The strategy used by one health maintenance organization (HMO) for balancing residents' training needs and patient health problems, often limited and routine in an HMO, is to allocate patients to residents by matching them with curriculum content. A process for handling patient resistance to such an arrangement was also instituted. (MSE)

It is proposed that, contrary to existing views, medical expertise is not as much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures describing the features of prototypical or actual patients. Evidence supporting the theory is examined. (Author/MSE)

Fifteen community-based primary care physician-preceptors were interviewed while working with and without a medical student concerning questions that had arisen that required further investigation. Follow-up indicated that preceptors generated fewer questions when students were present; the proportion of questions pursued also decreased when…

To provide medical students in community-based clinical settings with access to the same range of educational resources (medical literature, student colleagues, feedback, faculty) available at the academic medical center, this paper proposes that advancing information technology be applied to create a "virtual clinical campus" in the community…

Final-year Ontario medical students (n=88) took a 4-station objective structured clinical examination (OSCE) using standardized patients and involving decisions to forgo life-sustaining treatment. Performance was scored on a checklist of behaviors unique to each case. Results indicated that because of low reliability, the OSCE is not a feasible…

Information about the consultative practice of nephrology in a community environment was gathered and used to speculate about improvements that could be made in the training of nephrologists in academic medical centers, based on their knowledge of such training. (Author/MLW)

At the University of Iowa problems associated with managing evaluations of anesthesia residents led to a major backlog of unanalyzed evaluation forms. A system developed at the University that enables ongoing feedback to residents and provides a method to assess the clinical competence of residents is described. (Author/MLW)

Students from two medicine rotations were assigned to experimental and control groups. Instruction was the same except that the control group was assigned required readings. The groups were compared in terms of their performances on a final written examination and on the National Board of Medical Examiners Part II examination. (Author/MLW)

A survey was conducted of the first authors of half of the research papers published in 18 leading peer-reviewed medical journals over a six-month period in 1986. They were sent a questionnaire that assessed their previous research training and their recommendations for training of clinical research faculty members. (Author/MLW)

A trained research assistant used a structured observation form to observe hospital attending rounds, measuring the use of population perspective (risk-factor assessment, prevention, epidemiology, social aspects of illness) during internal medicine case presentations. Results indicated this perspective was raised more frequently when a generalist…

A study investigated the construct validity of three methods for assessing clinical performances of internal medicine clerks: a clinical evaluation form completed by faculty and residents, an objective structured clinical examination, and the National Board of Medical Examiners medicine subject test. Results suggest a significant but…

A study compared the productivity and patient-care revenues of clinical teaching faculty and their nonteaching physician counterparts over two years. Productivity was reduced by 30-40 percent when teaching, and revenue lost reached as high as $24,000 per student taught. Implications for ambulatory-care delivery system planning are discussed.…

A study compared the costs of a six-station structured oral examination and an objective structured clinical examination (OSCE) for a surgery clerkship, assessing both faculty and materials costs. The OSCE was found to be more time consuming and expensive. Cost-cutting measures and guidelines to assist medical schools in selecting test type are…

A study with 137 third-year medical students found little correlation between students' self-assessments of clinical skills before and after their clerkships and external skill indicators (grades, test scores, and faculty ratings). These results are similar to those of previous studies. (Author/MSE)

A study supported use of the objective structured clinical examination for screening foreign medical graduates (n=67) wishing to enter a preinternship program in at the University of Toronto. However, it also showed that appropriate training for the candidates was the internship, not preinternship, program. (MSE)