Co-teaching: a faculty development strategy.

It has been stated that faculty development programmes which are closely linked to particular teaching contexts are most likely to be effective. Over the past 10 years we have developed a model of 'co-teaching' for faculty development which is based upon this premise and which can be applied to any clinical rotation. In this paper we describe our model, in which paired physicians focus on developing their teaching skills while sharing the clinical supervision of residents and medical students. Through iterative phases of teaching, debriefing and planning, co-teachers gain experience in analysing teaching encounters and develop skills in self-evaluation. Teaching occurs in the usual clinical settings such as attending (consultant) teaching rounds, clinic precepting, and case conferences. We discuss our model in the context of educational theory and related literature. We support our positive assessment of the co-teaching model through the precepts of collaborative inquiry and case study methodology. Vignettes, taken from the experiences of the authors, are used to demonstrate how the model is used to develop effective solutions to problems and to help in the maturation of one's skill as an educator. Successful implementation of the model is predicated on the development of a truly collaborative process between co-teachers. We share lessons we have learned from our experience of implementing the model in different clinical venues, such as the contrast between teaching on a hospital ward or in the clinic. This collaborative process has been well received by junior and senior faculty participants in our institution for more than a decade.

The interaction of patient perception of overmedication with drug compliance and side effects.

OBJECTIVE: Little is known about the significance of patient-perceived overmedication. We sought to determine its prevalence and relation to medication compliance, adverse drug reactions, health-related quality of life (HRQOL), and burden of illness. DESIGN: Analysis of self-reported questionnaire data. PATIENTS/PARTICIPANT: There were 1,648 participants in a longitudinal study of male veterans. INTERVENTION: Participants listed each of their medications with indication, missed doses, adverse reactions, and whether their amount of medication was "too much, the right amount, or too little." The survey included questions about medication adherence, "problems with medications," common symptoms, and screening questions for a number of chronic conditions. We assessed HRQOL with the Multiple Outcomes Study 36-Item Short Form Health Study (SF-36). MEASUREMENTS AND MAIN RESULTS: Of the 1,256 respondents, 1,007 (80%) had taken medication within 4 weeks. Forty (4%) thought they were taking too much. They reported a 1.6-fold increase in prescription medications, a 5-8 fold increase in adverse effects, a 1.5-2 fold decrease in compliance, an increase in each of seven measured symptoms, and a decrease in six of eight SF-36 domains (p < .05 for all comparisons), the exceptions being the mental health and role-emotional scales. There was also a slight increase in the report of any chronic illness (95% vs 86%, p > .05). CONCLUSIONS: Patient perception of overmedication correlates with self-report of decreased compliance, adverse drug reactions, decreased HRQOL, and an increase in symptomatology that is compatible with unrecognized side effects of medication. Such patients warrant careful evaluation.

High prevalence of chronic gastrointestinal symptoms in a National Guard Unit of Persian Gulf veterans.

OBJECTIVES: To determine the prevalence and spectrum of GI complaints in a group of Persian Gulf veterans (PGV) and to compare these data to a group of veterans (controls) from the same unit who were not deployed to the Persian Gulf region. METHODS: A 68-item survey was distributed to 136 members of a single National Guard Unit. The survey asked the veterans to rate the frequency of GI symptoms before, during, and after the Persian Gulf war had concluded. The participants were also asked to rate frequency of 10 non-GI symptoms at the time of this survey. RESULTS: Fifty-seven PGV and 44 nondeployed veterans participated in the survey. Before the Persian Gulf war, both PGV and control groups reported low frequencies of GI symptoms. A majority of the PGV experienced GI symptoms during their deployment to the Gulf region, which persisted after their return to the United States. There were many significant differences observed between the two groups in frequency of both GI and non-GI symptoms. The greatest differences seen were for excessive gas, loose or greater than three stools per day, incomplete rectal evacuation, and abdominal pain. CONCLUSIONS: A high prevalence of chronic GI symptoms exists in this group of PGV and is significantly greater than a group of controls. The most prevalent chronic GI symptoms are those that have been associated with functional GI disorders. However, the abrupt onset and clustering in this group suggests that nonfunctional etiologies may be contributing factors.

Soliciting feedback: on becoming an effective clinical teacher.

The art of teaching is difficult to master. When teaching in small groups, as often happens in clinical medicine, there is an opportunity to find out what works by speaking directly with students. The information they provide can serve as an invaluable guide, permitting refinement of skill over time. There are, however, significant barriers to this process. The art lies in finding an approach that is comfortable for both parties. The authors refer to this activity as soliciting feedback. They offer guidelines for soliciting feedback as an aid to improving teaching efforts.

The medical day hospital. A new concept in ambulatory medical education.

The shift of patients from inpatient to outpatient settings as a result of various well-known economic, technologic, and demographic forces presents a challenge for internal medicine residency training programs. In response, we developed a new ambulatory site for education of medical students and residents. The Ambulatory Diagnostic and Treatment Center functions as a medical day hospital serving the needs of patients requiring intensive diagnostic or therapeutic interventions on a short-term basis. The center maintains many of the educational advantages of an inpatient service including block rotations of house officers, easy access to consultants and specialized services, and daily attending rounds while providing experience in outpatient management skills. This unit represents a new concept in ambulatory education and, if adaptable to other institutions, may be a valuable component of a broad ambulatory medicine curriculum.