Assuntos
Diversidade Cultural , Currículo , Homossexualidade , Internato e Residência/métodos , Humanos , Estados UnidosRESUMO
Chemically dependent women face special problems. This article reviews the epidemiology, screening, clinical consequences, and treatment of substance-abusing women. Alcohol, opiate, and cocaine abuse are often linked in women, and the individual and overlapping effects of these drugs are described. Gender difference also are highlighted.
Assuntos
Alcoolismo , Transtornos Relacionados ao Uso de Substâncias , Saúde da Mulher , Alcoolismo/etiologia , Alcoolismo/terapia , Feminino , Humanos , Programas de Rastreamento , Gravidez , Complicações na Gravidez , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
In this study, directors of primary care residency programs were sent a questionnaire that asked for information about their program and examined their perceptions of program curricula and resident mastery of seven preselected topics in women's health. An elective ambulatory gynecology experience was offered in 52% of programs, and 35% of programs had all residents experience such a rotation. All seven selected topics were felt to be important for residents to master, but the prevalence of structured teaching experiences and resident mastery for each topic varied widely. For the majority of programs, domestic violence was not a curricular component. However, 44% of respondents spontaneously commented that they were expanding their curriculum in the area of women's health.
Assuntos
Medicina Interna/educação , Internato e Residência , Saúde da Mulher , Currículo , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Atenção Primária à Saúde , Estados UnidosAssuntos
Neoplasias da Mama/fisiopatologia , Terapia de Reposição de Estrogênios , Osteoporose Pós-Menopausa/prevenção & controle , Neoplasias da Mama/induzido quimicamente , Contraindicações , Estrogênios/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/induzido quimicamente , Neoplasias Hormônio-Dependentes/fisiopatologia , Progesterona/fisiologia , Fatores de Risco , Resultado do TratamentoRESUMO
Residency education in internal medicine should be based in the ambulatory setting. The challenge in ambulatory education lies not only in the unique opportunities afforded by the setting but also in the careful implementation of a program based on sound educational principles. We have designed a new ambulatory-based model of internal medicine residency that adheres to the principles of adult learning theory. Four aspects of the proposed residency model are discussed: the setting, the teaching-learning model, the curriculum, and the schedule. Potential barriers to implementation of the model are reviewed, and solutions are suggested. Residency programs in internal medicine are at an important crossroad. Either we can substantially change the programs' content and focus, or we can risk the continued unpopularity and "second-class" status of the programs among medical students. Internal medicine needs to be recognized and accepted as a fundamental primary care discipline to justify continued public support in an era of overspecialization.
Assuntos
Instituições de Assistência Ambulatorial , Medicina Interna/educação , Internato e Residência/organização & administração , Currículo , Aprendizagem , Admissão e Escalonamento de Pessoal/organização & administração , Ensino/métodos , Estados Unidos , Recursos HumanosRESUMO
Substance abuse in women is a substantial problem. This article covers the issues surrounding abuse of alcohol, illicit and prescription drugs, and cigarettes in women. Specifically, for each group of substances, the epidemiology and complications are presented, as well as the physician's role in detection and treatment.
Assuntos
Transtornos Relacionados ao Uso de Substâncias , Alcoolismo/complicações , Feminino , Humanos , Recém-Nascido , Gravidez , TabagismoAssuntos
Alcoolismo/diagnóstico , Adolescente , Fatores Etários , Idoso , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Métodos , Fatores Sexuais , Inquéritos e Questionários , VeteranosRESUMO
Residency programs consist of a range of activities involving service to patients and education of residents. The observation that a conflict exists between the service and education components of residency is widespread and has been used to explain many of the problems afflicting such programs today. The authors believe that the service/education conflict is a significant barrier to change in residency programs. A model is presented for residency education that reorganizes the service and education components. First, they present a broad overview of the conflict. Then they provide a brief historical perspective and comment on some of the current recommendations for residency programs. Next, they discuss how principles of adult learning relate to residency and propose a new model of residency that adheres more closely to these principles. Finally, the proposed model is presented in some detail and its implications are discussed. Only if the service and education components of residency are carefully delineated can residency programs adapt to the changing and growing needs of postgraduate medical education.
Assuntos
Medicina Interna/educação , Internato e Residência/organização & administração , Currículo , Humanos , Modelos Teóricos , Estados UnidosRESUMO
To assess the prevalence of alcoholism in an ambulatory medical clinic and to determine the effectiveness of screening questions for alcoholism, 232 new patients in a medical primary care unit were interviewed using a questionnaire that included the Michigan Alcoholism Screening Test (MAST). Based on MAST scores, 47 of 232 subjects were designated as alcoholics, yielding a prevalence of alcoholism of 20.3%. Sensitivities and specificities for alcohol-use questions were calculated using the MAST diagnosis of alcoholism. The questions "How much do you drink?" and "How often do you drink?" yielded low sensitivities of 34.0% and 46.8%, respectively. The question "Have you ever had a drinking problem?" considered alone had a high sensitivity of 70.2%; when combined with "When was your last drink?" this question had a sensitivity of 91.5%. We recommend the routine incorporation of these last two questions into the medical history in light of the high prevalence of alcoholism in this outpatient population.