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OBJECTIVE: Little is known about the best approaches and format for measuring physicians' communication skills in an online environment. This study examines the reliability and validity of scores from two Web-based communication skill assessment formats. METHODS: We created two online communication skill assessment formats: (a) MCQ (multiple-choice questions) consisting of video-based multiple-choice questions; (b) multi-format including video-based multiple-choice questions with rationales, Likert-type scales, and free text responses of what physicians would say to a patient. We randomized 100 general internists to each test format. Peer and patient ratings collected via the American Board of Internal Medicine (ABIM) served as validity sources. RESULTS: Seventy-seven internists completed the tests (MCQ: 38; multi-format: 39). The adjusted reliability was 0.74 for both formats. Excellent communicators, as based on their peer and patient ratings, performed slightly better on both tests than adequate communicators, though this difference was not statistically significant. Physicians in both groups rated test format innovative (4.2 out of 5.0). CONCLUSION: The acceptable reliability and participants' overall positive experiences point to the value of ongoing research into rigorous Web-based communication skills assessment. PRACTICE IMPLICATIONS: With efficient and reliable scoring, the Web offers an important way to measure and potentially enhance physicians' communication skills. [ABSTRACT FROM AUTHOR]

The physician assistant (PA) profession originated to train former medics and corpsmen for a new civilian health care career. However, baccalaureate degree prerequisites to training present barriers to discharged personnel seeking to enter this profession. A survey was administered (2006-2007) to all MEDEX Northwest PA program graduates who had entered with military experience. The survey addressed attitudes toward the profession, PA education, and practice and how military experience influenced their education and careers. The response rate was 46.4%, spanning all branches of the military. Respondents reported military experience positively impacting ability to handle stress and work in health care teams and that patients and colleagues viewed their military background positively. Most (75.5%) respondents did not hold a bachelor's degree at matriculation. Veterans bring substantial health care training to the PA profession. However, program prerequisites increasingly present barriers to entry. Veterans' contributions to health care and the consequences of losing this resource are discussed. [ABSTRACT FROM AUTHOR]

To determine if the actual rate of coronary artery bypass grafting (CABG) has been decreasing in Washington state, CABG and percutaneous coronary intervention (PCI) procedure rates from 1987 to 2001 were age- and gender-adjusted and standardized to the year 2000 to normalize case rates for changes in population demographics. CABG rates remained stable through 1997, then decreased 19% from 1997 to 2001. From 1987 to 2001, PCI rates increased 128%. These changes occurred simultaneously with decentralization of cardiac surgical services. [ABSTRACT FROM AUTHOR]

BACKGROUND: Computing and biomedical informatics technologies are providing almost instantaneous access to vast amounts of possibly relevant information. Although students are entering medical school with increasingly sophisticated basic technological skills, medical educators must determine what curricular enhancements are needed to prepare learners for the world of electronic information. PURPOSE: The purpose was to examine opinions of academic affairs and informatics administrators, curriculum deans and recently matriculated medical students about prematriculation competence and medical education learning expectations. METHODS: Two surveys were administered: an Information Literacy Survey for curriculum/informatics deans and a Computing Skills Survey for entering medical students. RESULTS: Results highlight differences of opinion about entering competencies. They also indicate that medical school administrators believe that most basic information skills fall within the domain of undergraduate medical education. CONCLUSIONS: Further investigations are needed to determine precise entry-level skills and whether information literacy will increase as a result of rising levels of technical competence. [ABSTRACT FROM AUTHOR]

This research note presents an overview of the contemporary "professional organization" research area. We begin with the historical roots and evolution of research into professionals and the organizations in which they work, identifying five theoretical traditions-namely sociology of organization, sociology of the professions, professional organization, professional service firms, and public professionalism. Reviewing recent research in these areas allows us to identify important research phenomena-such as hybridity, institutional work, internationalization, and professional identity-and to understand how the institutional view within the "sociology of the professions" tradition has become a dominant paradigm for this research. This review also reveals the extent to which various occupations, methodological approaches, and academic fields, and locations have assumed positions of importance in recent years. Finally, future directions relevant to sociology researchers are discussed., (© 2021 Canadian Sociological Association/La Société canadienne de sociologie.)

School nursing practice has changed dramatically over the past 20 years, yet few nationally representative investigations describing the school nursing workforce have been conducted. The National School Nurse Workforce Study describes the demographic and school nursing practice patterns among self-reported public school nurses and the number and full-time equivalent (FTE) positions of all school nurses in the United States. Using a random sample stratified by public/private, region, school level, and urban/rural status from two large national data sets, we report on weighted survey responses of 1,062 public schools. Additional questions were administered to estimate the school nurse population and FTEs. Findings reported illustrate differences by strata in public school nurse demographics, practice patterns, and nursing activities and tasks. We estimate approximately 132,300 self-identified practicing public and private school nurses and 95,800 FTEs of school nurses in the United States. Research, policy, and school nursing practice implications are discussed.

Trends in malpractice awards and adverse actions (e.g., revocation of provider license) following an act or omission constituting medical error or negligence were examined. The National Practitioner Data Bank was used to compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs). During 2005 through 2014, there ranged from 11.2 to 19.0 malpractice payment reports per 1,000 physicians, 1.4 to 2.4 per 1,000 PAs, and 1.1 to 1.4 per 1,000 NPs. Physician median payments ranged from 1.3 to 2.3 times higher than PAs or NPs. Diagnosis-related malpractice allegations varied by provider type, with physicians having significantly fewer reports (31.9%) than PAs (52.8%) or NPs (40.6%) over the observation period. Trends in malpractice payment reports may reflect policy enactments to decrease liability.

Purpose: The number of physician assistant (PA) programs has increased exponentially across the past decade, and the demand for PAs will likely remain strong through 2025. Because of this rapid growth, both new and established PA programs face significant challenges in recruiting experienced educators. We describe the value of using PAs trained through the Interservice Physician Assistant Program (IPAP) as civilian PA educators., Methods: The literature on IPAP and its graduates proved too limited to conduct a formal systematic review. We searched the PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for works speaking to the value that IPAP-trained PAs may bring to civilian PA training. Those findings were supplemented with informal conversations with IPAP-trained PAs currently employed in the military and those working in civilian PA education. Themes were identified supporting the potential value of IPAP-trained PAs in civilian training., Results: Military PAs work within hierarchical organizations and may transition easily to academic settings. They leave military service not only as highly trained and proficient primary care providers but also as experienced educators. Military PAs must demonstrate professionalism across their entire military careers. They serve as leaders and work in teams, but they are also experienced in negotiating up chains of command. They are trained in and apply the latest innovations in health care delivery and have provided care with a degree of autonomy uncommon in civilian PA practice., Conclusions: The PAs trained through IPAP leave the service with skills and experiences valuable to civilian PA training. Employing these PAs in civilian education honors their service contributions while addressing emerging PA educator workforce demands.

National guidelines call for health care organizations to provide around-the-clock coaching for medical error disclosure. However, frontline clinicians may not always seek risk managers for coaching. As part of a demonstration project designed to improve patient safety and reduce malpractice liability, we trained multidisciplinary disclosure coaches at 8 health care organizations in Washington State. The training was highly rated by participants, although not all emerged confident in their coaching skill. This multisite intervention can serve as a model for other organizations looking to enhance existing disclosure capabilities. Success likely requires cultural change and repeated practice opportunities for coaches., (© 2017 American Society for Healthcare Risk Management of the American Hospital Association.)

Despite widespread engagement in quality improvement activities, little is known about the designs of studies currently published in quality improvement journals. This study's goal is to establish the prevalence of the types of research conducted in articles published in journals dedicated to quality improvement. A cross-sectional analysis was performed of 145 research articles published in 11 quality improvement journals in 2011. The majority of study designs were considered pre-experimental (95%), with a small percentage of quasi-experimental and experimental designs. Of the studies that reported the results of an intervention (n = 60), the most common research designs were pre-post studies (33%) and case studies (25%). There were few randomized controlled trials or quasi-experimental study designs (12% of intervention studies). These results suggest that there are opportunities for increased use of quasi-experimental study designs., (© The Author(s) 2015.)

Risk managers often meet with health care workers who are emotionally traumatized following adverse events. We surveyed members of the American Society for Health care Risk Management (ASHRM) about their training, experience, competence, and comfort with providing emotional support to health care workers. Although risk managers reported feeling comfortable and competent in providing support, nearly all respondents prefer to receive additional training. Risk managers who were comfortable listening to and supporting health care workers were more likely to report prior training. Health care organizations implementing second victim support programs should not rely solely on risk managers to provide support, rather engage and train interested risk managers and provide them with opportunities to practice., (© 2016 American Society for Healthcare Risk Management of the American Hospital Association.)

Background: Nurse practitioners (NP) and physician assistants (PA) serve as independent or semiautonomous providers and as fundamental members of healthcare teams., Purpose: Differentiating roles of health professionals is needed for optimal employment utilization. Clinically practicing PAs and NPs were characterized., Methodology: Data included wage and workforce projections to 2022.Variables included number practicing, age, gender, race, ethnicity, education, principal employer, practice specialty, and wages., Results: Health delivery establishments employed 88,110 PA and 113,370 NP clinicians in 2013. Both were predominantly female: NPs were older (49 years) on average than PAs (38 years). A significant number of them practiced in physicians' offices or in acute care hospitals. Median wages were at parity. Growth predictions from 2012 to 2022 were 31%-35%., Conclusions: PAs and NPs constitute 20% of the composite clinician labor force (MD, DO, PA, NP). Labor market analysis suggests they are in demand. A majority of NPs and a third of PAs work in primary care fields. Their collective projected growth suggests a solution to emerging workforce shortages and an ability to help meet healthcare demands., Implications for Practice: Adaptability to changing roles, especially in primary care and underserved areas, makes them facile responders to market demands in a continuously evolving healthcare environment., (©2015 American Association of Nurse Practitioners.)

Purpose: The ability to create a concise summary statement can be assessed as a marker for clinical reasoning. The authors describe the development and preliminary validation of a rubric to assess such summary statements., Method: Between November 2011 and June 2014, four researchers independently coded 50 summary statements randomly selected from a large database of medical students' summary statements in virtual patient cases to each create an assessment rubric. Through an iterative process, they created a consensus assessment rubric and applied it to 60 additional summary statements. Cronbach alpha calculations determined the internal consistency of the rubric components, intraclass correlation coefficient (ICC) calculations determined the interrater agreement, and Spearman rank-order correlations determined the correlations between rubric components. Researchers' comments describing their individual rating approaches were analyzed using content analysis., Results: The final rubric included five components: factual accuracy, appropriate narrowing of the differential diagnosis, transformation of information, use of semantic qualifiers, and a global rating. Internal consistency was acceptable (Cronbach alpha 0.771). Interrater reliability for the entire rubric was acceptable (ICC 0.891; 95% confidence interval 0.859-0.917). Spearman calculations revealed a range of correlations across cases. Content analysis of the researchers' comments indicated differences in their application of the assessment rubric., Conclusions: This rubric has potential as a tool for feedback and assessment. Opportunities for future study include establishing interrater reliability with other raters and on different cases, designing training for raters to use the tool, and assessing how feedback using this rubric affects students' clinical reasoning skills.

Objective: Previously unclassified inflammatory skin lesions referred to as sun bumps have been observed throughout the year on participants of wilderness trips; however, the underlying cause and diagnosis remain unclear. The purpose of this prospective observational study was to document the incidence, characteristics, and risk factors associated with these skin lesions as they occurred on a winter wilderness expedition., Methods: For this study, the lesions were defined as pruritic or erythematous skin lesions occurring while in the wilderness. Seventy-four participants in a wilderness ski touring course in Wyoming fully completed a 44-question written survey concerning occurrence and risk factors for these lesions. Weather information and photographs were collected., Results: Twenty-six percent of participants had similar lesions. The lesions were described as edematous pale papules and plaques with erosions and crusts on an erythematous background. The face was involved in 90% of affected persons. Lesions occurred after an average of 8.7 days in the wilderness and resolved 10.6 days later. Skin that was less prone to sunburn was associated with a decreased incidence (odds ratio 0.44). No association could be found between lesion incidence and history of polymorphous light eruption, sun exposure, ambient temperature, affected contacts, sex, or body mass index., Conclusions: Overall, the lesions were common among study participants but occurred only after prolonged exposure to wilderness conditions. It was not possible to classify the skin condition as an example of any known diagnosis. We propose the name "prolonged exposure dermatosis" for this condition until further studies better define its etiology, prevention, and treatment., (Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Purpose: Accreditation standards require physician assistant (PA) programs to ensure students receive adequate clinical experiences. During their clinical year of training, PA students complete rotations with multiple clinical preceptors, introducing them to practice and exposing them to a variety of clinical problems. In this article, we examined Typhon Physician Assistant Student Tracking (PAST) system patient encounter logs' value for program evaluation, but also in research to address questions relevant to PA education. Specifically, we explored the MEDEX Northwest Physician Assistant Training Program student experience across rural versus suburban/urban placements in a 4-month family medicine preceptorship., Methods: Student experience was analyzed from 2 years of collected Typhon PAST encounter data. Encounter characteristics included duration, number of clinical problems, student level of responsibility, and decision type. Patient characteristics included sex, age, race, and clinical problems recorded as ICD-9 codes., Results: Individual student experience varied widely across different preceptors. However, these differences were more specific to the preceptor-student relationship than to whether the site was classified as rural or suburban/urban. Across these settings, significant differences were only noted for percentage of female and 65 or older patient encounters. The most common clinical problems reported across rural versus suburban/urban sites were highly correlated., Conclusions: Physician Assistant Student Tracking data demonstrated that individual student experience in their family medicine rotation varied widely. However, in general, rural and suburban/urban experiences were more similar than different. This study supports the value of the Typhon PAST logging system for not only tracking student activity but also addressing program evaluation and research questions.

This study sought to assess physician assistant (PA) wages, make comparisons with other healthcare professionals, and project their earnings to 2025. The Bureau of Labor Statistics PA employment datasets were probed, and 2013 wages were used to explore median wage differences between large employer categories and 14 years of historical data (2000-2013). Median wages of PAs, family physicians and general practitioners, pharmacists, registered nurses, advanced practice nurses, and physical therapists were compared. Linear regression was used to project the PA median wage to 2025. In 2013, the median hourly wage for a PA employed in a clinical role was $44.70. From 2000 to 2013, PA wages increased by 40% compared with the cumulative inflation rate of 35.3%. This suggests that demand exceeds supply, a finding consistent with similar clinicians such as family physicians. A predictive model suggests that PA employment opportunities and remuneration will remain high through 2025.

Increasingly health professions schools and academic health centers are required to include interprofessional education (IPE) as a standard part of their core curricula to maintain accreditation. However, challenges continue to surface as faculty struggle to develop and participate in IPE activities while balancing increasing workloads and limited resources, and also trying to keep current in the changing profession-specific accreditation and standards. This guide shares lessons learned from developing and sustaining IPE activities at the University of Washington (UW) based in the United States. In 2008, the UW Schools of Nursing and Medicine were awarded funds to develop, implement, and evaluate an interprofessional program focused on team communication. This funding supported the creation of two annual large-scale IPE events, provided infrastructure support for the Center for Health Sciences Interprofessional Education, Research and Practice (CHSIERP), and supported numerous interprofessional activities and initiatives in the health professions curricula. Our experiences over the years have yielded several key lessons that are important to consider in any IPE effort. In this guide we report on these lessons learned and provide pragmatic suggestions for designing and implementing IPE in order to maximize long-term success.

Guidelines call for healthcare organizations to provide emotional support for clinicians involved in adverse events, but little is known about how these organizations seek to meet this need. We surveyed US members of the American Society for Healthcare Risk Management (ASHRM) about the presence, features, and perceived efficacy of their organization's provider support program. The majority reported that their organization had a support program, but features varied widely and there are substantial opportunities to improve services. Provider support programs should enhance referral mechanisms and peer support, critically appraise the role of employee assistance programs, and demonstrate their value to institutional leaders., (© 2015 American Society for Healthcare Risk Management of the American Hospital Association.)

Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and Joint Commission, recommend that patients receive transparent communication when a medical error occurs. Recommendations for error disclosure typically consist of an explanation that an error has occurred, delivery of an explicit apology, an explanation of the facts around the event, its medical ramifications and how care will be managed, and a description of how similar errors will be prevented in the future. Although error disclosure is widely endorsed in the medical and nursing literature, there is little discussion of the unique role that the physician assistant (PA) might play in these interactions. PAs are trained in the medical model and technically practice under the supervision of a physician. They are also commonly integrated into interprofessional health care teams in surgical and urgent care settings. PA practice is characterized by widely varying degrees of provider autonomy. How PAs should collaborate with physicians in sensitive error disclosure conversations with patients is unclear. With the number of practicing PAs growing rapidly in nearly all domains of medicine, their role in the error disclosure process warrants exploration. The authors call for educational societies and accrediting agencies to support policy to establish guidelines for PA disclosure of error. They encourage medical and PA researchers to explore and report best-practice disclosure roles for PAs. Finally, they recommend that PA educational programs implement trainings in disclosure skills, and hospitals and supervising physicians provide and support training for practicing PAs.

Background: Important changes are occurring in how the medical profession approaches assessing and maintaining competence. Physician support for such changes will be essential for their success., Objective: To describe physician attitudes towards assessing and maintaining competence., Design: Cross-sectional internet survey., Participants: Random sample of 1,000 American College of Physicians members who were eligible to participate in the American Board of Internal Medicine Maintenance of Certification program., Main Measures: Questions assessed physicians' attitudes and experiences regarding: 1) self-regulation, 2) feedback on knowledge and clinical care, 3) demonstrating knowledge and clinical competence, 4) frequency of use and effectiveness of methods to assess or improve clinical care, and 5) transparency., Key Results: Surveys were completed by 446 of 943 eligible respondents (47%). Eighty percent reported it was important (somewhat/very) to receive feedback on their knowledge, and 94% considered it important (somewhat/very) to get feedback on their quality of care. However, only 24% reported that they receive useful feedback on their knowledge most/all of the time, and 27% reported receiving useful feedback on their clinical care most/all of the time. Seventy-five percent agreed that participating in programs to assess their knowledge is important to staying up-to-date, yet only 52% reported participating in such programs within the last 3 years. The majority (58%) believed physicians should be required to demonstrate their knowledge via a secure examination every 9-10 years. Support was low for Specialty Certification Boards making information about physician competence publically available, with respondents expressing concern about patients misinterpreting information about their Board Certification activities., Conclusions: A gap exists between physicians' interest in feedback on their competence and existing programs' ability to provide such feedback. Educating physicians about the importance of regularly assessing their knowledge and quality of care, coupled with enhanced systems to provide such feedback, is needed to close this gap.

The University of Washington (UW) Institute for Translational Health Sciences (ITHS), funded by a Clinical and Translational Sciences Award program, has supplemented its initial Kellogg Logic Model-based program evaluation with the eight judgment-based evaluative elements of the World Health Organization's (WHO) Health Services Assessment Model. This article describes the relationship between the two models, the rationale for the decision to supplement the evaluation with WHO evaluative elements, the value-added results of the WHO evaluative elements, and plans for further developing the WHO assessments.

Background: Patients want all their concerns heard, but physicians fear losing control of time and interrupt patients before all concerns are raised., Objective: We hypothesized that when physicians were trained to use collaborative upfront agenda setting, visits would be no longer, more concerns would be identified, fewer concerns would surface late in the visit, and patients would report greater satisfaction and improved functional status., Design and Participants: Post-only randomized controlled trial using qualitative and quantitative methods. Six months after training (March 2004-March 2005) physician-patient encounters in two large primary care organizations were audio taped and patients (1460) and physicians (48) were surveyed., Intervention: Experimental physicians received training in upfront agenda setting through the Establishing Focus Protocol, including two hours of training and two hours of coaching per week for four consecutive weeks., Main Measures: Outcomes included agenda setting behaviors demonstrated during the early, middle, and late encounter phases, visit length, number of raised concerns, patient and physician satisfaction, trust and functional status., Key Results: Experimental physicians were more likely to make additional elicitations (p < 0.01) and their patients were more likely to indicate agenda completion in the early phase of the encounter (p < 0.01). Experimental group patients and physicians raised fewer concerns in the late encounter phase (p < 0.01). There were no significant differences in visit length, total concerns addressed, patient or provider satisfaction, or patient trust and functional status, Conclusion: Collaborative upfront agenda setting did not increase visit length or the number of problems addressed per visit but may reduce the likelihood of "oh by the way" concerns surfacing late in the encounter. However, upfront agenda setting is not sufficient to enhance patient satisfaction, trust or functional status. Training focused on physicians instead of teams and without regular reinforcement may have limited impact in changing visit content and time use.

Objective: To evaluate the effect of changing a 1-hour weekly all-resident didactic conference to an expanded 4-hour bimonthly level-specific didactic conference., Design: Prospective outcome measures included an anonymous 10-item perceptions survey administered at 4 time points (preintervention, 6 months postintervention, 1 year postintervention, and 2 years postintervention), mean attendance rates preintervention and postintervention, and mean ABSITE scores preintervention and postintervention., Setting: Large university-based surgical residency., Participants: Surgical residents (R1-R5, n = 75) were divided into junior (R1-R3, n = 56) and senior (R4-R5, n = 19) groups. Each group attended a session every other Wednesday., Results: Significant improvements were observed in overall resident satisfaction (55% vs 80%, p < 0.005) and level-specific appropriateness of content (81% vs 94%, p < 0.001). Furthermore, resident attendance rates were improved substantially (33% vs 55%, p < 0.001). ABSITE scores were not affected significantly by the change in curriculum structure., Conclusions: An expanded, bimonthly level-specific didactic curriculum is more effective than a shorter, weekly all-resident conference as evidenced by resident attitudes and attendance. Additional benefits of the alternating schedule include a reduced number of residents in each conference and the availability of residents for clinical educational activities (eg, operative cases or clinic). Expanded educational time has allowed the introduction of nontraditional topics that include leadership, communication, practice management, professionalism, and technical skills training.

Context: The physician assistant profession has been moving toward requiring master's degrees for new practitioners, but some argue this could change the face of the discipline., Purpose: To see if there is an association between physician assistants' academic degrees and practice in primary care, in rural areas, and with the medically underserved., Methods: Surveys were sent to 880 graduates of the first 32 University of Washington physician assistant classes through 2000. Respondents noted their academic degree at program entry and the highest degree attained at any time up to the time of survey. Relationships between practice characteristics and academic degree levels were tested by unadjusted odds ratios and logistic regression after controlling for year of graduation and sex., Results: Of the 478 respondents, 54% worked in primary care, about 30% practiced in nonmetropolitan communities, and 42% reported providing care for the medically underserved. Respondents with no degree (33% of total at entry, 24% at survey) were significantly more likely than degree holders to work in primary care and nonmetropolitan areas. Respondents with no degree at program entry were significantly more likely, and those with no degree at the time of the survey were marginally more likely, to self-report work with the medically underserved., Conclusion: Respondents with no academic degree are significantly more likely to demonstrate a commitment to primary, rural, and underserved health care. These findings may inform the national debate about the impact of required advanced degrees on the practice patterns of nonphysician providers.

Purpose: To describe the development of the Washington Primary Care Interest Inventory (WPCII), which was designed to assess attitudes toward what constitutes appropriate psychosocial concerns for visiting a family physician, and to demonstrate the relationship between these attitudes and specialty selection in matriculating medical students., Method: Five entering classes of medical students (1990 to 1995, without 1992) at the University of Washington were administered the WPCII during orientation. Reliability, factor, and predictive validity analyses were performed to measure the utility of the WPCII., Results: Factor analysis revealed three interpretable factors to underlie the WPCII: stressors, physical complaints, and familial complaints. Scales developed from these factors correlated with students' early career preferences and showed significant differences across students who were selected under different interviewing formats. Differences between the sexes were found for both specific items and scales., Conclusion: The WPCII is a reliable and valid measure of attitudes toward the appropriateness of family physicians' treating psychosocial complaints. These attitudes have implications for the selection of medical students, curriculum development, assessment, and health education research.

We report results of a seven-year prospective cohort study of physicians' attitudes about and intentions to provide 27 preventive care services in their future practices. Respondents in the cohort were surveyed three times: first, during orientation to medical school; second, during their third year of medical school; and finally, following completion of their third-year of residency training. The majority of preventive care services were viewed as more important to clinical practice in primary care than in non-primary care specialties. Positive attitudes toward preventive care services generally persisted among both primary and non-primary care physicians. Respondents expressed only fair to medium levels of confidence in the ability of physicians in their specialty areas to provide any of the preventive services examined. Respondents reported low levels of confidence in the ability of primary care physicians to provide nutritional counseling, though they ranked it as important. Respondents were fairly or moderately confident in the ability of primary care physicians to provide counseling about smoking cessation, health, AIDS education, and substance abuse. Participants ranked smoking cessation counseling, health counseling, AIDS education, cancer detection education, and substance abuse counseling and education as very important. In general, physicians were less likely to plan on providing preventive services than they were to expect their residency programs to prepare most or all to provide the services. Findings document the need to prepare physicians better to provide preventive services.

This paper describes a collaborative survey of Chinese medical school teacher opinion concerning clinical behaviours and skills that Chinese students should be expected to demonstrate prior to graduation from medical school. Selected teachers from four Chinese medical schools indicated whether each of 77 objectives was: essential for every student to know or demonstrate prior to graduation; useful but not essential; or not applicable to their educational programmes. Results show teachers' expectations regarding some of the behaviours and skills Chinese medical school teachers consider to be important for students to learn. Forty-nine per cent of the exit objectives were regarded as essential by 75% or more of the teachers. The most essential objectives involved performing clinical procedures, collaborating and communicating with health care professionals, conducting organ system examinations, formulating hypotheses and defining problems. Other essential objectives were concerned with communicating with patients and their families, maintaining currency within the discipline, and recognition, evaluation and triage of patients with life-threatening or chronic conditions. Exit objectives related to health promotion and risk assessment were regarded as useful but not essential at the undergraduate level. Implications for Chinese medical education are discussed.

This paper describes a 1988-1989 collaborative mail survey of faculty opinion about clinical behaviors and skills that students should be expected to demonstrate prior to graduation from undergraduate medical school (hereafter called "exit objectives"). Selected faculty from 12 American and Canadian medical schools indicated whether each of 77 objectives was essential for every student to know or demonstrate prior to graduation; useful but not essential at the undergraduate level; or not applicable to their undergraduate program. Their responses provide a glimpse into faculty expectations regarding some of the exit behaviours and skills they deemed essential. Forty-two percent (32) of the 77 objectives were regarded as essential by 75% or more of the faculty members who responded. Essential objectives involved conducting organ system examinations, formulating problems and hypotheses, and gathering fundamental interview, physical, and screening examination data, including emergency examinations of the airway and circulatory systems. Other essential objectives involved collaboration and communication, demonstrating concern for legal and ethical values, and keeping abreast of current information within the discipline. Exit objectives related to the diagnosis and management of specific conditions were regarded as useful but not essential at the undergraduate level. Implications for medical education are discussed.

Pager-based activity sampling (PAS) is described as a cost-effective and unobtrusive method for sampling residents' activities in clinical settings. A sample program evaluation is presented using residents in an urban children's hospital resident-training program. The purposes of the program evaluation were: (a) to establish a behavioral baseline that would help clinical faculty understand how residents were using their time, and (b) to determine whether alterations in the way residents were assigned within the hospital resulted in desired changes to time spent. The primary rationale for changing resident-assignment policies were: (a) to decrease the time residents were spending in transit between various locations within the hospital, and (b) to increase the time spent by residents in educational activities and in direct contact with patients and their families. This PAS application demonstrates that the technique can produce statistically supportable conclusions, at minimal cost, without unduly disrupting either the residents or their patients. PAS is compared with other time-sampling methods, its limitations are discussed, and suggestions for future applications are provided.

Psychiatry residency training programs were characterized on four dimensions in a pilot study of seven West Coast schools. Residents and faculty rated their programs on academic versus clinical, community-based versus institution-based, private versus public practice, and biological versus psychological orientation. Faculty and residents from the same schools differed only on the academic-clinical dimension. Significant differences existed between schools on each axis. Variation in ratings on the biological-psychological axis suggests that claims to a "biopsychosocial" orientation may be too broad to be meaningful. This method of dimensional ratings appears appropriate for program assessment and deserves further development.

This paper presents results from two studies of primary care residency programs. Study I was a survey of preventive cardiology attitudes and practice-related intentions of internal medicine and family medicine residents from throughout the United States. Study II consisted of an examination of family medicine residents' perceptions regarding preventive practices and a series of 1,528 medical record reviews of their related assessment and counseling practices. The specific aims were to examine residents' perceptions about their residency programs and to determine the percentages of patients who were assessed for and, if necessary, counseled for coronary heart disease prevention. Results indicated that internal and family medicine residents believe that they should be prepared by their residency training to offer these services and that their residencies were preparing most of them to do so. While they report that they intend to assess and counsel patients in these areas, they do not seem to be doing so. The medical record reviews strongly indicated that they are not providing these services at the recommended levels, especially for assessment of and counseling for smoking and blood cholesterol levels.

This study assessed whether overall academic performance in undergraduate medical coursework can be predicted with reasonable accuracy by using grades from initial college-level courses rather than total premedical grade point averages (GPAs). Initial college grades from four areas, MCAT scores, and NBME I and II scores were recorded for students admitted to the University of Washington Medical School, for students admitted to other medical schools, and for students not admitted to any medical school. The results documented a high relationship between cumulative GPAs and initial grades, with differences found between those students admitted to medical school and those not admitted. The importance of this study is the documentation that little predictive utility is gained by waiting for overall college GPAs from medical school applicants. Initial GPAs are available 2 years earlier than overall GPAs and provide virtually the same information. Exploratory suggestions for medical school admission policies are made.