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Biomedical subjects

T A Parrino

Publications and source records attributed to T A Parrino.

At least 19 recordsLinked to original sources
PubMed1994

The alumni survey as an instrument for program evaluation in internal medicine.

The objective of this analysis was to assess the practical value of the training experience for graduates of U.S. internal medicine residencies. Six alumni surveys were selected for analysis, wherein training items were grouped into comparable categories. Results of the studies were compared, using simultaneous preparation/importance ratings as the basis for assessment of items in each category. Six recent alumni surveys depict internal medicine residency training as a technical experience, wherein basic skills and practice-related issues may be underemphasized. Such surveys are useful for periodic re-evaluation of program goals and outcomes.

Data Collection↗
PubMed1994

The acquisition of practical skills by U.S. medical students.

Increasing interest in skills training has been prompted by concerns over risks posed by new, complex clinical environments and the need for medical students to function effectively in such settings. To gain a better idea of the type of instruction currently provided to U.S. medical students, a national survey was conducted in 1991. A survey instrument was prepared after a literature review on practical skills training. Eleven skill and knowledge areas were selected for analysis; six were considered "basic" and five "advanced." Mailings were directed to the deans of 126 U.S. medical schools. Based on a 94% response rate (118/126), the skill and knowledge areas taught most commonly included universal precautions, phlebotomy, intravenous line placement, advanced cardiac life support, and suturing lacerations. Fifty-one (43%) of 118 respondents reported that they conducted "transition courses" for practical skills training. At most such institutions, basic skills were taught more frequently than advanced skills. Where there was no transition course, formal instruction was provided in standing courses and clerkships. The survey indicates that five skills areas are formally taught in the majority of U.S. medical schools. These include universal precautions, phlebotomy, starting intravenous lines, suturing lacerations, and advanced cardiac life support. In most cases, evaluation and certification procedures are infrequent. Further studies are necessary to gain a better idea of what practical training should be undergone by all U.S. medical students.

Clinical Competence↗
PubMed1990

Grand rounds revisited: results of a survey of U.S. Departments of Medicine.

Medical grand rounds is a time-honored weekly conference at United States teaching hospitals. We surveyed 122 departments of medicine to test the hypothesis that grand rounds may have changed with the changing training environment. Our goal was to gain a new perspective on the way physicians learn clinical medicine and maintain their fund of information. A questionnaire was designed to assess several aspects of grand rounds, including format, objectives, popularity, and changes over time. The questionnaire was directed to department heads of 122 U.S. medical schools. Seventy-five percent of respondents were department chairs; the remainder were chief residents and other faculty. Survey response rate was 96%. According to respondents, the major objective of grand rounds was to provide "updates in diagnosis and treatment." Case presentations were regularly included in about one third of departments; patients were rarely present for examination or interview. The popularity of grand rounds was thought to have decreased. These data support the impression that medical grand rounds is still considered important in most academic medical centers. Suggestions are made for increasing the clinical relevance of the conference. New techniques for presenting clinical material are reviewed, and an argument is made for returning to a basic strategy of "solving the patient's problem."

Attitude of Health Personnel↗
PubMed1989

The nonvalue of retrospective peer comparison feedback in containing hospital antibiotic costs.

UNLABELLED: Antibiotics have accounted for an increasing percentage of hospital pharmacy charges. Recently, an inexpensive method, automated peer comparison feedback, has been developed to influence physician use of resources. The documented success of several implementations of this strategy led to a one-year experiment to influence hospital antibiotic utilization. Each month, attending physicians in the top 50 percentiles for expenditure were notified of their status in relation to their peers. Expenditures by feedback and control groups were compared to determine whether feedback would result in reduced expenditures by individuals, or whether there would be a generalized reduction in expenditure by the entire group (Hawthorne effect). Over the year, no significant reduction in expenditure was noted. However, some important utilization patterns were identified. Although more surgical patients received antibiotics than did nonsurgical patients, surgical antibiotic costs were less. Surgical therapy was typically of shorter duration and involved the use of less expensive antibiotics. Multiple-antibiotic prescribing was less frequent on surgical services. Thirty percent of attending physicians were responsible for 80 percent of all antibiotic costs; 60 percent of those in this top group were members of the medical cohort. IN CONCLUSION: (1) As implemented in the current study, automated peer comparison feedback was not an effective method for reducing antibiotic utilization; (2) Differences in prescribing patterns between services may dictate the best strategies for improving antibiotic utilization; (3) More attention should be directed toward the relatively small "reference group" of physicians responsible for most hospital antibiotic prescribing.

Anti-Bacterial Agents↗
PubMed1988

Computerized diagnosis: implications for clinical education.

The advent of the small computer as a basic clinical tool will have a significant impact on clinical practice and medical training. The application of probability theory to clinical diagnosis has led to the development of several practical diagnostic programs which run on small computers. Expert systems--interactive programs which function as 'electronic consultants'--have now been successfully developed for a number of clinical situations. Experience with two of these, INTERNIST/CADUCEUS and MYCIN, has provided insight into problems and prospects for expert systems in medicine. Less complex programs, particularly those employing clinical prediction rules, and expert system shells, seem well suited for clinical environments. Although computerized medical diagnosis holds great promise as an aid to clinicians, its success will largely be determined by the quality of the information that clinicians provide for analysis. A brief review of the status of bedside diagnosis reveals that data-gathering strategies and techniques must be better understood. In order to take full advantage of computer programs for diagnosis, basic diagnostic skills must be more heavily emphasized in clinical training.

Boston↗
PubMed1988

Preparation for practice in internal medicine. A study of ten years of residency graduates.

To evaluate the adequacy of preparation for medical practice, we surveyed 320 internal medicine program graduates. The 210 respondents gave their perceptions regarding preparation in training and importance in practice of eight clinical practice skills and 27 clinical procedure skills. The skills with highest preparation scores were venipuncture, intravenous line placement, and arterial puncture for blood gases. The skills rated as the most important in practice were history taking, physical examination, and selection of diagnostic tests. For 13 of the 27 clinical procedure skills, mean preparation scores were significantly higher than mean importance scores, suggesting "overpreparation." In contrast, seven of the eight clinical practice skills had mean preparation scores significantly lower than mean importance scores, suggesting "underpreparation." Furthermore, greater preparation during training was reported by more recent graduates for five of the overprepared skills. We concluded that skills emphasized in internal medicine training are not necessarily those important for practice and that recent changes in the training and practice environments may be increasing these discrepancies.

Clinical Competence↗
PubMed1986

The principles and practice of morning report.

Morning report is a traditional ritual on academic medical services. At morning report, house staff and faculty review case management and the principles of clinical medicine. To understand better the role and function of morning report and to assess its value for supervision, teaching, and evaluation of clinical knowledge and skills, a survey of academic departments of medicine was conducted. A questionnaire was sent to 124 departments of medicine represented by the membership of the Association of Professors of Medicine. The response rate was 94%. Morning report was important for teaching and was also useful for evaluation of resident performance and quality of clinical care. Some potential problems were identified when the conference is used for peer review and performance evaluation. Morning report stands out as the only large, formal conference generally used for the evaluation of case management and the performance of medical residents. As such, its limitations must be recognized. Recommendations are made for taking advantage of the unique educational opportunities available at morning report.

Clinical Competence↗
PubMed1985

The lasting value of clinical skills.

To assess the lasting value of clinical skills learned by residents in a subspecialty-oriented training program in internal medicine, we surveyed recent graduates. Graduates received a questionnaire contrasting separate ratings of the amount of training (preparation) they received during residency with the importance of this training in subsequent career activities. Topics included 12 traditional medical disciplines, 15 areas related to the practice of medicine, 15 allied medical disciplines, ten basic skill and knowledge areas, and 28 technical procedures. Response rate was 91.8% (56/61). Ninety-five percent of respondents had certification from the American Board of Internal Medicine, 80% had subspecialty training, and 89% rendered direct patient care. Fifty-six topics showed disparity between preparation and importance scores (45 with P less than .0001). For 14 categories, mainly technical procedures, disparate ratings suggested excessive programmatic emphasis, while for 42 categories, including history taking and physical examination, there may have been inadequate emphasis. These data suggest that basic clinical skills may require greater emphasis, even in traditional programs. The opinion of program graduates is an important resource in designing training programs in internal medicine.

Attitude of Health Personnel↗