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B Barzansky

Publications and source records attributed to B Barzansky.

At least 19 recordsLinked to original sources
PubMed1999

Educational programs in US medical schools, 1998-1999.

To describe the current status of medical education programs in the United States and to trace trends in medical education over this century, we used data from the 1998-1999 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and data from other sources. In 1998-1999, total full-time faculty members numbered 98202, a 1.5% increase from 1997-1998. The number of applicants to medical school declined for the second consecutive year, from 43020 in 1997 to 41004 in 1998, but the academic qualifications of entering students remained steady. The number of applicants from underrepresented minority groups decreased 1.3% from 1997 to 1998, compared with an 11.1% decrease between 1996 and 1997. Women constituted 43.4% of applicants in 1998, slightly more than the 42.5% in 1997. The total number of required hours in the first and second years of the curriculum and the number of scheduled hours per week have declined over the past 15 years, while the average lengths of clinical clerkships remained about the same. The number of schools requiring students to pass Steps 1 and 2 of the United States Medical Licensing Examination continued to increase in 1998-1999, with 50% of schools requiring passing both examinations, compared with 46% in 1997-1998.

Clinical Clerkship↗
PubMed1998

Educational programs in US medical schools, 1997-1998.

To describe the current status of medical education programs in the United States, we used data from the 1997-1998 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and from other sources. There were 96733 full-time medical school faculty members, a 1.2% increase from 1996-1997. The 43020 applicants for the class entering in 1997 represents an 8.4% decrease from 1996. The number of 1997 applicants who were members of underrepresented minority groups decreased 11.1 % from 1996, and the number of entering underrepresented minority group students decreased 8.4%. More than half of medical schools reported that the number of inpatients available for medical student education had decreased in at least some of their clinical sites or in some disciplines during the past 2 years. Thirty-nine medical schools (31.2%) reported having more difficulty recruiting or retaining volunteer clinical faculty to participate in medical student teaching in 1997 than in 1995.

Curriculum↗
PubMed1997

Educational programs in US medical schools, 1996-1997.

We use data from the 1996-1997 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, to describe medical education programs in the United States. In the 1996-1997 academic year, there were 95 568 full-time medical school faculty members, a 4.5% increase from 1995-1996. In clinical departments, the largest increases were in emergency medicine (a 29% increase from 1995-1996) and family medicine (a 13% increase). Of all full-time faculty members in clinical departments, 76.9% have an MD or DO as the highest degree, 4.5% have both an MD and PhD, 13.9% have a PhD, and 4.7% have an academic or professional bachelor's or master's degree as their final degree. The total number of applicants for the class entering in 1996 was 46968 (0.8% increase from 1995), while the number of first-time applicants decreased 1% from 1995. First-year medical students who were members of underrepresented minority groups numbered 2236, a 4% decrease from 1995. In 1996-1997, the total number of medical students was 66712 (0.3% less than in 1995-1996). For students graduating during the 1995-1996 academic year, 13% took longer than 4 years to complete the program. There were 47 medical schools that reported that 1 or more hospitals used for required clinical clerkships had changed ownership, merged, or closed during 1996. Medical schools used an average of 6 (range, 1-36) hospitals for core clinical clerkship. Ninety-five schools required a passing grade on Step 1 of the US Medical Licensing Examination (USMLE) for promotion or graduation; 54 schools required a passing grade on Step 2 of the USMLE.

Accreditation↗
PubMed1997

Comparisons between older and usual-aged medical school graduates on the factors influencing their choices of primary care specialties.

PURPOSE: To examine whether there are differences between older (30+ years) and usual-aged graduates in the factors that influence their decisions to enter primary care. METHOD: A national survey of primary care physicians was conducted by mail in early 1993. The survey population comprised physicians who had graduated from U.S. allopathic medical schools in 1983 and 1984. The questionnaire consisted of four parts: practice characteristics, 19 variables influencing the physicians' decisions to enter primary care (rated on a scale from 5 = very strong influence to 1 = no influence), the timing of the decision to enter primary care, and demographic and personal information. Data were analyzed through several statistical methods. RESULTS: In all, 355 (22%) older and 1,241 (78%) usual-aged graduates who were practicing in primary care specialties responded. Compared with the usual-aged graduates, the older graduates were more likely to have grown up in rural or inner-city areas, to have obtained a second academic degree, and to have made the decision to enter primary care earlier. The older graduates' decisions to enter primary care had been more influenced by children and familial responsibilities, whereas the usual-aged graduates had been more influenced by internship and residency experiences and by parents and role models before medical school. CONCLUSION: This study provides empirical evidence to support the notion that nontraditional students (i.e., older ones) are more likely to commit themselves earlier to a career decision and less likely to be influenced by the socialization process during medical school. In this regard, age-specific factors should receive more attention in the analysis of the physician workforce.

Adult↗
PubMed1997

The relationship between the race/ethnicity of generalist physicians and their care for underserved populations.

OBJECTIVES: The purpose of this study was to examine empirically the relationship between physicians' race or ethnicity and their care for medically underserved populations. METHODS: Generalist physicians who received the MD degree in 1983 or 1984 (n = 1581) were surveyed. The personal and background characteristics of four racial/ethnic groups of physicians were compared with the characteristics of their patients. RESULTS: When the potentially confounding variables of gender, childhood family income, childhood residence, and National Health Services Corps financial aid obligations were controlled, generalist physicians from underrepresented minorities were more likely than their nonminority counterparts to care for medically underserved populations. CONCLUSIONS: Physicians from underrepresented minorities are more likely than others to care for medically underserved populations.

Adult↗
PubMed1996

Medical student education in managed care settings: beyond HMOs.

OBJECTIVE: To describe the educational experiences of students in managed care settings and to compare these with recommendations for preparing physicians to practice in managed care. DESIGN: We searched MEDLINE using the keywords "medical education," "managed care," "health maintenance organization," and others; we manually checked the reference lists of identified articles and reports from 1969 to 1996. Survey information was obtained from all US medical schools in 1995 and 1996. Site visits were made to 6 managed care organizations selected according to size, geographic region, and involvement in education. MAIN OUTCOME MEASURES: The extent to which schools use managed care settings for clinical education, the types of settings used, and the kinds of educational programs experienced. RESULTS: In 1995 and 1996, an average of 16% of schools required all students to have clerkships or other clinical experiences in a group/staff model HMO, and some students from another 46% of schools spent time in an HMO for clerkships or physical diagnosis/introduction to clinical medicine courses. About 85% of schools potentially exposed students to other types of managed care during 1 or more required clinical experiences in ambulatory, community-based settings. The learning objectives of these experiences did not explicitly address features unique to managed care such as cost containment and disease prevention. CONCLUSION: The selection of managed care settings for undergraduate education is based on general clinical objectives rather than explicit goals tied to managed care. Whether these experiences in managed care settings help students to develop competencies for future practice in a managed care environment has not been demonstrated. While the feasibility of medical education in nonprofit group/staff model HMOs is well documented, it is not certain whether these models can be adapted to for-profit managed care settings.

Education, Medical↗
PubMed1996

Education programs in US medical schools, 1995-1996.

We present herein data on US medical education programs and describe how medical schools are adapting to a changing health care environment. The data mainly derive from the 1995-1996 Liaison Committee on Medical Education Medical School Questionnaire, which had a 100% response rate. The data indicate that in the 1995-1996 academic year there were 91 451 full-time faculty members in basic science and clinical departments, a 1.6% increase from 1994-1995. In clinical departments, major increases occurred in emergency medicine (a 10.6% increase in full-time faculty) and family medicine (a 13.5% increase). Applicants for the class entering in 1995 numbered 46 591, an increase of 2.7% from 1994; however, the number of first-time applicants decreased slightly (0.6%). Of the 17 357 applicants accepted, 2179 (12.6%) were members of underrepresented minority groups. Health system changes are affecting medical school clinical affiliations. During the past 2 years, 42 schools saw a merger, acquisition, or closure involving medical school-owned or medical school-affiliated hospitals used for core clinical clerkships. At 15 sites, this change affected the distribution of students across clinical sites. In 1995-1996, 40 medical schools or their universities owned a health maintenance organization or other managed care organization, 93 schools contracted with a managed care organization to provide primary care services, and 96 schools contracted with managed care to provide specialty services. During the past year, 57 schools acquired primary care physician practices, and 70 started primary care clinics in the community.

Accreditation↗
PubMed1995

Educational programs in US medical schools, 1994-1995.

This is a time of considerable uncertainty about the future of medical education. There are threats to medical school finances from state and federal levels. While medical schools derive only an average of about 11% of total revenues from state and local sources, these funds potentially give states the basis for imposing specific mandates on medical schools, in areas such as enrollment levels, curriculum content, and a desired specialty mix of graduates. Medical schools appear to be changing at varying rates in response to the health care system, including the growth of managed care. While the total number of full-time faculty members continues to increase, there are regional differences. It is unclear how the faculty size and composition ultimately will be affected or what implications this will have for educational programs. A number of medical schools are expanding into the community to ensure a patient base, and educational opportunities for medical students appear to be increasing in the community, including some limited use of managed care organizations. as educational settings. Medical school practice sites in the community have the potential to exacerbate "town-gown" tensions in the increasingly competitive health care environment. This, in turn, could jeopardize community-based medical education by the large number of practicing physicians who serve as volunteer faculty members and who are a valuable resource. Care will need to be taken to minimize these tensions as much as possible. As the health care system becomes even more competitive, concerns are being raised about whether volunteer faculty will continue to serve without compensation. The ability to begin to compensate community physicians who serve as teachers could be affected by decreasing medical school revenues from patient care, which, in the past, have been used to support activities such as community-based education. This is a time for strong and visionary academic leadership: medical schools must not only adapt to a changing health care system, but also maintain excellence in education, research, and patient care. This annual article will continue to describe the efforts of educational programs to do so.

Accreditation↗
PubMed1995

A national study of the factors influencing men and women physicians' choices of primary care specialties.

BACKGROUND: Despite a recent increase in the percentage of graduating U.S. medical students planning to pursue generalist careers, interest in primary care among students is still far below what it was in the early 1980s and falls well short of the stated goal of the Association of American Medical Colleges that half of all graduates should choose generalist careers. Also during the past decade, the number of women students and physicians has increased. Given the importance of concerns regarding the primary care work force, it is timely to examine the relationship between gender and other factors that influence the decision to enter primary care. METHOD: Totals of 1,038 (65%) men and 558 (35%) women primary care physicians selected from the 1983 and 1984 graduates of all allopathic U.S. medical schools were surveyed in early 1993. Gender comparisons were made on the 19 variables that influenced the physicians' decisions to enter primary care specialties and on the six factor scores derived from a factor analysis of these 19 variables. Also included in the gender comparisons were characteristics of practice, populations served, timing of making the decision to enter primary care, and personal demographic information. RESULTS: Men, more than women, were influenced to become primary care physicians by early role models. Women, more than men, were influenced by personal and family factors. Overall, medical school experience and personal values are two important factors that explained the largest variances of the 19 predictor variables influencing the physicians' choices of primary care disciplines. There was no gender difference in place of origin, family income as a child, timing of the decision to become a primary care physician, or the amount of debt upon graduation. CONCLUSION: This nationwide study of primary care physicians indicates that men and women physicians differ in their perceptions of the relative importances of factors influencing the choice of a primary care specialty. Gender-specific factors should receive more attention in the development of successful strategies to attract more medical students into primary care specialties.

Career Choice↗
PubMed1994

Medical school and student characteristics that influence choosing a generalist career.

OBJECTIVE: To identify predictors in medical schools that can be manipulated to affect the proportion of graduates entering generalist practice. DESIGN AND PARTICIPANTS: Cross-sectional and retrospective studies of medical schools and practicing generalist physicians; surveys of MD-granting and DO-granting medical schools; site visits to nine schools with a high proportion of graduates becoming generalist physicians; surveys of national samples of MD and DO generalist physicians. INDEPENDENT VARIABLES: Characteristics of medical schools, including structural characteristics, financing, mission, admissions policies, student demographics, curriculum, faculty, and the production of generalist physicians; information on personal characteristics, background, perceptions, and attitudes of practicing generalist physicians. DEPENDENT VARIABLE: Estimated proportion of graduates of the classes of 1989, 1990, and 1991 in family practice, general internal medicine, and general pediatrics. RESULTS: Institutional mission, certain admissions policies, characteristics of entering students, and the presence of a primary care-oriented curriculum explained statistically significant variation in the number of physicians choosing generalist careers, even after the structural characteristics of public or private status, age of the school, and class size were controlled for statistically. CONCLUSIONS: Public and institutional policies, where implemented, have had a positive effect on students' choice of generalist careers. The most influential factors under the control of the medical school are the criteria used for admitting students and the design of the curriculum, with particular emphasis on faculty role models. Personal social values was the individual characteristic that most strongly influenced graduates' career choice.

Career Choice↗
PubMed1994

Educational programs in US medical schools, 1993-1994.

From the data on faculty, students, and curriculum, is it possible to identify any responses to actual or anticipated health system changes? While one could foresee medical school downsizing in response to a potentially more competitive environment in which income from faculty practice would be reduced, what has occurred, on average, is steady growth in the number of faculty members across departments, with a large increase in the past year. However, expansion is not consistent across states. Between 1992-1993 and 1993-1994, the number of full-time faculty members decreased 1.5% in California medical schools, increased 3% in Minnesota medical schools, increased 6% in North Carolina medical schools, and increased 10% in New York and Pennsylvania medical schools. These differences may reflect the fiscal situation at the state level as well as differences in the practice environment in different areas. For example, managed care has not had a major effect in many markets. It will be important to monitor trends in faculty at both the national and regional levels to understand the full impact of health system changes. There is considerable diversity among US medical schools: in goals, in student profiles, and in curriculum structure. A number of schools have goals or objectives that contain a reference to the training of primary care physicians. The majority of these are public institutions, but a number of private schools have chosen to address the issue as well. Many schools, both public and private, are under external scrutiny related to the performance and specialty and practice location choices of their graduates.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗
PubMed1993

Educational programs in US medical schools.

As described in the introduction, the data presented in this report can be viewed in both a historical and an environmental context. From a historical perspective, there has been change in many areas of medical education. The number of applicants to medical schools has risen sharply in the past few years, a result seemingly inconsistent with the dissatisfaction with medicine expressed by many physicians and with the uncertainties about the eventual outcomes of health system reform. The number of minority applicants and enrollees is slowly rising, but at rates below the goals identified by such initiatives as the Association of American Medical Colleges' "Project 3000 by 2000." Even with the expansion of the applicant pool, however, most medical schools do not anticipate enrollment increases. Medical school tuition also continues to increase significantly, in both public and private schools. The number of faculty members in the clinical disciplines also has continued to rise, although the rate of increase has become less marked. The decrease in the number of basic science faculty members that occurred this year will need to be monitored to ensure that appropriate faculty resources are available for teaching, especially with the initiatives to introduce more active learning formats during the basic science years. The medical curriculum continues to evolve at differing rates across schools. Many "innovations" have become part of the curricular repertoire; for example, medical schools have incorporated educational formats, such as problem-based learning or computer-assisted instruction, which emphasize active student learning, although in a number of cases they are limited to a small portion of the curriculum. In addition, the availability of clinical experiences during the first 2 years of the curriculum, especially those located in ambulatory settings, gives students an early glimpse of the world of actual medical practice. The use of standardized patients provides system and structure in the teaching and evaluation of clinical skills. Therefore, a look at medical education as a whole in the historical context reveals many positive changes (for example, an increase in student diversity over time, the introduction of alternative instructional formats, and attempts to evaluate student clinical competence more reliably). Within the context of environmental expectations, however, many challenges still remain. Medical schools are experiencing pressure to solve perceived problems with the specialty distribution of their graduates and with the specialty distribution of the general physician population, even though factors outside the control of the medical school, such as reimbursement and the practice environment, also influence specialty choice.(ABSTRACT TRUNCATED AT 400 WORDS)

Accreditation↗
PubMed1992

Educational programs in US medical schools.

Trends of the past few years indicate that the 1990s will be a time of intense activity in medical education reform. A number of areas described in this annual review of medical education are grounds for optimism, tempered, however, by caution. The applicant pool has been increasing rapidly over the past 2 years and has reached the levels of the early 1980s. The average proportion of women and some minorities also has been rising. While these are positive signs, efforts to ensure diversity in the student population should not be abandoned. The number of faculty members continues to rise, especially in the clinical disciplines. The increases, occurring in the context of stable medical student enrollments, raise questions about the various roles and responsibilities of medical school faculty. Many medical schools are in the process of curriculum review and revision; while these changes respond to identified problems, they may have implications for faculty and other resources. External financial support fueled previous waves of curriculum innovation, and some of these gains could not be maintained when that support was withdrawn. The revisions in the examinations of the NBME are being well received, and the single pathway to licensure through USMLE has been initiated. This system does, however, affect graduates' options for licensure. Finally, the increased interest in program evaluation, especially the definition of goals and the measurement of educational outcomes to assess their attainment, demonstrates that medical schools are serious about educational accountability. Some schools also are being asked to address externally imposed objectives, related specifically to specialty choice, creating a potential for conflict between the objectives that the medical school sets for itself and those mandated by its external constituencies. While this analysis may imply that medical education is now in a "good news/bad news" situation, the message is that planning and careful assessment of options are perhaps even more important today than they were in the past. Change has its costs and its implications, but it must nonetheless be undertaken.

Accreditation↗
PubMed1991

Educational programs in US medical schools.

One noteworthy finding for the 1990-1991 academic year is the increasing number of applicants to medical school, coupled with stabilization in the credentials of accepted applicants. This increase appears to be reversing the downward trend of the 1980s. The percentages of women and total minority students in the entering class increased from the previous year. The prevalence of instructional formats such as problem-based learning and computer-assisted instruction illustrates that medical schools are willing to experiment with educational innovation. A number of schools are in the process of curriculum review, which may lead to important changes. The financial support offered by private foundations interested in curriculum innovation, for some, will be an added stimulus for change. While the majority of medical schools continue to require that students take the examinations and the subject tests of the NBME, evaluation formats that test clinical skills are receiving increased attention. The number of schools using multiple station examinations (often with standardized patients) is rising. The impact of the new US Medical Licensing Examination on medical school curricula should be analyzed in the future. Although steady increases have been reported in the number of medical school faculty members, especially clinical faculty, there is little information about how these faculty members apportion their time between teaching, research, and patient care. The assumption is that the increases are primarily driven by medical schools' need to provide clinical services, which are a source of income. Another explanation for faculty increases could relate to the need for more faculty involvement in educational innovations such as problem-based learning and new methods of clinical skills evaluation, which are relatively more faculty-intensive. Continued monitoring of the growth in clinical faculty will be necessary, as will more careful analysis of how medical school faculty spend their time. Since medical school faculty who have heavy involvements in teaching frequently do not receive appropriate recognition or reward, it will also be interesting to examine the effectiveness of diverse incentives used by the schools to reward teaching faculty. An appropriate reward system for teaching is important if undergraduate medical education is to command a high priority in institutions awarding the doctor of medicine degree.

Accreditation↗
PubMed1990

Undergraduate medical education.

The number of applicants to US medical schools, which declined steadily between 1985 and 1988, increased slightly for the class entering in 1989. The profile of entering students showed a small decline from last year in the percentage of students with grade point averages categorized as "A" (3.5 or above on a 4-point scale) and slight declines in four of the six MCAT subtest scores. The percentage of both women and minority students in the entering class increased from the previous year. An interesting observation is the large percentage increase this year in students transferring to LCME medical schools from graduate and professional degree programs and from osteopathic medical schools. While the number of full-time faculty members in medical schools continues to increase, significant vacancy rates exist in some departments. More than 5% of full-time faculty positions are vacant in genetics, pathology, dermatology, family medicine, neurology, obstetrics-gynecology, orthopedics, otolaryngology, pediatrics, and surgery departments. Along with faculty vacancies, there has been a considerable turnover of medical school deans. The curriculum in most medical schools includes some innovative instructional formats, such as problem-based learning and computer-assisted instruction. However, current data do not allow a generalization about the extent to which these are being utilized. It seems that, at least in some institutions, multiple methods are being used to assess the clinical competence of medical students (observation by faculty members and residents, written and oral examinations, and multiple station examinations), including the use of standardized patients. About half of the medical schools require students to pass the NBME Part I examination and about one third require passage of Part II. The subject examinations provided by the NBME seem to be used widely, at least in the clinical disciplines. Within the past year, about 14% of medical schools have reported the presence of students or residents who have been diagnosed with human immunodeficiency virus infection, and 12% have had students or residents diagnosed with hepatitis B virus infection. It is critical that medical schools teach students how to prevent occupational exposure to these infections, as well as ensuring that adequate health insurance coverage be provided for these conditions.

Accreditation↗