Educational benefits of blinding students to information acquired and management plans generated by other physicians.

At our university, Internal Medicine clerks are members of a team responsible for the care of patients hospitalized on a teaching ward. Clerks first encounter their patients after the latter have been fully worked up by other physicians who have examined them and initiated investigations and management. Clerks are thus deprived of the opportunity to practice information acquisition, hypothesis generation and problem solving. We therefore undertook a 'blinding' initiative wherein each clerk was required to work up at least one hospitalized patient per week without access to the patient chart and without knowledge of information acquired and hypotheses generated by other physicians. Weekly data collection during the 8-week experiment with 40 clinical clerks revealed that work up of 'blinded' patients was more time-consuming and more difficult than work up of unblinded patients. Clerks were appreciative of the educational value of blinding. Teaching faculty felt clerk 'blinding' to be a practical approach to approximating the true conduct of medical practice and as such was useful for student learning.

Using focus groups to design a valid questionnaire.

The authors planned to study the roles and concerns of senior faculty members at their institutions. To elaborate the aims of their study and to help them design a valid questionnaire, they conducted focus groups with senior faculty. The authors describe how the information gleaned from the focus groups helped them develop their questionnaire.

Ambulatory care training during core internal medicine residency training: the Canadian experience.

OBJECTIVE: To determine the status of ambulatory care training of core internal medicine residents in Canada. DESIGN: Mail survey. PARTICIPANTS: All 16 program directors of internal medicine residency training programs in Canada. OUTCOME MEASURES: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ambulatory care program and the kinds of teaching skills required of tutors. RESULTS: All of the directors responded. Fifteen stated that the ambulatory care program is mandatory, and the other stated that it is an elective. Block rotations are more common than continuity-of-care assignments. In 12 of the programs 10% or less of the overall training time is spent in ambulatory care. In 11 the faculty tutors comprise a mixture of generalists and subspecialists. The tutors simultaneously care for patients and teach residents in the ambulatory care setting in 14 of the schools. Most are paid through fee-for-service billing. The respondents felt that the ideal program should contain a mix of general and subspecialty ambulatory care training. There was no consensus on whether it should be a block or continuity-of-care experience, but the directors felt that consultation and communication skills should be emphasized regardless of which type of experience prevails. CONCLUSIONS: Although there is a widespread commitment to provide core internal medicine residents with experience in ambulatory care, there is little uniformity in how this is achieved in Canadian training programs.

Residency training in internal medicine: program design in an era of constraint.

Directors of postgraduate internal medicine programs face many problems in program design, particularly when numbers of house staff continue to decrease. This paper examines the training requirements of a resident in internal medicine and proposes a curriculum based on set rotations in the three key areas of training--subspecialty services, critical care and the clinical teaching unit. The distribution of time in these three areas and the balance of exposure to inpatients and outpatients are discussed in detail. This program design ensures exposure to all the key elements of internal medicine in 3 years and should prevent significant gaps in knowledge at the time of certification. The implications for "service" in major teaching hospitals is discussed. Hospital departments and administrators must confront the prospect of hospital units without house staff. Most important, program directors must resist sacrificing the pedagogic essentials of a training program for service requirements.