Enhancing learning during a clinical clerkship: the value of a structured curriculum.

Third-year clerkships, organized around clinical experiences, may provide students with an uneven or narrowly focused fund of clinical knowledge. This paper describes the results of a comparative trial in which a structured curriculum, based on learning objectives, was introduced into an internal medicine clerkship at one of three teaching hospitals of a single medical school; the other two hospitals, providing similar patient care experiences, were used for comparison purposes. Students who did their clerkship at the hospital using the structured curriculum scored significantly higher on the Medicine section of the National Board Part II examination when scores were adjusted for past academic performance. The structured curriculum was very well received and, according to student perceptions, achieved the goal of expanding their basic clinical knowledge beyond that derived from reading only in connection with patient care. These results support the use of curricular guidelines and objectives as a means of enhancing students' cognitive experience during clinical clerkships.

The academic viability of general internal medicine. The views of department of medicine chairmen.

A national survey of department of medicine chairmen was conducted to learn their views of the status of academic general internal medicine. Developing a research program in general internal medicine was considered a high priority by 60% of the department chairmen at the time their general internal medicine divisions were established, and by 1981, 83% considered this a high priority. However, only 17% stated that significant progress had been made by the division at their institutions toward achieving this goal. Chairmen identified problems with funding for research, their faculty's ability to do research, and available time of faculty to conduct research. They stated their intention to assist the division of general internal medicine in developing a research program through financial and organizational support. At least two thirds planned to recruit selectively general internal medicine faculty who had research backgrounds and interests and to require the existing faculty to do research as a condition for continued appointment.

Another myth: reduced hospital visiting by inner-city mothers.

Hospitalization of young children produces stress that can be reduced by the presence of a parent. Inner-city parents, however, are generally believed to visit the hospital less often than more affluent parents. At Boston City Hospital pediatric nursing and medical staff (N = 60) were surveyed to obtain their impressions of maternal visiting and its determinants; then 80/94 consecutive admissions of children less than age 5 years were surveyed to record the mothers' actual visiting times. Each mother was interviewed to determine sociodemographic status, her perception of her child's behavior, and her perception about visiting. The staff believed that few mothers (20%) would visit more than 4 h/d, but the study showed that nearly three times this many mothers did visit more than 4 h/d. The median visit length was five hours, and 20% of the mothers roomed-in at least once. Contrary to staff expectations, neither job nor child care responsibilities were related to visit length. Mothers who thought visits helped their children visited longer (10.6 v 5.3 hours, P less than .001). Contrary to staff beliefs, most inner-city mothers successfully overcame external and emotional barriers to visiting their hospitalized children. Staff input and an educational effort might facilitate longer visits by the one third of mothers who did not recognize the importance of their visiting their children.

General internal medicine units in academic medical centers: their emergence and functions.

By 1979, 77% of medical school primary teaching hospitals had functioning general internal medicine units; less than 5% had existed before 1970. These units were established to meet institutional needs for primary care internal medicine teachers and clinicians. By the end of the decade they had achieved major administrative and staffing responsibility for a wide variety of general education and service activities. The scope of general internal medicine units goes beyond the narrow definition of primary care internal medicine, to include activities traditionally considered those of the entire department of medicine.

The effect of a primary-care pathway on internal medicine residents' career plans.

There has been no evidence that primary-care pathways, a recent innovation in internal medicine residency programs, have affected the career choices of their trainees. We report the experience of the first four cohorts of primary-care trainees in internal medicine compared with traditional-pathway trainees at Boston City Hospital. Primary-care residents remained committed to their plans for a career in general internal medicine throughout training. In contrast, two thirds of the traditionally trained residents who were planning a career in general internal medicine at the beginning of their training changed their plans to subspecialty medicine. Thus, the primary-care pathway reinforced the career plans of trainees in general internal medicine, whereas traditional training influenced potential generalists toward subspecialty medicine.