Australopithecine endocast (Taung specimen, 1924): a new volume determination.

A redetermination of endocranial volume of the original 1924 Taung australopithecine described by Dart indicates a volume of 405 cubic centimeters, rather than the 525 cubic centimeters published earlier. The adult volume is estimated to have been 440 cubic centimeters. This value, plus other redeterminations of australopithecine endocasts, lowers the average to 442 cubic centimeters, and increase the likelihood of statistically significant differences from both robust australopithecines and the Olduvai Gorge hominid No. 7.

Sexual dimorphism in the human corpus callosum.

Preliminary observations suggest a sex difference in the shape and surface area of the human corpus callosum. The sexual dimorphism is striking in the splenium, the caudal or posterior portion of the corpus callosum. The female splenium is both more bulbous and larger than the male counterpart. Since peristriate, parietal, and superior temporal fibers course through the splenium, this finding could be related to possible gender differences in the degree of lateralization for visuospatial functions.

Asymmetry of chimpanzee planum temporale: humanlike pattern of Wernicke's brain language area homolog.

The anatomic pattern and left hemisphere size predominance of the planum temporale, a language area of the human brain, are also present in chimpanzees (Pan troglodytes). The left planum temporale was significantly larger in 94 percent (17 of 18) of chimpanzee brains examined. It is widely accepted that the planum temporale is a key component of Wernicke's receptive language area, which is also implicated in human communication-related disorders such as schizophrenia and in normal variations such as musical talent. However, anatomic hemispheric asymmetry of this cerebrocortical site is clearly not unique to humans, as is currently thought. The evolutionary origin of human language may have been founded on this basal anatomic substrate, which was already lateralized to the left hemisphere in the common ancestor of chimpanzees and humans 8 million years ago.

Academic promotion and tenure in U.S. family medicine units.

The authors interviewed by telephone the heads (or their representatives) of 101 of the 120 family practice units in U.S. medical schools in 1987. Each respondent was asked for his or her personal perceptions of the relative importances of research, teaching, patient care, and administrative activities in the academic promotion process. Respondents were also asked for their views of their units' and institutions' perceptions of the importances of the same four activities in the promotion process, as well as other related questions about promotion and tenure. The findings indicate that there is still a significant incongruence between the value structure of most family practice units and that of their institutions but that many family practice units are beginning to achieve parity of promotion and tenure with other departments in their institutions.

Valuing educational scholarship at the Medical College of Wisconsin.

Since the late 1980s faculty and staff at the Medical College of Wisconsin (MCW) have actively sought to align their school's academic culture and promotional process with its mission of educational excellence and innovation. As one of the top 50 medical schools receiving NIH funds, MCW has well-established mechanisms to evaluate and recognize the scholarship of discovery. Understanding, evaluating, and recognizing the value of individuals engaged in the scholarship of teaching, however, required changes in individuals' beliefs and in the MCW's promotion processes and organizational infrastructure. Building on the successful introduction of the MCW's Educator's PortfolioCopyright, a tool for documenting educational scholarship, a multifaceted change strategy was implemented to influence underlying beliefs and values about clinician-educators. Retrospectively, this strategy was consistent with John Kotter's eight-step change model, which the authors apply as an organizing framework for this case report of educational evolution at the MCW. Through creating a guiding coalition, developing vision and strategy, generating short-term wins, and anchoring new approaches in the MCW's culture, the MCW has made substantive progress in recognizing and rewarding educational scholarship. Changing academic cultures to value education is itself an educational process, requiring persistence and the ability to teach others about educational scholarship and its associated criteria.

Aptitude x treatment interactions in family medicine research.

A model for research, aptitude x treatment interactions (ATI), is presented. This model has some specific utility for family medicine research. ATI can test the interaction between individual differences (aptitudes) and experimental interventions (treatments). Thus, in an applied setting one might choose an intervention based on its suitability for a particular type of individual (as measured by some form of individual difference measure). Several studies confirm the usefulness of the approach, and examples are presented and discussed. Approaches to the study of ATI for the family medicine researcher are described with special attention to clinic based and patient education studies.

A profile of family medicine scholarship 1978-1995: an analysis of national presentations.

BACKGROUND AND OBJECTIVES: Presentations at the annual meetings of the Society of Teachers of Family Medicine were analyzed to determine trends in the content of the work and the types of work represented. METHODS: All program presentations from 1979, 1986, and 1993-1995 were analyzed. Content classifications were based on historic analyses of family medicine literature. Classifications of types of scholarship came from a 1990 Carnegie Foundation report, Scholarship Reconsidered: Priorities of the Professoriate. RESULTS: Results showed that a wide variety of scholarly activities were presented, but application of educational work was predominant. Many presentations crossed interdisciplinary boundaries, including behavioral science, faculty development, and health services. CONCLUSIONS: Contributions of family medicine scholarship may be applicable to other medical fields. The variety of family medicine scholarship may warrant a redefinition of reward systems for faculty.

Predicting resident confidence to lead family meetings.

BACKGROUND AND OBJECTIVES: Family physicians frequently encounter patients' family members in family meetings regarding health care. Although residents are expected to learn how to interview families, no quantitative studies have examined variables associated with building residents' confidence in their ability to lead family meetings. The current study sought to clarify the relationship between a number of training, participant, and situational components and resident confidence. METHODS: All family practice residents (n = 90) in a five-residency program system were sent a survey that examined their experience in and perceived competence to conduct family meetings. Responses were analyzed with a hierarchical regression analysis and an ex post facto univariate analysis. RESULTS: Residents with higher perceived confidence in their ability to run a family meeting were male, had specific training for leading family meetings, had participated in and initiated more family meetings, perceived stronger family physician faculty support, and had more family systems training than lower-confidence residents. CONCLUSIONS: The results highlight the experiential, curricular, and environmental variables that are associated with building resident confidence to lead family meetings. Residents may benefit from early exposure to the skills needed for family meetings and from reinforcement of these skills through observations of skilled practitioners, the expectation that they will initiate meetings, and the opportunity to debrief meetings with supportive faculty. Family meeting curricula should include conflict management skills and incorporate input from other specialists and hospital personnel who meet with families.

Academic mentoring and family medicine's research productivity.

The research productivity of family medicine faculty has been the focus of numerous faculty development interventions, including skills training, fellowships, and seminars. Mentorship relationships between junior and senior faculty may be another strategy for achieving optimal productivity. The available literature from a number of disciplines is reviewed to describe the potential of the process, and recommendations are outlined for junior and senior faculty. Department chairs who choose to use mentorship as a faculty development strategy are encouraged to follow these recommendations as well.

Redefining the need for faculty in family medicine: results of a 5-year follow-up survey.

BACKGROUND AND OBJECTIVES: A study was conducted in 1994 to determine the need for faculty in family medicine. This paper reports a comparative follow-up study in 1999. METHODS: This follow-up study determined faculty positions filled in the last 5 years, new faculty positions currently available, replacement faculty positions currently available, and new faculty positions anticipated to be available in the next 3 years. In addition, comparisons were made with the previous study regarding time available for clinical, educational, and research activities. RESULTS: In the 1994 survey, respondents reported 496 open faculty positions and anticipated that 677 would become available during the subsequent 3 years, for a total of 1,173 positions. The 1999 survey data indicated that the actual number of positions filled or still open since 1994 was 1,072. In contrast, new positions open in 1999 or anticipated to be open in the subsequent 3 years were 604. For both residencies and departments, most positions in both surveys were for clinicians. CONCLUSIONS: Despite a decrease in the number of available positions for family medicine faculty reported between the 1994 original survey and 1999 follow-up survey, there are still more than 600 faculty positions currently available, and additional new positions are anticipated over the next 3 years.

An advanced research seminar series for family medicine faculty members.

Due to the need to improve research skills and levels of research productivity among family physician faculty, the authors conducted a needs analysis, then designed, implemented, and evaluated a ten-week course entitled "An Advanced Research Seminar." The course goals were to enable faculty to draft a research proposal and outline a paper describing their study. Although the eight participants highly approved of course goals and level of difficulty, and showed significant cognitive gains in a self-report retrospective pre/post evaluation, few were able to achieve course goals. This paper discusses the discrepancy between self-reported ability and actual accomplishment, and the circumstances which can lead to inflated self-assessments. The importance of performance measures is discussed.

Family practice residents' learning needs and beliefs about office-based psychological counseling.

BACKGROUND AND OBJECTIVES: Teaching office-based psychological counseling is an essential component of family practice training. Most counseling training has been adapted from other disciplines without adequately identifying residents' learning needs, attitudes, and beliefs about counseling. This study was designed to 1) assess family practice residents' perceived learning needs for counseling, and 2) elicit and clarify their attitudes and beliefs about counseling. METHODS: Three consecutive groups of residents anonymously recorded their questions about psychological counseling. These questions were presented to the residents in focus groups for elaboration and clarification of underlying attitudes and beliefs. A consensus panel then categorized the learning needs and identified residents' attitudes and beliefs. RESULTS: Eighty-six distinct learning need questions were identified. These items clustered into four categories: skill development, problem/patient selection, practice management, and role confusion. Focus group findings identified four major themes: the need for limits and boundaries, limited understanding of change and the therapeutic process, doubts about personal readiness, and difficulty with the integration of mind and body. CONCLUSION: These findings parallel the concerns of physicians in practice and reinforce the need to identify resident concerns about office-based counseling. Failure to identify and respond to learner concerns may limit the effectiveness of teaching efforts in this curricular area.

Defining the need for faculty in family medicine: results of a national survey.

BACKGROUND: Although numerous anecdotal reports are being offered about the growing number of unfilled faculty positions in US family medicine departments, virtually no literature exists on faculty recruitment. The objective of this study was to define the scope and nature of current faculty recruitment needs in family medicine. METHODS: A national survey was sent to all family medicine department chairs and family practice residency program directors concerning faculty positions unfilled at their sites and positions for which recruitment would occur within the next 5 years. The survey asked for information on currently available positions; academic title of position; percentage of time to be devoted to clinical, educational, administrative, and research activities; primary focus of the position; date when the position became available; and the length of time the position has been unfilled. Similar information was collected on positions anticipated to be available within the next 5 years. RESULTS: A total of 364 surveys were returned, for an overall response rate of 70%. Information from the survey revealed a current, substantial demand for family medicine faculty throughout the country, with an even greater demand anticipated for the near future. Respondents reported 496 currently unfilled positions for family medicine faculty and another 677 positions anticipated to be available within the next 19.5 months on average. A total of 89.7% of those anticipated positions were reported as either "certain" or "somewhat certain," in terms of likelihood of availability. CONCLUSIONS: The demand for family medicine faculty is increasing, and much of the demand is financially motivated. Clinical expectations appear to be higher among departments than for residencies. Finally, it was revealed that most positions had minimal allotments for research time. Family medicine must recommit itself to the development of a scholarly agenda as it recruits new faculty.

Rubella susceptibility in young adults.

Despite widespread availability of rubella vaccine, a substantial group of young women remain at risk for delivery of infants with congenital rubella syndrome. In this study of 224 women students of childbearing age seen at a university gynecological clinic, 10.3 percent were shown serologically to have nonimmune rubella status. Of this group only five women returned for free immunization. Compliance and motivation appeared lacking. Patient history of infection or immunization was found to be unreliable; 59 percent of the sample population were uncertain of their immune status, and 32 percent showed poor understanding of rubella. Serological testing appears to be the only reliable test for detecting immune status.

A continuity model for research consultation in family medicine.

This paper describes a model of individualized research consultation designed to assist family physician faculty members to develop research skills. The consultative relationship described here is a one-to-one helping relationship between a client (a family physician researcher) and a research consultant that is directed toward enabling the client to complete a research project and ultimately to function as an independent researcher. The continuity model stresses a relatively longterm, intensive relationship--a departure from the typical consultation in which the consultant renders advice and then exits. Within this continuity model, the consultant is involved at regular intervals throughout the duration of the research project and is committed to its completion. The principal role of the consultant is that of educator, within which the consultant may at various times act as reflective listener, agent of change, role model, "linker" to resources, and informational expert.

Patient-initiated prevention discussions. Two interventions to stimulate patients to initiate prevention discussions.

BACKGROUND: When patients are active participants in discussions, comprehension and compliance are likely to improve. This study examines the use of two interventions to aid patients in initiating such discussions in the area of health maintenance. METHODS: The study was a randomized controlled trial of adult patients. The first intervention used two cards that listed seven core health maintenance concerns. The second intervention used a brief session with a nurse to help patients identify their health risks and develop a plan for seeking any desired information about these risks. An exit questionnaire and a telephone interview 4 to 6 weeks later assessed the extent to which (1) information seeking by patients was stimulated; (2) patients recalled the information obtained; (3) patients used the information to effect lifestyle changes; and (4) patients felt they participated in the decision to discuss health maintenance. RESULTS: Both interventions stimulated patients to request health maintenance information (both P < .05); the second intervention significantly increased patient recall (P = .018). Neither intervention, however, had a significant impact on lifestyle change or sense of participation in the decision to initiate discussion. Analysis of the second intervention did show that both increasing patients' recall of information (P = .008) and sense of involvement in the decision to discuss health maintenance (P = .003) significantly increases the likelihood of lifestyle change. CONCLUSIONS: Two interventions have been developed that are relatively simple and inexpensive methods to stimulate patients to seek health maintenance, and quite probably other health-related information. The blunted impact of these two interventions, however, raises the question of whether such simple and relatively inexpensive interventions are strong enough to stimulate patients to use this information to initiate change when one seeks to address a wide range of risks.