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Biomedical subjects

J K Stross

Publications and source records attributed to J K Stross.

At least 19 recordsLinked to original sources
PubMed1995

Implementation and evaluation of a primary care preceptorship.

As part of overall curricular reform, the University of Michigan Medical School developed and implemented a required primary care clerkship for third-year students in July 1993. The clerkship was intended to help students develop an understanding of the principles of comprehensive health care and of disease prevention and the knowledge and skills to manage common problems in primary care. The successful implementation of the program was based on agreement across primary care specialties on a common set of goals and objectives, which were developed with the involvement of community practitioners; frequent communication with preceptors to identify problems and students at risk; active feedback to preceptors; and thorough formal and informal evaluations of students and preceptors. Students and preceptors felt the program was beneficial to them; still, the medical school must in the future address concerns about more accurately grading students, retaining preceptors, and ensuring that students be exposed to the broadest possible range of primary care patients and services.

Clinical Clerkship↗
PubMed1992

Faculty tracks and academic success.

In 1977, the Department of Internal Medicine at the University of Michigan implemented two specific faculty career tracks, the physician-scientist and clinician-scholar, to define more clearly the goals and expectations to which individuals should strive to achieve academic success. In response to the changing environment, a leadership track and a full-time clinical track were added. Although concerns about comparability, transfer between tracks, and research productivity were raised initially, they were alleviated as it became apparent that the ability to achieve tenure was similar in the physician-scientist and clinician-scholar tracks. The development of well-defined faculty tracks has facilitated the alignment of talents, training, and effort with career goals. It has also enabled us to protect the time of young investigators to pursue their research activities and to define the expectations for promotion for clinicians with a major commitment to patient care.

Administrative Personnel↗
PubMed1992

Faculty expectations and primary care residents' perceptions concerning residents' growth in competence at one medical school.

The authors studied at one school both the developing confidence of primary care residents and the expectations of both internal medicine and specialty faculty members regarding the abilities of the residents. From 1980 to 1988, residents in the study institution's program in internal medicine primary care completed self-assessments concerning their diagnostic and management skills in primary care and several specialties at the start of their training and at the ends of their first, second, and third years. In 1988, the authors elicited the expectations of the primary care and specialty faculties regarding the levels of competence that residents should achieve in the specialties by the end of their third year. When the faculty assessments were compared, the specialists were found to ascribe greater levels of autonomy to residents. The authors conclude that involving residents and faculty members from various disciplines in developing expectations and evaluation criteria can enhance faculty members' perceptions of residents' clinical competence and residents' achievement of it.

Analysis of Variance↗
PubMed1990

A formal audit of continuing medical education activity for license renewal.

Formal audits of the continuing medical education activities of physicians licensed in Michigan were undertaken to assess compliance with a law mandating participation in 150 hours of continuing medical education each 3 years. A random sample of all physicians renewing their licenses in 1987 and 1988 were asked to provide documentation of their continuing medical education activities. The average physician participated in 175 hours of category I approved activities; 53.1% of the hours were obtained in a different state, and only 27.6% were obtained in the home community. A total of 13.7% (132/967) of the physicians were initially unable to document 150 hours of credit. Documentation deficiencies and addition errors were found on 72.5% of forms. If formal audits of compliance with legislation are to be undertaken, early notification of the participants and specific instructions for compliance are needed. Because of problems with documentation, only category I approved activities, with exclusions for trainees, should be used to assess compliance.

Adult↗
PubMed1990

Sensitivity to patients' psychosocial concerns: relationships among ratings by primary care and traditional internal medicine house officers and patient self-assessments.

This study examined house officers' sensitivity to patients' psychosocial concerns. Primary care house officers, traditionally trained internal medicine house officers, a social worker, and 104 ambulatory care patients independently completed an assessment instrument to indicate the extent to which a set of 20 defined psychosocial issues concerned the patients. We examined the magnitude of difference and extent of correlation in the independent reports of the patient, house officer, and social worker. These analyses were conducted on both the individual psychosocial issues and on sets of concerns derived from an oblique rotation factor analysis of the patients' responses. Primary care trainees' assessments of their patients' concerns correlated more frequently with the independent assessments of the patients and a social worker than did the judgments of the traditionally trained house officers. The factor analysis identified six factors that accounted for 64.4% of the variance in patients' responses. The correlations between the primary care trainees' and patients' assessments were statistically significant on five of these six factors; the correlations between the traditionally trained residents' and patients' assessments were statistically significant on two of the factors. These results provide evidence of the primary care house officer training program's achievement of the goal of enhanced physician awareness of patients' psychosocial concerns. The results also support training efforts aimed at increasing physicians' ability to assess their patients' psychosocial concerns.

Ambulatory Care↗
PubMed1989

Relationships between knowledge and experience in the use of disease-modifying antirheumatic agents. A study of primary care practitioners.

The timely dissemination of new medical information is a complex and often faulty process. We surveyed primary care physicians to determine their knowledge and use of disease-modifying antirheumatic agents for the treatment of rheumatoid arthritis. Only 26.2% of patients hospitalized for rheumatoid arthritis had been treated with disease-modifying antirheumatic agents in the past, and 13.9% were presently receiving them. When responding to a clinical vignette on rheumatoid arthritis, only 12% (10/84) of practitioners would implement therapy with disease-modifying antirheumatic agents, while the majority would refer the patient to a rheumatologist. Experience with similar patients was clearly the factor that led to initiation of therapy. While 73% of practitioners were aware of the value of disease-modifying antirheumatic agents, only 14% prescribed them in the last year. These findings suggest that dissemination of information concerning disease-modifying antirheumatic agents has been successful, but the problems inherent in their use result in referral rather than initiation of therapy.

Adult↗
PubMed1988

The influence of general and case-related experience on primary care treatment decision making.

In an effort to examine how general vs case-related clinical experience influenced physicians' treatment decisions, four clinical case vignettes (rheumatoid arthritis, fever of undetermined origin, exercise-induced asthma, and cor pulmonale) were presented to 387 primary care physicians. For each case, physicians indicated (1) their willingness to proceed with treatment without seeking additional information, (2) their preferences for sources of supplementary information, and (3) their preferences for continued care responsibility. The results indicated that the nature of the particular vignette had a major impact on how physicians made treatment decisions. Also, having greater case-related experience and being younger led to greater willingness to proceed with treatment and preferences for continued care responsibility. Preferences for information sources were largely independent of either form of experience. Treatment decision making appears to be quite dependent on experience with similar problems and being up-to-date on current treatment procedures.

Adult↗
PubMed1987

Mandatory continuing medical education revisited.

To detect changes in continuing medical education (CME) activities related to a law mandating CME for relicensure, we surveyed current physician reports and compared the results to previous surveys in 1969 and 1977. The findings were similar and confirm that formal short courses and journals are reported to be of greatest value. The paucity of change in CME habits and behaviors ten years after mandatory participation became law indicates no major changes in education resulting from the regulations. Moreover, there have been no demonstrable improvements in patient care, in frequency of malpractice suits, or in reduced health care costs. Although CME remains an integral part of medicine, mandatory CME laws cannot be recommended and further development of CME remains primarily for the educational, not legal, system.

Data Collection↗
PubMed1987

Information-seeking strategies and differences among primary care physicians.

Differences in the sources of information that physicians utilize in their practice have several implications for the quality of care delivered and the dissemination of medical information. In order to examine the extent of differences in information preferences in primary care settings, 98 general internal medicine physicians and 73 family physicians were asked to indicate which of six alternative information sources they relied on most when faced with difficult medical problems. The alternatives were: journals, textbooks, informal consultations with colleagues, consultations with community specialists, consultations with outside specialists, and transfer of the patient to another physician. The results indicated that primary care internists have a greater preference for consulting the medical literature, while family physicians more often rely on colleagues and specialists as sources of information. These differences suggest that the focus of information dissemination through journals or textbooks may be more effective for internists, while colleagues or "educationally influential" physicians in the community may be more effective vehicles for information dissemination to family physicians.

Choice Behavior↗
PubMed1987

Practice preferences of primary medical care and traditional internal medicine house officers.

In an academic medical centre between 1980 and 1985, the attitudes, preferences and career goals of house officers in a primary medical care residency training programme were assessed at entry and at the end of each house officer year. Primary care trainees who went on to practise in a general medicine setting were compared to primary care trainees who subsequently received subspecialty training and also to traditional internal medicine trainees. House officers in the primary care programme generally maintained attitudes and preferences central to the practice of primary care, and scored significantly higher than traditional track house officers on attitudes and preferences compatible with the practice of medicine in a primary care setting. However, primary care house officers who later went into subspecialty training received scores similar to those of traditional track house officers on practice preferences relating to specialty care. There were no significant differences between primary care and traditional track house officers on standard measures of knowledge and clinical skill.

Attitude of Health Personnel↗
PubMed1987

Prediction rules for patients with suspected myocardial infarction. Applying guidelines in community hospitals.

Several clinical prediction rules have been developed to assist physicians in managing intensive care resources for patients with suspected myocardial infarction. These guidelines, developed in university settings, attempt to identify patients at high or low risk for developing life-threatening complications or death. Since some prediction rules have not performed well when applied to different patient populations, we applied these rules to 397 patients with suspected myocardial infarction who were admitted to community hospital coronary care units. The relative risk of dying associated with an abnormal initial electrocardiogram declined from 17 in the academic center to 2.9 in the community hospital. In contrast, a guideline that uses data available after 24 hours of observation did segregate patients at higher and lower risk in both the community and academic hospitals. This study shows that clinical prediction rules that were developed in academic medical centers should be validated before applying them in community hospital settings.

Coronary Care Units↗