Supporting primary care medical education.

A number of fundamental issues must be considered in preparing the education system to produce more primary care physicians. Governmental controls and redirection of resources will force significant changes in the structuring of approaches to both undergraduate and graduate education in primary care. Particularly challenging will be restructuring and funding medical student programs in primary care, given a nearly certain requirement that more than 50% of medical school graduates enter primary care disciplines. Institutions will need to make strategic resource allocations to compete for the funding once the allocation process begins. Educational institutions will also face a cultural adaptation to primary care as an educational priority. This paper presents a model to study costs and funding for residency programs as they move from the traditional inpatient orientation to an outpatient focus. The authors suggest that for medical student education, the development of large academic health care systems may make funding primary care education more feasible.

Resident, faculty, and residency program development. An integrated approach through annual retreats.

Retreats during residency training have evolved as an escape from the daily routine. Recognizing that the retreat format could also be used as a foundation for program design and personal development, we have designed annual retreats for each of the 3 years of pediatric residency training. The sessions vary in length and agenda, but serve as the basis for an ongoing effort fostering growth and maturation of the department and its component participants. The effectiveness of the program (and the morale of the residents) is greatly influenced by this program.

[Incidence and characteristics of lumbar disk hernias in older patients]. / Häufigkeit und Charakteristika lumbaler Diskushernien beim älteren Patienten.

Previous history, clinical findings, course and therapeutic outcome in 149 elderly patients with lumbar disk hernia were analyzed and compared with younger adult patients. 21% of all patients with lumbar disk hernia undergoing surgical treatment, and 25% under conservative treatment, were aged over 60 years. In these patients no history of low back pain is present in one third, the course is prolonged and motor deficits are more often encountered. Concomitant osseous narrowing (spinal stenosis, narrowed recessus lateralis) were present in 72% of this elderly group. Surgical complications are increased (34%) and are due to age-related diseases. Functional results are excellent after both conservative treatment and surgical therapy.

Using an organizational development strategy to improve residency training.

Medical students' preferences for residencies in internal medicine are in decline. To attract outstanding students, departments of medicine must strive to improve the quality of their training programs. In the setting of a university-affiliated residency program, the authors employed a strategy based on organization development principles to identify remediable educational problems and to facilitate the process of solving these problems. Residents, attending physicians, and administrators used a consensus-building method, the nominal group technique, to develop problem lists ranked by two criteria--relative importance and potential for solution. Problems of high importance and high potential for solution were identified and assigned to committees of housestaff and faculty for action. Management plans consisting of short-term and long-term interventions were created to solve each problem. These plans were widely accepted and short-term interventions were successfully implemented. This strategy represents a pragmatic approach to improving internal medicine residency programs because it focuses limited institutional resources on problems that are both important and amenable to change.

Types of medical writing and teaching of writing in U.S. medical schools.

U.S. medical schools were surveyed to determine which types of medical writing are most important for physicians, house officers, and medical students to learn and whether such types are formally taught. According to the responding schools, the five most important types were: write-up of the patient history and physical examination, progress note and discharge summary (tied), peer-reviewed published paper (of either clinical or laboratory research), and grant proposal. Certain types, however, were considered more important for some categories of physicians and trainees than others. Although these major types of writing represent complex and diverse writing tasks, they are not taught extensively in medical schools or thoroughly explained in the literature on medical writing.

Competency requirements. A new approach to medical school admissions.

The faculty of the University of Pennsylvania School of Medicine, Philadelphia, have substituted definitions of knowledge and skills for course requirements as requirements for admission. The school expects that this action will allow students more flexibility in the development of their undergraduate academic programs, while guiding them specifically to the necessary preparation in the sciences. It is further hoped that this action will encourage the faculties of undergraduate schools to examine the way in which they prepare students for careers in medicine. This article describes the approach used for bringing about this change in policy and presents the new admissions requirements.

A consumer/medical educator conference: new objectives for the medical curriculum.

The authors discuss the development and proceedings of a highly structured conference at which 17 representatives from diverse non-medical groups and 14 medical educators from one medical school identified objectives needing greater emphasis in the medical curriculum. The conference emulated industry's use of consumer advisory panels. Using the nominal group technique, a group process used in business, the non-medical group developed independently a priority list of areas in which physicians might be better educated to serve society. The medical educators then joined the non-medical group to discuss and clarify the concerns given highest priority. The authors describe subsequent initiatives by the medical school to address aspects of the general concerns raised by the non-medical group. The conference represents an approach to seeking input from non-traditional sources in the development of the medical curriculum.

Managing medical education at the University of Pennsylvania.

In meeting the challenge of educating students to be physicians in the 21st century, schools of medicine must develop management systems that promote change and encourage innovation. In this paper, the authors describe the approach used by the University of Pennsylvania School of Medicine over the past five years for managing its programs. The major elements of this management scheme are centralization of administrative functions concerned with medical education; networks for communication about education problems and issues; a system for obtaining consensus among the institution's constituencies on the goals of the school's educational programs; a system for including information on teaching performance as an element in the promotion process; and multiple systems for providing the faculty, students, and administration with information about the quality of the school's educational activities.