Scholarship in teaching: an imperative for the 21st century.

At some medical schools broader definitions of scholarship have emerged along with corresponding changes in their academic reward systems. Such situations are not common, however. The definition of scholarship generally applied by medical schools is unnecessarily narrow and excludes areas of legitimate academic activity and productivity that are vital to the fulfillment of the school's educational mission. The authors maintain that creative teaching with effectiveness that is rigorously substantiated, educational leadership with results that are demonstrable and broadly felt, and educational methods that advance learners' knowledge are consistent with the traditional definition of scholarship. Faculty whose educational activities fulfill the criteria above are scholars and must be recognized by promotion. The authors specifically address scholarship in education, focusing on teaching and other learning-related activities rather than on educational research, which may be assessed and rewarded using the same forms of evidence as basic science or clinical research. They build on Boyer's work, which provides a vocabulary for discussing the assumptions and values that underlie the roles of faculty as academicians. Next, they apply Glassick et al.'s criteria for judging scholarly work to faculty members' educational activities to establish a basis for recognition and reward consistent with those given for other forms of scholarship. Finally, the authors outline the organizational infrastructure needed to support scholars in education.

Surgical practice of primary care physicians in a rural state: implications for curriculum design.

BACKGROUND: We surveyed practicing primary care physicians to help determine surgical practice patterns of primary care physicians in a rural state. The information obtained can be used to make surgical curriculum decisions for generalist medical students and primary care residents. METHODS: We developed a questionnaire in which practicing primary care physicians were asked to rate, on a 5-point Likert scale, the importance of 145 areas of surgical knowledge and 48 areas of clinical skills to their practice. Responses were rank ordered by the mean ratings for each individual item. The questionnaire was sent to all 876 primary care physicians in the home state of the institution. RESULTS: The survey response rate was 61% (n = 534). The most highly ranked items and procedures included acute otitis media, sinusitis, gastroesophageal reflux disease, pharyngitis, urinary tract infection, performance of abdominal exam, history and physical, daily progress notes, ear canal cleaning, and ability to write admission orders. The lowest ranked items included transplantation, infertility, amputations, performance of tracheostomy, venous cutdown, and cricothyrotomy. CONCLUSIONS: Information regarding the surgical practice patterns of practicing primary care physicians can be used to develop a surgical curriculum for medical students and primary care residents.

Student and faculty perceptions of problem-based learning on a family medicine clerkship.

BACKGROUND AND OBJECTIVES: The value of problem-based learning (PBL) in the preclinical years of medical school has been described widely in the literature. This study evaluates student and faculty perceptions of PBL during the clinical years of medical school, on a family medicine clerkship. METHODS: Students used a 4-point scale to rate clerkship educational components on how well learning was facilitated. Faculty narratives of their perceptions of PBL were reviewed. RESULTS: Educational components that involved active learning by students--clinical activity, independent learning, and PBL tutorials--were ranked highest by students. Faculty perceived that PBL on the clerkship simulated "real-life" learning, included more behavioral and population issues, and provided substantial blocks of student contact time for improved student evaluation. CONCLUSIONS: Students and faculty in a family medicine clerkship ranked PBL sessions higher than any other nonclinical component of the clerkship. In addition to providing students with opportunities for self-directed learning, the PBL sessions provide faculty with more contact time with students, thereby enhancing the assessment of students' learning and progress.

Adolescent sexuality issues in office practice.

Sexuality is an important aspect of development during adolescence. A knowledge of the sexual issues relevant to each stage of adolescence will help the physician address sexual issues with adolescent patients. The ability to identify and communicate with adolescents who may be at high risk of premature sexual activity is particularly important since sexual intercourse at an early age can have serious short- and long-term consequences. A nonjudgmental manner, an emphasis on confidentiality and an honest appraisal of the implications of early sexual activity will enhance discussions about sexual issues with adolescents.

The problem of teenage pregnancy.

PIP: In this question and answer dialogue along with a case study, the psychosocial issues and medical aspects of teenage pregnancy are discussed. Suggestions for improving the situation included 1) developing a community based approach which utilizes school sex education integrated with parent, church, and community groups, 2) increasing teenage knowledge of contraception, and 3) providing counseling and medical and psychological health, education, and nutrition of the mother and father in order to reduce low birth weight babies and the school dropout rates. Advice to providers is to involved in supporting community based adolescent pregnancy and childbearing programs, and serving the needs of of teenagers by providing contraceptive information in confidence, and providing nonjudgmental information to parents and teenagers on sexuality, pregnancy and birth control. The cost of teenage childbearing is estimated at 16.6 billion for 1985, with the U.S. fertility rate, birth and abortion rates higher than Canada, France, the Netherlands, Great Britain and Sweden. Within 1 month of 1st initial intercourse, 20% result in teenage pregnancy. 50% will give birth to a second child. The health risk to the mother and child due to poor nutrition, toxemia conditions, while psychosocial effect is the cycle of failure and low self-esteem. For disadvantaged youth, a baby appears as a reachable achievement, and for those with an additional child, the goal of security and financial independence is less likely. Financial and emotional support from family or social services and family planning practices can lead to completion of H.S., limitation in family size, and independence. Of those receiving public assistance in 1969, 66% were independent, and only 12% receiving assistance between 1969 and 1974 were still receiving assistance. Teen fatherhood has not been adequately addressed, and findings suggest that parenting and contraceptive education, job training, support to stay in school are receptive ideas to fathers and also impact favorable on mothers and children.^ieng