship training, how well they felt they could perform these procedures on entrance to and exit from their clerkship year, and the estimate of frequency of personal performance during the clerkship year. Surveys were mailed to 223 graduating senior students of a medical school. They were asked to supply data regarding 15 pre-selected procedures. In only seven cases did a majority of students recall being taught a procedure. Higher percentages of students who trained at health science centres and a Veterans Administration hospital recalled being taught procedures compared to students who trained at community hospitals. In general, students who performed their pre-clerkship training at the health science centres rated their ability to perform procedures without assistance on entrance to the clerkship year higher than the other two groups. Students who performed at least one half of their clerkships at a health science centre rated their ability to perform procedures without assistance at the termination of their clerkship year higher than those who performed a majority of clerkships at community hospitals. The former group also reported a higher frequency of performance of the procedures than the community hospital group. Most of the procedures for all groups, however, were performed at a rate of less than one/month.

The art and science of clinical teaching.

A review of the literature on clinical teaching indicates that medical schools emphasize didactic teaching of facts. Interpersonal skills, problem solving skills and cultivation of attitudes are neglected. However, the literature also described the skills of 'good' clinical teachers, and enumerates them. Programmes attempting to develop students' interpersonal skills and problem solving skills are reported. Finally, areas for further practice and study in clinical teaching are recommended.

Improvement of teaching skills in a clinical setting.

The article describes the efforts of the faculty members in the Department of Community Medicine at the Rockford School of Medicine to improve their clinical teaching skills in the Primary Care Experience (formerly the Basic Ambulatory Experience). Faculty members opted for an instructional development program under the direction of an educational consultant as a result of their problems with clinical teaching in a new medical school. Each faculty member's teaching was videotaped and analyzed by the consultant, who met with the instructor to discuss the videotape, From this initial discussion problem areas were defined to be discussed at large group meetings. Faculty members will be videotaped in the present academic year to ascertain improvement in their clinical teaching.