Medical understanding and its limits in clinical reasoning.
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Biomedical subjects
Publications and source records attributed to J T Bruer.
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An exhaustive bibliography which assesses the methodological rigor of the patient compliance literature, and citation data from the Science Citation Index (SCI) are combined to determine if methodologically rigorous papers are used with greater frequency than substandard articles by compliance investigators. There are low, but statistically significant, correlations between methodological rigor and citation indicators for 138 patient compliance papers published in SCI source journals during 1975 and 1976. The correlation is not strong enough to warrant use of citation measures as indicators of rigor on a paper-by-paper basis. The data do suggest that citation measures might be developed as crude indicators of methodological rigor. There is no evidence that randomized trials are cited more frequently than studies that employ other experimental designs.
The growth and rising cost of bibliographic materials require that attempts to make all medical libraries comprehensive and self-contained be replaced by the provision of selective collections devoted to the most used and useful materials, particularly in developing countries with limited resources. Journals constitute the most important and expensive component of a biomedical collection. While use data are important, a method is presented to guide selection in the absence of this information. The method identifies 35 nucleus journals and uses citation analysis to generate a list of 92 journals, partitioned into 31 medical specialty classes. Local expert consensus can guide selection of important local or regional literature not in the international archives. Careful selection results in efficient collections. Access to less used materials can be provided to individual libraries through resource sharing networks with affiliations to major comprehensive international libraries.
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Twenty-five leading physicians, medical educators, and humanists convened and affirmed the contributions of a liberal arts education to the study and practice of medicine. Participants agreed that overemphasizing technical expertise does have deleterious effects on premedical and medical education, which might be alleviated by encouraging a more broadly based undergraduate and medical curriculum. Admissions statistics show that approximately 50% of all applicants of medical school are admitted to some school and that there is no apparent bias against nonscience majors in the admissions process. Increased student awareness of these statistics should relieve anxieties and intense competitive pressures. A publication based on the conference recommendations will be made available to deans, advisors, and career counselors.
There is widespread interest in the claim that new breakthroughs in neuroscience have radical implications for early child care policy. Yet despite parents', educators', and policy makers' enthusiasm, there are good reasons to be skeptical. The neuroscience cited in the policy arguments is not new, depending primarily on three well-established neurobiological findings: rapid postnatal synapse formation, critical periods in development, and the effects of enriched rearing on brain connectivity in rats. Furthermore, this neuroscience is often oversimplified and misinterpreted. While child care advocates are enthusiastic about potential applications of brain science, for the most part neuroscientists are more cautious and skeptical. After reviewing the evidence and the arguments, the author suggests that in the interest of good science and sound policy, more of us might adopt a skeptical stance.