PubMed Health⌕ Search

Biomedical subjects

K A Halbritter

Publications and source records attributed to K A Halbritter.

5 recordsLinked to original sources
PubMed1999

Educational and career outcomes of an internal medicine preceptorship for first-year medical students.

OBJECTIVE: Medical educators have attempted in recent years to provide quality clinical experiences for medical students early in their medical training. We questioned whether participating in a preceptorship in internal medicine (PIM) resulted in better performances on subsequent clinical rotations and increased interest in internal medicine. PARTICIPANTS: Fifty-four students have participated in the PIM to date, with control groups consisting of students who applied for it but were not selected (n = 36), students participating in a preceptorship in family medicine (n = 168), and the remaining students (n = 330). DESIGN: Prospective cohort study. SETTING: University medical center and community practices. INTERVENTION: A 2-month, clinical preceptorship following the first year of medical school. MEASUREMENTS AND MAIN RESULTS: The following outcomes were assessed: scores in the introduction to clinical medicine course; grades in the medical ethics course; scores from the internal medicine clerkship; and choosing a career in internal medicine. In their second year, PIM students scored higher in both semesters of the introduction to clinical medicine course (87% and 86% vs 84% and 84%, p's <.01) and were more likely to receive honors in ethics (50% vs 29%, p <.01) than non-PIM students. During the internal medicine clerkship, PIM students' scores were significantly higher on an objective structured clinical examination (79% vs 76%, p =.05), ambulatory clinical evaluations (80% vs 76%, p <.01), and overall clerkship scores (78% vs 75%, p =.03) but not on inpatient clinical evaluations or on the National Board of Medical Examiners Subject Examination. Preceptorship students were more likely to receive honors grades in the medicine clerkship (33% vs 10%, p <.01), and they were more likely to match into internal medicine residencies than control students (54% vs 27%, p <.01). CONCLUSIONS: The PIM course is an intervention, early in students' careers, which appears to benefit them academically and increase their interest in internal medicine as a career.

Career Choice↗
PubMed1996

Interpretive and procedural skills of the internal medicine clerkship: performance and supervision.

This descriptive study prospectively examined the performance and supervision of interpretive and procedural skills during an internal medicine clerkship. Students (N = 150) documented having done 7 required and 12 elective skills. Preceptors of required skills were interns (44%), residents (29%), attending physicians (12%), and others (16%). The elective procedures and the percentage of students doing them were as follows: skin tests, 78%; nasogastric tube insertion, 57%; paracentesis, 44%; bone marrow sampling, 35%; lumbar puncture, 34%; thoracentesis, 34%; Papanicolaou smear, 29%; central line placement, 27%; cardioversion, 13%; bladder catheter insertion, 11%; arthrocentesis, 9%; and skin biopsy, 7%. Elective procedures per student ranged from 0 to 9 (mean = 4) and were done less often in the first clerkship group than later in the academic year. Preceptors of electives were interns (46%), residents (39%), and attending physicians (9%). House staff were more likely and faculty less likely to precept electives than required procedures. Students' exposures to these skills are unequal. Their preceptor are generally house staff. To prepare medical students for postgraduate training, technical skills should be specifically addressed in the curriculum.

Analysis of Variance↗
PubMed1993

Creating an objective structured clinical examination for the internal medicine clerkship: pitfalls and benefits.

The objective-structured clinical examination (OSCE) is a useful tool in evaluating clinical competence. Traditional clinical-evaluation measures have been criticized as arbitrary and lacking reliability, whereas written exams test primarily cognitive aspects. The OSCE focuses on learner actions rather than abstract knowledge and evaluates in a uniform fashion. A 15-station OSCE was created for an internal medicine junior clerkship, based on predetermined skill and content goals. The exams then were scored by a single, blinded reviewer, again in a predetermined fashion. The OSCE has been studied in terms of reliability, content validity, and construct validity. The exam has become accepted by the department and has guided the continuing curricular development. The OSCE is not designed to measure all the domains of a learner's educational process. However, when used in conjunction with other evaluating mechanisms, it provides an objective outcome measure of the medical education process.

Clinical Clerkship↗
PubMed1989

Smoke inhalation.

Two cases of smoke inhalation injury are reported with a brief review of the pertinent literature. The frequency of occurrence, the mortality rate, the clinical course of this common event are discussed with emphasis on the following facts: 1) Pulmonary injury is often associated with skin burns and, conversely, skin burns, particularly when severe, are accompanied by significant effects on pulmonary function; 2) Domestic fires, which account for most of these casualties, may involve complex exposure to a variety of aggressive agents (CO, HCN, NOx, etc.), causing systemic effects; 3) The clinical course of the most severe occurrences characteristically consists of three phases, namely acute pulmonary insufficiency, pulmonary edema and bronchopneumonia, in sequence; 4) The mortality rates of these clinical phases range at or about 50 per cent; 5) Significant laryngeal edema and even pulmonary edema may follow an interval of several hours, during which both subjective and objective evidence of injury may be minimal or unnoticed; and 6) The determination of carboxyhemoglobin levels often helps in gauging the severity of the exposure and related effects of either immediate or delayed appearance.

Aged↗