Experiences with a combined residency in internal and preventive medicine.

BACKGROUND: The importance of integrating preventive medicine training into other residency programs was reinforced recently by the residency review committee for preventive medicine. Griffin Hospital in Derby CT has offered a 4-year integrated internal medicine and preventive medicine residency program since 1997. This article reports the outcomes of that program. METHODS: Data were collected from surveys of program graduates and the American Boards of Internal and Preventive Medicine in 2005-2007, and analyzed in 2007-2008. Graduates rated the program in regard to job preparation, the ease of transition to employment, the value of skills learned, the perceived quality of board preparation, and the quality of the program overall. Graduates rated themselves on core competencies set by the Accreditation Committee for Graduate Medical Education. RESULTS: Since 1997, the program has enrolled 22 residents. Residents and graduates contribute significantly toward quality of care at the hospital. Graduates take and pass at high rates the boards for both for internal and preventive medicine: 100% took internal medicine boards, 90% of them passed; 63% took preventive medicine boards, 100% of them passed). The program has recruited residents mainly through the match. Graduates rated most elements of the program highly. They felt well-prepared for their postgraduation jobs; most respondents reported routinely using preventive medicine skills learned during residency. Graduates either have gone into academic medicine (31%); public health (14%); clinical fellowships (18%); or primary care (9%); or they combine elements of clinical medicine and public health (28%). CONCLUSIONS: Integrating preventive medicine training into clinical residency programs may be an efficient, viable, and cost-effective way of creating more medical specialists with population-medicine skills.

Should disagreement about physician-assisted suicide discourage professional societies from engaging in public debate? A survey of 677 Connecticut internists.

OBJECTIVE: To determine whether physicians within a state-level professional association who disagree about the ethics of physician-assisted suicide (PAS) also disagree about organized professional engagement in public discussions regarding PAS. DESIGN: Anonymous mail questionnaire. PARTICIPANTS: Connecticut members of the American College of Physicians-American Society of Internal Medicine as of February 1999. MEASUREMENTS: Attitudes toward the legalization of PAS and organized participation in public discussions about PAS, and demographic and religious characteristics. MAIN RESULTS: The mean age of 677 respondents was 51 years and 20% were women. The legalization of PAS was favored by 28% of respondents, and opposed by 53%, but 84% favored organized participation in appropriate public discussions regarding PAS. Differences in religious affiliation were strongly associated with disagreements about PAS: physicians with Jewish affiliation or no affiliation were more likely to favor legalizing PAS than those with Catholic or other Christian affiliations (45%, 38%, 14%, and 19%, respectively, P < .001). Religious affiliation was not associated with differences in attitude toward organized participation in public discussions about PAS. Statistically significant differences in attitude toward public participation were found between some subgroups according to differing attitudes toward PAS, but in each case at least 80% of physicians still supported participation. CONCLUSIONS: Internists in this state-level organization widely supported organized participation in public discussions regarding PAS despite disagreements about its legalization, and support for organized participation was not affected by differences in religious affiliation nor substantially attenuated by differences in attitudes toward PAS.

Nine years of the freebase cocaine epidemic in the Bahamas: emergence of a new pattern

Nine years the beginning of the first reported nationwide epidemic of freebase (crack) cocaine abuse, which occurred in the Bahamas, a follow-up study was done to determine the pattern of the epidemic and the effectiveness of control measures. Data included the incidence of new cases at the only psychiatric hospital in the Bahamas and the primary community pschiatric clinic in the nation. Data on police arrests, drug seizures, and results for urine screenings for cocaine abuse came from the reports of the Royal Bahamas Police Force. The number of new cases of crack abuse presenting for treatment fell from 1987 to mid-1991, with a corresponding reduction of load at the treatment facilities. However, hospitalized cocaine abuse cases began rising again in mid-1991. This paper analyzes correlates of the fall and partial resurgences of the epidemic. In 1992, crack is much more difficult to obtain than in the early and middle 1980's. The Bahamian reponse to the epidemic - including 1) demand reduction, 2) supply reduction and 3) reduction of money laundering - played an important role in the decline of new cases. Crack has not been replaced by other illegal drugs, but alcohol has resumed its former place of preference. However, despite a reduction in the rate of new crack abuse cases appearing for treatment, there has been a recent rise in violent, robberies and gang activity. This apparently is due to chronic cocainism, a pattern of long term use of crack and other forms cocaine that is resistant to treatment

Nine years of the freebase cocaine epidemic in the Bahamas: emergence of a new pattern

Nine years the beginning of the first reported nationwide epidemic of freebase (crack) cocaine abuse, which occurred in the Bahamas, a follow-up study was done to determine the pattern of the epidemic and the effectiveness of control measures. Data included the incidence of new cases at the only psychiatric hospital in the Bahamas and the primary community pschiatric clinic in the nation. Data on police arrests, drug seizures, and results for urine screenings for cocaine abuse came from the reports of the Royal Bahamas Police Force. The number of new cases of crack abuse presenting for treatment fell from 1987 to mid-1991, with a corresponding reduction of load at the treatment facilities. However, hospitalized cocaine abuse cases began rising again in mid-1991. This paper analyzes correlates of the fall and partial resurgences of the epidemic. In 1992, crack is much more difficult to obtain than in the early and middle 1980's. The Bahamian reponse to the epidemic - including 1) demand reduction, 2) supply reduction and 3) reduction of money laundering - played an important role in the decline of new cases. Crack has not been replaced by other illegal drugs, but alcohol has resumed its former place of preference. However, despite a reduction in the rate of new crack abuse cases appearing for treatment, there has been a recent rise in violent, robberies and gang activity. This apparently is due to chronic cocainism, a pattern of long term use of crack and other forms cocaine that is resistant to treatment (AU)