What did we learn about the impact on community-based faculty? Recommendations for recruitment, retention, and rewards.

All ten schools participating in the Interdisciplinary Generalist Curriculum (IGC) Project were required to offer students significant generalist longitudinal preceptorship experiences during the first two years of medical school. Each school needed to recruit and then retain many new preceptors to meet the continued large demand. Effective recruitment was usually carried out by established community physicians and/or qualified staff coordinators. Retention of preceptors required establishing regular and succinct communications, quick response to problems, and flexible faculty development programs. For rewards, preceptors primarily requested acknowledgment and appreciation, along with tangible rewards such as decreased fees for continuing medical education and library or e-mail access. Preceptors continue to state that they teach because of the "joys of teaching" even in the current environment with increased demands for productivity. This article describes what has been learned about recruitment, retention, and rewards for community preceptors and how to maximize the positive impacts and minimize the negative impacts of teaching for community preceptors.

The Interdisciplinary Generalist Curriculum Project at Eastern Virginia Medical School.

The proposed Interdisciplinary Generalist Curriculum (IGC) Project at Eastern Virginia Medical School (hereafter Eastern Virginia) intended to encourage students to select generalist disciplines by featuring generalist role models, focusing on patients' perspectives, teaching generalist skills early, providing care to indigent and other populations, and emphasizing students' personal and professional development. To do so, Eastern Virginia proposed that collaborative interdisciplinary groups of faculty plan and oversee the implementation of first- and second-year students' early clinical experiences in generalists' offices as integrated with new and revised first- and second-year courses, the coordination of generalist curricula longitudinally from year one through year four, and the provision of appropriate faculty development. With minor exceptions described, the project was implemented as proposed. The project did have desirable effects, both intended and unexpected. The curricular changes made in the project will remain.

Integrating early clinical experience curricula at two medical schools: lessons learned from the Robert Wood Johnson Foundation's Generalist Physician Initiative.

The University of Texas Medical Branch and Eastern Virginia Medical School have created community-based generalist clinical experiences early in the first two years of medical school as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative. This article describes these experiences and related curricula, outlining the common elements and differing approaches at the two institutions. It discusses the success of the new curriculum, presenting information from performance measures and surveys of students, clerkship directors, and faculty involved in the programs, and it describes further evaluative studies being planned. The authors discuss nine lessons learned and their conclusion that early clinical experience with generalist physicians is an important element of generalist curriculum reform. It improves student satisfaction with the first two years' experience and provides a structure for teaching patient-centered, integrated clinical medicine, which is important in the general professional education of all students. Whether or not the long-term goal of increasing students' interest in generalist careers is realized, incorporating early clinical experiences with generalists into a curriculum has positive effects on students, faculty, and the overall curriculum.

Metabolism of explosive compounds by sulfate-reducing bacteria.

The metabolism of various explosive compounds-1,3,5-trinitrobenzene (TNB), hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), and octahydro-1,3,5,7-tetranitro-1,3,5,7-tetraazocine (HMX)-by a sulfate-reducing bacterial consortium, Desulfovibrio spp., was studied. The results indicated that the Desulfovibrio spp. used all of the explosive compounds studied as their sole source of nitrogen for growth. The concentrations of TNB, RDX, and HMX in the culture media dropped to below the detection limit (<0.5 ppm) within 18 days of incubation. We also observed the production of ammonia from the nitro groups of the explosive compounds in the culture media. This ammonia served as a nitrogen source for the bacterial growth, and the concentration of ammonia later dropped to <0.5 mg/L. The sulfate-reducing bacteria may be useful in the anaerobic treatment of explosives-contaminated soil.

Types of faculty development programs.

This paper offers an overview of faculty development program types, with references to specific programs described in the recent literature. Faculty development programs have been categorized in a number of ways. This review uses a variation of those typologies and suggests six types of faculty development activities: 1) organizational strategies, 2) fellowships, 3) comprehensive local programs, 4) workshops and seminars, 5) continuing medical education, and 6) individual activities. While these categories provide a conceptual basis for distinguishing among programs, actual programs in use often contain elements of more than on type.

An alternative approach to defining the role of the clinical teacher.

BACKGROUND: A number of studies have attempted to identify the components of the clinical teacher role by examining learners' numerical ratings of items on researcher-generated lists. Some of these studies have also compared different groups' perceptions of clinical teaching, but have not directly compared the perceptions of first- and third-year residents. This study addressed two questions: (1) What do residents consider important components of the clinical teacher role? (2) Do first- and third-year residents perceive this role similarly? METHOD: A content analysis was performed on the comments written on evaluation forms by 268 residents about 490 clinical teachers over a five-year period (1980-81 through 1984-85) at a large family practice residency. Of 5,664 forms completed by the residents, 2,388 (42%) contained written comments; comments were on 1,024 (46%) of the first-year resident's forms, 701 (41%) of the second-year residents' forms, and 663 (39%) of the third-year residents' forms. Themes in these comments were coded into a coding dictionary of 157 categories, within 37 clusters, within four roles. RESULTS: The ten highest-ranked categories (Global; Teaching: General; Knowledgeable; Gives Resident Responsibility; Supportive; Miscellaneous; Interested in Teaching; Clinical Competence; Makes Effort to Teach; and Gives Resident Opportunity to Do Procedures) accounted for 41% of the themes coded. The first- and third-year residents differed in the clusters they used to describe their clinical teachers on evaluation forms (chi 2 = 149.86, df = 36, p < .0001). CONCLUSION: The results suggest that content analysis can be used to validly and reliably study residents' written evaluative comments about their teachers. This study contributes to the definition of the clinical teacher role, showing the relative importances of its components, and also supports Stritter's Learning Vector theory, finding the anticipated differences between the comments made by first- and third-year residents.

Teaching medical decision making and students' clinical problem solving skills.

Medical students need to be taught explicitly about decision making to be prepared for the changing health care environment. Medical decision making curricula have received favourable responses from students and have influenced some aspects of student performance. Questions remain about the impact of the teaching on students' general problem solving skills. A 15 hour course covering decision making topics was presented during a preclinical elective preceptorship for 5 years. Problem solving ratings made by clinical supervisors for the third year psychiatry and internal medicine clerkships were not better for the students who had the instruction and clinical experience than for the students in the comparison group. The results suggest that this approach to teaching decision making requires further development and testing.

User-centered evaluation.

Much has been written on graduate medical education and its evaluation. Seldom, however, are mentioned the uses made or the benefits of such evaluations. Drawing on current models for increasing the use of information from external evaluations, the authors offer a user-centered approach for increasing the use of results from internal evaluations, the more typical form of evaluation in graduate medical education. The over-riding emphasis of the user-centered approach to evaluation is the utility of the resultant data. Three features characterize user-centered evaluation: an ordered set of steps with usefulness as the primary concern at each step; delineation of evaluator and decision-maker roles; and attention to the general communication aspects of evaluation. This article describes these three characteristics, concluding with two fundamental points: (1) A user-centered approach to evaluation will help evaluation do what it is supposed to do: provide information that gets used to increase the effectiveness of everyday decisions. (2) A user-centered evaluation accomplishes this, first, by having a pervasive attitude of utility and, second, by carefully attending to the three characteristic features of this approach to evaluation.