Medical students' experience with psychiatric diagnoses in a family medicine clerkship.

BACKGROUND: Many medical schools require a family medicine clerkship, yet little is known about the quantity and diversity of the diagnoses encountered by the students. PURPOSE: This study examines patients encountered with psychiatric diagnoses using quantitative data collected by students in a family practice clerkship. METHODS: Over a 2-year period, 445 students completed 3,320 patient encounter forms for patients with a psychiatric diagnosis, noting their comfort level and responsibilities. RESULTS: The patients' diagnoses reflect those seen in a typical family practice. Of the 71,869 presenting diagnoses, 3,548 were for a psychiatric condition, most commonly depression (37.1%) and neuroses (28.0%). Students reported a high level of comfort in diagnosing and treating patients with a psychiatric disorder. The students routinely discussed these cases with their preceptors. CONCLUSIONS: By using a relatively simple computerized database, many curricular issues can be identified. For example, analysis of the database shows that the clerkship provides students with substantial practice in taking patient histories and performing initial patient examinations in patients presenting with a psychiatric problem. However, students infrequently provided patient education and counseling to patients with psychiatric disorders. Specific psychiatric diagnoses reflecting limited experience and lower levels of perceived competence include attention deficit disorder and senile and presenile organic psychotic disorders.

Gender and preceptors' feedback to students.

To determine whether evaluation comments differed based on preceptors' and students' genders, preceptors' evaluations of medical students were analyzed. Preceptors tended to comment on the same themes in the same proportions, regardless of gender. However, women preceptors commented about "Personality/Maturity" and "Personality/Character" more frequently for men students than they did for women students. Conversely, women preceptors commented about "Clinical Skills-Negative" more frequently for women students than for men.

Organizational environment and perceptions of teaching quality in seven South Carolina family medicine residency programs.

PURPOSE: To explore the relationship between organizational environment and teaching quality in seven family medicine residency programs. METHOD: In 1995, a questionnaire on organizational environment was administered to the faculties at all seven family medicine residency programs in South Carolina. Eighty-seven percent of the faculty members participated, as did convenience samples of residents, nurses, and administrative staff. The questionnaire measured seven variables: teaching quality, job satisfaction, organizational climate, employees' autonomy, goal attainment, organizational commitment, and job-related stress. RESULTS: Residents, nurses, and administrative staff who were connected to programs at which faculty expressed high levels of job satisfaction assessed teaching quality as higher than did those at other programs. The residents' perceptions of teaching quality were positively correlated with high ratings of organizational climate and job-related stress. The staffs' ratings of goal attainment were also associated with teaching quality. Faculty satisfaction was associated with their reported employee autonomy and goal attainment. CONCLUSION: The organizational characteristics of family medicine residency programs significantly influence the perceptions of teaching quality: specifically, there perceptions are correlated with the degree to which faculty are satisfied with their work environments. In addition, residents' and staffs' perceptions of teaching quality are associated with their attitudes toward their organizations' environments.

Tracking the contribution of a family medicine clerkship to the clinical curriculum.

BACKGROUND AND OBJECTIVES: Medical educators are working to articulate the objectives and measure the outcomes of medical education. In clinical training, faculty need methods to identify both the principal educational contributions of individual clerkships and how prior experiences influence student learning. METHODS: We analyzed students' perceived acquisition of clinical knowledge and skills on a 4-week, community-based family medicine clerkship. The data represent 349 third-year medical students who participated in the clerkship during a 2-year time period. Results were summarized by three different combinations of prior clerkship experiences and overall. RESULTS: Students reported gains as a result of the clerkship for the majority of medical problems and procedures. However, there were differences in the clerkship's perceived contribution depending on the timing and sequence of clinical rotations. Even when the family medicine clerkship followed all other primary care rotations, students perceived that the clerkship contributed to gains in knowledge of undifferentiated and commonly seen problems; applications of health promotion, disease prevention, and patient education; importance of family dynamics in patient care; business aspects of medical practice; and appreciation of family practice. CONCLUSIONS: The results demonstrate how a required family medicine clerkship can enhance the clinical learning that occurs on other rotations. The study also demonstrates that it is possible to track a clerkship's contribution to student development and to understand how a clerkship's role may change according to students' prior experiences.

Leadership and organizational skills in academic medicine.

BACKGROUND AND OBJECTIVES: The complex and unique challenge of academic medicine requires that faculty possess both organizational and leadership skills. This article presents a framework of leadership and organizational skills in family medicine. METHODS: We conducted a focused review of the literature, of presentations at national primary care meetings, and of the curricula of several national faculty development fellowship programs to identify the current emphases, strategies, and outcomes regarding organizational and leadership development activities for academic physicians. RESULTS: We identified three types of organizational and leadership development strategies and programs, including isolated faculty development workshops at national meetings, longitudinal faculty development fellowship programs, and organizational change efforts within an academic department or residency training program. Indicators that these efforts are successful have primarily been reported in the context of career satisfaction, retention in academic medicine, and attainment of administrative roles or higher academic rank among faculty who have participated. CONCLUSIONS: Organizational and leadership development is occurring in the context of both individual and organizational initiatives. We propose a cycle-of-learning framework that provides one model for development of these essential skills.

Desirable features of qualitative research.

Family medicine investigators are beginning to use qualitative approaches to research questions. This paper reviews guidelines for qualitative research from several social sciences, and summarizes discussions of "standards" for qualitative research among health professionals. From these sources, the authors propose desirable characteristics of qualitative research. These include values of empathy, collaboration, service, and moral sensitivity; characteristics of clarity and coherence; techniques of participatory dialogue, triangulation, purposeful sampling, and immersion in context; and outcomes of useful knowledge and behavior effectively shared with readers.

Characteristics and job satisfaction of nonphysician full-time family medicine faculty members.

BACKGROUND: Nonphysician educators comprise a significant portion of the faculty in family medicine, yet little is actually known about this cohort of educators. This survey identifies and examines the population of nonphysician faculty. METHODS: a questionnaire was sent to 859 nonphysician faculty teaching full time in 113 family medicine departments and 377 family medicine residency programs. The questionnaire was used to determine the composition, characteristics, and levels of job satisfaction of respondents. The responses of this nonphysician cohort were compared to responses of physician faculty who participated in a previous study. RESULTS: Nonphysician faculty were more satisfied with the jobs they performed than they were with the recognition and rewards they received. Satisfaction levels of nonphysicians were significantly greater than their physician colleagues in the areas of research, clinical work, and administration. Physicians were significantly more satisfied than nonphysicians only in response to questions relating to teaching. CONCLUSIONS: Further research is needed to determine how to optimally integrate nonphysicians into family medicine education and fully utilize their expertise.

Organizational development in academic medicine: an educational approach.

Can organizational development work in the academic setting? Because current cost constraints and federal regulations are forcing departments and services to integrate, organizational development may be the best option for management. The study reported here shows that it can work successfully in the family medicine department.