An elective in primary care internal medicine for students in the preclinical years.

A two-week elective to introduce first- and second-year medical students to primary care internal medicine was developed and evaluated. Course time is divided between conference sessions (25 percent) provided by full-time clinical faculty members and office experience (75 percent) provided by volunteer clinical faculty members (general internists in private practice and in prepaid health plans). Evaluations by the students (n = 58) who took the elective consisted of a questionnaire assessment of the conference session topics, the student's ability to carry out course objectives, and the preceptor's teaching activities. The conference topics were highly rated, with a mean score of 4.1 on a rating scale ranging from 1 (unfavorable) to 5 (favorable). The course objectives and teaching activities were also well rated, with a mean score of 4.1 and 3.9, respectively, on a rating scale ranging from 1 (none) to 5 (outstanding).

Impact of therapeutic guidelines on antibiotic use by residents in primary care clinics.

Inappropriate use of antibiotics has been well documented for inpatient settings, but there are few studies in ambulatory patients. In a prospective study, the authors monitored the outpatient prescribing patterns of internal medicine residents and evaluated the effect of placing a one-page set of antibiotic guidelines in each patient examining room. Appropriateness of antibiotic choices was scored periodically. A 12-month pre-intervention survey of antibiotic use showed that 50% of the choices were inappropriate. Comparison of a four-month post-intervention analysis with the same four-month interval in the pre-intervention period showed no significant difference between the percentages of inappropriate prescriptions. The most common reasons for inappropriate use were: 1) failure to document a clinically significant bronchial infection, and 2) inadequate evaluation of nonspecific urinary tract complaints. The authors conclude that the ready availability of information about appropriate antibiotic use is not effective in changing antibiotic choices, and that educational strategies regarding antibiotic use must also address diagnostic evaluation.

Alexithymia and handedness. A pilot study.

Exploration of the connection between alexithymia and handedness has not been addressed in the literature. Although trends which have been reported between alexithymia and characteristics of individuals may vary with the methods of assessment and types of population, the possible relationships between alexithymia and males and between left-handedness and males raise questions about the relationship between alexithymia and handedness. This pilot study (n = 100) indicates a higher incidence of alexithymia in individuals who are not right-handed. The possible influence of left hemisphere development on the occurrence of alexithymia is discussed.

Development of an Analog Alexithymia Scale. Testing in a nonpatient population.

The present study describes a new self-administered Analog Alexithymia Scale (AAS). A nonpatient sample representing a broad range of ages and socioeconomic groups was used. Scores were normally distributed with 6.8% of subjects in the alexithymic range. Retest reliability was encouraging. The correlation between the AAS and the Schalling-Sifneos Personality Scale was low. Validity has not been established for either test. Factor analyses suggest distinct clinical components, the differentiation of which might facilitate understanding of the psychologic and neurophysiologic underpinnings of alexithymia. There is a need for a clinical standard for validating self-administered scales.