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Biomedical subjects

John E Delzell

Publications and source records attributed to John E Delzell.

11 recordsLinked to original sources
PubMed2006

Case-based exercises fail to improve medical students' information management skills: a controlled trial.

BACKGROUND: Tomorrow's physicians must learn to access, retrieve, integrate and apply current information into ambulatory patient encounters, yet few medical schools teach 'real time' information management. METHODS: We compared two groups of clerkship students' information management skills using a standardized patient case. The intervention group participated in case-based discussions including exercises that required them to manage new information. The control group completed the same case discussions without information management exercises. RESULTS: After five weeks, there was no significant difference between the control and intervention groups' scores on the standardized patient case. However, third rotation students significantly outperformed first rotation students. CONCLUSION: Case-based exercises to teach information management failed to improve students' performance on a standardized patient case. Increased number of clinical rotations was associated with improved performance.

Adult↗
PubMed2005

The University of Tennessee's accelerated family medicine residency program 1992-2002: an 11-year report.

BACKGROUND AND OBJECTIVES: In 1992, with the approval of the American Board of Family Medicine (ABFM) (formerly known as the American Board of Family Practice), we established an accelerated residency program (ARP) involving five residency programs at the University of Tennessee (UT). An accredited resident can complete medical school and residency in a combined total of 6 years. This paper is a report of our experience with the ARP. Our objective was to determine if accelerated residents performed as well as or better than non-accelerated residents. METHODS: Students are selected for the ARP on the basis of academic achievement, life experience, interviews, and commitment to family medicine. For the accelerated residents, we tracked outcomes measures, including medical school grade point average (GPA), US Medical Licensing Examination (USMLE) scores, ABFM In-training Examination scores, and board certification status. RESULTS: From 1992 to 2002, 47 students entered the ARP at five UT residency programs. Five students did not complete the program. The average entering GPA was 3.17, and the average USMLE Step I score was 207. The accelerated residents, on average, performed better on ABFM In-training Examinations in the first and third years of residency than the non-accelerated residents did. Accelerated residents have a 100% ABFM certification rate. A total of 76% practice in Tennessee, and 65% began practice in a rural county. CONCLUSIONS: The UT ARP has been an effective means for allowing medical students to complete their family medicine training in 6 years. Accelerated residents have performed as well as or better than non-accelerated residents on standardized testing.

Academic Medical Centers↗
PubMed2005

The ACGME core competencies: a national survey of family medicine program directors.

BACKGROUND AND OBJECTIVES: Beginning in July 2002, all residencies were required to show that their residents were obtaining competency in six core areas defined by the Accreditation Council for Graduate Medical Education (ACGME). METHODS: In 2003, we surveyed all 444 family medicine program directors regarding the ACGME Core Competencies and how programs evaluated them. RESULTS: A total of 287/444 (64.6%) responded. Almost all (279/287) had heard of the ACGME Core Competencies, and most (257/287) had begun to implement evaluation programs. Of program directors responding, 67.6% identified patient care as the most important competency. Evaluation methods most frequently used were active precepting (76.0%), record review (72.8%), and procedure logs (63.8%). The least commonly used tools were OSCE (9.1%), audit of computer utilization and knowledge (10.5%), and simulations (11.1%). Respondents identified time (74.3 %) and faculty development (13.0%) as primary implementation barriers. CONCLUSIONS: Program directors believe that patient care is the most important competency. Some programs are not yet attempting to address the competencies, and some were unaware of the accreditation implications of noncompliance with the Outcome Project. Time was identified as the major barrier to implementing core competency evaluation methods.

Data Collection↗
PubMed2004

Evaluation of interns by senior residents and faculty: is there any difference?

INTRODUCTION: Both senior residents and faculty members evaluate family practice interns (PGY-1) on the inpatient family medicine service at the University of Missouri-Columbia. The purpose of this study was to investigate the content and nature of narrative comments on a clinical evaluation sheet. METHODS: Objective 1. The authors placed the subjective comments made by faculty and senior residents in their evaluations of PGY-1 residents into 12 distinctive categories. Objective 2. Comments were coded with a positive or negative valence. Objective 3. The genders of the evaluator and learner were recorded. RESULTS: All evaluations made between 1996 and 1999 were analysed. A total of 1341 individual comments were reviewed. Objective 1. Categories used most often were generic comments (20.2%), personal attributes (18%), and clinical competence (14.1%). There was no difference in category use based on the experience level of the evaluator (P = 0.17). Objective 2. The majority of the comments (81.9%) were positive in nature. Senior faculty members were significantly less likely to make negative comments than were junior faculty members or senior residents (P = 0.004). Objective 3. There were no differences in category use based on the gender of the evaluator (P = 0.13). CONCLUSIONS: Objective 1. Narrative evaluation comments may be placed into 12 distinctive categories. Most comments are generic and do not help to inform learning. Objective 2. A total of 82% of comments were positive. Residents were more likely to make negative comments than senior faculty members. Objective 3. There was no demonstrable gender bias in writing negative comments.

Clinical Competence↗
PubMed2003

The University of Missouri Rural Obstetric Network: creating rural obstetric training sites for a university-based residency program.

This paper describes a rural obstetric experience that was developed for a university-based family practice residency program and designed to increase the number of deliveries per resident, the number of graduates practicing in rural areas, and the number of graduates doing obstetrics. Rural hospitals can be a source of deliveries for residency training programs. This rural obstetric experience also offers more training months in a rural setting and more months training with family physicians.

Family Practice↗
PubMedDate not supplied

Treatment of primary insomnia.

Ten percent to 40% of adults have intermittent insomnia, and 15% have long-term sleep difficulties. This article provides a review of the classification, differential diagnosis, and treatment options available for insomnia. We performed a MEDLINE search using OVID and the key words "insomnia," "sleeplessness," "behavior modification," "herbs," "medicinal," and "pharmacologic therapy." Articles were selected based on their relevance to the topic. Evaluation of insomnia includes a careful sleep history, review of medical history, review of medication use (including over-the-counter and herbal medications), family history, and screening for depression, anxiety, and substance abuse. Treatment should be individualized based on the nature and severity of symptoms. Nonpharmacologic treatments are effective and have minimal side effects compared with drug therapies. Medications such as diphenhydramine, doxylamine, and trazodone can be used initially, but patients may not tolerate their side effects. Newer medications such as zolpidem and zaleplon have short half-lives and minimal side effects. Both are approved for short-term use in the insomniac.

Algorithms↗
PubMedDate not supplied

Patients' understanding and use of snack food package nutrition labels.

PURPOSE: Little information exists on how patients in medical practice use food package nutrition labels. We theorized that patients in a general medical practice might not make the distinction between serving size and total package nutrition information, and this might lead to obesity. METHODS: Ninety patients between ages of 18 and 65 attending the St. Francis/University of Tennessee Family Practice Center were interviewed to determine whether they could calculate the total calories in sample snack food packages that contained more than one serving. RESULTS: Ninety percent of our patient sample correctly identified the number of calories per individual serving, but only 37% were able to recognize that the sample packages contained multiple servings. Confusion between calories per serving size and total calories per package was correlated with lower educational levels (P =.011) and with the presence of cardiovascular heart disease in our patient sample. CONCLUSIONS: Our patients tended to think of a multiple serving package as one serving. They underestimated and under-reported caloric intake from snack food sources. We conclude that snack food labels as actually used by patients do not lead to informed dietary choices. These findings could impact our understanding and management of the obesity epidemic in the United States.

Adolescent↗
PubMedDate not supplied

Changing practice patterns of family medicine graduates: a comparison of alumni surveys from 1998 to 2004.

BACKGROUND AND OBJECTIVE: The University of Missouri family medicine residency has 297 family physician graduates. We suspected that the practice patterns of graduates were changing. METHODS: All graduates of the residency were surveyed in 1998, 2001, and 2004, asking about practice patterns. To characterize current practice characteristics and scope, we used the latest survey returned by each respondent. We analyzed data for persons who returned all 3 surveys to examine trends across surveys. RESULTS: Annual response rates ranged from 58% to 78%. Of graduates who responded to all 3 surveys, fewer graduates care for patients in the hospital (71.3%, 1998; 56.5%, 2004), practice obstetrics (40.7%, 1998; 23.2%, 2004), or provide primary care for their patients in the emergency department (25.9%, 1998; 13.0%, 2004). Fewer recent graduates perform flexible sigmoidoscopy or exercise electrocardiograms. Graduates who are practicing obstetrics are more likely to be rural or to have graduated since 1994. Those performing flexible sigmoidoscopy are more likely to be male or to have graduated before 1994. The perceived need for more training in practice management is higher for more recent graduates (14.9% for 1975 to 1983 graduates; 31.9% for 1994 to 2003 graduates). CONCLUSIONS: Across the 3 surveys, there was a decline in the proportion of graduates of this family medicine residency program performing procedures, obstetrics, intensive care unit care, or hospital medicine. This study highlights how the practices of family medicine residency graduates may change over time. Data regarding residency graduate practice profiles may help predict the knowledge and skills residency graduates will need in their future practices and evaluate the impact of the Future of Family Medicine recommendations.

Family Practice↗
PubMedDate not supplied

How do medical students gather information about residency training programs?

UNLABELLED: New electronic sources of information are available for medical students in their search for residency training programs. METHODS: Senior students at the University of Missouri were surveyed regarding types and methods of information sought, and residency choice. RESULTS: Response rate was 96 percent. Ninety-one point five percent used the Internet to access information. Eighty-six percent used a computer at medical school; seventy-eight percent used one at home. Sixty-five point one percent used the university's web site for information. CONCLUSION: Students use the world wide web and the Internet for accessing residency programs information.

Female↗
PubMedDate not supplied

Teaching medical students to prioritize preventive services.

BACKGROUND: Clinicians cannot provide all recommended preventive services in a single office visit and must learn to prioritize. This skill is not overtly addressed in medical school. METHODS: We designed a workshop to teach third-year medical students to prioritize preventive services during an office visit. In a prospective controlled trial, we compared performance on a standardized patient case. RESULTS: Students performed well, but there was no significant difference between intervention and control groups' mean scores on the standardized patient encounter. CONCLUSIONS: Our brief intervention failed to increase students' scores on a standardized patient case requiring preventive services prioritization.

Clinical Competence↗