Changes in admissions, lengths of stay, and discharge diagnoses at a major university-affiliated teaching hospital: implications for medical education.

The implications for medical education of a declining average length of stay (ALOS) and changes in numbers of hospital admissions have been the subject of considerable discussion. The changing hospital reimbursement schedules and the rise of managed-care systems have altered patterns of hospital use and consequently posed new problems for the education of medical students and residents. Between 1980 and 1986 in one university-affiliated hospital, the ALOS for patients with any of the most frequent discharge diagnoses for either of those years had declined 34% since 1980, despite a 59% increase in the number of patients with those diagnoses. Patients with any one of 21 of the 88 most frequent discharge diagnoses for 1986 were hospitalized for less than one day. Those patients with another eight of the disorders had an ALOSs of between one and two days; some of these patients had serious and common gastrointestinal disorders. Discharge diagnoses were categorized by the hospital service in which students and residents would have rotations and were analyzed for changes in case mix. This study showed that for the hospital's medical students and residents to be exposed to the same case mix of clinical disorders that were seen in-hospital in 1980, it is now necessary for them to have experience in the ambulatory setting.

Program for increasing enrollment of early acceptees in medical school.

Early acceptees by medical schools generally have higher Medical College Admission Test (MCAT) scores and grade-point averages than those accepted later. Between 1977 and 1979, the number of these individuals actually enrolling at the University of Medicine and Dentistry of New Jersey Rutgers Medical School (UMDNJ-RMS) declined from 20.4 to 6.5 percent of all incoming medical students. This prompted the development in 1980 of a one-day, preenrollment program informing early acceptees about the UMDNJ-RMS educational program. Subsequently, more than 40 percent of the early acceptees have enrolled at the UMDNJ-RMS, and this noticeable increase appears to be related directly to the program.

Traditional admissions variables as predictors of minority students' performance in medical school. A cause for concern.

This study explored the relationship between traditional admissions criteria, performance in the first semester of medical school, and performance on the National Board of Medical Examiners' (NBME) Examination, Part 1 for minority medical students, non-minority medical students, and the two groups combined. Correlational analysis and step-wise multiple regression procedures were used as the analysis techniques. A different pattern of admissions variables related to National Board Part 1 performance for the two groups. The General Information section of the Medical College Admission Test (MCAT) contributed the most variance for the minority student group. MCAT-Science contributed the most variance for the non-minority student group. MCATs accounted for a substantial portion of the variance on the National Board examination.