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A national study of internal medicine and its specialties: II. Primary care in internal medicine.

A nationwide study of practitioners in 24 medical and surgical specialties was conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. In this second report of a series presenting findings for internal medicine, general internal medicine and 10 subspecialties of internal medicine are compared using a care classification scheme designed for the study. On the basis of characteristics of the individual patient encounter, this care classification scheme distinguishes several dimensions associated with the concept of primary care. Five empirically derived types of care rather than a simple "primary" or "non-primary" dichotomy are described, and the distributions of each type for the 11 subspecialties examined are noted. Types of care (according to the care classification) are examined by the time per patient, the complexity of physician services, the severity and chronicity of problems, and the degree of specialization associated with providing different types of care. Estimates of the number of annual encounters, and the number of annual encounters for three of the five types of care, with the proportion of each accounted for by each subspecialty, are given.

Consultants

A national study of internal medicine and its specialties: I. An overview of the practice of internal medicine.

A nationwide study of 24 medical and surgical specialties has been conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. This article is the first in a series reporting findings for general internal medicine and 10 subspecialties of internal medicine. Populations for these 11 specialties are defined and enumerated, and the specialties are compared in terms of demographic and geographic distribution. Practice comparisons are presented based on characteristics such as workload, allocation of professional time, location of encounters with patients, distribution of primary problem diagnoses, and projections of annual patient encounters. Forthcoming specialty-specific articles will present highly detailed information for general internal medicine and for the subspecialties of cardiology, gastroenterology, pulmonary disease, allergy, hematology, endocrinology, nephrology, medical oncology, rheumatology, and infectious diseases.

California

Attitudes of departments of medicine in the United States toward provision of internal medicine training for prospective neurologists.

A questionnaire was sent to directors of training programs in internal medicine to assess attitudes towards providing a year of internal medicine training for prospecitve neurologists. Such applicants are handled in a variety of ways. Among the 92 responding institutions with neurology training programs, three were not willing to accept prospective neurologists for 1 year of internal medicine. Seventy-three percent would either reserve places for prospective neurologists, arrange with neurology for a position through the intern matching program, or arrange medical rotations for candidates accepted by neurology. Twenty-four percent would accept neurologists for a single year without specifying any special arrangement.

Attitude of Health Personnel

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

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

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

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

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

[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