Competency requirements. A new approach to medical school admissions.

The faculty of the University of Pennsylvania School of Medicine, Philadelphia, have substituted definitions of knowledge and skills for course requirements as requirements for admission. The school expects that this action will allow students more flexibility in the development of their undergraduate academic programs, while guiding them specifically to the necessary preparation in the sciences. It is further hoped that this action will encourage the faculties of undergraduate schools to examine the way in which they prepare students for careers in medicine. This article describes the approach used for bringing about this change in policy and presents the new admissions requirements.

Teaching cost-effective diagnostic test use to medical students.

The purpose of this project was to develop and evaluate a program to teach medical students how to order diagnostic tests in a cost-effective manner. The 1-month educational program included a seminar, a simulated patient-care exercise, special case presentations by students, newsletters about diagnostic tests, and concurrent review of patients' bills. Content analysis of answers to open-ended questions and pretests and posttests were used to measure differences in the study and control groups. Although students said the program was useful, no significant differences were found in students' knowledge, attitudes, or simulated test-ordering behavior. The authors conclude that the lack of improvement in objective measures limits the potential effectiveness of restricted efforts such as this one and that the discrepancy between the subjective and objective measures reinforces the need for more rigorous evaluations of programs that teach cost-effective diagnostic test use.

Mental health of medical school applicants: the role of the admissions committee.

This study was of the role of admissions committees as it relates to the mental health of applicants. Two-part questionnaires were sent to 115 medical schools. The first part explored the composition of the committee. In most schools the dean selected the members, attempting to obtain equal representation from clinical and basic science departments; most of the schools had one or more psychiatrists on the committee. The second part focused on the policy for applicants with former mental health problems. Over one-third of the committees asked about previous or present mental illness or therapy. Ninety percent of the schools had no policy or guidelines for using such information; instead, most relied on psychiatric interview or outside reports in making admissions decisions. The impact of federal legislation regarding the handicapped on admissions procedures is discussed. Since more students with previous or current psychiatric problems may be admitted, schools must be prepared to respond to their needs as fully as they now respond to other medical problems.

Teaching psychological diagnosis and management.

Teaching experiences have been described which illustrate the medical student's tendency to isolate what is learned in psychiatry from clinical work in general medicine. This tendency can be minimized by presenting diagnosis as the complete assessment of a patient, rather than exclusively as a search for disease. Early experience in patient care helps the student broaden his or her concept of clinical assessment. An important goal of psychiatric teaching in medical school is to help students learn to evaluate the psychological status of the general medical patient. Attention is focused upon this evaluation by use of the problem-orientated record. Since the data base is derived largely from the medical history, objectives for the interview are presented in detail. Students are encouraged to consider the relations between the patient's psychological status and other aspects of the medical problems. Only after they have learned to make evaluations of general medical patients, are the psychiatric syndromes introduced. An example is presented of a programme in which psychiatric teaching is carried out in a surgical ward of a general hospital. Success of such programmes depends upon explicit description of goals and methods, and upon collaboration with colleagues in other departments who share similar goals.