Financial assistance and education programs to encourage care to the underserved.
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Health Education↗
Biomedical subjects
H S Jonas
Publications and source records attributed to H S Jonas.
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fueled previous waves of curriculum innovation, and some of these gains could not be maintained when that support was withdrawn.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↗
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↗
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↗
The search for a lower cesarean rate goes on.
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Cesarean Section↗
Undergraduate medical education.
The number of applicants to US medical schools continued to decline, while the number of accepted applicants increased slightly. From 1987-1988 to 1988-1989 academic years, the number of first-year medical students (including repeaters) who were white non-Hispanic males decreased 2.5%, the number of black non-Hispanic males decreased 6.3%, and the number of Asians or Pacific Islander males increased 10.3%. During the same period, the number of first-year students who were white non-Hispanic females decreased 0.8%, the number of black non-Hispanic females decreased 4.8%, and the number of Asians or Pacific Islander females increased 13.7%. Women constituted one third of the entering class in the 1988-1989 academic year. During the past 5 years, the ratio of full-time medical school faculty to medical students increased from 0.88 to 1.08. About 4.8% of budgeted full-time faculty positions were unfilled, down from 5% in the 1987-1988 academic year. However, in the 1988-1989 academic year, more than 5% of positions were unfilled in microbiology, anesthesiology, dermatology, family medicine, neurology, obstetrics-gynecology, ophthalmology, orthopedics, pediatrics, and surgery. Many schools are showing signs of adopting new curricular approaches. A majority of medical schools have implemented many recommendations of the GPEP Report, at least at some level. Problem-based learning is present in the curriculum of 82% of schools, mainly as an experience in one or a few courses. In about two-thirds of schools, computer-based instruction is a formal part of one or more courses or laboratories. Thus, the medical schools appear to be addressing the challenges presented by the changing environment of medical education.
Curriculum↗
Undergraduate medical education.
There were 28,123 applicants to US medical schools for the 1987-1988 academic year, a 10% decrease from the 1986-1987 year. Of this number, 17,027 applicants were accepted by at least one school. First-year enrollment equaled 16,686 students, of whom 639 students were repeating the first year. Thus, the number of first-time enrolled students was 16,047. This represents a decrease of 159 new-entry students from the previous year. Over 46% of the students entering medical school in the 1987-1988 academic year had a premedical GPA of 3.50 or higher (on a four-point scale). Eighty-seven percent of US medical schools academically qualified candidates on the basis of noncognitive criteria. In the past five years the number of first-year white male students has decreased by 13.2%, while the number of black male students has decreased by 1% [corrected]. In the same period, the number of white female students increased by less than one tenth of 1%, while the number of black female students has increased by 31.7%. The number of Asians or Pacific Islanders entering US medical schools has more than doubled: the percentage of male students increased by 106.5% and that of female students by 128.4%. The total number of students enrolled in 127 US medical schools in the 1987-1988 year was 65,742; of this number, 22,539 (34.3%) were women. The estimated number of graduates in the 1987-1988 year was 15,947. The total enrollment of students from underrepresented ethnic/racial groups was 6955 (10.6%), of which 4086 (6.2%) were blacks of non-Hispanic origin. The number of new-entry first-year students from underrepresented groups was 1776 (11.1%), of which 1063 (6.6%) were blacks. The number of full-time medical school faculty members was 66,798; another 130,437 were part-time and volunteer faculty members. The average time needed to complete the curriculum requirements leading to the MD degree is 152 weeks. Twenty-two medical schools offered a combined college-medical school program. The length of these combined programs averaged 256 weeks. The number of schools offering a Fifth Pathway program has decreased, and the number of applicants for these programs has also declined. The net attrition rate, which excludes students who withdrew temporarily to pursue advanced study or research, has remained at about 2%. Students dismissed because of poor academic standing represent 16% of the total student attrition.(ABSTRACT TRUNCATED AT 400 WORDS)
Accreditation↗
On the abortion issue.
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Abortion, Legal↗
Perinatal deaths in twin pregnancy. A five-year analysis of statewide statistics in Missouri.
Analysis of computer-stored State of Missouri birth and death records over a 5 year period revealed 3,594 twin pregnancies (1.02% of all pregnancies), which accounted for 10.1% of the perinatal deaths. The mean birth weight according to weeks of gestation was computed for the pregnancies with no complications noted prior to labor and the perinatal mortality rate was determined. Complications of pregnancy were evaluated. Low birth weight appears to be the major factor in the elevated perinatal death rate in twin pregnancy, with a significant elevation of the perinatal death rate noted with labor prior to 36 weeks, any episode of hemorrhage, or premature rupture of membranes. A more liberal use of cesarean section currently shows no effect in altering the perinatal mortality rate. Programs are suggested to increase early detection and appropriate consultation and referral of multiple pregnancies in a statewide comprehensive effort to decrease the perinatal mortality rate in twin pregnancy.
Birth Weight↗
Correlates of clinical performance during medical school.
Many efforts have been made to define the complex factors related to successful clinical performance and to determine relationships among them. This study was an attempt to increase the understanding of cognitive and noncognitive attributes of clinical performance. Intercorrelations among overall clinical performance ratings, quarterly comprehensive examination scores, total scores on the Part II examination of the National Board of Medical Examiners, and overall grade-point average were computed for a graduating class of medical students. Aspects of clinical performance pertaining to information, concepts, skills, ingenuity, and conscientiousness were found to correlate with academic achievement as measured by grades and cognitive tests; however, such a correlation was not found for other aspects pertaining to attitude, peer relations, maturity, patient rapport, and integrity.
Clinical Competence↗
Management of premature rupture of the membranes.
A 14-month prospective study of patients with premature rupture of the membranes was performed. The purpose of the study was to determine the effect of different therapeutic regimens for management of premature rupture of the membranes (PROM) on perinatal morbidity and mortality, as well as on maternal morbidity. Maternal and fetal risk factors and predictive factors in pregnancy outcome were prospectively defined. In patients with PROM whose gestational age was 34 weeks or more, induction within the first 12 hours of membrane rupture resulted in minimal maternal and fetal morbidity and mortality. Patients with gestational age of less than 34 weeks had an improved maternal and fetal outcome if left alone until spontaneous labor or 34 weeks' gestation was reached unless signs of sepsis developed. Respiratory distress syndrome (RDS) was the leading cause of morbidity and mortality in the infants of patients who delivered prematurely due to premature rupture of the membranes. Incidence of fetal infection was significantly less than that of RDS as a cause for fetal morbidity and mortality.
Bacterial Infections↗
Correction of congenital absence of the vagina. Case report.
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Adolescent↗
Neoplastic potential of the dysgenetic gonad. Case report.
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Adolescent↗
Virilization in Turner syndrome.
A case of gonadal dysgenesis in a phenotypic female associated with neoplastic changes is presented. The patient typified a classic case of Turner syndrome with a 45, XO chromosomal compliment, becoming virilized as a result of the development of bilateral hilar cell hyperplasia in her dysgenetic gonads. The malignant potential of the dysgenetic gonad is stressed in this report. Early diagnosis and appropriate management are emphasized as the two factors that make the difference in the outcome of the patient with gonadal dysgenesis.
Adult↗
Ovarian pregnancy.
Two cases of primary ovarian pregnancy are described. The etiologic, clinical, and pathologic findings and management are discussed briefly with a review of pertinent literature. Routine removal of all bleeding corpora lutea and careful examination of the tissue and blood clots is recommended as this should reveal more cases of early ovarian pregnancies.
Adult↗
Giant uterine tumors: case report and review of the literature.
This is a case report of the management and surgical removal of a 65-lb uterine leiomyoma. This is the 56th reported case of a giant uterine tumor (25 lb or over) and the eighth such case reported in the last 35 years. The literature concerning these large tumors is reviewed, and a discussion of some of the important aspects of surgical management is presented.
Female↗