Measuring the use of the population perspective on internal medicine attending rounds.

Abstract

The population perspective (risk-factor assessment, prevention, epidemiology, and the social aspects of illness) is increasingly important in medical school and residency curricula. The authors designed an observational study to assess the population-perspective content of internal medicine teaching rounds led by attending physicians at the Columbia-Presbyterian Medical Center. During eight months in 1992 a trained research assistant used a structured observation form in observing attending rounds. Population scores were calculated by totaling the number of times population-perspective topics were mentioned during each case presentation (one point was awarded per mention, with an additional point being added for discussions lasting 30 seconds or more). Chi-square tests and unpaired t-tests were used to compare scores between teams with one generalist and one subspecialist attending physician and teams with two subspecialists. Fifteen teams and 368 patient presentations were observed. The mean population scores were 24.5 for teams with generalist attending physicians and 17.9 for teams with subspecialists only (p < .0001). The population scores for individual case presentations ranged from 2 to 55. The population-perspective topics were raised more frequently on the internal medicine teaching rounds when a generalist attending physician was present than when there were only subspecialist attending physicians.