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Biomedical subjects

J A Chappell

Publications and source records attributed to J A Chappell.

8 recordsLinked to original sources

Zidovudine for prophylaxis of human immunodeficiency virus infection after accidental exposure.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in emergency medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in emergency medicine that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Emergency Medicine of the California Medical Association, and the summaries were prepared under its direction.

Accidents, Occupational

Medical school performance of initially rejected students.

At the University of Texas Medical School at Houston we had a unique opportunity to examine performance through the medical curriculum and one year of postgraduate training of 50 students initially rejected for medical school. Each had been interviewed by the same Admissions Committee, which earlier had selected 150 students through the traditional process. In contrasting the initially accepted and initially rejected groups, academic and demographic variables accounted for only 28% of group difference. The 72% of group difference not accounted for by the variables examined was presumed to relate to Admissions Committee preference. In attrition and in both preclinical and clinical performance through medical school and one year of postgraduate training, there were no meaningful differences between the groups. The observations suggest that the traditional interview process probably does not enhance the ability to predict performance of medical school applicants.

Achievement

A hospital experiment in teamwork among students, nurses, and administrators.

The adversarial relationships existing in 1982 among medical students, nurses, and hospital staff members were recognized at Hermann Hospital, a private, nonprofit teaching hospital in Houston, Texas, to be potentially detrimental to patient care. A joint communications committee--composed of medical students, faculty members, and hospital and nursing administrators--was developed to identify ways to improve relations between medical students and hospital personnel. The results of the committee's efforts have been an orientation program offered to medical students by the hospital prior to their third-year clerkships; elective workshops for second-year students on skills such as venipuncture, ventilatory management, and physiologic monitoring taught by practicing nurses and other health care personnel; and roundtable seminars for all medical students. Three years after its inception, the committee continues to offer and refine the orientation program and skills workshops. In the authors' opinion, the success of the committee can be attributed to the fact that medical students have been instrumental in directing and evaluating the programs.

Clinical Competence

Evaluation of extramural programs.

Extramural programs may be evaluated in terms of effectiveness in achieving their particular goals. The components of structure, process, and outcome are examined as related sets of program elements. Goals influence appropriate structure in organization, facilities, and manpower. Structure in turn influences process or activities which result in outcome. Outcome is considered in terms of goals. Each set of elements is examined by institutional faculty and administration, extramural faculty, and students. Where all agree that desired outcome variables are relevant to the goal(s) and are achieved, the program is "effective." Where outcome and goal are not compatible, process and then structure must be examined for appropriateness of each. When there is disagreement between groups about any element, a problem area in the program is specifically identified. The procedure for cyclic assessment may be used by a school or program for self-study or for periodic internal monitoring of problem areas. Use of this method has shown some characteristics common to different types of extramural programs.

Education, Medical

Implications of rubella susceptibility in young adults.

Rubella history and antibody titre were determined for 457 medical, graduate, and physician assistant students. Eighteen per cent were estimated at risk for rubella. There were no male-female differences. Health-profession students did not differ in rubella immune status from the general population. History was not helpful in assessing immune status. Approximately one-half of persons with low antibody titres had considered themselves immune, while one-half with moderate to high antibody titres had considered themselves at risk. Less than one-half of students with low antibody titres available themselves of immunization which was recommended and offered. With a high percentage of adult females at risk for rubella even in a health-motivated population and with poor follow-up on recommended immunization, current immunization practices must be improved if congenital rubella syndrome is to be further reduced. Mass inoculation of school age males and prepubertal school age females without prior determination of rubella antibody titres is suggested as a cost-effective means of decreasing incidence of congenital rubella syndrome.

Adult