Comparing medical school graduates who perform poorly in residency with graduates who perform well.

BACKGROUND: Most medical school graduates perform well as residents. However, the authors' annual surveys have shown that a few graduates from each class at their school fail to meet residency directors' expectations. METHOD: The medical school records of the 20 of the 153 graduates from the class of 1983 at the University of California, San Francisco, School of Medicine who received poor evaluations from their residency directors in the first and/or second year of residency were compared with the records of 20 of their best-received classmates. The poorly received graduates did not necessarily receive poor numerical ratings of their knowledge, skills, or overall performances, but they did receive negative or ambivalent responses to the following question: "Knowing what you now know about this resident, would select him or her again? Please explain." The two groups of graduates were matched for sex, racial-ethnic identification, and residency discipline. RESULTS: The groups were quite similar with respect to qualifications for admission to medical school, overall academic achievement, and performance on standardized national examinations. There were minor differences in performances on clinical clerkships. CONCLUSION: As indicated by residency directors' ratings and comments, most of the poorly received graduates' problems during residency appear to have been personal and motivational rather than skills- or knowledge-related. With but few exceptions, the medical school records contained little evidence that might have predicted the graduates' poor reception as residents.

Student expectations and personal perceptions as an approach to course evaluation.

Evaluation of courses tends to emphasize individual teacher behaviour and/or student reaction to the course. To avoid this approach a technique to determine student expectations and the degree to which the expectations were or were not met by the course was used. In addition, student perceptions of laboratory teaching/learning objectives of teachers were obtained.

A comparison of primary care residents with conventional internal medicine and pediatric residents.

A study was done of 15 residency training programs in primary care (not family practice residencies) to determine how the residents compared with their counterparts in conventional programs. Primary care residents are equally or more clinically skilled and equally or better grounded in the science of medicine. Their clinical research is directed toward different issues, and they are decidedly more psychosocially oriented.

Institutionalization of programs in medical education.

Through the use of questionnaires and interview schedules during extended site visits, sixteen programs training residents in non-family medicine primary care were studied to determine what factors contributed to program success -- known as "institutionalization" -- or to program failure. The findings revealed that programs were initiated for either philosophic or pragmatic money reasons. For programs to begin, to continue, and to be institutionalized was due to several contributing key factors. These included the resolution of programmatic differences in regard to goals; development of a substantive quality program; presence of forceful and respected leadership; tangible support of the administration and key academic departments; commitment of the teaching staff; anticipation of potential conflicts; participation of the involved lay and professional community; and the availability of some continued funding. The study also revealed that one program was a complete failure and had to be aborted because none of the key factors were present. The study concluded that the best way for institutionalization to occur is to assure that sound and comprehensive planning takes place. With thorough and anticipatory planning, the conditions essential to program institutionalization can be met more easily.

Developing the medical curriculum at King Abdulaziz University.

The kingdom of Saudi Arabia has placed a high priority on medical education. King Abdulaziz University is developing a medical curriculum aimed at being responsive to the health needs of the people of the kingdom. In creating the curriculum, planners devoted considerable time and effort to studying health manpower resources and needs, regional developments, demographic patterns, socioeconomic and cultural factors, general education development plans, vital statistics, and existing and projected health facilities. These and many other factors played a role in determining the format and the content of the curriculum, which is intended to produce individuals for leadership roles as medical educators, medical practitioners, and researchers.

The central San Joaquin Valley area health education center.

With federal financial support, an area health education center was established in the central San Joaquin Valley of California. The center is a cooperative health sciences education and health care program organized by the University of California and some of the educational and health care institutions of the valley. The center's goals include providing and improving primary health care education, and improving the distribution of health personnel. These goals are achieved through the cooperative development of a number of independent and interdependent activities. An extensive evaluation of the Area Health Education Center has shown that it is a highly effective program.

The educational challenge of consultation-liaison psychiatry.

The authors examine issues related to quality of psychiatric consultation-liaison education programs on the basis of data from the fiscal year 1975 NIMH review of grant proposals for 71 such programs. This category received the lowest percentage of approval (31 approved, 40 disapproved), which is seen as a reflection of the state of development of the field. Although this is a difficult field in which to teach and practice, the authors feel that the numbers and quality of consultation-liaison programs will grow over the next 10 years and that the proliferation of training programs for primary care physicians and the return of psychiatry to the mainstream of medicine will facilitate this growth.