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Biomedical subjects

J Bickel

Publications and source records attributed to J Bickel.

At least 19 recordsLinked to original sources
PubMed1991

Parental leave policies for faculty in U.S. medical schools.

OBJECTIVE: To assess medical school policies for maternity and other parental leaves as well as related opportunities for part-time employment, flexibility in tenure systems, and the availability of child care centers. DESIGN: Cross-sectional survey of all 127 U.S. medical schools based on telephone interviews and review of faculty handbooks. MEASUREMENTS AND MAIN RESULTS: Ninety-three percent of medical schools responded. Twenty-two percent of medical schools have no written guidelines for maternity leave, 45% categorize maternity leave as a form of sick or disability leave, and only 34% have developed specific policies. Most schools (61%) require that maternity leave be taken from allotted sick days or from vacation days (or from both) for women to obtain salary support. The time available from sick and vacation leave averages 6.8 weeks. Although 72% of schools make allowances in the tenure probationary period for extended leaves of absence, few have developed specific provisions for childbearing or childrearing. Finally, 18% of medical schools have child care facilities. CONCLUSIONS: Considerable work is needed to develop adequate support for faculty members who are parents. Recommendations include developing specific parental leave policies and flexible tenure systems and providing adequate child care facilities.

Absenteeism↗
PubMed1991

The changing faces of promotion and tenure at U.S. medical schools.

Faced with many potentially divisive questions related to tenure and promotion, leaders at medical schools have lacked an overview of examples of how other medical schools are adapting their faculty policies to reflect changing realities. This article reports results of a survey of U.S. medical school deans and of interviews with faculty affairs administrators regarding areas of change in faculty appointment, promotion, and tenure policies. Examples of adaptations are reported under the following headings: use of tenure; financial guarantees of tenure; criteria for award of tenure; probationary period; post-tenure review; advising faculty; clinician-educator tracks; and recruting women and minority faculty. Of these, the adaptation entailing the most activity and about which the most information was obtained concerns establishing a clinician-educator track. Numerous examples are provided of schools' evolutions of policies with regard to modifying titles of clinical-educators, defining promotion criteria, monitoring transfer between tracks, and defining contract periods, benefits, and privileges. The primary challenge for medical school administrators is to build sufficient flexibility into their promotion policies to show that the institution values the many different types of faculty needed, and at the same time to provide adequate security to essential faculty.

Career Mobility↗
PubMed1991

Medical students' professional ethics: defining the problems and developing resources.

An AAMC working group concluded that medical educators have paid insufficient attention to students' development of professional standards and to the immediate ethical dilemmas that students face as students. Its discussion of the primary determinants of medical students' ethical development focused on improving: (1) the evaluation of candidates for admission; (2) the medical school learning climate, including recognition of the challenges inherent in the increasing cultural diversity among students and patients; and (3) communication to students of expectations of professional behaviors and standards. An AAMC initiative is outlined that includes preparation of a resource book featuring cases illustrating common ethical dilemmas that medical students face, descriptions of effective honor systems, suggestions for faculty development, and an annotated bibliography.

Adolescent↗
PubMed1990

Ifosfamide/etoposide and mesna uroprotection in advanced breast cancer.

The object of the study was to evaluate the effectiveness of ifosfamide/etoposide and mesna therapy in advanced breast cancer. A total of 44 patients with breast cancer were included in the trial. Eligibility criteria included measurable, refractory disease; prior anthracycline therapy (or its contraindication); a life expectancy of at least 3 months; and adequate hepatic, renal, CNS and bone marrow function. All patients were less than or equal to 70 years of age and had a Karnofsky performance status of greater than or equal to 50%. There were 36 evaluable cases. Sites of metastatic disease included bone (19), skin (18), liver (9), lung (14), lymph node (19), and miscellaneous (7). Treatment consisted of 1,500 mg/m2 ifosfamide given i.v. on days 1-5, 120 mg/m2 etoposide given i.v. on days 1-3, and 400 mg i.v. mesna given with and at 4 and 8 h after ifosfamide. Cycles were repeated every 28 days. Initial doses were reduced by 25% or 50% in patients who had previously undergone both chemotherapy and radiotherapy. A median of 4 cycles (range, 2-8) were given. The myelotoxicity was marked: WHO grades 3/4 leukopenia (n = 37), grades 3/4 thrombocytopenia (n = 12), and grades 2/3 anemia (n = 13). Due to myelotoxicity, dose reduction or prolongation of treatment-free intervals was necessary in 28 cases. Alopecia was seen in 35 patients and CNS toxicity, in 8. Partial remission (PR) was obtained in five cases and complete remission (CR), in three. Sites of response included the lung (5), skin (4), lymph node (5), and peritoneum (1). The duration of response was 4 (n = 2) and 8 (n = 1) months for CR and 2 (n = 2), 6 (n = 2), and 10 (n = 1) months for PR. We conclude that the ifosfamide/etoposide and mesna regimen is effective, but its myelotoxicity is treatment-limiting.

Adult↗
PubMed1990

Specialty choice.

Explore the source record for details and available documents.

Career Choice↗
PubMed1989

Sex differences in rank attainment among radiology and internal medicine faculty.

Overall, the percentage of women attaining the ranks of associate professor and professor remains well below the percentage of men in those ranks. Few studies of women in academic medicine have been conducted that might guide the leaders of medical schools and specialty societies in addressing the reasons for this disparity. The Association of American Medical Colleges (AAMC) Faculty Roster System allows comparison of a cohort of faculty at any selected time following their first faculty appointments. This study examined men and women faculty who received their first appointments in the departments of radiology and internal medicine in 1976 and who were still active in 1986. Disparities between men and women in rank attained were apparent in both specialties but were greater in radiology than in internal medicine. Other variables examined include ethnic-racial self-description and teaching, research, patient care, and administrative responsibilities. The authors pose additional research questions requiring information that the Faculty Roster System is not designed to provide.

Achievement↗
PubMed1989

Maternity leave policies for residents: an overview of issues and problems.

This article examines evidence of the need for maternity leave policies in residency programs and reviews studies of such policies. The author concludes that communication to residents of an established maternity leave policy facilitates equitable treatment of residents and minimizes disruptions for their colleagues and patients. The development of maternity leave policies is discussed in the context of existing and proposed federal legislation and the current pressures on program director and hospital administrators to improve other aspects residency training. Strategies for building flexibility in residency programs are presented.

Adult↗
PubMed1989

Medical ethics education: coming of age.

Medical ethics education is instruction that endeavors to teach the examination of the role of values in the doctor's relationship with patients, colleagues, and society. It is one front of a broad curricular effort to develop physicians' values, social perspectives, and interpersonal skills for the practice of medicine. The authors define medical ethics education as more clinically centered than human values education and more inclusive of philosophical, social, and legal issues than is interpersonal skills training. The authors review the history of the emergence of medical ethics education over the last 20 years, examine the areas of consensus that have emerged concerning the general objectives and premises for designing medical ethics programs, and describe teaching objectives and methods, course content, and program evaluation used in such programs on both preclinical and clinical levels. The four interrelated requirements for successful institutionalization of medical ethics education programs are defined and discussed, and the paper ends with an overview of the uncertain future of medical ethics education, an accepted but still not fully mature part of physician training in the United States. An extensive reference list accompanies the article.

Bioethical Issues↗
PubMed1988

Women in medical education. A status report.

Women now make up 37 percent of medical school applicants, 34 percent of medical students, 28 percent of residents, and 19 percent of full-time medical school faculty members. These proportions have grown from 26, 25, 19, and 15 percent, respectively, 10 years ago. A comparison of the academic performance of male and female medical students reveals few differences, particularly on standardized measures. However, women trainees experience more stress than men. Traditional differences in the choice of specialty by men and women are not diminishing. Women's accession to senior faculty positions has not kept pace with their increasing representation on the faculty--a cause of continuing concern. The percentage of female faculty members who are professors has changed from 8 to 9 percent in 10 years (as compared with 32 percent of male faculty members in 1988). I conclude that the numbers of women are increasing rapidly at the lower levels of medical education, but not at the upper levels.

Education, Medical↗
PubMed1987

AI/LEARN: an interactive videodisk system for teaching medical concepts and reasoning.

This paper describes AI/LEARN, an educational videodisk system designed to teach clinical observational skills and reasoning in medicine. The AI/LEARN system uses a learning conditions approach to teaching. To teach visual concepts, we use the principle of exemplar/nonexemplar pairs and immediate feedback. To teach If-Then problem solving we use the format of minicases with delayed feedback. The software to operate the system has been custom developed and is domain independent. The result is a prototype of a new authoring package for videodisk teaching which operates on IBM compatible microcomputers. The medical domain selected for this prototype system was rheumatic diseases; the knowledge used to teach reasoning skills is derived from the knowledge base of an expert system: AI/RHEUM.

Computer Systems↗
PubMed1987

Human values teaching programs in the clinical education of medical students.

Medical school deans and faculty members were surveyed by the Association of American Medical Colleges to obtain information on 1984-85 courses designed to improve students' ability to examine their values in relation to those of patients, communicate effectively with patients, or think critically about cultural, social, and ethical issues arising in medical care. Of the 126 deans contacted, 113 supplied course descriptions, and 99 responded to survey questions about the integration of human values programs into students' clinical education. Ninety-five schools reported that at least one human values course was required during the first or second year of the curriculum; 38 schools listed a program as part of the required curriculum for the third or fourth year. The respondents reported several ways in which human values programs were integrated into clinical education. The most frequently mentioned method was reinforcement or addition of human values emphases during medical clerkships. The process considered to be most important by respondents in achieving this integration was a combination of interactions among faculty members, improvement of human values courses, and the support of the dean. The respondents also reported on the characteristics of faculty members who teach such courses, on faculty development efforts, on barriers to the integration of human values teaching into the curriculum, and on the evaluation of such courses.

Clinical Clerkship↗
PubMed1982

Pathologic features of muscle in systemic lupus erythematosus: a biopsy series with comparative clinical and immunopathologic observations.

Clinical evidence of skeletal muscle involvement is frequent in systemic lupus erythematosus (SLE). In order to characterize the manifestations of SLE in skeletal muscle, a biopsy series on 19 patients with SLE was studied in terms of the histologic, histochemical, and direct immunofluorescent features of skeletal muscle. The results were correlated with clinical and laboratory data. The histologic spectrum included inflammatory myopathy, vasculitis, perifascicular atrophy, and neurogenic atrophy. Histochemical examination revealed type I fiber predominance in 44 per cent of patients and selective type II fiber atrophy in 33 per cent. Direct immunofluorescent examination of skeletal muscle biopsy specimens revealed immunoglobulin and complement deposition in vessel walls, in sarcolemmal basement-membrane areas, and within non-necrotic muscle fibers. The histologic, histochemical, and immunochemical findings are correlated with the findings in other organ systems.

Adult↗