Evaluating faculty development outcomes by using curriculum vitae analysis.

BACKGROUND AND OBJECTIVES: Many faculty development (FD) programs depend on external private and public sponsors that routinely require systematic studies on FD outcomes. The results of evaluation studies can influence whether or not programs continue to be funded. To better evaluate program outcomes on academic productivity, this paper presents and illustrates an evaluation method that uses the curricula vitae (CVs) of FD program graduates. METHODS: The evaluation method is implemented by first preparing a record-review template of coding categories that is applied to FD graduates' updated CVs. Next, semi-structured interviews are held with subjects to resolve uncertain CV codes. Finally, coded data are entered into standardized forms and analyzed to yield descriptive findings. The method was piloted with two groups of FD graduates (n = 17) to determine its utility and limitations. RESULTS: Results show excellent inter-rater reliability (Cohen's Kappa = .79). There was an overall increase in productivity, measured by the CV, during and after the FD program. CONCLUSIONS: CV analysis can be a useful method for assessing FD program outcomes. Several limitations of the method, such as incomplete CVs and self-report bias, must be considered.

The effects of the ALSO course as an educational intervention for residents. Advanced Life Support in Obstetrics.

BACKGROUND AND OBJECTIVES: Previous descriptions of the Advanced Life Support in Obstetrics (ALSO) course have indicated increases in physician comfort in managing obstetric emergencies and in their intentions to continue offering maternity care after taking the course. No previous studies have been done about the educational outcomes of the ALSO course on family practice residents. This study compared residents' pre- and post-ALSO course confidence to manage obstetrical emergencies and their intention to provide maternity care when they enter practice. METHODS: A self-selected group of 55 family practice residents completed questionnaires before and after ALSO training. The questionnaire was designed to measure confidence, using Bandura's model of self efficacy, and future intention, using Ajzen's Theory of Planned Behavior. RESULTS: Residents' confidence in their abilities to manage obstetrical emergencies increased significantly after the ALSO course. Residents' intent to provide maternity care when the residents enter practice did not change. CONCLUSIONS: The ALSO course is a valuable teaching intervention that can improve family practice residents' perceived self-confidence in managing obstetric emergencies. The study had sufficient power to detect a moderate effect size of the ALSO course on resident intention to provide maternity care but did not do so.

Personal values related to primary care specialty aspirations.

BACKGROUND AND OBJECTIVES: Two recent studies showed that personal values influence specialty choice. However, both studies assessed the perceived influence of values instead of measuring values directly. The present study measured and compared the values of aspirants to primary care versus other specialties. METHODS: In 1993, first-year medical students, entering residents, and graduating residents at a private Midwestern medical school completed a questionnaire on their specialty aspirations and completed the Schwartz Values Survey, which measures the importance of 10 types of values: achievement, benevolence, conformity, hedonism, power, security, self-direction, stimulation, tradition, and universalism. A three-factor MANOVA (specialty aspiration, gender, level of training) was performed on the importance ratings. RESULTS: The three MANOVA main effects were significant. Primary care aspirants rated power and self-direction values lower and benevolence values higher than did aspirants to other specialties. Women gave higher ratings to universalism and benevolence and lower ratings to power, tradition, and conformity values than did men. Medical students rated security values lower than did the two resident groups. CONCLUSIONS: This study demonstrates the relationship of personal values and specialty choice and provides empirical support for admissions policies that incorporate personal values into the admissions process.

Adolescent life experiences of physicians in primary care compared with other specialties.

BACKGROUND AND OBJECTIVES: The perceived need for more primary care physicians has stimulated several studies of specialty choice. One study that used a cross-sectional design found that life-history experiences differentiated between generalist and specialist physicians. The present study assessed whether life history experiences reported during college could differentiate between physicians currently in primary care versus other specialties. METHODS: We tracked students who completed a 118-item inventory of life history experiences (biodata) during their freshman orientation at a large, public university and who subsequently graduated from the state's largest medical school. We compared biodata responses of those currently practicing in primary care with those in other specialties. RESULTS: Biodata and medical specialty information were available for 169 physicians, of which 145 were men (27 primary care, 118 other specialties), and 24 women (three primary care, 21 other specialties). Women were excluded from further analyses. Using 13 biodata factors identified in prior studies, primary care physicians had lower scores on "orientation toward academics," and higher scores on "personal and social adjustment." Biodata accounted for 19% of the variance in specialty choice. CONCLUSIONS: Biodata can help identify medical school applicants who will have a greater likelihood of selecting a primary care specialty.

Personal values of exemplary family physicians: implications for professional satisfaction in family medicine.

BACKGROUND: Personal social values have been identified as important determinants of generalists' specialty choice. However, the personal values or "guiding principles" of generalist physicians have not been identified scientifically. To establish a benchmark, we measured the personal values of exemplary family physicians because they serve as role models for current and future physicians. We also explored the relationship between personal values and practice satisfaction. METHODS: We obtained a list of 330 family physicians nominated for the American Academy of Family Physicians' (AAFP) Family Doctor of the Year award for the years 1988 through 1993. We asked them to complete the Schwartz Values Questionnaire, a 56-item instrument for measuring personal values. They also answered three questions concerning practice satisfaction. RESULTS: The return rate was 83%. The physicians' mean age was 63 years. They had been in practice an average of 34 years, 93% were male, and 52% practiced in rural areas. Honesty was rated as the most important of the 56 values, and social power as the least important. Of the 10 value types (groups of common values), the responding physicians rated "Benevolence" as most important and "Power" as least important. Practice satisfaction correlated positively with the Benevolence value type (r = .21, P = .001) and negatively with the Power value type (r = -.15, P = .023). CONCLUSIONS: Of the 10 value types, Benevolence was rated the most important and Power the least important by exemplary family physicians, and both value types also correlated, positively and negatively, respectively, with their practice satisfaction. These results have implications for the selection, training, and career satisfaction of generalist physicians.

Caries pattern identification in primary dentition: a comparison of clinician assignment and clinical analysis groupings.

The purpose of this study was to compare the assessment of caries patterns by clinical definition and by cluster analysis. One of five etiology-oriented caries patterns was assigned to Head Start children in primary dentition. Cluster analysis grouped children based on carious tooth surfaces for each child. One hundred twenty-seven of the 155 children with at least one carious lesion fell into clusters of at least four children. At least two-thirds of the subjects in each cluster were assigned to a single caries pattern. The largest cluster of 70 children had 66 of its subjects assigned to the pit and fissure pattern. The second largest cluster of 26 children had 20 of its subjects assigned to the faciolingual pattern (intended to identify bottle caries). This study is interpreted to reinforce the notion that caries in the primary dentition occurs in fairly distinct patterns.

Does prenatal care decrease the incidence and cost of neonatal intensive care admissions?

This study was conducted to examine the potential effects of expanded Medicaid coverage for low income women. Statewide birth data for 1983 to 1985 were examined to determine the relationship between prenatal care and admissions to neonatal intensive care units (NICUs) and the costs of this care. An NICU sample was constituted from infants who were discharged live following more than 7 NICU days, were referred to an out of state tertiary center, or died following NICU admission. Inadequate care (no prenatal care, only last trimester care, or less than five visits) was received by 11% of the total birth cohort and by 18% of the infants in the NICU sample (p less than 0.001). Infants with inadequate care had a NICU admission rate of 5.10% versus 2.86% for those with adequate prenatal care (p less than 0.001). The hospital billings for infants in the NICU sample with inadequate care were significantly higher than were those for infants with adequate care (p less than 0.05). Assuming that economic resources limit access to prenatal care, the projection can be made that had all women with inadequate prenatal care received Medicaid-covered adequate prenatal care, expenditure for this care would yield more than a two to one return in savings in NICU costs.

Perceptions of South Dakota adults concerning selected adolescent health problems.

A telephone survey was conducted of a random sample of 1,015 South Dakota households to assess adults' perceptions of whether alcohol and drug abuse, teen pregnancy, and suicide attempts are problems in their community, and across the state, among seventh through twelfth grade adolescents. A majority of the respondents indicated that alcohol and drug abuse, and teen pregnancy are a problem for adolescents in their community and across the state. Regarding suicide attempts among adolescents, over a quarter of the respondents indicated that they are a problem in their community, and one half of the respondents indicated that they are a problem across the state. Alcohol and drug abuse, teen pregnancy, and suicide attempts are more likely to be reported as being a problem across the state than in the local community. Respondents overwhelmingly agreed that health education programs in schools can help prevent alcohol and drug abuse, teen pregnancy, and suicide attempts among seventh through twelfth graders.

Caries patterns in Head Start children in a fluoridated community.

Assessment of caries experience based on the person rather than on the tooth opens the possibility for qualitative descriptions of caries in a population, as well as for the study of specific factors associated with different caries experiences. The study of a Head Start population in adjacent fluoridated communities was divided into two parts. It was the purpose of part one of the study to determine the prevalence of specific caries patterns (presumably associated with different etiologies). Of the children, 39 percent were caries-free; 32 percent had carious lesions only in pit-and-fissure defects of molars; 6.5 percent had carious lesions in hypoplastic defects; 11 percent had facial-lingual lesions, compatible with "nursing caries"; and 11.5 percent had approximal lesions of molars; no child in the study had rampant caries. The second part compared specific lifestyle variables with specific caries patterns. Statistically significant differences or trends were found between caries-free children and those with smooth-surface lesions for mother's educational level, time spent with grandparents, mother's perceived primary reason for cavities, and mother's tendency to permit the child to eat sweets without restriction. No significant differences or trends were found for lifestyle variables between caries-free children and those having lesions associated only with tooth defects.