Interns' self-evaluations compared with their faculty's evaluations.

The accuracy with which individuals evaluate and judge their knowledge and skills is an important component of adult and life-long learning. This study compared the evaluations that interns made of themselves with those made by their faculty.

Curricular change in medical schools: how to succeed.

Society's changing needs, advancing knowledge, and innovations in education require constant changes of medical school curricula. But successful curricular change occurs only through the dedicated efforts of effective change agents. This study systematically searched and synthesized the literature on educational curricular change (at all levels of instruction), as well as organizational change, to provide guidance for those who direct curricular change initiatives in medical schools. The focus was on the process of planning, implementing, and institutionalizing curricular change efforts; thus, only those articles that dealt with examining the change process and articulating the factors that promote or inhibit change efforts were included. In spite of the highly diverse literature reviewed, a consistent set of characteristics emerged as being associated with successful curricular change. The frequent reappearance of the same characteristics in the varied fields and settings suggests they are robust contributors to successful change. Specifically, the characteristics are in the areas of the organization's mission and goals, history of change in the organization, politics (internal networking, resource allocation, relationship with the external environment), organizational structure, need for change, scope and complexity of the innovation, cooperative climate, participation by the organization's members, communication, human resource development (training, incorporating new members, reward structure), evaluation, performance dip (i.e., the temporary decrease in an organization's performance as a new program is implemented), and leadership. These characteristics are discussed in detail and related specifically to curricular change in medical school settings.

Ambulatory care training standards for continuity of care in osteopathic family medicine.

The authors developed statewide standards of excellence for ambulatory care training in an osteopathic medical consortium of family medicine residency programs. A total of 16 osteopathic family medicine residency programs joined with the Michigan State University-College of Osteopathic Medicine to form the Consortium for Osteopathic Graduate Medical Education Training (COGMET) Family Medicine Division. Standards were developed and implemented on a statewide basis for all member residency programs. Initial qualitative evaluations discovered minor as well as more substantive noncompliance after a 6-month trial. Results from longitudinal quantitative evaluations will determine the effectiveness of these standards.

Medical care costs of high-risk infants after neonatal intensive care: a controlled study.

Total medical care costs were studied prospectively from neonatal intensive care unit (NICU) discharge to 3 years of age for 60 children, 35 of whom had neurologic and/or developmental deficits detected immediately following NICU discharge and 25 children did not. At the end of the study period the children were classified as unhandicapped (group A), mildly handicapped (group B), or moderately-severely handicapped (group C). Medical costs are reported per infant per month following NICU discharge (mean +/- SD). The outpatient costs in group A were $31 +/- 23 as compared with $86 +/- 93 in group B and $109 +/- 59 in group C (A less than B, A less than C; P less than .001). The greatest contributor to outpatient costs was occupational and physical therapy (with unproven efficiency to date). The inpatient costs were $31 +/- 56 in group A, $328 +/- 574 in group B, and $542 +/- 737 in group C (A less than C; P less than .01). The US Department of Agriculture estimates of medical costs of raising a child at home ranges from $22 to $26.80 per month. The cost of raising one of our NICU infants in an institution was $1,216 per month. Children with and without neurodevelopmental deficits after NICU discharge have significantly higher medical costs than children without.

Communicable illnesses in the mentally retarded and nonretarded populations of three Michigan counties.

Fourteen categories of communicable diseases reported on a weekly basis to state public health officials were considered. Mentally retarded persons living in a three-county area were compared with the counties' general population over a 4-year period. Results indicated that retarded persons had a significantly higher prevalence rate of 6 of the 14 communicable diseases and a higher probability rate for 3 of the diseases studied than did the general population. The few illnesses that the retarded population did contract, however, occurred at a much higher rate than that of the nonretarded population.