What did we learn about early clinical experience?

This article explores the lessons learned by ten demonstration schools regarding the early clinical experience (ECE) component of the Interdisciplinary Generalist Curriculum (IGC) PROJECT: Students in ECE at these schools participated in longitudinal, one-to-one or two-on-one preceptorships with primary care physician preceptors in outpatient settings. Development of an ECE was a key component of curricular change at each of the IGC Project schools. Shattering the traditional barrier between preclinical and clinical years of the 2 + 2 medical curriculum model helped create a leading edge for innovation at each of the schools. In this article, the authors incorporated evaluation information from several sources, including the external evaluation reports of the IGC Project, final annual reports from demonstration schools, and curriculum evaluations from the coauthors' schools (the University of Colorado School of Medicine, Nova Southeastern University College of Osteopathic Medicine, and the University of California, San Francisco School of Medicine).

What did we learn about the impact on students' clinical education?

Analysis of the impact of the Interdisciplinary Generalist Curriculum (IGC) Project would be incomplete without discussion of how it affected students' clinical education. This article explores the impact of the IGC Project on medical students' clinical education at the ten IGC schools. The schools typically lacked pre-IGC Project baseline data for comparison, although they all collected data on the impact of the new curriculum on the clinical education of students. Measures included some objective indicators and various subjective measures of the perceptions of the students, faculty, and community preceptors. The impact of curricular innovations at the IGC Project schools on students was immediate as they began to see patients early and continuously as part of their medical education. Students, faculty, and community preceptors who interacted with these students during their third year believed they were "different" because of their participation in the IGC. Not only did the IGC students approach patients with better integrated basic science knowledge, but also a different kind of student arrived at the third year, the traditional beginning of clinical experiences in medical education.

The Interdisciplinary Generalist Curriculum Project at the University of Colorado School of Medicine.

The University of Colorado School of Medicine first considered a longitudinal primary care preceptorship in 1992, when the dean formed the dean's Ad Hoc Committee to launch the "generalist initiative," to include a three-year required longitudinal generalist preceptorship. Being awarded an Interdisciplinary Generalist Curriculum (IGC) Project contract provided the dean's Ad Hoc Committee with the momentum it needed to enact the curriculum. This article describes the IGC Project at the University of Colorado as it was originally proposed and the intended and unintended outcomes over time. Intended outcomes included establishing early continuous clinical experiences as a vital part of the curriculum and increased exposure to primary care, while examples of unintended outcomes were the development of a longitudinal skill and behavior evaluation process and the integration of problem-based learning in the curriculum. The article concludes with a description of what is ahead for the curriculum.

Student perspectives on primary care preceptorships: enhancing the medical student preceptorship learning environment.

BACKGROUND: Medical students participate in a longitudinal (3-year) primary care preceptorship to assist them in developing skills in interviewing and examining patients in an ambulatory care setting. PURPOSE: To identify from a student's perspective important context and process issues in a longitudinal preceptorship. METHODS: The investigators used an "editing" style of analysis to identify significant themes across 24 medical student focus groups held between October 1995 and December 1997. RESULTS: Significant themes emerged from the data analysis that describe important features of what makes the preceptorship work for students. The main themes are active teaching, active learning, a trusting relationship, sufficient time, and a shared understanding of preceptorship objectives. The potential benefits to students in an enhanced learning environment are comfort, confidence, responsibility, skills, knowledge, reinforcement, learning opportunities, teaching opportunities, and models for practice. CONCLUSIONS: We offer recommendations for enhancing longitudinal preceptorships for preceptors, students, and leaders in medical education.

Characteristics of and issues faced by rural female family physicians.

The purpose of this study was to identify characteristics of and issues faced by female family physicians practicing in rural areas. A 37-item survey was designed to obtain demographic information about the background, community and practice of rural female physicians. An open-ended question regarding the issues and problems faced by female physicians in rural communities was included. Study subjects were identified from the membership of the American Academy of Family Physicians (AAFP). The questionnaire was mailed to all 850 active female AAFP members practicing in communities with less than 50,000 inhabitants during the winter of 1999. Completed and usable surveys were received from 587 (69.9 percent). The average age of respondents was 45. The majority were married (81.1 percent) and had children (80.1 percent). Half of the women had grown up in communities of 25,000 or less population. Twenty-seven percent of the respondents had no rural exposure in medical school; 39 percent had no rural exposure in residency; and 16 percent had no rural exposure in medical school or residency. The majority of respondents (62 percent) practiced in communities of less than 10,000. A large majority (70 percent) of these women planned to stay in the community for 10 years or more, with 58.6 percent responding that they plan to stay indefinitely. Assumptions regarding rural physicians, especially women, must be updated to accurately assist communities in recruiting rural physicians and to assist medical schools and residencies in adequately preparing graduates for rural practice.

Unique issues of older medical students.

PURPOSE: Many persons applying to medical school have had other careers or experiences prior to their application. Comprising an increasing proportion of our student population, these older medical students often have unique difficulties differing from those of their younger peers. We undertook a 2-part study to evaluate possible differences in attitudes and beliefs between younger and older medical students. SUMMARY: We conducted the study in 2 parts. In the 1st part, a focus group of students who would be 30 years old or older at the completion of medical school ("older students") was assembled to ascertain potential themes. Themes articulated by this group were then constructed into a questionnaire that was administered to the entire 4th-year class. Results of the questionnaire were evaluated qualitatively by content and quantitatively when appropriate. Eight students participated in the focus group. The themes expressed by the group included increased home responsibilities relative to their peers, lack of perceived respect by attendings and residents, and different learning strategies. Eighty-eight students completed the questionnaire. More older than younger students agreed with the statements that their previous experiences made them better learners (p = .06) and that their personal responsibilities made it difficult to study (p = .0001). On open-ended questions, the responses from the older students were longer and contained stronger language. CONCLUSION: Older medical students express unique concerns regarding the learning environment and the impact of medical school on their personal lives. This study provides preliminary information that our older students may have more special needs and concerns than traditional students.

The family physician and house calls. A survey of Colorado family physicians.

BACKGROUND: Visiting patients at home has long been one of the activities of the family physician, but the practice of making house calls has diminished significantly during the second half of the 20th century. The goal of this study was to describe physicians' attitudes about house calls and their practice of making them in the rapidly changing health care environment of the United States. METHODS: A 30-item, self-administered questionnaire was designed to obtain demographic information about physicians and their attitudes toward house calls, practice experiences with making house calls, and any additional factors that influence making house calls. It was mailed to all members of the Colorado Academy of Family Physicians, during the summer of 1997. RESULTS: A 66% response rate was obtained from practicing physicians. Overall attitudes toward house calls were positive. Fifty-three percent of the respondents reported making house calls, and 8% reported making more than 2 house calls per month. Male physicians, those older than 40 years, those in rural settings, and those trained in a community-based residency were more likely to make house calls. Patient payer mix and practice setting were also related to whether a physician made house calls. House calls were most frequently made to geriatric patients, cancer patients, trauma patients, and patients with transportation difficulties. Many physicians reported using home health agencies for assessment and treatment of patients needing home care. CONCLUSIONS: Family physicians agree that house calls are good for patients. More than half of the respondents reported that they occasionally make house calls. However, few physicians routinely perform house calls.

Update on early medical and surgical abortion.

Abortion is one of the most common surgical procedures in the United States. Recent innovations in medicine make early pregnancy termination safe and effective. Our purpose is to review advances in early detection and confirmation of intrauterine pregnancy and discuss medical and surgical techniques for elective termination early in pregnancy. Manual vacuum aspiration is a safe and effective method for pregnancy termination through 10 weeks' gestation. Medical abortion using methotrexate or mifepristone with misoprostol is safe and effective for early pregnancy termination through 7 weeks' gestation.