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Examines the strategies and accomplishments in local advocacy for the medically indigent in the U.S. Origins of advocacy efforts; Research to document local access problems; Summary of local health advocacy; Political strategies for the medically indigent.

Compares the academic performance of internal medicine residents with their specific teaching behaviors in Irvine, California. Utilization of baseline teaching videotapes; Correlation between the academic performance and teaching behavior of internal medicine residents; Evaluation of medical students' global ratings of residents' teaching skills.

Systems-based practice improvement is one of the Accreditation Council for Graduate Medical Education's six required core competencies for house staff training. The continuous quality improvement (CQI) project is a required exercise for every second year internal medicine resident at the University of California, Irvine. There are several goals of the CQI project. First, to provide residents with practical experience in systems-based improvement. Second, to provide an avenue for resident input into the operations and improvement of the residency programme and its teaching sites. Third, to provide a mechanism for evaluation of residents' competency in systems-based practice.

Context: Although interest exists among medical educators in using writing that reflects on clinical experience to enhance medical students' communication skills, empathy, and overall professionalism, little empirical research documents the value of this approach. This study explored whether students trained in one type of writing would first demonstrate increased awareness of emotional aspects of a clinical encounter in their writing; and second, be evaluated more positively in an OSCE situation by standardized patients., Method: Ninety-two students were assigned to either a point-of-view writing or a clinical reasoning condition as part of a second year doctoring course. At the end of the year, students were evaluated in an OSCE format on 3 cases, and completed a writing assignment about an ER death from cardiac arrest. Student essays were scored according to presence or absence of various themes. A linguistic analysis of the essays was also performed. Point-of-view and clinical reasoning group scores were compared on both measures, as well as on the standardized patient OSCE ratings., Results: Students trained in point-of-view writing demonstrated significantly more awareness of emotional and spiritual aspects of a paper case in a writing assignment than did students trained in clinical reasoning. By contrast, students in the clinical reasoning group were more likely to distance from the scenario. The two groups did not differ on SP OSCE ratings., Conclusion: Training in point-of-view writing can improve medical students' written skills on certain affective dimensions. It is not clear that these skills can translate into clinical behavior.

The authors describe a longitudinal third- and fourth-year elective, 'The Art of Doctoring', introduced in an attempt to counteract perceived frustration and cynicism in medical students at their home institution during the clinical years. The course goals aimed at helping students to develop self-reflective skills; improve awareness of and ability to modify personal attitudes and behaviors that compromise patient care; increase altruism, empathy and compassion toward patients; and sustain commitment to patient care, service and personal well-being. These goals were accomplished through introduction and development of five skill sets: learning from role models and peers; on-site readings of works by medical student- and physician-authors; self- and other-observation; self-reflective techniques; and case-based problem-solving. The course involved regular in-class exercises and homework assignments, as well as a personal project related to improving personal compassion, caring and empathy toward patients. Students also learned to use a coping algorithm to approach problematic clinical and interpersonal situations. Class discussions revealed three issues of recurring importance to students: loss of idealism, non-compliant patients, and indifferent, harsh or otherwise unpleasant attendings and residents. Quantitative and qualitative student evaluations overall indicated a generally favorable response to the course. Problems and barriers included attendance difficulties and variable levels of student engagement. Future directions for this type of educational intervention are considered, as well as its implications for medical education.