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Objectives • As the use of complementary and alternative medicine (CAM) has increased in the general population, so has the interest in CAM education among medical students and medical educators. The purpose of this study is to determine the impact of a CAM workshop using standardized patients (SP) on knowledge and clinical skills of third-year medical students. Design • A 4-hour CAM workshop was developed as part of a new curriculum for a required third-year 4-week primary care internal medicine clerkship. The CAM workshop and 3 other novel workshops were randomized for delivery to half of the rotational groups. The CAM workshop incorporates 4 SP cases representing different clinical challenges. All students in every rotation group are assigned CAM readings. At the end of the rotation, all students take a 100-item written exam (7 CAM items) and 9-station SP exam (1 CAM station) including a post- SP encounter open-ended written exercise. Scores on the writ- ten exam CAM items, CAM SP checklist, and CAM open-ended written exercise of workshop participants and nonparticipants were analyzed with simple means, standard deviations, and multiple regression approaches. Results • The CAM workshop was delivered to 12 of the 24 rotation groups during the 2004-2005 and 2005-2006 academic years. Ninety-two students participated in the workshop, and 94 did not. Workshop participants performed significantly better than nonparticipants on the CAM-specific SP checklist items (58 vs 36.6%, P<.0001), post-SP encounter written exercise (76.9 vs 63.3%, P<.0001), and 7 CAM written exam items (84.8 vs 76.3%, P<.0001). Conclusions • Students participating in a 4-hour SP workshop exhibit superior CAM knowledge as assessed by SP checklist, open-ended exercises, and multiple choice items. It appears that practice with SPs assists in acqusition and application of counseling skills. [ABSTRACT FROM AUTHOR]

The purpose of our study was to determine how time spent with the physician might be related to patient dissatisfaction with their waiting time. During a 2-month period, patients in our internal medicine resident continuity clinic completed a survey assessing their satisfaction with their waiting time and their estimates of their waiting time and time spent with the resident physician. For patients with long waiting times (more than 15 mm in the waiting room or more than 10 mm in the exam room), patient dissatisfaction with waiting time was associated with a shorter physician visit (48% were dissatisfied if the physician spent less than 15 mm vs. 18% if the physician spent more than 15 mm with them, p = .03). These data suggest that physicians can mediate the negative effects of long waiting times by spending more time with their patients. Future studies on patient satisfaction should consider this interaction. [ABSTRACT FROM AUTHOR]

Sexual history and HIV counseling are essential clinical skills. Our project's purpose was to evaluate a standardized patient (SP) educational intervention teaching third-year medical students sexual history taking and HIV counseling. A 4-hour SP workshop was delivered to one-half of the class. Four weeks later, all students engaged in an SP examination including one station on assessing sexual history taking and HIV counseling. Workshop participants scored one standard deviation higher on sexual history and HIV counseling items than nonparticipants. Our sexual history and HIV counseling curriculum was associated with students asking more thorough sexual histories and providing more HIV counseling. [ABSTRACT FROM AUTHOR]

Due to recent public debate and newly imposed resident work hour restrictions, we decided to investigate the relationship of resident call status to their ambulatory patients' satisfaction. Resident continuity clinic patients were asked to rate their level of satisfaction on a 10-point Likert-type scale. Using multiple regression approaches, these data were then assessed as a function of resident call status. We found that in 646 patient encounters, patient satisfaction scores were significantly less when the resident was postcall, 8.99 ± 1.8, than when not postcall, 9.31 ± 1.3. We herein discuss etiologies and implications of these findings for both patient care and medical education. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify what patient and physician factors influence resident satisfaction with patient encounters in a continuity clinic setting. Resident satisfaction was assessed from postencounter questionnaires completed by 68 internal medicine residents regarding 979 patient encounters. We found that residents were more satisfied with patients diagnosed with general medical problems than with patients diagnosed with pain and psychiatric disorders. First-year residents were less satisfied with patients diagnosed with pain and psychiatric disorders than second- and third-year residents. However, this dissatisfaction with seeing patients with pain or psychiatric disorders lessened as continuity of care was enhanced. J GEN INTERN MED 2004;19:456 – 459. [ABSTRACT FROM AUTHOR]

Background: Changes in academic medicine have left clerkship directors (CDs) anxious about their career pathway, because clerkship administrative efforts may detract from other activities. Purpose: The Clerkship Directors in Internal Medicine (CDIM) asked members about benefits of being a CD or CDIM membership toward career development. Methods: Responses were on 1-5 Likert scales with 5 (strongly agree). Background and demographic issues were analyzed for associations with the career benefits statements. Results: The response rate was 75% (n = 92). Mean agreement with CD benefit was 4.2 (SD = 0.82) and CDIM membership 3.8 (SD = 0.95). Eighty-one percent and 58% of CDs agreed with the respective statements. Significant predictors of CD benefit were CD and coordinator salary support, years as CD, and receiving a university teaching award. Structured discussions of expectations strongly predicted perceiving CDIM benefit. Conclusions: Most CDs agreed that their CD role and CDIM benefited their careers. Salary support and clearly defining expectations may increase the likelihood of perceiving benefit. [ABSTRACT FROM AUTHOR]

Peer and self-evaluation are crucial in the professional development of physicians. However, these skills must be learned, and there are barriers to their acceptance and successful utilization. To overcome these obstacles, it has been suggested that these concepts should be addressed longitudinally throughout medical education. Therefore, first-year medical students were introduced to peer and self-assessment as part of a videotape review during an interviewing course by having students complete written peer and self-assessments of the interviews. Students' self-assessments were compared with the assessments of peers and faculty. Written evaluations showed peers were more lenient than faculty and students were most critical of their own performances. Students could provide balanced assessments of their peers but were predominately negative regarding their own performances. It appears first-year students are capable of evaluating their peers but have difficulty accurately assessing their own performance. Further interventions are needed to foster self-assessment skills in first-year students. [ABSTRACT FROM AUTHOR]

The purpose of this study was to specify how student attitudes toward different types of patients and the profession change during clinical rotations. A questionnaire was given to all medical students prior to 3rd-year rotations regarding their attitudes toward the medical profession and patient types. It was given again after students completed their 16-week medicine-surgery clerkship. Eighty-eight of 96 students responded to pre- and posttests. Students became less idealistic toward two patient groups: the elderly and people with chronic pain. After clerkship, students believed a greater percentage of the elderly were demented (26% increasing to 35%, p = .09 and that a greater percentage of patients with chronic pain are drug seekers (15% increasing to 24%, p = .004). The authors conclude that in the 3rd year of medical school students become less idealistic toward elderly patients, those with chronic pain, and the profession. [ABSTRACT FROM AUTHOR]

Assesses whether providing physicians with routine comprehensive social history information on their patients will improve patient outcomes. Methodology of the study; Results and discussion.

Objectives. This study examined a private-sector, Statewide program (Kentucky Physicians Care) of care for uninsured indigent persons regarding provision of preventive services. Methods. A survey was conducted of a stratified random sample of 2509 Kentucky adults (811 with private insurance, 849 Medicaid recipients, 849 Kentucky Physicians Care recipients). Results, The Kentucky Physicians Care group had significantly lower rates of receipt of preventive services. Of the individuals in this group, 52% cited cost as the primary reason for not receiving mammography, and 38% had not filled prescribed medicines in the previous year. Conclusion. Providing free access to physicians fills important needs but is not sufficient for many uninsured patients to receive necessary preventive services. [ABSTRACT FROM AUTHOR]

Examines the effectiveness as a teaching tool of problem-based learning sessions incorporated into the third-year Internal Medicine Clerkship curriculum at the University of Kentucky in Lexington. Results of a survey of the teaching staff; Negative attitude toward the curriculum; Respondents' belief that students learn best on ward teams seeing patients.

As revealed by a quality-of-life survey done in a small rural Kentucky cohort, adults who live in rural areas who have congenital heart disease have a relatively poor health-related quality of life and face unique challenges in gaining employment, maintaining health insurance, and overcoming the perceived childhood stigma of being “different.” [Copyright &y& Elsevier]