The Jefferson-Penn State B.S.-M.D. program: a 26-year experience.

Since the 1960s a number of physicians have completed both their baccalaureate and their M.D. degrees in six or fewer years. In this longitudinal study the authors track the academic performances, clinical ratings, and career follow-up data of 659 students in one of these accelerated programs, the Jefferson Medical College-Pennsylvania State University B.S.-M.D. program, from entering years 1964 through 1989. The medical school performances, clinical performances in residencies, and rates of board certification and faculty appointment of the accelerated students compared favorably with those of a control group of medical students with similar high school credentials who had followed a four-year baccalaureate program. The authors conclude that a carefully chosen group of students can achieve high academic standards in an accelerated medical school program, graduate as younger physicians able to perform well in postgraduate training, and go on to highly productive careers in medicine.

Reexamination of relationships between students' undergraduate majors, medical school performances, and career plans at Jefferson Medical College.

A reexamination of the possible relationships between medical students' undergraduate academic majors and their medical school performances and career plans seems appropriate, given the continuing changes in the characteristics of the medical school applicant pool in the last several years. This study investigated these relationships by comparing cognitive and noncognitive characteristics of medical students who had had different undergraduate majors. The study sample consisted of 812 students who entered Jefferson Medical College between 1985 and 1988. They were classified into six categories based on their undergraduate majors: biological, chemical and physical, social and behavioral, other sciences, humanities and arts, and indeterminate majors. Results indicated that performances in the basic science component of medical education were about the same for students with different undergraduate majors. The groups had similar rates of delayed graduation, but the attrition rate was highest for students who had majored in humanities and arts. The students in undergraduate disciplines traditionally oriented toward medicine (biological, physical, and chemical sciences) were younger and had made the decision to become a physician at earlier ages than had their counterparts with undergraduate majors in social sciences and humanities. Also, the groups differed with regard to their estimates of their future incomes and plans for professional activities after graduation. Similarities concerning the students' preferred professional activities were also noticed among the groups.

The problem of late hospitalization: a quality and cost issue.

Emphasis on controlling health-care costs has led to many activities aimed at avoiding medically unnecessary hospitalizations. Much less attention has been given to patients hospitalized in advanced stages of illness and the impact of these late admissions on cost and quality of care. A panel of physicians developed criteria to categorize hospital admissions into one of three groups--early, timely, or late--based on the timing of the initial hospitalizations of patients admitted with any one of 14 diagnoses. Over a period of one year (fiscal year 1984) the criteria were applied retrospectively to 2,713 patients admitted to either of two hospitals. Twenty-one percent of the admissions studied in one hospital and 19% in the other were judged to occur later than was desirable. The mean length of stay for late hospitalizations exceeded that for timely hospitalizations by 11.1 days at one hospital and by 7.5 days at the other (p less than .01). Similar patterns were observed in analyzing the 14 diseases individually and in an analysis of hospital charges at the one hospital where charge data were available. In-hospital mortality rates for patients with a principal diagnosis of bacterial pneumonia were over ten times greater for those admitted late than for those whose admissions were timely (39.0% versus 3.8%, p less than .001, at one hospital; 28.9% versus 2.1%, p less than .001, at the other). While not all late hospitalizations are avoidable, the authors believe that the analysis of late hospitalization patterns is an important part of any effort that can be made to reduce them.

Confidence weighted answer technique in a group of pediatric residents.

Physicians who are excessively underconfident or overconfident about their knowledge may have impaired clinical judgement. Confidence weighting of multiple choice examinations asks test-takers to state how confident they are that the answers they selected are correct. This previously described method allows the examinee to receive 'overconfidence' and 'underconfidence' scores. This study was designed to test the hypothesis that these scores would correlate with faculty assessment of pediatric residents' confidence level as observed in the clinical setting. Thirty-three pediatric residents took an examination of general pediatric knowledge using confidence weighting method. Percentage of questions answered correctly ranged from 40 to 81%. There was an association between increasing overconfidence and lower examination scores (r = 0.58; p = 0.001). Increasing overconfidence was also associated with decreasing underconfidence (r = 0.38; p = 0.04). Five faculty members, the program director and the chief resident were asked to rate their perceptions of the residents' confidence on a Likert-type scale. The period of observation ranged from 9 months to 3 years. Linear regression demonstrated an association between underconfidence indices and observed confidence in the clinical setting (r = 0.39; p = 0.03). In addition, three of four residents who left the program had either over- or underconfidence indices greater than one standard deviation from the mean. These results indicate that the multiple choice examination with confidence weighting can predict residents who will be judged as underconfident by clinical preceptors. This finding is important in light of our impression that such house officers often have difficulties later during their residencies.

Students' certainty during course test-taking and performance on clerkships and board exams.

Psychometric aspects of multiple-choice tests were investigated using a confidence-weighted scoring technique. The contributions of two indices, overconfidence and underconfidence, in the prediction of subsequent academic performance of examinees were studied. A total of 444 sophomore students (entering classes of 1982 and 1983) in one medical school were asked to indicate their confidence, on a 5-point scale (100, 75, 50, 25, and 0), in the correctness of their responses to each multiple-choice item on an Introduction to Clinical Medicine examination. Examinations were scored in two ways: in the conventional way, using the total number of correct responses, and by a confidence-weighted technique based on the level of certainty indicated for each response by the examinee. Only the conventional score determined the grade; the confidence-weighted score was calculated for the purely experimental purposes of this study. Overconfidence and underconfidence indices were also calculated by using the indicated levels of certainty. Improvements in the psychometrics of the examinations were observed when confidence-weighted scoring was used. In multiple-regression models, the confidence-weighted scores and indices of over- and underconfidence contributed significantly to predicting scores of the students studied on Parts I and II of the National Board of Medical Examiners examinations, whereas the conventional score did not contribute to the prediction of Part II scores. Significant differences on junior clerkship examinations and ratings were observed between those who were highly overconfident and those who were slightly overconfident. The highly overconfident students also estimated higher future incomes than did those who were slightly overconfident.

Predictive validity of the MCAT as a function of undergraduate institution.

The question of whether the predictive ability of the Medical College Admission Test (MCAT) differed for students from different undergraduate institutions was addressed by the authors in the study reported here. Two groups of students were studied: group 1 comprised 1,859 students who entered Jefferson Medical College of Thomas Jefferson University between 1964 and 1977, and group 2 consisted of 999 students who entered the college between 1978 and 1982. Ten undergraduate institutions with at least 20 matriculants in each group were selected for analysis. Group 1 students had taken the old version and group 2 the new version of the MCAT. Scores on the Science subtest of the old MCAT were used as the predictor for group 1, and scores on the Science Problems subtest of the new MCAT were used as the predictor for group 2. First-year and second-year medical school grade-point averages and total scores on the Part I and Part II examinations of the National Board of Medical Examiners were the performance measures used. Validity coefficients were derived of the predictive value of the MCAT scores at each of the 10 undergraduate institutions. Striking differences were found in validity coefficients among these institutions. These differences raise questions about the predictive validity of the MCAT when scores for different undergraduate institutions are combined in deriving the coefficients. Possible explanations, implications for admissions decisions and validity studies, and limitations of these findings are discussed.

Predictive validity of the MCAT for students with two sets of scores.

Addressed in the study reported here is the question of which set of scores for those students who retake the Medical College Admission Test (MCAT) yields a better predictive validity. The sample was comprised of 304 students who retook the MCAT prior to entering Jefferson Medical College between 1978 and 1981. Five sets of MCAT scores were considered as predictors in the study: earlier, later, higher, and lower sets of MCAT scores and the average of the earlier and later scores for each MCAT subtest. Twenty-five criteria were used, including grades earned in the freshman and sophomore years and scores on the subtests of Part I and Part II of the examinations of the National Board of Medical Examiners. Correlational techniques, such as bivariate and multiple correlation analyses and canonical correlation followed by redundancy analysis were utilized. The magnitude of redundancy indices indicated that the set of MCAT scores in which the earlier and later scores were averaged was the best predictor, followed by the earlier, lower, higher, and later sets of MCAT scores. The implications of these findings for the admissions process and for validity studies are discussed.

Baccalaureate preparation for medical school: does type of degree make a difference?

Four groups of medical school matriculants (43 with a B.A. degree in social sciences, 68 with a B.A. degree in the humanities, 49 with a B.A. degree in science, and 40 with a B.S. degree in science) were studied. No significant difference was found among the four groups on yearly grade-point averages in medical school or on parts I, II, and III of the examinations of the National Board of Medical Examiners. Those with an undergraduate degree in the humanities considered leaving medical school more frequently than the others. A substantial proportion of medical students with an undergraduate major in the sciences and social sciences reported they would choose the humanities if they were once again high school seniors. Those with a science background were disproportionately more likely than the others to choose residencies in internal medicine and surgery, and those with undergraduate degrees in the humanities and social sciences were more likely to choose psychiatry residencies.

Relationships between performance in medical school and first postgraduate year.

Data from a longitudinal study of Jefferson Medical College graduates were analyzed to determine levels of clinical competence in the first postgraduate year and relationships between postgraduate ratings and performance during medical school. Ratings were obtained on knowledge, data-gathering skills, clinical judgement, and professional attitudes from the hospitals in which the graduates received their training. Significant relationships were found among three levels of performance in medical school and postgraduate ratings and in all four competence areas. Relationships were strongest at the highest and lowest performance levels. It is concluded that in a substantial number of cases good and poor performance in the first postgraduate year can be predicted on the basis of information already available to the medical school faculty.

Jefferson Medical College Student Model Utilization Review Committee.

A Student Model Utilization Review Committee Project is in progress at Jefferson Medical College. Students participate in the program for 90 minutes during the six weeks of their clerkship in family medicine at the university hospital. Information collected from participants and controls before and after the program indicates that the experimental group has greater knowledge and more positive attitudes about utilization review and cost control in the health care field than do the controls. Students express positive feelings about the program. More importantly, one year later, as seniors, those in the experimental group demonstrated clinical behavior which was more consistent with the objectives of the program than other students. These results have led the Department of Family Medicine to incorporate the utilization review program into its formal curriculum beginning in the 1979-1980 academic year.

The mandate project: institutionalizing a system of patient care quality assurance.

In 1970, prior to present-day requirements for quality assurance programs, a project was undertaken to institute such a program voluntarily in ten hospitals. Five hospitals succeeded in fully implementing the program which was based on the "Bi-Cycle Process" and each documented improvements in desired patient care behaviors. Two hospitals partially implemented the process and demonstrated no significant changes in desired patient care behaviors. Two hospitals failed to provide the data upon which assessments could be made and one hospital never got beyond preliminary efforts at instituting the process. The project demonstrates that a voluntary quality assurance program is feasible and has important implications for PSROs and continuing medical education. It also provides evidence that attention to psychosocial factors is essential in the institutionalization of programs designed to produce desired changes in patient care behaviors.