Factors associated with changing levels of interest in primary care during medical school.

PURPOSE: To examine changing levels of interest in primary care as related to clinical experiences during medical school, and to other variables. METHOD: A total of 1,911 (74%) allopathic medical school graduates responded to a national survey in early 1993. Respondents' reported changes of interest in primary care during medical school were cross-tabulated with their clinical experiences in medical school, their demographics, their interests prior to medical school, and their future practice plans. RESULTS: Increased interest in primary care during medical school was strongly associated with the electives taken in primary care. This positive change of interest in primary care was found to be associated with interest prior to medical school and with primary care career plans. CONCLUSION: Schools wishing to graduate more students who enter primary care specialties may want to raise the number of primary care elective courses to increase students' interests, and to help them choose to enter and remain in primary care specialties.

Assessing emergency medicine resident communication skills using videotaped patient encounters: gaps in inter-rater reliability.

We report on a process for assessing the communication skills of emergency medicine residents that includes 1) a faculty development initiative; 2) videotaping of actual resident-patient encounters in the emergency department; and 3) creation of an observation instrument for evaluating communication behaviors. We tested this observation instrument for inter-rater reliability, finding moderate-to-high agreement for only 11 of 32 items. These related to personal introductions, conflict management, nonverbal communication, and overall performance. There was poor or no agreement for behaviors related to establishing rapport, gathering information, and contracting or informing. Challenges of assessing interpersonal skills of emergency medicine residents are discussed.

Medical students' personal values and their career choices a quarter-century later.

A longitudinal study of 391 physicians tested two hypotheses regarding personal values and career choices: that higher preference for social values would be associated with physicians' being more interested in "people-oriented" rather than "technology-oriented" specialties and that higher preference for economic values would be associated with expectations of high income. The physicians (344 men, 47 women) were graduates of Jefferson Medical College in 1974 and 1975 who completed the Allport-Vernon-Lindzey Study of Values during medical school. Analysis showed that physicians currently in the "people-oriented" specialties scored significantly higher on the Social Value scale than their peers in "technology-oriented" specialties. A moderate but statistically significant correlation was found between scores on the Economic Value scale and expectations of higher income. The findings suggest that physicians' personal values are relevant to their career decisions such as specialty choice and expectations of income. The findings have implications with regard to two major issues in the evolving health care system, namely, the distribution of physicians by specialty and cost containment.

Students' satisfaction and perceptions of attending physicians' and residents' teaching role.

BACKGROUND: Changes in the health care system imply that fewer patients will be admitted to hospitals and attending physicians will be devoting more time to clinical activities with less time for student education. METHODS: Surveys of third-year students were conducted for 5 consecutive years at Jefferson Medical College at the end of the required 6-week surgical clerkship at the university hospital or at one of the eight affiliates. RESULTS: The numbers of new inpatients and outpatients encountered by students were not significantly related to students' overall satisfaction. The ratings of teaching rounds and conferences were significant predictors of satisfaction with the clerkship, as were the ratings of residents' teaching. CONCLUSIONS: As medical education shifts to ambulatory settings, didactic teaching such as rounds and conferences should be maintained and efforts to enhance the teaching skills of residents should be encouraged.

Primary care and nonprimary care physicians' concerns in practice and perceptions of medical school curriculum.

The purpose of the present study is to address the issue of physicians' concerns in practice and their perception of a medical school's curriculum with an emphasis on comparisons between primary and nonprimary care physicians. The sample consisted of 663 physicians who graduated from Jefferson Medical College (JMC) between 1982 and 1986, and also responded to a mailed questionnaire. Comparisons were made between physicians in primary care (n=234) and in nonprimary care (n=429) specialties on their responses regarding concerns in medical practice and evaluation of the medical school curriculum. Primary care physicians were more concerned about the time for their professional development whereas nonprimary care physicians were more concerned about an oversupply of physicians in their specialties, prospective hospital payment, and malpractice litigation. Regardless of the specialties, the physicians overall seemed very concerned about their personal time. Interpersonal skills were regarded by all respondents as an important aspect of the medical school's curriculum. The importance of psychological, social, and cultural factors in the curriculum was strongly supported by these physicians' responses, particularly among primary care and women physicians.

Perceptions of practice problems encountered by family physicians, pediatricians, and orthopedic surgeons.

Information about physicians' practice problems was solicited through a structured questionnaire mailed to a group of family physicians, pediatricians, and orthopedic surgeons. Overall, a lack of personal time was the major concern across the three groups of physicians. Comparisons among the three types of physicians revealed two patterns: Family physicians reported more concerns in the "interpersonal" dimension, whereas orthopedic surgeons had more concerns in the "legal-economic" dimension. These patterns of differences persisted with two variables controlled: gender and time period in which they completed their residency program. These findings indicate that physicians' concerns in their practice vary among the specialties, and they imply that the changed economy and reimbursement system might have more impact on one than the other. Thus the effectiveness of residency training and continuing education might be improved by emphasizing the specialty-related problems in practice.

Attendings' and residents' teaching role and students' overall rating of clinical clerkships.

The study was conducted with a sample of third-year students (n = 584) at Jefferson Medical College to explore students' perception of patterns of differences between attending physicians and residents in their teaching behaviors during clinical clerkships. Attending physicians' teaching behaviors were perceived more in a mentorship mode whereas residents' teaching behaviors were equally divided between mentorship and preceptorship modes. Attending physicians and residents' teaching behaviors varied among clerkships. Results were discussed in terms of difference of teaching roles played by attending physicians and residents and relationship of the teaching behaviors to students' overall rating of clerkship.