Division Of General Internal Medicine Research Articles

67 RELIABILITY OF SELF-REPORT IN IDENTIFYING ANABOLIC STEROID USE AMONG WEIGHTLIFTERS

Division of General Internal Medicine, Department of Medicine, Michigan State University, East Lansing. Michigan

Strengthening academic generalist departments and divisions

Academic departments of family medicine and divisions of general internal medicine and general pediatrics exist in the majority of medical schools in the United States and have important roles in generalist medical education. The major organizational issues facing these units concern institutional influence, faculty development, role in medical education, research productivity, financial stability, and clinical responsibilities. These issues must be understood in order for medical schools and teaching hospitals to achieve the societal goal of producing necessary generalist physicians.

Can technology assessment control health spending?

Because medical technology is the most important controllable component of health spending growth, the success of strategies for limiting spending growth depends upon their impact on technology dissemination. Technology assessment is fundamental to any strategy for controlling the adoption of medical technologies. Cost-effectiveness analysis holds particular promise as a method for evaluating alternative health care technologies because it explicitly incorporates costs. This paper describes how the widespread adoption of health insurance promoted the dissemination of medical technologies and how technology dissemination fueled spending growth. It then describes approaches to technology assessment and the ways in which technology assessment, in the form of cost-effectiveness analysis, can be applied to help control spending growth.

The ethics objective structured clinical examination.

To develop objective structured clinical examination (OSCE) stations to assess the ability of physicians to address selected clinical-ethical situations, and to evaluate inter-rater agreement in these stations. Two ten-minute OSCE stations were developed using video-taped encounters between attending physicians and standardized patients. One scenario involved a daughter requesting a do-not-resuscitate (DNR) order for her competent mother without the mother's knowledge; the other involved a competent elderly woman requesting not to be re-intubated if her congestive heart failure worsened. The scenarios were evaluated using foreign medical graduates taking an OSCE. Each candidate was scored on his or her interaction with a standardized patient in the two OSCE stations by two independent observers. Eight attending physicians from the Division of General Internal Medicine at the Toronto Hospital were used to develop the OSCE stations, and 69 foreign medical graduates taking the University of Toronto Pre-Internship Program OSCE were used to evaluate the stations. The inter-rater reliability coefficients for the DNR and intubation scenarios were 0.79 (95% CI 0.69-0.87) and 0.75 (95% CI 0.62-0.84), respectively. For the DNR station, the scores of the two examiners, on a scale of 0 to 10, agreed exactly for 34 candidates (50%), within one mark for 59 candidates (87%), and within two marks for 65 candidates (96%). For the intubation station, the scores of the two examiners agreed exactly for 27 candidates (40%), within one mark for 56 candidates (84%), and within two marks for 63 candidates (94%). The authors produced ethics OSCE stations with face and content validity and satisfactory inter-rater agreement. Ethics OSCE stations may be suitable for evaluating the ability of medical students and residents to address selected clinical-ethical situations.

Health Care Workers Infected With the Human Immunodeficiency Virus

The Program in Medical Ethics. The Robert Wood Johnson Clinical Scholars Program; The Center for AIDS Prevention Studies, and the Division of General Internal Medicine, University of California, San Francisco, California

Do we still need primary care tracks?

Primary care tracks in internal medicine residency programs were initiated in the late 1970s in response to the need for more primary care physicians. These programs have shown that internists can be trained effectively in ambulatory settings. Graduates of primary care tracks are more likely to choose careers in general internal medicine than are other internal medicine graduates. Primary care internist training has been accompanied by the growth of academic general internal medicine divisions and by the enhancement of the scientific base for ambulatory care practice and medical education. Expanded ambulatory training opportunities, modeled after current primary care tracks, should be offered to all residents in internal medicine. At the same time, primary care tracks should be revised to address deficiencies in current ambulatory training. These tracks should be designed to commit most resident time to ambulatory care settings, to involve residents in community-based and interdisciplinary health care, and to expose residents to conditions outside of the medical sector that affect health. Revised primary care tracks can serve as pathfinder programs for ongoing reform in internal medicine residency training. Three models for organizing and funding such reform are presented.

General Internal Medicine

Some 20 years ago, general internal medicine residencies and divisions were organized to move training outside the hospital and to produce a new generation of general internists for primary care. Despite public and private support for such training, the number of general internists from these special programs and from the traditional medical residency programs is fewer today than when this reform began, and the percentage of all primary care practitioners (general internists, family practitioners, and pediatricians) is also lower. These failed manpower outcomes aside, the development of general internal medicine has improved care and learning outside the hospital by other contributions: (1) training curriculums in ambulatory medicine, (2) practitioner-teachers, (3) teaching group practices, and (4) new knowledge about and for practice. The details of these contributions are notable: (1) The curriculum reforms for outpatient training in general internal medicine continue to be adapted for the training of all medical residents;

Factors encouraging research productivity in a division of general internal medicine [published erratum appears in Acad Med 1991 May;66(5):272

The authors investigated two of the causes of and possible remedies for low research activity (as measured by rate of publication) of faculty members in a division of general internal medicine at a university hospital and its affiliated Veterans Administration medical center. They did this by analyzing information about the faculty in the health center's records spanning a 16-year period. This 1989 study suggests that the general medicine faculty members who are also involved in subspecialties and who have protected research time can improve their research productivity.

Administrative Data and Outcomes Research

From the Division of Health Services Research and Policy, University of Minnesota School of Public Health and the Division of General Internal Medicine, Hennepin County Medical Center, University of Minnesota

A practical approach to housestaff teaching conferences in a multi-site training program

The challenges of providing useful didactic teaching conferences for house officers and students on ward rotations in a program with several training sites are reviewed. An approach used by the Division of General Internal Medicine at the University of Washington minimizes these difficulties and may be of interest to others responsible for the teaching of house officers.

Teaching models in an ambulatory training program

Ambulatory care training is increasingly important in internal medicine. Such training centers on the practice where residents and faculty see their patients; thus, features of the practice model influence what residents learn. A resident-faculty group practice affiliated with a division of general internal medicine has many advantages. In such a practice, learning centers on resident-patient interactions, around which a comprehensive teaching program must be built. Major features of such a program include the mentoring of residents by faculty who work with them longitudinally and the presence of a well-balanced structured curriculum addressing clinical and nonclinical topics related to patient care. Teaching residents to interact and communicate with patients is crucial; approaches include role-modeling by faculty, use of videotaping, and role-playing and other innovative methods. Feedback is integral to learning and helps shape the attitudes and values that permeate residents' practices.

IV. Grants

IV. Grants

Development of a central division of general internal medicine.

A division of general internal medicine was, by design, developed to be central to many of the activities of the department of medicine. Since 1979 the division has grown from five faculty members to 29 members and has the potential for substantial additional growth. The division provides approximately 70% of all inpatient teaching by attending physicians, provides all of the general medicine outpatient teaching, and has substantial impact on medical student training programs. The division is responsible for more than $1.5 million of clinical services and approximately 10% of hospital admissions, and it is responsible for approximately 40% of all patients on the general medicine service. Research activities are divided into several distinct modules, including medical informatics, clinical epidemiology, occupational medicine, geriatrics, medical competency testing, and ethics. The division receives approximately $1.2 million from external sources, including the federal government and foundations, for its research activities. Because of its success, it may serve as a potential model for similar divisions in other departments of medicine.

Assessing quality of a diagnostic test evaluation.

To develop a standardized scale for assessing the quality of a diagnostic test evaluation. Fourteen participants with formal and practical experience in evaluating diagnostic tests formed a consensus panel. Panel members identified and weighted questions that should be addressed when assessing the quality of a diagnostic test evaluation. General internal medicine division at an academic medical center. A 19-item weighted scale was developed. It prioritizes and addresses issues such as description of the proposed purpose of the test; appropriate selection and description of the study population; appropriate performance and description of the diagnostic test; appropriate selection and performance of the reference standard; and adequate presentation of test characteristics. The scale is proposed as a useful instrument for readers, investigators, reviewers, and editors, because it represents an updated synthesis of important criteria to consider when evaluating diagnostic tests. It can also be used to rate quantitatively the quality of diagnostic test evaluations.

The gastrointestinal side effects of the nonsteroidal anti-inflammatory drugs.

The Journal of Clinical PharmacologyVolume 28, Issue 6 p. 554-559 The Gastrointestinal Side Effects of the Nonsteroidal Anti-Inflammatory Drugs Jeffrey L. Carson MD, Corresponding Author Jeffrey L. Carson MD Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey; and the Clinical Epidemiology Unit, Section of General Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.UMDNJ-Robert Wood Johnson Medical School, Division of General Internal Medicine, One Robert Wood Johnson Place, New Brunswick, NJ 08903-0019.Search for more papers by this authorBrian L. Strom MD, MPH, Brian L. Strom MD, MPH Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey; and the Clinical Epidemiology Unit, Section of General Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.Search for more papers by this author Jeffrey L. Carson MD, Corresponding Author Jeffrey L. Carson MD Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey; and the Clinical Epidemiology Unit, Section of General Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.UMDNJ-Robert Wood Johnson Medical School, Division of General Internal Medicine, One Robert Wood Johnson Place, New Brunswick, NJ 08903-0019.Search for more papers by this authorBrian L. Strom MD, MPH, Brian L. Strom MD, MPH Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey; and the Clinical Epidemiology Unit, Section of General Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.Search for more papers by this author First published: June 1988 https://doi.org/10.1002/j.1552-4604.1988.tb03175.xCitations: 14AboutPDF 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 onFacebookTwitterLinked InRedditWechat Citing Literature Volume28, Issue6June 1988Pages 554-559 RelatedInformation

Changing Patterns of Hip Fracture Care Before and After Implementation of the Prospective Payment System

Division of General Internal Medicine, Department of Medicine, Indiana University School of Medicine, and the Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana

Stats on Lower Back Pain

of the Multipurpose Arthritis Center and the Division of General Internal Medicine. Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, Tex., 78284.

Faculty Development in General Internal Medicine

To understand the educational needs of faculty general internists in academic hospital environments, surveys of general internal medicine division chiefs, department of medicine chairmen, and members of the Society for Research and Education in Primary Care Internal Medicine were undertaken. Results indicated considerable interest in faculty development activities among all physicians sampled. Division chiefs and department chairmen viewed such activities as feasible, potentially effective, and were willing to assume considerable responsibility in providing educational opportunities to their faculty. Although some physicians viewed self-learning as a potentially effective educational method, the vast majority preferred learning in a small group taught by an expert. Specific content areas for faculty development were assessed, as were the skills thought to be essential for personal job satisfaction, academic promotion, and organizational effectiveness.

Academic general internists' work roles and motivations for learning.

As part of an assessment of interests and needs for continuing medical education among academic general internists, a 20 per cent random sample of the 1985 physician membership of SREPCIM was asked to describe how they divided their time among basic work activities (patient care, teaching, housestaff supervision, administration, and research), how they perceived the importance of specific skills related to those basic activities, and how interested they were in participating in a faculty development program in order to improve those skills. Although respondents reported a great diversity of work roles, attitudes, and values, there was a strong and consistent tendency to value and want to improve upon only those skills related to basic activities in which physicians were already spending more time. Also, physicians who spent more time in direct patient care were significantly less likely to value classroom teaching or research, less likely to be doing teaching or research, and less motivated to improve their skills in those activities. Likewise, faculty who spent more time doing research were less interested in improving their patient care skills. The implications of these findings for meeting current and future manpower needs of divisions of general internal medicine are discussed.

Cardiac Assessment for Patients Undergoing Noncardiac Surgery

Departments of Health Administration and Medicine, University of Toronto, and the Division of General Internal Medicine and Clinical Epidemiology, Toronto General Hospital, Toronto, Canada