Acad Med Research Articles

The Art of Asking: Teaching Through Questioning

Since the time of Socrates, educators have acknowledged that questioning is a key instructional tool. Many contemporary teaching and evaluation techniques, however, rely almost exclusively on developing and then probing learners' understanding with standard multiple-choice testing formats. Recent reports about medical education—especially the Report of the Panel on the General Professional Education of the Physician and College Preparation for Medicine ( 1 Physicians for the twenty-first century: the GPEP report—report of the Panel on the General Professional Education of the Physician and College Preparation for Medicine. Association of American Medical Colleges, Washington, DC1984 Google Scholar ), and the ACME-TRI report ( 2 Association of American Medical Colleges ACME-TRI report: educating medical students; assessing change in medical education—the road to implementation. Acad Med. 1993; June Google Scholar )—criticize overreliance on so-called passive teaching methods (eg, lectures and evaluation methods), which test the “regurgitation” of learned material. The aforementioned reports encourage a more active, problem-oriented approach to learning that fosters critical thinking. The curricula of many residency programs, however, have changed very little and remain dominated by an apprenticeship model that relies substantially on lecture and case presentation. Herein, we highlight the important role that questioning can play, both in fostering a more active, problem-oriented approach to learning and enabling residents to improve their critical thinking skills.

Race, ethnicity, and heart failure

Few issues stir as much emotion and can be as divisive as the issue of race. Centuries of history and decades of deep social changes are unquestionably major factors contributing to the sensitivity of this issue. Medicine, which according to Virchow 1 Taylor R Rieger A Medicine as social science: Rudolf Virchow on the typhus epidemic in Upper Silesia. Int J Health Serv. 1985; 15: 547-559 Crossref PubMed Scopus (66) Google Scholar is a social science in its very bone and marrow, could not escape dealing with this issue. 2 Green AR Betancourt JR Carrillo JE Integrating social factors into cross-cultural medical education. Acad Med. 2002; 77: 193-197 Crossref PubMed Scopus (80) Google Scholar

The Quiet Revolution in Postgraduate Training**

Academic Emergency MedicineVolume 9, Issue 11 p. 1222-1226 Free Access The Quiet Revolution in Postgraduate Training** Robert W. Strauss MD, Robert W. Strauss MD Immediate Past-Chair, Residency Review Committee—Emergency MedicineSearch for more papers by this author Robert W. Strauss MD, Robert W. Strauss MD Immediate Past-Chair, Residency Review Committee—Emergency MedicineSearch for more papers by this author First published: 08 January 2008 https://doi.org/10.1197/aemj.9.11.1222Citations: 8 † **Based on presentation at the Council of Emergency Medicine Residency Directors (CORD) Consensus Conference on the ACGME Core Competencies: “Getting Ahead of the Curve,” March 2002, Washington, DC. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References Website: http://www.aamc.org/meded/start.htm. Kohn, LT, Corrigan, JM, Donaldson, MS. Institute of Medicine, Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Washington , DC : National Academy Press, 2000. Website: www.acgme.org. Accreditation Council for Graduate Medical Education 2001 Annual Report. Chicago , IL : ACGME, 2002. Hockberger, RS, Binder, LS, Graber, MA et al. The model of the clinical practice of emergency medicine. Acad Emerg Med. 2001; 8: 660– 81. Website: http://www.cordem.org/news/2002/jan-feb/corecomp.htm. Website: http://www.acgme.org/outcome/assess/keyconsider.asp. Cydulka, RK, Emerman, CL, Jouriles, NH. Evaluation of resident performance and intensive bedside teaching during direct observation. Acad Emerg Med. 1996; 3: 345– 51. Callahan, EJ, Bertakis, KD. Development and validation of the Davis observation code. Fam Med. 1991; 23: 19– 24. Arnold, L. Assessing professional behavior: yesterday, today, and tomorrow. Acad Med. 2002; 77: 502– 15. Adams, J, Schmidt, T, Sanders, A, Larkin, GL, Knopp, R. Professionalism in emergency medicine. Acad Emerg Med. 1998; 12: 1193– 9. Baldwin, DC, Daugherty, SR, Rowley, BD. Unethical and unprofessional conduct observed by residents during their first year of training. Acad Med. 1998; 73: 1195– 200. Nolan, TW. Understanding medical systems. Ann Intern Med. 1998; 128: 293– 8. Ashton, CM. “Invisible” doctors: making a case for involving medical residents in hospital quality improvement programs. Acad Med. 1993; 68: 823– 4. Frankford, DM, Patterson, MA, Konrad, TR. Transforming practice organizations to foster lifelong learning and commitment to medical professionalism. Acad Med. 2000; 75: 708– 17. Website: http://www.msu.edu/dsolomon/res00014.pdf. Burack, JH, Irby, DM, Carline, JD, Root, RK, Larson, EB. Teaching compassion and respect: attending physicians' responses to problematic behaviors. J Gen Intern Med. 1999; 14: 49– 55. Schmidt, TA, Norton, RL, Tolle, SW. Sudden death in the ED: educating residents to compassionately inform families. J Emerg Med. 1993; 10: 643– 7. Website: http://www.acgme.org/outcome/project/timeline.pdf. Citing Literature Volume9, Issue11November 2002Pages 1222-1226 ReferencesRelatedInformation

In-home Prenatal Nutrition Intervention Increased Dietary Iron Intakes and Reduced Low Birthweight in Low-Income African-American Women

Low birthweight (LBW), defined as an infant weighing less than 2,500 grams ( (1) Institute of Medicine; Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy. National Academy Press, Washington, DC1990 Google Scholar ), is a major determinant of infant mortality and contributes to infant and childhood morbidity and increased healthcare costs ( (2) Orr S.T. James S.A. Miller C.A. Barakat B. Kaikoku N. Pupkin M. Engstom K. Huggins G. Psychosocial stressors and low birthweight in an urban population. Am J Prev Med. 1996; 12: 459-466 PubMed Google Scholar , (3) Sable M.R. Herman A.A. The relationship between prenatal health behavior advice and low birth weight. Public Health Rep. 1997; 112: 332-339 PubMed Google Scholar , (4) Lewit EM, Baker LS, Corman H, Shiono PH. The direct cost of low birth weight. Available at: http://www.futureofchildren.org/LBW/04LBWLEW.htm. Accessed November 1, 2000. Google Scholar ). LBW occurs due to preterm delivery (length of gestation less than 37 weeks), growth retardation, or both ( (2) Orr S.T. James S.A. Miller C.A. Barakat B. Kaikoku N. Pupkin M. Engstom K. Huggins G. Psychosocial stressors and low birthweight in an urban population. Am J Prev Med. 1996; 12: 459-466 PubMed Google Scholar ). In the United States, higher rates of LBW occur in urban areas with high concentrations of low-income ethnic minorities ( (5) Zambrana R.E. Dunkel-Schetter C. Collins N.L. Scrimshaw S.C. Mediators of ethnic-associated differences in infant birth weight. J Urban Health: Bull NY Acad Med. 1999; 76: 102-116 PubMed Google Scholar ). Results of the 1997 Pediatric Nutrition Surveillance indicate that the rate of LBW in the United States was 13% for African-American infants, and 8% for whites ( (6) Centers for Disease Control and Prevention. Pediatric Nutrition Surveillance 1997 full report. US Dept of Health and Human Services, Atlanta, Ga1998 Google Scholar ). Healthy People 2010 ( (7) Healthy People 2010-Conference Edition, Maternal, Infant and Child Health. Available at: Accessed http://www.health.gov/healthypeople/Document/HTML/Volume2Date: 2000 Google Scholar ) outlines an overarching goal to eliminate health disparities among different segments of the population, including differences that occur by race or ethnicity.

Community-based teaching: defining the added value for students and preceptors

Ambulatory care training has an increasing presence on the medical education landscape. Mean training time in internal medicine ambulatory settings is approximately 30% for students and residents ( 1 Levinsky N.G A survey of changes in the proportions of ambulatory training in internal medicine clerkships and residencies from 1986–87 to 1996–97. Acad Med. 1998; 73: 1114-1115 Crossref PubMed Scopus (17) Google Scholar ). Several studies have failed to demonstrate educationally meaningful differences in the subjective or objective evaluation of student competencies of those trained part-time in ambulatory settings compared with students trained entirely in the hospital ( 2 Pangaro L Gibson K Russell W Lucas C Marple R A prospective, randomized trial of a six-week ambulatory medicine rotation. Acad Med. 1995; 70: 537-541 Crossref PubMed Scopus (27) Google Scholar , 3 Papadakis M.A Kagawa M.K A randomized, controlled pilot study of placing third-year medical clerks in a continuity clinic. Acad Med. 1993; 68: 845-847 Crossref PubMed Scopus (16) Google Scholar , 4 Kalet A Schwartz M.D Capponi L.J Mahon-Salazar C Bateman W.B Ambulatory versus inpatient rotations in teaching third-year students internal medicine. J Gen Intern Med. 1998; 13: 327-330 Crossref PubMed Scopus (29) Google Scholar ).

Assessing How Well Three Evaluation Methods Detect Deficiencies in Medical Studentsʼ Professionalism in Two Settings of an Internal Medicine Clerkship. Hemmer PA, Hawkins R, Jackson JL, Pangaro LN (F Edward Hebert School of Medicine, Bethesda, Md). Acad Med. 2000;75:167-173.

Assessing How Well Three Evaluation Methods Detect Deficiencies in Medical Studentsʼ Professionalism in Two Settings of an Internal Medicine Clerkship. Hemmer PA, Hawkins R, Jackson JL, Pangaro LN (F Edward Hebert School of Medicine, Bethesda, Md). Acad Med. 2000;75:167-173.

Continuing Medical Education for Life: Eight Principles. Abrahamson S, Baron J, Elstein AS, et al (University of Southern California School of Medicine, Los Angeles, Calif; University of Pennsylvania School of Arts and Sciences, Philadelphia, Pa; University of Illinois at Chicago College of Medicine, Chicago, Ill; Hope Heart Institute, Seattle, Wash). Acad Med. 1999;74:1288-1294.

Continuing Medical Education for Life: Eight Principles. Abrahamson S, Baron J, Elstein AS, et al (University of Southern California School of Medicine, Los Angeles, Calif; University of Pennsylvania School of Arts and Sciences, Philadelphia, Pa; University of Illinois at Chicago College of Medicine, Chicago, Ill; Hope Heart Institute, Seattle, Wash). Acad Med. 1999;74:1288-1294.

Do We All Mean the Same Thing by “Problem-Based Learning”? A Review of the Concepts and a Formulation of the Ground Rules. Maudsley G (University of Liverpool, Merseyside, United Kingdom), Acad Med. 1999;74:178-185.

Do We All Mean the Same Thing by “Problem-Based Learning”? A Review of the Concepts and a Formulation of the Ground Rules. Maudsley G (University of Liverpool, Merseyside, United Kingdom), Acad Med. 1999;74:178-185.

Medical Studentsʼ Self-Assessments and Their Allocations of Learning Time. Gruppen LD, White C, Fitzgerald JT, et al. Acad Med. 2000;75:374-379.

Medical Studentsʼ Self-Assessments and Their Allocations of Learning Time. Gruppen LD, White C, Fitzgerald JT, et al. Acad Med. 2000;75:374-379.

The Philosophical Limits of Evidence-Based Medicine. Tonelli MR (University of Washington School of Medicine, Seattle, Wash). Acad Med. 1998;73:1234-1240.

The Philosophical Limits of Evidence-Based Medicine. Tonelli MR (University of Washington School of Medicine, Seattle, Wash). Acad Med. 1998;73:1234-1240.

Making sense of antimicrobial use and resistance surveillance data: application of ARIMA and transfer function models

Making sense of antimicrobial use and resistance surveillance data: application of ARIMA and transfer function models

Dermatomyositis and cancer: East and West

I read with interest the CME article entitled “Dermatomyositis” by Kovacs and Kovacs in the December 1998 issue (J Am Acad Dermatol 1998;39:899-920). As stated in the review, the population-based, albeit retrospective, study by Airio, Pukkala, and Isomaki1Airio A Pukkala E Isomaki A. Elevated cancer incidence in patient with dermatomyositis: a population-based study.J Rheumatol. 1995; 22: 1300-1303PubMed Google Scholar from Finland demonstrated a 6.5-fold risk of malignancy in patients with dermatomyositis but no increased risk with patients with polymyositis. The highly associated internal malignancies were ovarian, stomach, and lung (with standardized incidence ratios between observed and expected numbers of cancer cases of 32, 14, and 10, respectively). There is no mention of nasopharyngeal carcinoma as an associated malignancy. In the Far East the most common cancer, by far, associated with adult dermatomyositis is nasopharyngeal carcinoma.2Wong KO. Dermatomyositis: a clinical investigation of 23 cases in Hong Kong.Br J Dermatol. 1969; 81: 544-547Crossref PubMed Scopus (79) Google Scholar, 3Goh CL Rajan VS. Dermatomyositis in a skin clinic.Ann Acad Med. 1983; 12: 6-12PubMed Google Scholar, 4Chan HL. Dermatomyositis and cancer in Singapore.Int J Dermatol. 1985; 24: 447-450PubMed Google Scholar We strongly suggest that an ear-nose-throat evaluation should constitute an essential part of the examination in this group of patients. 16/8/103267 doi:10.1067/mjd.2000.103267

10 YEARS OF EXPERIENCE WITH PENILE PROSTHESIS IMPLANTATION IN TAIWANESE PATIENTS

We evaluated the long-term results of penile prosthesis implantation during the last 10 years. Special considerations were examined concerning Asian corporeal diameter, device survival and sociocultural factors influencing patient-partner satisfaction. We followed 331 patients who underwent penile prosthesis implantation from December 1985 to May 1996. Surgical data, postoperative complications and information from a survey on satisfaction are reported. The most prevalent corporeal diameter in our patients was 11.0 to 11.5 cm. Postoperatively wound infection was the most serious surgical complication. The 5-year device survival was similar in the malleable and inflatable types except for a poorer outcome with the self-contained inflatable Hydroflex penile prosthesis. Overall patient satisfaction with surgery was 86.6%. Penile prosthesis implantation still has its place as definitive therapy in some patients with uncorrectable erectile dysfunction. In Taiwanese society more consideration of prosthesis selection, surgical preparation and patient-partner counseling is the basis for further success in the future.

The dishonest Dean's letter: An analysis of 532 Dean's letters from 99 U.S. medical schools: Edmond M, Roberson M, Hasan N. Acad Med 1999;74:1033–5

The dishonest Dean's letter: An analysis of 532 Dean's letters from 99 U.S. medical schools: Edmond M, Roberson M, Hasan N. Acad Med 1999;74:1033–5

Relationship Between Clinical Competence and Interpersonal and Communication Skills in Standardized-Patient Assessment. Colliver JA, Swartz MH, Robbs RS, Chien DS. Acad Med. 1999;74:271-274.

Relationship Between Clinical Competence and Interpersonal and Communication Skills in Standardized-Patient Assessment. Colliver JA, Swartz MH, Robbs RS, Chien DS. Acad Med. 1999;74:271-274.

The future of medicine and radiology: Part I.

HomeRadiologyVol. 212, No. 2 PreviousNext PerspectivesThe Future of Medicine and Radiology: Part IRichard M. FriedenbergRichard M. FriedenbergAuthor Affiliations1From the Department of Radiological Sciences, UCI Medical Center, University of California, Irvine, 101 The City Dr, Orange, CA 92868-3298. Received March 16, 1999; accepted May 21. Address reprint requests to the author (e-mail: [email protected]).Richard M. FriedenbergPublished Online:Aug 1 1999https://doi.org/10.1148/radiology.212.2.r99au57301MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References 1 Harris ED, Jr. Dartmouth Medical School bicentennial symposium: great issues for medicine in the twenty-first century—a consideration of the ethical and social issues arising out of advances in the biomedical sciences. Pharos 1998; 61:26-33. Google Scholar2 Friedenberg RM. The radiologist: a middleman (person) of medicine. Radiology 1994; 190(1):49A-51A. Link, Google Scholar3 Friedenberg RM. A compendium of managed care: past, present, and hints of the future: part I. Radiology 1998; 208:289-292. Link, Google Scholar4 Hamer R, VanAntwerp S. Study results show decline in HMO operating margins. Healthc Financ Manage 1997; 51:78-80, 82, 84. Google Scholar5 Thompson JC. Seedcorn: impact of managed care on medical education and research. Ann Surg 1996; 223:453-463. Crossref, Medline, Google Scholar6 Insurance Policy Committee of University of California, Berkeley. and UCLA. Bulletin of State Health Insurance Committee of California Sacramento, Calif: State Health Insurance Committee of California, 1998. Google Scholar7 Moynihan DP. On the commodification of medicine. Acad Med 1998; 73:453-459. Crossref, Medline, Google Scholar8 Lamm RD. The coming clash: patient advocates vs the public interests. Pharos 1998; 61:18-20. Google Scholar9 Cooper RA, Henderson T, Dietrich CL. Roles of nonphysician clinicians as autonomous providers of patient care. JAMA 1998; 280:795-802. Crossref, Medline, Google Scholar10 Oransky I, Varma JK. Nonphysician clinicians and the future of medicine (editorial). JAMA 1997; 277:1090. Crossref, Medline, Google Scholar11 Chapman AH. Changing work patterns. Lancet 1997; 350:581-583. Crossref, Medline, Google Scholar12 Bernstein S, Cleeland N, Riccardi N. Salaried doctors are courted by labor union. Los Angeles Times; March 1999; 2(1):. Google ScholarArticle HistoryPublished in print: Aug 1999 FiguresReferencesRelatedDetailsCited ByJapanese Journal of Radiological Technology, Vol. 64, No. 6Haigan, Vol. 47, No. 6The American Heart Hospital Journal, Vol. 4, No. 3The Underinsured: A Problem That Must Be Solved1Richard M. Friedenberg, 1 June 2001 | Radiology, Vol. 219, No. 3Managed Care and Social Justice1Richard M. Friedenberg, 1 October 2000 | Radiology, Vol. 217, No. 1The Role of the Supertechnologist1Richard M. Friedenberg, 1 June 2000 | Radiology, Vol. 215, No. 3The Future of Medicine and Radiology: Part II1Richard M. Friedenberg, 1 October 1999 | Radiology, Vol. 213, No. 1Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 212, No. 2 Metrics Altmetric Score PDF download

The changing landscape for clinical research.

The authors review the history of U.S. clinical research and identify the profound changes stemming from advancements in the biomedical sciences, the recent transformation in the organization and financing of health care delivery, and the increasing application of information technologies. They observe that the enterprise must reorganize to account for the changed landscape, but there is a lack of the data necessary to monitor change and determine the extent to which clinical research is successfully realigning and sustaining itself. The authors discuss the evolving definition, scope, and venues for clinical research, and review previous analyses of clinical research's difficulties and remedies proposed: shared responsibility in the financing of academic medicine, support by federal and private health insurers for routine costs of patient care in clinical trials, and strengthened collaboration between and among industry, academia, insurers, and government. The authors conclude by describing two major initiatives to foster clinical investigation in the new landscape. The first is the Clinical Research Summit Project, a convocation of representative stakeholders from the health care system with an interest in clinical research, whose charge will be to formulate a national agenda for clinical research that has the broad-based support of the stakeholders. Among the challenges of this undertaking are the needs to identify new and stable sources of support for clinical research infrastructure, assess the future workforce needs for clinical investigation, and devise new methods to ensure the continued vitality and account-ability of clinical research. The second is the Clinical Research Task Force, an initiative of the Association of American Medical Colleges (AAMC), which is already exploring and advising on how AAMC member organizations can best strengthen their capacity to support clinical research programs in the current scientific, health care delivery, and financial environment.

The Amount of Small-Group Case-Study Discussion Needed to Improve Moral Reasoning Skills of Medical Students. Self DJ, Olivarez M, Baldwin DC. Acad Med. 1998;73:521-523.

The Amount of Small-Group Case-Study Discussion Needed to Improve Moral Reasoning Skills of Medical Students. Self DJ, Olivarez M, Baldwin DC. Acad Med. 1998;73:521-523.

Oral and Upper Aero-Digestive Tract Malignancy: A Review of a Five-Year Experience

(25%) and 179 males (69.4%). In 12 cases (4.7%), sex was not specified. The most affected age group was between 41-50 years (24.5%), and the least affected were those above 91 years and below 11 years ( Table 1). The most common malignancy was squamous cell carcinoma (50.7%), followed by basal cell carcinoma (15.9%). Metastatic carcinoma constituted about 13.2%, nonHodgkin’s lymphoma 10.8%, including Burkitt’s lymphoma (1.2%), and adenocarcinoma was 2.3%. 5 The lowest incidence was mucoepidermoid, verrucous carcinoma, and melanoma, accounting for 1.2%. This was followed by Hodgkin’s (0.8%) and adenoid cystic carcinoma (0.5%). There were three cases of anaplastic carcinoma (1.2%). Rhabdosarcoma and neuroblastoma constituted 0.8%. (Table 2). Lymph nodes were the most affected site, with malignancy comprising 20.2%. The skin of the head and neck was the second most common site (19.3%), followed by the nasopharynx (15.9%), buccal mucosa (9.7%), tongue (8.9%), neck (6.9%), and larynx and salivary glands (3.9% each) ( Tables 3 and 4). The least involved sites were the minor salivary glands and gingiva. The sternocleidomastoid was involved with rhabdosarcoma in one case.

What hysterectomy [corrected] patients want to know about the roles of residents and medical students in their care.

To determine what patients want to know regarding the participation of trainees in their care. In 1995, questionnaires were sent to 111 women who had undergone elective hysterectomies between September 1992 and June 1994 at two teaching hospitals at the University of California, San Francisco, School of Medicine. The questionnaires asked the women about their awareness of and attitudes toward the participation of residents and medical students in their care and about how they thought physicians should communicate information regarding residents to patients. Fifty-nine women (68%) returned the questionnaire. Thirty-seven of them (63%) knew that a resident had been involved in their care. Eighty percent of the respondents felt it important to know how residents were supervised and what they would do during the operation. Nearly half did not know whether a medical student had been involved in their care. Over 90% agreed that the attending gynecologist should tell patients that a resident would participate in the operation as well as what the resident would do. Most believed that residents are adequately supervised and that medical students have time to provide more attention to patients. Most of the women wanted to know about the participation and specific roles of residents and students. Attending physicians should take the initiative to talk with patients about the roles of trainees. Open discussions can promote patient autonomy, maintain public confidence in academic health institutions, and benefit future patients.