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Biomedical subjects

John Smucny

Publications and source records attributed to John Smucny.

11 recordsLinked to original sources
PubMed2006

National Health Service Corps staffing and the growth of the local rural non-NHSC primary care physician workforce.

CONTEXT: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. PURPOSE: To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support. METHODS: Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001. FINDINGS: From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P < .001). The estimated number of "extra" non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations. CONCLUSIONS: These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s.

Humans↗
PubMed2005

An evaluation of the Rural Medical Education Program of the State University Of New York Upstate Medical University, 1990-2003.

PURPOSE: The Rural Medical Education Program (RMED) of the State University of New York (SUNY) Upstate Medical University is a 36-week clinical experience in rural communities for medical students that began in 1989. The authors sought to assess RMED's success in providing a valuable educational experience for students that assists rural communities recruit physicians. METHOD: In 2004, the authors used the Physician Masterfiles of the American Medical Association to compare practice locations of SUNY Upstate graduates who completed RMED with those who did not; surveyed former RMED students to assess their satisfaction with their practice location and the importance of RMED in helping them choose a location; interviewed hospital administrators in communities that have hosted RMED students to understand the impact of RMED on host communities; and compared United States Medical Licensing Examination Step 2 scores of RMED students with those of non-RMED students to evaluate educational attainment. RESULTS: A greater percentage of former RMED students practiced in rural locations [22/86 (26%)] than did non-RMED students [95/1,307 (7%)]. Ninety-one percent (69/76) of former RMED students were satisfied with their location, and 84% (64/76) believed that RMED was important in helping them choose a location. Hospital administrators viewed the program highly because it helped them recruit physicians and benefitted their medical staff. RMED students had higher adjusted mean Step 2 scores than did non-RMED students (212.3 versus 199.1). CONCLUSION: The RMED program has successfully met its goals of providing a valuable educational experience for medical students and assisting rural communities recruit physicians.

Attitude of Health Personnel↗
PubMed2004

A Web-based approach to teaching students about diagnostic reasoning.

BACKGROUND: Web-based curricula can decrease classroom time and provide self-paced, active learning experiences for medical students. INTERVENTION: In our family medicine clerkship, we implemented a Web-based module on applying diagnostic reasoning to determine the likelihood that a patient has Group A beta-hemolytic streptococcal pharyngitis based on the history, physical examination, and diagnostic tests. RESULTS: Students rated the module more favorably than other classroom sessions and homework assignments. Most students accurately calculated pretest and posttest probabilities in a write-up of an actual patient with a sore throat. CONCLUSIONS: This Web-based module was well received and effective.

Clinical Clerkship↗
PubMed2002

Teaching evidence-based medicine skills through a residency-developed guideline.

Though many residencies have recognized the need for instruction in evidence-based medicine, the best way to teach these skills to resident physicians remains uncertain. We designed a curriculum intended to develop a resident-produced, evidence-based guideline for the care of patients with diabetes. Each resident was supervised going through the steps of evidence-based medicine: asking a clinical question, searching for the evidence to answer that question, appraising that evidence, and producing an evidence-based answer. These answers were then compiled into a guideline distributed in the residency practice. An evaluation of this curriculum using focus group and survey data showed that learners appreciated the skills and knowledge gained in devising guidelines in an evidence-based manner but were uncertain that their searches were complete. The clinical evaluation of the guideline implementation showed improvement in several clinical markers of diabetes care.

Curriculum↗