A second look at consequences for medical education of problem solving in science and medicine.

This article reports that most freshman and senior medical students in one medical school were not able to solve a written problem case, concerning back pain, that required the examinee to recognize that foot drop was a key physical finding. The students' responses were not influenced by the fact that half of the examinations listed the foot drop finding first and the other half listed it seventh in a list of eight physical findings. The authors conclude that the outcome of this sample problem hints at a fault in medical education: the failure of medical students to learn the skill of formulating overall hypotheses and subhypotheses before choosing treatment options.

Where, how, and from whom do family practice residents learn? A multisite analysis.

This paper presents the results of a multisite study of 2,481 teacher-learner events reported by family practice residents in four separate training programs. Teacher-learner events were characterized by the location, activity, and teacher involved. Distinct patterns of teacher-learner interaction emerged across each of the three years of training. Hospital based direct patient care under the supervision of a non-family practice specialist was the most frequent type of educational experience in each of the three years. In contrast, family practice faculty influence throughout each of the three years is minimal. Learning in the outpatient setting with another specialist matched, or in some cases, exceeded that with a family physician. This study raises several important issues regarding the type and appropriate nature of educational influences on family practice physicians. Of greatest concern is the adequacy of role modeling and direct teaching by family practice specialists of family practice residents.

Promoting the management of weight reduction.

Many people try to lose weight. Health providers who try to help these people often feel frustrated, as do the patients, because long-term success is rarely experienced, especially for those patients whose weight is a serious medical problem. A new approach is offered in which the client assumes responsibility for weight loss, and the role of the health provider is to help the client become an increasingly independent manager of his or her own weight reduction. An instrument is offered that guides the clients through the planning, conducting, and assessing of their own actions.

The effect of Public Law 94--484 on pathology residency programs.

The Health Professions Educational Assistance Act of 1976 (Public Law 94--484) will affect graduate medical programs. The author surveyed directors of medical education in one major metropolitan area to study what the effects might be. With regard to pathology residency programs there are a number of important influences. For example, there will be fewer foreign medical graduates available to study in United States pathology programs. However, those who do come may be of higher quality. Also, owing to financial incentives to increase primary care, medical schools and hospitals may show less interest in the development of speciality programs such as pathology. The changing environment poses challenges to pathology directors to maintain or improve their programs.

Academic tenure and collective bargaining in American dental schools.

In thier survey of organizational structures in American dental schools, Dilts and Fields reported that the organization and administration of dental schools are of importance in the operation and attainment of educational goals. If one institutional goal is to provide faculty with attractive working conditions, then academic tenure and collective bargaining are important. In this respect, dental schools run true to higher education form. Having great variability, tenure systems were reported to be universal in dental schools. On the other hand, collective bargaining was found to be a new phenomenon on trial. The experience of dental schools with academic tenure and the trial of collective bargaining are of some interest to all college educators. Dilts and Fields concluded that "Although dental education is traditional in nature, resisting changes as do other phases of higher education, the results indicate that dental education is dynamic and is responding to internal as well as external needs." Dental educators may wish to follow these tenure and union issues to help determine successful policies for the conditions of dental faculty employment.