The Class Mentor Program at the University of Wisconsin Medical School: a unique and valuable asset for students and faculty.

There is a paucity of published data on mentor programs for medical students. The University of Wisconsin Medical School has 19 years of experience with a unique Class Mentor Program. A single mentor is dedicated to each class of incoming medical students. The mentor attends all classes in the first 2 years and varied clinical venues in later years, following the class all 4 years through graduation. The mentors appointed have been experienced physicians who tend to be in the later years of their careers. As of 2003, 16 such mentors have been appointed. One mentor has taken 2 classes. Available survey data from students who have graduated demonstrate that most graduates recall their own mentor to have been a positive influence to student medical training. A recent accreditation review commended the Class Mentor Program as a unique help to students and to medical school curriculum evaluation. Five of the more recent mentors describe herein their own assessment of the Class Mentor Program and they encourage other medical schools to consider such a program for their own institutions.

Bloodstream infections in a community hospital: a 25-year follow-up.

OBJECTIVE: To examine the current status of bloodstream infections (BSIs) in a community hospital as part of a 25-year longitudinal study. DESIGN: Retrospective descriptive epidemiologic study. SETTING: Community teaching hospital. PATIENTS: All inpatients in 1998 with a positive blood culture who met the CDC NNIS System case definition of BSI. METHODS: Cases were stratified by underlying illness category using case mix adjustment categories (after McCabe) and reviewed for associations among mortality, underlying illness severity, and multiple clinical and laboratory parameters. RESULTS: Of 19,289 patients discharged in 1998, 185 had an episode of infection documented by blood culture (96 cases per 10,000 inpatients). BSI was twice as frequent in patients 65 years and older compared with younger patients. BSIs caused or contributed to the deaths of 22 patients for an overall case-fatality rate of 11.9% compared with 20.7% in 1982 (P = .02). Striking decreases were noted for in-hospital patient mortality in 1998 for BSIs with ultimately and rapidly fatal underlying illnesses (P = .02 and P < .10, respectively). Primary bacteremia decreased compared with 1982. Antibiotic use was vigorous, but resistance was modest in both nosocomial and community-acquired organisms and had changed little from 1982 and 1987. CONCLUSIONS: Compared with previous studies, case-fatality rates in patients with BSI were substantially lower in rapidly fatal and ultimately fatal underlying illness categories. Antibiotic use was extensive but prompt and appropriate. Microorganism resistance to antibiotics changed little from the 1980s.

Physician job satisfaction, dissatisfaction, and turnover.

OBJECTIVES: We studied how physicians' relative satisfaction and/or dissatisfaction with 10 distinct aspects of their work protected against or promoted their plans for leaving their jobs. STUDY DESIGN: Cross-sectional mail survey. POPULATION: A total of 1939 practicing generalists and specialists across the United States. OUTCOME MEASURED: We used logistic regression analysis to assess whether physicians in the top and bottom quartiles of satisfaction for each of 10 aspects of their work and communities were more or less likely to anticipate leaving their jobs within 2 years, compared with physicians in mid-satisfaction quartiles. Separate analyses were compiled for generalists vs specialists, and physicians by age groups (27-44 years, 45-54 years, and 55 years and older). RESULTS: Generalists and specialists had generally comparable levels of satisfaction, whereas physicians in the oldest age group indicated greater satisfaction than younger physicians in 8 of the 10 work areas. One quarter (27%) of physicians anticipated a moderate- to-definite likelihood of leaving their practices within 2 years. The percentage that anticipated leaving varied with physicians' age, starting at 29% of those 34 years or younger, steadily decreasing with age until reaching a nadir of 22% of those from 45 to 49 years, then reversing direction to steadily increase thereafter. Relative dissatisfaction with pay and with relationships with communities was associated with plans for leaving in nearly all physician groups. For specific specialty and age groups, anticipated departure also correlated with relative dissatisfaction with other selected areas of work. CONCLUSIONS: To promote retention, these data suggest that physicians and their employers should avoid physician dissatisfaction in particular. Building particularly high levels of satisfaction generally is not helpful for this end. Avoiding relative dissatisfaction with pay and with community relationships appears broadly important.

Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study.

OBJECTIVE: To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. DATA SOURCES: Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. STUDY DESIGN: A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. PRINCIPLE FINDINGS: The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. CONCLUSIONS: These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both "physician friendly" and "family friendly" seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.