Understanding chronic illness: a curriculum using nonmedical literature.

This is a report on the development of a curriculum designed to meet the need to teach residents a caring model of medicine for effective management of the growing chronically ill population. A central unifying theme in this curriculum is the use of nonmedical literature, specifically Heartsounds, to provide a common experience and focus for discussion. The goal of the curriculum is to help residents increase their understanding of the meaning of chronic illness to the patient, family, and physician. Objectives and a structured conference series are described, including the use of nonmedical literature as required reading. Long-term evaluation of the effect of the curriculum on attitude and behavior is in progress.

Preceptor development in residency training through a faculty facilitator.

To address the demand for training preceptors, a community hospital-based residency program is using a part-time preceptor in a consultative capacity as a faculty facilitator to model, assess skills, and generally improve the level of teaching. Direct observation of resident-patient interactions and subsequent preceptor critiques are followed by feedback to the preceptor on the cogency and effectiveness of comments made. Goals, objectives, and teaching style are jointly examined by the preceptor and faculty facilitator. Evaluation of videotaped resident-preceptor interactions before and after six months' experience with the faculty facilitator shows significant increases in preceptor skills. Greatest improvement is in comments related to resident's clinical assessments, the resident-patient relationship, and in the quality of the resident-preceptor interaction. Scores by the faculty facilitator are significantly lower but parallel those of an independent, blind evaluator. Preceptor, resident, and administration reactions to the project are all positive. This ongoing program assures the continued upgrading of preceptor skills and provides for faculty attrition. A faculty facilitator providing direct feedback in the clinical setting is a low-cost and viable alternative to workshops and conferences for training effective teachers of family medicine.