To determine the convergent validity of four methods of physician assessment--physician interview, patient interview, chart audit, and videotaped observation--these methods were compared for their ability to detect medication regimens prescribed for patients with chronic obstructive pulmonary disease (COPD). Comparisons of data from the four methods revealed substantial discrepancies among them. In fact, the methods were in full accord only 36% of the time in detecting theophylline prescription, and even less often for the other COPD medications. According to physician interview, 78% of patients were on theophylline; chart audit revealed 62% of patients were on the medication; videotaped observation, 69%; and only 59% of patients reported themselves to be on theophylline. An iterative analysis, applied to determine which method most accurately captures data, revealed that reports from physician interviews were the most precise source of data. Although the order of merit was much the same for each of the drugs studied, there were some differences in levels of sensitivity across drugs. Specificities were consistently high for all drugs and all methods.

Adrenal Cortex Hormones↗

PubMed1988

AIDS and dental practice.

Dental health care workers (DHCWs) can provide important diagnostic, treatment, and referral services for patients with AIDS and at risk for AIDS. They also have a responsibility to protect all patients in their practices, and themselves, from infectious disease transmission through the use of infection control. To determine the extent to which DHCWs are prepared to assume these responsibilities, a randomized survey of California DHCWs was conducted. Responses were obtained from 297 dentists, 128 hygienists, and 177 dental assistants. DHCWs who expressed a greater willingness to treat people with AIDS or HIV infection also practiced more thorough infection control. Respondents in all groups who perceived a greater percent of their patients to be at risk for AIDS were more likely to use infection control procedures (P less than .0001). They also were more willing to treat such patients (P less than .004) and were more likely to assess patients for AIDS by taking a thorough medical history (P less than .02) and sexual history (P less than .04). Since attitudes toward AIDS and perception of the percent of patients at risk in one's practice affect patient assessment and infection control procedures used by dental health care workers, educational programs designed to enhance DHCWs' response to the HIV epidemic should alert them to the extent of the problem and help them cope with their concerns.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Changing dentists' knowledge, attitudes, and behaviors relating to AIDS: a controlled educational intervention.

The efficacy of an educational intervention designed to improve dentists' knowledge, attitudes, and behaviors about acquired immune deficiency syndrome (AIDS) was tested. The intervention had three components: computerized feedback comparing participants' own knowledge, attitudes, and behaviors with those of fellow participants and with an ideal; periodic bulletins; and telephone conference calls with experts. The group receiving the educational package had better scores than a control group on outcomes of willingness to treat persons with AIDS; identification of human immunodeficiency virus lesions; knowledge of AIDS; and completeness of both intraoral and extraoral examinations. It was concluded that intervention is one approach to increasing dentists' positive response to the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Attitudes about AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Attitudes about AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

PubMed1988

The residency-practice training mismatch. A primary care education dilemma.

Primary care practice requires clinical skills and knowledge that differ greatly from those required for successful completion of residency training. Discrepant clinical settings and physician responsibilities have thus created a mismatch between the educational content of residency training and the content of clinical practice, which may result in suboptimal preparation of internists, family practitioners, and pediatricians for patient care. Of equal concern, the psychosocial environment of residency does not prepare physicians for their future community and personal adult roles. Barriers to correcting this worsening mismatch include the following: (1) economic pressures to use house staff to meet service needs of hospitals, (2) changes in patient demographics and the focus of hospital-based medicine that are making hospitals progressively more unsuitable as the principal training site for primary care physicians, (3) the deemphasis of practicing physicians as role models and teachers in postgraduate training, and (4) the often heated disagreement among medical educators regarding the purpose and content of residency training. Efforts to resolve this mismatch should include the following: reexamining the educational objectives of the current system of postgraduate training, better counseling of physicians in training regarding career goals, and emphasizing the primary care physician as role models and faculty.

Clinical Competence↗

PubMed1987

AIDS and infection control in dental practice: dentists' attitudes, knowledge, and behavior.

A random sample of 541 dentists in California was surveyed to determine the dentists' attitudes toward AIDS and their role in relation to AIDS, their knowledge about AIDS, their behaviors in regard to screening for AIDS, and their use of infection-control measures. The survey results showed that dentists believe they have a responsibility to care for patients with AIDS but preferred not to do so; were moderately knowledgeable about AIDS and AIDS-related issues; and were inconsistent in their use of infection-control measures.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Recent graduates' evaluation of their dental school education.

To assess recent dental graduates' perceptions about the adequacy of their education, a random sample of individuals who graduated between 1980 and 1982 was surveyed. The 362 respondents (56 percent response rate) indicated their perceived level of preparedness and the importance to practice of 75 topics in the dental school curriculum. The means for level of preparedness and importance to practice were plotted for each of the 75 topics. Those topics that new dentists believed to be underemphasized or overemphasized in the curriculum were identified. These findings have implications for planning curricular changes for dental education.

Adult↗

PubMed1987

The changing dynamics of graduate medical education. Implications for decision-making.

Cost-containment pressures and changes in traditional patient-care patterns are altering the process of graduate medical education. A thorough understanding of this process is a prerequisite to implementing changes that preserve the function of graduate medical education. This report describes the structure of the graduate medical education system and analyzes possible responses to the changes that are affecting it. The decision-making process within academic health centers is described, including an assessment of the roles of hospital directors, deans and faculty, as well as external regulatory agencies such as residency review committees, medical specialty boards and state licensing agencies. The activities of these participants are analyzed within the framework of the teaching hospital's service and education functions, and potential conflicts are described and illustrated by recent examples. Understanding the complex structure and functions of graduate medical education is a first step toward responding effectively to a changing environment.

Education, Medical, Graduate↗

PubMed1986

Measuring physician behavior.

Reliable and valid information on physician behavior is required for measuring the adequacy of physician performance. We studied 4 methods of obtaining information on physician behavior in the ambulatory care of chronic obstructive pulmonary disease. Physician interview, patient interview, chart audit, and videotaped observation were used to record the performance of 63 physicians in office visits with 214 adult patients. High interrater agreement was attained. All methods are of reasonable cost and all are acceptable to physicians. The content validity of the 2 interview methods was reasonably good, but chart audit and videotaped observation had poor content validity. Our findings suggest that no one method provides an accurate picture of physician behavior and, therefore, that a combination of methods should be used.

Adult↗

PubMed1986

Residency training in internal medicine: time for a change?

Internal medicine residencies risk becoming obsolete if they are not adjusted to changing patterns of medical practice. Declining length of hospital stay, increased intensity of hospital care, movement of critical management decisions to outpatient settings, increased proportions of admissions for specific diagnostic procedures, and increased needs for perioperative consultations all erode the foundation of traditional internal medicine training. Furthermore, demographic shifts, the move to prepaid care, and a projected oversupply of subspecialists warrant more exposure to generalism and geriatrics. To prepare internists for clinical practice, some training should shift from medical wards and intensive care units to outpatient settings and surgical consultation, additional process skills must be taught, and the epidemiologically important non-internal-medicine disciplines should be included in the curriculum. These shifts will require changes in methods to pay for residency training, accreditation procedures for residency programs, and the residency certifying process. Most importantly, the model and organization of internal medicine training need to be reconsidered.

Aged↗

PubMed1986

Planned change and the future of the dental education system.

Dentistry today faces an environment that clearly requires changes in dental education. Future dentists must be prepared to deal with new patterns of dental disease, revised manpower requirements, and new developments in the nature of dental practice. The dental education system can best adapt to this situation by initiating a process of planned change. A well-developed literature in this area provides both a theoretical framework and a practical approach that the dental education system can follow in its planning process. In this paper, the principles of planned change are interpreted in the context of dental schools' characteristic structure, goals, leadership, and communication mechanisms. The traits of successful change and specific strategies for achieving it are offered as a means for the dental education system to build with confidence a productive and healthy future.

Decision Making↗