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PubMed1979

The effect of a primary-care pathway on internal medicine residents' career plans.

There has been no evidence that primary-care pathways, a recent innovation in internal medicine residency programs, have affected the career choices of their trainees. We report the experience of the first four cohorts of primary-care trainees in internal medicine compared with traditional-pathway trainees at Boston City Hospital. Primary-care residents remained committed to their plans for a career in general internal medicine throughout training. In contrast, two thirds of the traditionally trained residents who were planning a career in general internal medicine at the beginning of their training changed their plans to subspecialty medicine. Thus, the primary-care pathway reinforced the career plans of trainees in general internal medicine, whereas traditional training influenced potential generalists toward subspecialty medicine.

Boston↗
PubMed1977

[Laboratory diagnosis and internal medicine. Introduction].

The development of internal medicine went parallel with the clinico-chemical diagnostics. The increase of the laboratory achievements, also in the field of prevention, is possible by a regional graduation of the laboratories with a centralisation as effective as possible under management of specialists. It is referred to the observation of quality instructions in standardized methods. The improvement of diagnostics by exchange between clinic and laboratory is particularly emphasized.

Clinical Laboratory Techniques↗
PubMed1979

National study of internal medicine manpower: IV. Residency and fellowship training 1977-1978 and 1978-1979.

The National Study of Internal Medicine Manpower gathered data on the number of residents in training in internal medicine and the number of fellows in subspecialty training, for 1977-1978 and for 1978-1979. In the latter period, there were 16720 residents in all years of training. The 7.2% average annual increase in the number of first-year residents during the earlier half of the 1970s slowed in 1977-1978 and 1978-1979 to 4.6% and 4.2%, respectively, reflecting a similar decline in the number of medical school graduates. The most important finding of the study is that the steep rise (10.6% per year) in the number of subspecialty fellowship trainees characteristic of the years 1972-1973 through 1976-1977 has abated. The number of fellows in subspecialty training has remained essentially constant in the past 2 years. Thus, although the number of residents continued to increase and the number of fellows remained constant, the number (and percentage) of internists in training who intend to practice general internal medicine rose.

Career Choice↗
PubMed1977

[Psychiatric morbidity of patients hospitalized at the internal medicine ward].

Report on two studies to investigate psychiatric morbidity in patients hospitalized in an internal medicine ward of a distric general hospital. In the first charts of 783 patients hospitalized in 1975 were evaluated retrospectively, while the second study (conducted in 1976) involved clinical assessment by the author of 244 newly admitted patients. A psychiatric diagnosis could be established in some 70% of all patients hospitalized in the internal medicine ward, and the morbidity rate in patients for whom therapy was indicated was 40%. Investigation of the medication utilized on the ward revealed that psychopharmacologic agents (chiefly given as hypnotics) were the most frequently prescribed group of drugs, whereas they were administered to 25% of patients on a regular basis (without indication as hypnotics). These high figures emphasize the need to decentralize psychiatric services and to intergrate psychiatry into internal medicine.

Adolescent↗
PubMedDate not supplied

The Yale Affiliated Hospital Program in Internal Medicine. I. Organization, goals and plans.

In July, 1975, the Departments of Internal Medicine at the Yale University School of Medicine and eight community hospitals in southern and western Connecticut formed the Yale Affiliated Hospital Program (YAHP) in Internal Medicine. The YAHP provides a planned and focused program of continuing education for medical staff and housestaff at the affiliated hospitals. Six formats for the over 1,000 rounds, lectures, and conferences given annually are used. The members of the YAHP also cooperate in housestaff and faculty recruiting, evaluation of quality of care and evaluation of the process of continuing medical education itself. This report summarizes the organization, goals and future plans of the YAHP.

Connecticut↗
PubMed1979

Student performance in internal medicine: the effect of previous clerkship experience.

To test the assumption that students who have completed other clerkships are likely to perform better in internal medicine, the authors undertook a prospective study of 160 senior students from two classes. Groups of students with little or no senior clerkship experience before their internal medicine clerkship were compared with groups of students who had extensive clerkship experience in disciplines other than medicine. Groups were compared with respect to ward-performance scores and scores on identical multiple-choice examinations. Neither ward-performance nor multiple-choice scores revealed differences attributable to previous clerkship experience. It is concluded that despite areas of instruction and experience which overlap between medicine and other disciplines, previous clerkship experience apparently does not have a beneficial effect on student performance in internal medicine, as measured by these two commonly used methods of evaluation.

Analysis of Variance↗
PubMed1977

Patterns of practice in internal medicine in Ontario.

To determine the feasibility of wholly referral practice in internal medicine within a prepaid health service, the practice profiles of 694 internists in metropolitan, nonmetropolitan urban, and rural areas of Ontario were delineated by analysis of data from questionnaires and health-insurance billing. The questionnaire showed that two thirds of internists, chiefly younger practitioners, confined themselves to a referral consultant practice; the other one third included primary care. Subspecialists practised predominantly in metropolitan areas; most general internists in such areas provided primary care, whereas most general internists elsewhere had an entirely referral practice. This pattern of practice is greatly different from that in the United States but probably similar to that in other provinces in Canada. Extension of wholly referral practice to all internists in Ontario appears feasible, provided the numbers entering residency training are controlled. The present Ontario curricula for internal medicine and its subspecialties appear suitable for such a pattern of practice.

Humans↗
PubMed1979

Interpersonal skills training: evaluation in an internal medicine residency.

To determine the effectiveness of teaching interpersonal skills in a general internal medicine residency, a program was developed utilizing videotape feedback of house-staff/patient interactions, a modification of Interpersonal Process Recall (IPR). Fifty-one randomly selected house officers at different levels of training were included in a controlled, pretest-posttest study design. The major pre-post measures were three independent ratings of videotapes of actual first-visit interviews between resident and patient. House officers in the experimental group significantly increased the proportion of each interview devoted to psychosocial issues compared with controls, although the interviews remained predominantly medical; increased the use of effective responses; and improved their level of empathy with patients. Personality and attitude measures were found not to correlate with observed interpersonal skills on pretest or posttest videotapes. House officers rated the training program as being interesting, valuable, relevant, and nonthreatening. The data suggest that interpersonal skills can be effectively taught to internal medicine residents utilizing a videotape feedback training program.

Feedback↗
PubMed1977

[The teaching of internal medicine in the forming of the physician].

This paper was presented as a working document to the Second Meeting of the PAHO/WHO Program of Textbooks for the Integrated Teaching of Internal Medicine and its Specialties (Washington, D.C., 13-18 December 1976). The need to place the medical student in his environment from the first as an active member of the health team is stressed, and several considerations about the usual obstacles to this proposal are advanced. Reference is made to the subject of curricular integration as related to the length of medical studies and to the traditional use of the hospital in the teaching of internal medicine. The second part of the document reports on the results of the PAHO survey on how internal medicine is taught in Latin America, in which 84 faculties and schools in 15 countries of the Region participated.

Education, Medical↗
PubMed1978

A follow-up study of residents in internal-medicine, pediatrics and obstetrics-gynecology training programs in Massachusetts. Implications for the supply of primary-care physicians.

A questionnaire survey of physicians who had been residents in internal medicine, pediatrics or obstetrics-gynecology in Massachusetts during the years 1967-1972 was undertaken to determine that specialties they now practice and the extent to which they deliver primary care. Over 600 physicians (74 per cent) responded. Devoting more than half their practice to a primary-care specialty were only 28 per cent of the former residents in internal medicine as compared with 56 per cent of those in pediatrics and 74 per cent of those in obstetrics-gynecology. For each group the fraction of full-time equivalent primary-care physicians produced was 0.27, 0.42 and 0.39 for the internal-medicine, pediatrics and obstetrics-gynecology programs respectively. These findings indicate that, although Massachusetts is meeting the requirements of PL 94-484 concerning the percentage of residency positions in the primary-care specialties, such compliance does not guarantee an adequate future supply of primary-care practioners.

Certification↗
PubMed1976

[Gram-negative bacterial lung diseases in an internal medicine department].

In a department of internal medicine in Paris, the pneumonopathies with Gram negative "wild" bacilli represent about the third of recognized bacterial pneumonopathies. If started before the results of bacterial tests are known, the treatment should always include a drug active on Gram negative bacteria. Together with KLASTERSKY (1972) we think that synergic associations including the use of Gentamicin are the most effective. Once the responsible germ isolated and its sensitivity to antibiotics determined, therapy can be modified accordingly. With an appropriate antibiotic and by treating an unfavourable background and the initial localization, prognosis is favourable in most cases. This contrasts with the heavy mortality of pulmonary infections with Gram negative bacilli pertaining to hospital.

Adult↗
PubMed1976

Teaching of primary care in an internal medicine residency program.

A teaching module in ambulatory internal medicine has been added to a residency program in a large referral hospital. The effort was directed to structure a program of instruction reflecting common problems seen by primary care internists. Patients were screened by supervising staff to make the rotation an efficient learning experience. Experienced nurse clinicians were used to monitor patients with stabilized medical problems, thus freeing the housestaff for problems more suited to their level of training. The nurses also served as role models with which the housestaff could interact and provide continuity and accessibility of care to patients being followed up by transient physicians-in-training. Various teaching conferences based on traditional inpatient models were conducted. Self-assessment and peer review techniques were structured around monthly conferences in which medical records were assessed by each participant.

Curriculum↗
PubMed1977

Consultations in internal medicine: a training program resource.

At the Milton S. Hershey Medical Center of the Pennsylvania State University an internal medicine consulting resident sees all medical consultation requests not directed to a specific subspecialty division. An audit of a nine-month experience on the consult service was compared with that of a general medicine ward service. The audit revealed that consulting residents were exposed to a quantitatively and qualitatively different spectrum of medical problems than were found on the ward service. The interdisciplinary aspects of the experience expand the consulting internist's fund of knowledge and complement outpatient exposure to other specialties, such as surgery and obstetrics-gynecology. Chief medical residents at 36 university medical centers were surveyed regarding the nature of the internal medicine consultation programs in their institutions. The survey indicated that half the programs were service oriented rather than educational and were not felt to be of profit to the medicine residents.

Adolescent↗
PubMed1979

A 'firm' system for graduate training in general internal medicine.

The faculty of the Department of Medicine at Cleveland Metropolitan General Hospital has responded to the challenge of fostering general internal medicine in a graduate training program by organizing a "firm" system of medical care which has appealed to academic internists with broad interests in clinical medicine. This firm system consists of four medical teams which care for distinct patient populations, closely integrating their outpatient and inpatient care. The firms are made up of all the house staff in training in internal medicine together with senior and junior faculty members who are directors for the firms. Medical students in general medicine are also assigned to firms. This firm system is relatively simple to understand and establish and is readily applicable to other academic departments with general medical responsibilities.

Education, Medical, Graduate↗
PubMed1978

[The development of neurology since A. v. Strümpell and its relation to internal medicine].

A. v. Strümpell is appreciated as one of those internal specialists who inaugurated neurology in Germany and furthered decisively its development. Issuing from the opinions which Strümpell expressed at the end of his life the further way of the German neurology up to an independent clinical discipline is described in short. Here the partly historically, partly really proved relations of neurology to internal medicine as well as to psychiatry are taken into consideration. Integration is characterized as an actual request, since with progressing differentiation and specialisation of medicine the adherence to the traditional structures and borders of the specialities becomes more and more questionable.

Germany↗
PubMed1977

The literature and history of internal medicine: an annotated bibliography.

This bibliography includes 58 books on the history of various medical subspecialties and general reference works useful in obtaining historical and biographical material relevant to internal medicine and related areas. In addition to a brief review of the contents of each volume, information is included on their publication and availability. It is designed to serve as an introduction to the history of internal medicine as well as a source of reference.

Bibliographies as Topic↗