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American College of Emergency Physicians Research Forum. October 23-24, 2000. Philadelphia, Pennsylvania, USA. Abstracts.
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Evaluating the competence of physicians in practice: from peer review to performance assessment.
Evaluation of physician competence has traditionally been defined by the medical profession largely through standardized tests and board certifying examinations. However, a level of physician evaluation that takes place outside academic medical centers and certifying boards is rapidly developing. This article describes three programs for such physician evaluation: (1) the program of US Healthcare, a national managed health care company; (2) the DEMPAQ--Developing and Evaluating Methods to Promote Ambulatory Care Quality--project, a joint research effort between Harvard University (Cambridge, Massachusetts) and the State of Maryland's (and District of Columbia's) Peer Review Organization (PRO); and (3) a project initiated by the American College of Physicians (ACP) in Philadelphia, Pennsylvania, to assess both medical competence and technical performance in the hospital setting. The authors argue for the need to inform physicians-in-training about the types of evaluation to which they will be subjected over the courses of their careers. In order to further this goal, the authors advocate increased collaboration between leaders in the academic setting and those spearheading these new programs for assessment of physician performance.
A physician retraining program. Assessment update.
The Medical College of Pennsylvania, Philadelphia, has sponsored a retraining program for clinically inactive physicians since 1968. A previous study examined return to clinical medicine of retrainees from 1968 to 1975. The present study tracked changes in physician characteristics from 1976 to 1981 and compared return to clinical medicine of retrainees in the two time periods. Although important shifts in gender, nature of inactivity, status of licensure, and geographic distribution occurred during the past five years, the number of retrainees returning to clinical activity after the program was comparable for the two time periods (85% and 83%). Women inactive because of family responsibilities and non-clinically active physicians made more career changes than non-primary care clinical specialists. This study demonstrated that a retraining program is an effective method for reintroducing inactive physicians to clinical medicine.
Critical factors for designing programs to increase the supply and retention of rural primary care physicians.
CONTEXT: The Physician Shortage Area Program (PSAP) of Jefferson Medical College (Philadelphia, Pa) is one of a small number of medical school programs that addresses the shortage of rural primary care physicians. However, little is known regarding why these programs work. OBJECTIVES: To identify factors independently predictive of rural primary care supply and retention and to determine which components of the PSAP lead to its outcomes. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: A total of 3414 Jefferson Medical College graduates from the classes of 1978-1993, including 220 PSAP graduates. MAIN OUTCOME MEASURES: Rural primary care practice and retention in 1999 as predicted by 19 previously collected variables. Twelve variables were available for all classes; 7 variables were collected only for 1978-1982 graduates. RESULTS: Freshman-year plan for family practice, being in the PSAP, having a National Health Service Corps scholarship, male sex, and taking an elective senior family practice rural preceptorship (the only factor not available at entrance to medical school) were independently predictive of physicians practicing rural primary care. For 1978-1982 graduates, growing up in a rural area was the only additionally collected independent predictor of rural primary care (odds ratio [OR], 4.0; 95% CI, 2.1-7.6; P<.001). Participation in the PSAP was the only independent predictive factor of retention for all classes (OR, 4.7; 95% CI, 2.0-11.2; P<.001). Among PSAP graduates, taking a senior rural preceptorship was independently predictive of rural primary care (OR, 2.5; 95% CI, 1.3-4.7; P =.004). However, non-PSAP graduates with 2 key selection characteristics of PSAP students (having grown up in a rural area and freshman-year plans for family practice) were 78% as likely as PSAP graduates to be rural primary care physicians, and 75% as likely to remain, suggesting that the admissions component of the PSAP is the most important reason for its success. In fact, few graduates without either of these factors were rural primary care physicians (1.8%). CONCLUSIONS: Medical educators and policy makers can have the greatest impact on the supply and retention of rural primary care physicians by developing programs to increase the number of medical school matriculants with background and career plans that make them most likely to pursue these career goals. Curricular experiences and other factors can further increase these outcomes, especially by supporting those already likely to become rural primary care physicians.
Why support a women's medical college? Philadelphia's early male medical pro-feminists.
The male founders and early faculty of Philadelphia's Woman's Medical College were mostly abolitionist physicians, zealous moralists for whom medical feminism formed only one of the cherished causes they could "manfully" and righteously defend. Male faculty of the late nineteenth century comprised "self-made" men, mostly new specialists, for whom strict sexism probably seemed inconsistent with progressive medicine. For some of these physicians-obviously a small minority-defending medical women and breaking the barriers of fraternity could be consistent with "manly" responsibility. The outcome of the collaboration of women and the dissident men physicians in nineteenth-century Philadelphia amounted to another seeming paradox: the majority of the male medical profession, both locally and nationally, tyrannically hindered women's entry into the profession, yet medicine opened its doors in advance of law and the clergy; and where this first occurred, such as in the community centered on Woman's Medical College, a novel gender rearrangement arose based on collaboration and friendship.
Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy. A survey of pulmonologists and review of the literature.
BACKGROUND: Transbronchial lung biopsy (TBLB) via flexible bronchoscopy is a common procedure performed by pulmonologists. Limited scientific data exist concerning the risk of this procedure in patients with conditions that may adversely affect the rate of procedural complications. OBJECTIVES: To evaluate the current practice pattern and attitude of pulmonologists toward the performance of TBLB in the presence of high-risk conditions. METHODS: A survey was constructed and distributed at the American College of Chest Physicians annual meeting, held in Philadelphia, USA, in November of 2001. RESULTS: A total of 227 surveys were distributed with a return of 158 (69.6%). Anticoagulation medications are temporarily held prior to TBLB by the majority of our survey respondents (98.7% for intravenous heparin, 90.5% for warfarin, and 87.3% for low-molecular-weight heparin). Medications with effect on platelet function are held by fewer pulmonologists. There is a wide variation in the pulmonologists' perception of the risk of performing TBLB when certain medical conditions coexist: pulmonary hypertension [absolute contraindication (AC), 28.7%; relative contraindication (RC) 58.6%], superior vena cava syndrome (AC 19.6%, RC 51%), mechanical ventilation (AC 17.8%, RC 58.6%) and lung cavity/abscess (AC 7%, RC 44.9%). A significant percentage of pulmonologists (55%) do not regard an elevated serum creatinine at any level as AC to TBLB. Thirty-eight percent of the survey participants administer desmopressin prior to TBLB in uremic patients to prevent excessive bleeding. CONCLUSIONS: Prior to performing bronchoscopic TBLB, the majority of pulmonologists temporarily holds anticoagulation medications. However, there is a lack of agreement in relation to perceived contraindications and safety of TBLB.
The first American medical school.
John Archer, a physician from Harford County, was one of the graduates of the first medical school on American soil-Philadelphia College-in 1768. The names of the initial instructors, including John Morgan, William Shippen, and Thomas Bond, and of the first graduates, including John Archer and Jonathon Potts, are well known to most medical historians. Many of these early American physicians had a deep sense of political commitment, and placed conscience and love of country above their medical practices.
The compulsory registration of patients with tuberculosis: an 1894 debate at the College of Physicians.
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A note on the Philadelphia Regional Medical Library Committee.
No rigid library plan can fullfil the needs of every region. The Philadelphia Regional Medical Library Committee, composed of representatives of the five medical schools, the College of Physicians, and other medical organizations, was formed to determine cooperative activities that best suit its own needs. The committee has reviewed plans for new libraries at several medical schools to avoid duplication of library resources. It envisions, also, cooperative storage of little-used materials, messenger service, an acquisition program to expand regional resources, improved communication by means of mechanical devices, and the establishment of a regional center and distribution of bibliographies from regionally located MEDLARS tapes.
PHILADELPHIA'S MEDICAL LIBRARIES.
Philadelphia medical libraries embrace the past, the present, and the future. Typifying the expansion in medical communications, area libraries cover the broad spectrum of medical and paramedical fields. Serving workers in these fields are the College of Physicians Library, the five medical school libraries, and a host of hospital and special libraries. Many of these libraries date from the early years of this country. Pharmaceutical firms and governmental institutions in the city, as well as medical libraries in neighboring states, contribute to the area's rich resources. The cooperative efforts and outlook of all these libraries are reflected in the strength of the Regional Group of the Medical Library Association and the plans being made for the future of medical libraries in the Philadelphia area.
Abraham Lincoln's suit against a medical imposter who assaulted his client.
In 1851, A. Lincoln, Esquire represented Edward Jones who charged in a law suit that his attending physician had assaulted him. Jones, also a lawyer, had sharply questioned Dr. Joseph S. Maus about his claims of attendance and graduation from Philadelphia's Jefferson Medical College, an allopathic medical school. Jones claimed that Maus became enraged at his persistent questioning and attacked him. In turn, Maus denied the allegation. He said that he was merely defending himself from Jones' blows with a large cane. Lincoln's legal approach was to argue about the state of medical education and whether Maus had really graduated from Jefferson Medical College. Acting as a peacemaker, he finally arranged to settle the dispute between Jones and Maus out of court.
Preliminary evaluation of the Health Background Questionnaire for Pain and clinical encounter form for pain.
OBJECTIVES: The principal aims of this study were to evaluate the extent to which patients completed, understood, and were satisfied with the Health Background Questionnaire for Pain (HBQ-P), a health and pain history questionnaire that includes a modification of the Medical Outcome Study Short Form-36, the Treatment Outcomes in Pain Survey, and to examine the degree to which the questionnaire produced reliable and valid responses. A secondary aim was to determine the length of time for a physician to complete the Clinician Evaluation Form for Pain (CEF-P), a brief questionnaire designed to obtain key elements resulting from clinical assessment and management decisions. METHODS: This cross-sectional study utilized data from consecutive new patients seen from January to December 2001 in Drexel University College of Medicine's Pain Medicine and Comprehensive Rehabilitation Center at Graduate Hospital in Philadelphia, PA. The HBQ-P and an accompanying brief satisfaction inventory were completed at home by the patient prior to the individual's initial office visit. The CEF-P was completed by the physician after seeing the patient. RESULTS: Ten of 11 comparisons of patient responses to similar questions on the HBQ-P showed significant consistency. Of eight comparisons between the CEF-P and HBQ-P, two pain duration comparisons showed moderate agreement and one depression comparison showed significant association. Patients consistently had difficulty in answering six single questions and two question sets. Overall patient satisfaction was high. The mean time for the physician to complete the CEF-P was 90 seconds. CONCLUSIONS: Analyses indicate patient responses to similar HBQ-P questions have sufficient reliability to support the use of the Health Background Questionnaire for clinically related data collection and for outcome evaluation of treatments for chronic and recurring pain. The consistently missed questions on the HBQ-P should be revised.
The University of Delaware/Jefferson Medical College Medical Scholars Program: an approach to educating physicians for academic leadership and practice.
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William Thomson and Joseph Janvier Woodward.
William Thomson and Joseph Janvier Woodward were two of several exceptionally versatile and highly productive young physicians who volunteered for service with the Union Army at the outbreak of the Civil War, and then were subsequently assigned to the Washington Area where they played significant roles and made major contributions towards the development of the Army Medical Museum. Both pioneered in photomicrography. While Thomson deserves priority, Woodward was the more prolific contributor whose work and publications helped draw attention to the Army Medical Museum as a center for excellence in pathology. After the War Thomson returned to Philadelphia where his interests in photography stimulated his pursuit of optics and eventually his becoming one of the first American physicians to specialize in ophthalmology. He became Professor of Ophthalmology at Jefferson Medical College.
Philly physician executive combats big city blight.
Despite no money for college and little encouragement from his teachers, Eric Mitchell was determined to make something of himself. Ever since he got that plastic doctor kit when he was 7, he dreamed of becoming a physician. Learn how he achieved that goal--and so much more.
Requesting consent for an invasive procedure in newly deceased adults.
OBJECTIVE: Ethical concerns exist over the performance of medical procedures, such as endotracheal intubation, on newly deceased patients without family consent. This study examined the process of obtaining consent for the purpose of performing an invasive procedure in newly deceased adults. DESIGN: A prospective case series. PARTICIPANTS: The families of patients who died during a 5-month period were requested to provide consent to perform wire-guided retrograde tracheal intubation. MAIN OUTCOME MEASURES: Differences between success and failure in obtaining consent including information on the decreased, family reasons for their decision, and the experience of those requesting consent. RESULTS: Consent was requested from 44 families and 26 (59%) agreed to the procedure. This success rate was achieved despite the lack of a prior relationship with the family by the persons requesting consent. Consent was obtained more frequently in unexpected than expected deaths (77% vs 41%, P = .03). There were no differences in success rates for consent for age, race, sex, or do-not-resuscitate status of the deceased. Spouses consented more frequently than children (77% vs 50%, P = .25). The two physicians reported greater comfort in requesting consent than the nurse anesthetist investigator. In one instance, the consent process may have increased the emotional distress of the family. CONCLUSION: Consent can frequently be obtained from families for an invasive procedure in newly deceased adults. Physicians should reconsider the practice of performing postmortem procedures without obtaining family consent.
Attendings' and residents' teaching role and students' overall rating of clinical clerkships.
The study was conducted with a sample of third-year students (n = 584) at Jefferson Medical College to explore students' perception of patterns of differences between attending physicians and residents in their teaching behaviors during clinical clerkships. Attending physicians' teaching behaviors were perceived more in a mentorship mode whereas residents' teaching behaviors were equally divided between mentorship and preceptorship modes. Attending physicians and residents' teaching behaviors varied among clerkships. Results were discussed in terms of difference of teaching roles played by attending physicians and residents and relationship of the teaching behaviors to students' overall rating of clerkship.