The physical examination of patients with abdominal pain: the long-term effect of adding standardized patients and small-group feedback to a lecture presentation.

BACKGROUND: One of the most effective methods for teaching physical diagnosis may be standardized patient instructors. PURPOSE: To determine if a lecture plus standardized patient instructors with small-group sessions is more effective than a lecture alone for teaching the evaluation of patients with abdominal pain. METHODS: Control (class of 2001) and intervention (class of 2002) groups both attended a lecture on the abdominal examination. The intervention group then underwent an exercise with standardized patient instructors and a review session with surgical faculty. An evaluation 18 months later used standardized patient instructors to complete evaluations assessing history-taking and physical examination skills. RESULTS: The intervention group performed significantly better than the control group on both the history and the physical examination subscales. CONCLUSION: It is possible to have an important, measurable, and lasting effect on physical examination skills by adding standardized patient instructors and small-group discussion to a lecture presentation.

Personalized follow-up increases return rate at urban eye disease screening clinics for African Americans with diabetes: results of a randomized trial.

OBJECTIVE: To evaluate the effectiveness of using personalized follow-up, as compared to reminder letters, in increasing return rates at urban eye disease screening clinics for African Americans with diabetes, and to identify factors predictive of the patient's likelihood of returning for annual follow-up exams. RESEARCH DESIGN AND METHODS: All patients attending free community-based retinopathy screening clinics who were advised to return in one year for another diabetes eye evaluation (DEE) were randomized to standard or personalized follow-up interventions. Patients in the standard follow-up group received reminder letters a month before it was time to return for their next annual DEE. Patients in the intensive personalized intervention also received the letters, but those patients who did not call for an appointment within 10 days received a phone call from project staff, encouraging them to return for a DEE. RESULTS: One hundred thirty-two African Americans with diabetes were randomized to one of the 2 treatments. The return rate for the intensive, personalized follow-up group was 66%, significantly (P=.001) higher than the 35% return rate for the standard follow-up group. CONCLUSION: This study demonstrated the efficacy of personal contact by telephone in improving return rates for annual DEEs in this population of patients. This finding is consistent with one of the key design principles of the project, which was to establish credible personal relationships with community leaders and patients as a means to maximize the utilization of the eye screening clinics.

Decreasing rate of fatty involution at screening mammography.

RATIONALE AND OBJECTIVES: This study was performed to document the perceived decrease in fatty involution at screening mammography during the past decade and evaluate the influence of hormone replacement therapy (HRT). MATERIALS AND METHODS: In December 1996, the mammograms of 261 consecutive screening patients with a comparison study obtained 5 years earlier were evaluated, and their breasts were categorized according to Breast Imaging Reporting and Data System categories for breast density. The women, aged 50-59 years, included 119 who had been receiving HRT for 0.25-15 years (mean, 3 years). From the files, 261 age-matched screening mammograms from 1986 were obtained; these patients also had comparison mammograms from 1981. Analysis of variance was used to determine differences between the 1980s group, the 1990s group receiving HRT, and the 1990s group not receiving HRT. Scheffé tests were used for post hoc comparisons. Stepwise regression analysis was used to evaluate the relative influence of age, decade, score of the first mammogram, and HRT. RESULTS: Breast density for the 1991 mammograms did not differ significantly from that in 1981 (P < .05). Initial breast density was the best predictor of final breast density in both decades (P < .001), regardless of HRT status. The change in breast density (toward fatty) over the 5-year interval in the 1980s (mean, 0.48) was significantly greater than that in both 1990s groups (mean for HRT group, 0.11; no HRT, 0.30; P < .05). CONCLUSION: These results confirm that breast density at screening mammography in the 1990s did not decrease with age at the same rate as in the 1980s, even in patients not receiving HRT.

Conducting community-based, culturally specific, eye disease screening clinics for urban African Americans with diabetes.

The purpose of this study was to evaluate the need for, and efficacy of, community-based culturally specific eye disease screening clinics for urban African Americans with diabetes. The study employed a variety of culturally specific methods in the design and performance of 43 community-based eye disease screening clinics in southeastern Michigan. One thousand, thirty-seven subjects were recruited for the study. Of that number, 817 identified themselves as African Americans and are the focus of this report. Of the 817 African-American patients screened, 84 (10%) needed to be examined by an ophthalmologist immediately (< 30 days), and 180 (22%) needed to be examined soon (within 1 to 3 months), while 544 (67%) were advised to return for another exam a year later. The project demonstrated that it was possible to use culturally specific techniques to identify a significant number of urban African Americans with diabetes in need of eye screening and treatment. However, lack of health insurance proved to be the primary barrier to receiving needed treatment. Although the project was successful, it is not a solution to what is essentially a health systems problem, ie, inadequate access to appropriate diabetes care for a significant number of our population.

Does medical school performance predict radiology resident performance?

RATIONALE AND OBJECTIVES: The authors performed this study to examine the relationship, if any, of a large number of measures of medical school performance with radiology residency performance. MATERIALS AND METHODS: Applications of 77 radiology residents enrolled from 1991 to 2000 were reviewed. Medical school grades, dean's letter summary statements, letters of recommendation, selection to Alpha Omega Alpha (AOA), and National Board of Medical Examiners (NBME) and U.S. Medical Licensing Examination (USMLE) Step 1 scores were recorded. Student t tests, analysis of variance, and correlation coefficients were used to examine the relationship between these measures of medical school performance and subsequent performance during radiology residency as determined by rotation evaluations, retrospective faculty recall scores, and American College of Radiology (ACR) and American Board of Radiology (ABR) examination scores. Resident performance was also correlated with prestige of the medical school attended. RESULTS: Preclinical grades of Honors or A; clinical grades of Honors or A in medicine, surgery, and pediatrics; and high NBME/USMLE scores strongly predicted success on the ABR written clinical examination but did not predict rotation performance. Most other measures of medical school performance, including outstanding Dean's letters and letters of recommendation, AOA selection during the senior year, and high medical school prestige did not predict high examination scores or superior rotation performance during residency. CONCLUSION: Success on the ABR examination can be predicted by medical school success in preclinical courses, some clinical courses, and USMLE examination scores. Dean's letters, letters of recommendation, AOA selection during the senior year, and medical school prestige do not appear to predict future resident performance as reliably.