45 results on '"Skeff KM"'
Search Results
2. Role models -- guiding the future of medicine.
- Author
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Skeff KM and Mutha S
- Published
- 1998
3. Trauma-Informed Healthcare Leadership? Evidence and opportunities from interviews with leaders during COVID-19.
- Author
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Harris SR, Amano A, Winget M, Skeff KM, and Brown-Johnson CG
- Subjects
- Humans, Male, Female, Interviews as Topic, Adult, Pandemics, Middle Aged, COVID-19 epidemiology, Leadership, SARS-CoV-2, Health Personnel psychology, Qualitative Research
- Abstract
Background: COVID-19 impacted the mental health of healthcare workers, who endured pressures as they provided care during a prolonged crisis. We aimed to explore whether and how a Trauma-Informed Care (TIC) approach was reflected in qualitative perspectives from healthcare leaders of their experience during COVID-19 (2020-2021)., Methods: Semi-structured interviews with healthcare leaders from four institutions were conducted. Data analysis consisted of four stages informed by interpretative phenomenological analysis: 1) deductive coding using TIC assumptions, 2) inductive thematic analysis of coded excerpts, 3) keyword-in-context coding of full transcripts for 6 TIC principles with integration into prior inductive themes, and 4) interpretation of themes through 6 TIC principles (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and awareness of cultural, historical, and gender issues)., Results: The actions of leaders (n = 28) that were reported as successful and supportive responses to the COVID-19 pandemic or else missed opportunities reflected core principles of Trauma-Informed Care. To promote safety, leaders reported affirmative efforts to protect staff by providing appropriate physical protection, and enhanced psychological safety by providing channels for communication about emotional well-being. To promote trustworthiness and transparency, leaders listened to their staff, shared current COVID-19 information, and increased frequency of meetings to disseminate accurate information. To promote mutual support, strategies included wellness check-ins, sharing uplifting stories, affirming common goals, articulating fears, and leading by example. Examples of empowerment included: making time and adjusting modalities for flexible communication; naming challenges outside of the hospital; and functioning as a channel for complaints. Reported missed opportunities included needing more dedicated time and space for healthcare employees to process emotions, failures in leadership managing their own anxiety, and needing better support for middle managers. Awareness of the TIC principle of cultural, historical, and gender issues was largely absent. Results informed the nascent Trauma-Informed Healthcare Leadership (TIHL) framework., Conclusions: We propose the Trauma-Informed Healthcare Leadership framework as a useful schema for action and analysis. This approach yields recommendations for healthcare leaders including creating designated spaces for emotional processing, and establishing consistent check-ins that reference personal and professional well-being., (© 2024. The Author(s).)
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- 2024
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4. Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record.
- Author
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Skeff KM, Brown-Johnson CG, Asch SM, Zionts DL, Winget M, and Kerem Y
- Subjects
- Electronic Health Records, Humans, Qualitative Research, Burnout, Professional prevention & control, Group Practice, Physicians psychology
- Abstract
Goal: Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR., Methods: In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR "distressing events" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies., Principal Findings: Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed., Practical Applications: Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Foundation of the American College of Healthcare Executives.)
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- 2022
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5. Restructuring the patient's history: enhancing the consultant's role as a teacher.
- Author
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Skeff KM
- Subjects
- Adult, Education, Medical, Continuing, Female, Humans, Interprofessional Relations, Physician-Patient Relations, Documentation methods, Documentation standards, Gastroenterology education, Medical History Taking methods, Medical History Taking standards, Referral and Consultation standards
- Published
- 2014
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6. Reassessing the HPI: the Chronology of Present Illness (CPI).
- Author
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Skeff KM
- Subjects
- Adult, Diarrhea therapy, Disease Progression, Fissure in Ano therapy, Humans, Male, Medical Records, Physician-Patient Relations, Time, Medical History Taking methods
- Published
- 2014
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7. Teaching behaviors in the cardiac surgery simulation environment.
- Author
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Fann JI, Sullivan ME, Skeff KM, Stratos GA, Walker JD, Grossi EA, Verrier ED, Hicks GL Jr, and Feins RH
- Subjects
- Animals, Clinical Competence, Communication, Comprehension, Curriculum, Educational Measurement, Feedback, Psychological, Humans, Internship and Residency, Learning, Models, Animal, Motor Skills, Perception, Program Evaluation, Self-Assessment, Surveys and Questionnaires, Swine, Task Performance and Analysis, Time Factors, Cardiac Surgical Procedures education, Education of Intellectually Disabled methods, Faculty, Medical, Models, Anatomic, Models, Cardiovascular, Teaching methods
- Abstract
Objective: To understand how teaching behaviors contribute to simulation-based learning, we used a 7-category educational framework to assess the teaching behaviors used in basic skills training., Methods: Twenty-four first-year cardiothoracic surgery residents and 20 faculty participated in the Boot Camp vessel anastomosis sessions. A portable chest model with synthetic graft and target vessels and a tissue-based porcine model simulated coronary artery anastomosis. After each 2-hour session on days 1 and 2, residents assessed teaching behaviors of faculty using a 20-item questionnaire based on the 5-point Likert scale. After session on day 1, faculty completed a self-assessment questionnaire. At 3 months, faculty completed self-assessment questionnaires regarding teaching behaviors in simulation and clinical settings. Each questionnaire item represents 1 or more teaching categories: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," "evaluation," "feedback," and "self-directed learning.", Results: Generally, resident ratings indicated that faculty showed positive teaching behaviors. Faculty self-assessment ratings were all lower (P < .025) than those assigned to them by the residents except for 1 component representative of "feedback," which approached significance (P = .04); 2 items, representative of "promoting understanding and retention" and "evaluation", had mean scores of less than 3. At 3 months, compared with self-assessment at Boot Camp, faculty ratings suggested improved teaching behaviors in their simulation settings in the following: "learning climate," "control of session," "communication of goals," "promoting understanding and retention," and "evaluation." The simulation environment was perceived as more positive for technical skills training in certain aspects compared with clinical setting: instructor reviewed function and operation of equipment with learner before session (representative of "promoting understanding and retention") and instructor allowed the learner ample time to practice (representative of "control of session" and "promoting understanding and retention") (P < .025)., Conclusions: Simulation-based skills training is perceived by residents to be associated with positive teaching behaviors. Faculty self-ratings indicate that they do not always use many of these teaching behaviors and that their performance can be improved. The simulation setting may provide greater opportunity for positive teaching behaviors compared with the clinical environment., (Published by Mosby, Inc.)
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- 2013
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8. A randomised controlled study of role play in a faculty development programme.
- Author
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Johansson J, Skeff KM, and Stratos GA
- Subjects
- Female, Humans, Male, Middle Aged, Program Evaluation, Self-Assessment, Sweden, Teaching methods, Faculty, Medical, Role Playing, Staff Development methods
- Abstract
Background: The Stanford Faculty Development Center at Stanford University has developed a teaching improvement course for medical teachers that has been widely disseminated using a train-the-trainer model., Aims: This study was designed to investigate the relative impact of role playing as an instructional technique within that course for facilitating change in teaching behaviours., Method: From January 2009 to April 2010, six faculty development courses were delivered at Uppsala University Hospital to 48 physicians from different departments. The standard course presentation includes a range of instructional methods including short lectures, small group discussion, review of video re-enactments, role-play exercises and personal goal setting. For this study, participants were randomised to participate in (1) a 'standard' course with role play or (2) an 'alternative' course with no role play. The effects of the course on teaching performance were assessed with retrospective pre- and post-course self-ratings of 29 specific teaching behaviours., Results: Self-assessment ratings indicated significantly greater positive changes in teaching behaviour among faculty who attended the standard course (with role play) as compared to those in the alternative course (p = 0.015)., Conclusions: This study validates the commonly held view that role play is a useful instructional method for improving teaching.
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- 2012
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9. "Teaching as a Competency": competencies for medical educators.
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Srinivasan M, Li ST, Meyers FJ, Pratt DD, Collins JB, Braddock C, Skeff KM, West DC, Henderson M, Hales RE, and Hilty DM
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- Humans, Clinical Competence standards, Competency-Based Education methods, Education, Medical methods, Faculty, Medical standards, Teaching standards
- Abstract
Most medical faculty receive little or no training about how to be effective teachers, even when they assume major educational leadership roles. To identify the competencies required of an effective teacher in medical education, the authors developed a comprehensive conceptual model. After conducting a literature search, the authors met at a two-day conference (2006) with 16 medical and nonmedical educators from 10 different U.S. and Canadian organizations and developed an initial draft of the "Teaching as a Competency" conceptual model. Conference participants used the physician competencies (from the Accreditation Council for Graduate Medical Education [ACGME]) and the roles (from the Royal College's Canadian Medical Education Directives for Specialists [CanMEDS]) to define critical skills for medical educators. The authors then refined this initial framework through national/regional conference presentations (2007, 2008), an additional literature review, and expert input. Four core values grounded this framework: learner engagement, learner-centeredness, adaptability, and self-reflection. The authors identified six core competencies, based on the ACGME competencies framework: medical (or content) knowledge; learner- centeredness; interpersonal and communication skills; professionalism and role modeling; practice-based reflection; and systems-based practice. They also included four specialized competencies for educators with additional programmatic roles: program design/implementation, evaluation/scholarship, leadership, and mentorship. The authors then cross-referenced the competencies with educator roles, drawing from CanMEDS, to recognize role-specific skills. The authors have explored their framework's strengths, limitations, and applications, which include targeted faculty development, evaluation, and resource allocation. The Teaching as a Competency framework promotes a culture of effective teaching and learning.
- Published
- 2011
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10. Global health training and international clinical rotations during residency: current status, needs, and opportunities.
- Author
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Drain PK, Holmes KK, Skeff KM, Hall TL, and Gardner P
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- Humans, Needs Assessment, Education, Medical, Graduate organization & administration, Global Health, International Educational Exchange, Internship and Residency organization & administration
- Abstract
Increasing international travel and migration have contributed to globalization of diseases. Physicians today must understand the global burden and epidemiology of diseases, the disparities and inequities in global health systems, and the importance of cross-cultural sensitivity. To meet these needs, resident physicians across all specialties have expressed growing interest in global health training and international clinical rotations. More residents are acquiring international experience, despite inadequate guidance and support from most accreditation organizations and residency programs. Surveys of global health training, including international clinical rotations, highlight the benefits of global health training as well as the need for a more coordinated approach. In particular, international rotations broaden a resident's medical knowledge, reinforce physical examination skills, and encourage practicing medicine among underserved and multicultural populations. As residents recognize these personal and professional benefits, a strong majority of them seek to gain international clinical experience. In conclusion, with feasible and appropriate administrative steps, all residents can receive global health training and be afforded the accreditation and programmatic support to participate in safe international rotations. The next steps should address accreditation for international rotations and allowance for training away from continuity clinics by residency accreditation bodies, and stipend and travel support for six or more weeks of call-free elective time from residency programs.
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- 2009
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11. The chromosomal analysis of teaching: the search for promoter genes.
- Author
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Skeff KM
- Subjects
- Education, Medical, Undergraduate standards, Education, Medical, Undergraduate trends, United States, Education, Medical, Undergraduate methods, Teaching standards, Teaching trends
- Abstract
The process of teaching is ubiquitous in medicine, both in the practice of medicine and the promotion of medical science. Yet, until the last 50 years, the process of medical teaching had been neglected. To improve this process, the research group at the Stanford Faculty Development Center for Medical Teachers developed an educational framework to assist teachers to analyze and improve the teaching process. Utilizing empirical data drawn from videotapes of actual clinical teaching and educational literature, we developed a seven-category systematic scheme for the analysis of medical teaching, identifying key areas and behaviors that could enable teachers to enhance their effectiveness. The organizational system of this scheme is similar to that used in natural sciences, such as genetics. Whereas geneticists originally identified chromosomes and ultimately individual and related genes, this classification system identifies major categories and specific teaching behaviors that can enhance teaching effectiveness. Over the past two decades, this organizational framework has provided the basis for a variety of faculty development programs for improving teaching effectiveness. Results of those programs have revealed several positive findings, including the usefulness of the methods for a wide variety of medical teachers in a variety of settings. This research indicates that the development of a framework for analysis has been, as in the natural sciences, an important way to improve the science of the art of teaching.
- Published
- 2007
12. Benefits of resident work hours regulation.
- Author
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Skeff KM, Ezeji-Okoye S, Pompei P, and Rockson S
- Subjects
- Continuity of Patient Care standards, Fatigue prevention & control, Humans, Personnel Staffing and Scheduling, Internship and Residency standards, Patient Care standards, Work Schedule Tolerance
- Published
- 2004
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13. Embedding faculty development in teaching hospitals: moving beyond the status quo.
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Stratos GA, Bergen MR, and Skeff KM
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- Education, Medical, Continuing standards, Humans, Program Evaluation, Training Support trends, United States, Education, Medical, Continuing organization & administration, Faculty, Medical, Staff Development trends
- Published
- 2004
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14. Lymphatic biology and disease: is it being taught? Who is listening?
- Author
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Rockson SG, Granger DN, Skeff KM, and Chaite W
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- Humans, Lymphatic Vessels physiopathology, Education, Medical methods, Lymphatic Diseases physiopathology, Lymphatic Vessels physiology
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- 2004
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15. The development and implementation of a curriculum to improve clinicians' self-directed learning skills: a pilot project.
- Author
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Bravata DM, Huot SJ, Abernathy HS, Skeff KM, and Bravata DM
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- Clinical Competence, Humans, Internal Medicine, Internship and Residency, Learning, Pilot Projects, Curriculum, Education, Medical
- Abstract
Background: Clinicians need self-directed learning skills to maintain competency. The objective of this study was to develop and implement a curriculum to teach physicians self-directed learning skills during inpatient ward rotations., Methods: Residents and attendings from an internal medicine residency were assigned to intervention or control groups; intervention physicians completed self-directed learning curricular exercises., Results: Among the 43 intervention physicians, 21 (49%) completed pre- and post-curriculum tests; and 10 (23%) completed the one-year test. Immediately after exposure to the curriculum, the proportion of physicians defining short- and long-term learning goals increased [short-term: 1/21 (5%) to 11/21 (52%), p = 0.001; long-term: 2/21 (10%) to 15/21 (71%), p = 0.001]. There were no significant changes post-curriculum in the quantity or quality of clinical question asking. The physicians' mean self-efficacy (on a 100-point scale) improved for their abilities to develop a plan to keep up with the medical literature (59 vs. 72, p = 0.04). The effects of the curriculum on self-reported learning behaviors was maintained from the immediate post-curriculum test to the one-year post curriculum test: [short-term learning goals: 1/21 (5%) pre-, 11/21 (52%) immediately post-, and 5/10 (50%) one-year after the curriculum (p = 0.0075 for the pre- vs one-year comparison); long-term learning goals: 2/21 (10%) pre-, 15/21 (71%) immediately post-, and 7/10 (70%) one-year (p = 0.0013 for the pre- vs one-year comparison). At one-year, half of the participants reported changed learning behaviors., Conclusions: A four-week curriculum may improve self-directed learning skills.
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- 2003
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16. How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting?
- Author
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Simon SR, Davis D, Peters AS, Skeff KM, and Fletcher RH
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- Faculty, Medical, Female, Humans, Male, Massachusetts, Physician-Patient Relations, Primary Health Care, Students, Medical, Teaching, Ambulatory Care organization & administration, Internal Medicine education, Patient Selection, Pediatrics education, Preceptorship
- Abstract
Objective: To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process., Design: Qualitative analysis of transcribed interviews., Setting: Harvard Medical School, Boston, Mass., Participants: Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors., Measurements: Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching., Main Results: Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient., Conclusions: These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.
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- 2003
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17. Factorial validation of an educational framework using residents' evaluations of clinician-educators.
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Litzelman DK, Westmoreland GR, Skeff KM, and Stratos GA
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- Clinical Competence, Factor Analysis, Statistical, Faculty, Medical, Humans, Indiana, Surveys and Questionnaires, Education, Medical, Graduate, Internal Medicine education, Internship and Residency, Teaching standards
- Published
- 1999
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18. Regional teaching improvement programs for community-based teachers.
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Skeff KM, Stratos GA, Bergen MR, Sampson K, and Deutsch SL
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- Adult, Aged, Education, Faculty, Medical, Feasibility Studies, Female, Humans, Male, Middle Aged, Program Evaluation, Societies, Medical, Surveys and Questionnaires, United States, Workforce, Education, Medical, Continuing, Teaching methods
- Abstract
Purpose: Community-based clinical teachers provide an important cadre of faculty for medical education. This study was designed to examine the feasibility and value of an American College of Physicians-sponsored regional teaching improvement program for community-based teachers., Subjects and Methods: We conducted five regional (Connecticut, New Hampshire/Vermont, New York, Ohio, and Virginia) 1- to 2-day teaching-improvement workshops for 282 faculty (49% community based, 51% university based). The workshops were conducted by regional facilitators trained by the Stanford Faculty Development Program using large group and small group instructional methods to teach participants a framework for analyzing teaching, to increase their repertoire of teaching behaviors, to define personal teaching goals, and to identify the educational needs of their teaching site. Participants used Likert ratings [1 (low) to 5 (high) scale] to assess workshop quality, facilitator effectiveness, and rewards for and barriers to teaching in their clinics. Using retrospective pre- and postintervention ratings, participants also assessed workshop impacts on teacher knowledge, attitudes, and skills. Finally, participants completed open-ended questions to identify recommended changes to improve their clinic as an educational site for students and residents., Results: At all sites, participants evaluated the program as highly useful (4.6 +/- 0.6, mean +/- SD). Participants' ratings indicated that the program had a positive effect on their knowledge of teaching principles (4.0 +/- 0.9), an increase in their teaching ability (P <0.001), and an increase in their sense of integration with their affiliated institution (P <0.001)., Conclusions: Regional training of university and community faculty can be an effective way of promoting the improvement of teaching and the collaboration between community-based teachers and academic centers. National physician organizations and regionally based facilitators can provide important resources for the delivery of such training.
- Published
- 1999
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19. Living with gout: preventing the fire.
- Author
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Skeff KM
- Subjects
- Gout drug therapy, Gout psychology, Humans, Patient Compliance, Communication, Gout prevention & control, Learning, Patient Education as Topic, Teaching
- Published
- 1998
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20. Factorial validation of a widely disseminated educational framework for evaluating clinical teachers.
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Litzelman DK, Stratos GA, Marriott DJ, and Skeff KM
- Subjects
- Adult, Female, Follow-Up Studies, Hospitals, Teaching, Humans, Information Services, Male, Program Evaluation, Reproducibility of Results, Retrospective Studies, Surveys and Questionnaires, United States, Education, Medical, Undergraduate standards, Faculty, Medical standards, Staff Development methods, Teaching standards
- Abstract
Purpose: To examine an instrument for evaluating clinical teaching using factor analysis and to refine the validated instrument to a practical length., Method: Factor analysis on a split sample of 1,581 student evaluations rating 178 teachers. The instrument was based on the seven-category Stanford Faculty Development Program's (SFDP's) clinical teaching framework and contained 58 Likert-scaled items, with at least seven items per category plus five items measuring "teacher's knowledge." Standard methodology for survey item reduction was used to remove items with low or complex factor loadings and iteratively remove items with low item-scale correlation. Results were replicated on the second sample., Results: The seven original categories emerged and items originally categorized under "knowledge" statistically combined with "promoting self-directed learning." Over 73% of the variance was explained. Item reduction resulted in 25 items with overall internal consistency over .97 and internal consistency of constructs ranging from .82 to .95., Conclusions: Factor analysis of student ratings validated the seven-category SFDP framework. An abbreviated instrument to measure the seven categories is described. Results suggest that students may not systematically distinguish between their teachers' knowledge and their teachers' ability to promote self-directed learning, an important finding for both administrators and faculty development programs.
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- 1998
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21. A pilot study of faculty development for basic science teachers.
- Author
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Skeff KM, Stratos GA, Bergen MR, and Regula DP Jr
- Subjects
- Adult, Aged, Curriculum, Education, Medical, Undergraduate organization & administration, Education, Medical, Undergraduate trends, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pilot Projects, Program Evaluation trends, Surveys and Questionnaires, Teaching organization & administration, Teaching trends, Teaching Materials standards, United States, Education, Medical, Undergraduate standards, Faculty, Medical organization & administration, Faculty, Medical standards, Pathology education, Program Evaluation methods, Staff Development, Teaching standards
- Abstract
Purpose: Relatively little research has focused on faculty development methods that assist basic science teachers to improve their instructional skills. This study was designed to assess the effectiveness for basic science faculty of a faculty development seminar series that had been previously shown useful for clinical teachers., Method: The Stanford Faculty Development Program's seminars on clinical teaching were adapted for basic science instruction. Eight pathology faculty participated in a series of nine small-group seminars designed to provide teachers with knowledge of a framework for analyzing teaching and identifying areas for improvement, and skill-based training in specific teaching behaviors. Each seminar included (1) brief lectures, (2) review of videotaped reenactments of teaching interactions, (3) role-play exercises with videotape review, and (4) formulation of personal and departmental teaching goals., Results: Program evaluation included multiple measures: participant self-assessment, student ratings of the participants, and blinded ratings of pre- and post-seminar videotapes of participants' classroom teaching. All measures indicated a positive effect of the intervention., Conclusion: Faculty development programs have significant potential to enhance basic science instructors' teaching effectiveness.
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- 1998
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22. Beneficial and harmful effects of augmented feedback on physicians' clinical-teaching performances.
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Litzelman DK, Stratos GA, Marriott DJ, Lazaridis EN, and Skeff KM
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- Clinical Clerkship, Communication, Feedback, Humans, Indiana, Internship and Residency, Linear Models, Medical Staff, Hospital, Clinical Medicine education, Professional Competence, Students, Medical, Teaching
- Abstract
Purpose: To evaluate whether clinical-teaching skills could be improved by providing teachers with augmented student feedback., Method: A randomized, controlled trial in 1994 included 42 attending physicians and 39 residents from the Department of Medicine at the Indiana University School of Medicine who taught 110 students on medicine ward rotations for one-month periods. Before teaching rotations, intervention group teachers received norm-referenced, graphic summaries of their teaching performances as rated by students. At mid-month, intervention group teachers received students' ratings augmented by individualized teaching-effectiveness guidelines based on the Stanford Faculty Development Program framework. Linear models were used to analyze the students' mean ratings of teaching behaviors at mid-month and end-of-month. Independent variables included performance ratings, intervention status, teacher status, teaching experience, and interactions with baseline ratings., Results: Complex interactions with baseline performance were found for most teaching categories at mid-month and end-of-month. The intervention-group teachers who had high baseline performance scores had higher student ratings than did the control group teachers with similar baseline scores; the intervention group teachers who had low baseline performance scores were rated lower than were the control group teachers with comparable baseline scores. The residents who had medium or high baseline scores were rated higher than were the attending physicians with comparable baseline scores; the performance of the residents who had low baseline scores was similar to that of the attending physicians with comparable baseline scores., Conclusion: Baseline performance is important for targeting those teachers most likely to benefit from augmented student feedback. Potential deterioration in teaching performance warrants a reconsideration of distributing students' ratings to teachers with low baseline performance scores.
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- 1998
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23. Prioritizing areas for faculty development of clinical teachers by using student evaluations for evidence-based decisions.
- Author
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Vu TR, Marriott DJ, Skeff KM, Stratos GA, and Litzelman DK
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- Adult, Education, Medical, Undergraduate, Female, Humans, Internship and Residency, Male, Medical Staff, Hospital, Surveys and Questionnaires, Decision Making, Faculty, Medical, Program Evaluation, Staff Development, Students, Medical, Teaching
- Published
- 1997
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24. Protecting time for teaching in the ambulatory care setting.
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Skeff KM, Bowen JL, and Irby DM
- Subjects
- Time Factors, Ambulatory Care, Clinical Medicine education, Preceptorship methods, Teaching
- Abstract
The current drive for efficient clinical teaching threatens the educational mission of academic medical centers. With pressures to increase clinical productivity, protected time and compensation for teaching have become scarce resources for clinical teachers in all settings. Although it may yield new approaches to education, the push for efficiency may ultimately result in insufficient time for teaching and may cause some clinical preceptors to stop teaching completely. Further, it may lead to the illusion that comprehensive teaching truly requires little time. Since the future of American health care depends upon the provision of high-quality clinical education to young physicians, this situation presents a potential national crisis. In this article, the authors discuss the complex nature of teaching, its time requirements, and the special challenges of teaching in outpatient settings. To avoid overemphasizing efficiency to the detriment of education they recommend adhering to two principles: (1) academic medical centers are educational as well as training institutions, and therefore should provide a broad-based education as well as training in clinical skills; and (2) the clinical teaching process is complex and adequate time must be provided for its many phases, including planning, instructing, and reflecting. Finally, the authors make recommendations for ensuring the delivery of high-quality education in ambulatory care settings.
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- 1997
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25. Clinical teaching improvement: past and future for faculty development.
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Skeff KM, Stratos GA, Mygdal WK, DeWitt TG, Manfred LM, Quirk ME, Roberts KB, and Greenberg LW
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- Curriculum trends, Forecasting, Humans, Program Evaluation, United States, Clinical Clerkship, Education trends, Education, Medical, Continuing trends, Faculty, Medical, Family Practice education, Fellowships and Scholarships trends
- Abstract
Faculty development programs have focused on the improvement of clinical teaching for several decades, resulting in a wide variety of programs for clinical teachers. With the current constraints on medical education, faculty developers must reexamine prior work and decide on future directions. This article discusses 1) the rationale for providing faculty development for clinical teachers, 2) the competencies needed by clinical teachers, 3) the available programs to assist faculty to master those competencies, and 4) the evaluation methods that have been used to assess these programs. Given this background, we discuss possible future directions to advance the field.
- Published
- 1997
26. Faculty development. A resource for clinical teachers.
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Skeff KM, Stratos GA, Mygdal W, DeWitt TA, Manfred L, Quirk M, Roberts K, Greenberg L, and Bland CJ
- Subjects
- Education, Medical, Graduate trends, Faculty, Medical standards, Guidelines as Topic, Health Knowledge, Attitudes, Practice, Humans, Internship and Residency, Program Evaluation, Teaching methods, United States, Clinical Competence, Education, Medical, Graduate methods, Faculty, Medical organization & administration, Hospitals, Teaching methods, Teaching standards
- Published
- 1997
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27. Effective learning of geriatric medicine. A challenge to clinical teachers.
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Skeff KM, Pompei P, and Stratos GA
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- Humans, Educational Measurement, Geriatrics education
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- 1996
- Full Text
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28. Assessing clinician-teachers in the outpatient clinic.
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Skeff KM and Litzelman DK
- Subjects
- Evaluation Studies as Topic, Internship and Residency, Outpatient Clinics, Hospital, Clinical Competence, Internal Medicine education
- Published
- 1995
- Full Text
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29. The effect of a clinical teaching retreat on residents' teaching skills.
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Litzelman DK, Stratos GA, and Skeff KM
- Subjects
- Education, Medical, Undergraduate, Educational Measurement, United States, Clinical Medicine education, Internship and Residency, Teaching standards
- Published
- 1994
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30. Impact of a clinical preventive medicine curriculum for primary care faculty: results of a dissemination model.
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Albright CL, Farquhar JW, Fortmann SP, Sachs DP, Owens DK, Gottlieb L, Stratos GA, Bergen MR, and Skeff KM
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- Adult, Female, Humans, Internship and Residency, Male, Models, Theoretical, Teaching, Clinical Competence, Curriculum, Faculty, Medical, Internal Medicine education, Preventive Medicine education
- Abstract
Background: This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States., Methods: The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise., Results: Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics., Conclusions: The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.
- Published
- 1992
- Full Text
- View/download PDF
31. Improving clinical teaching. Evaluation of a national dissemination program.
- Author
-
Skeff KM, Stratos GA, Berman J, and Bergen MR
- Subjects
- Information Services, Models, Theoretical, Program Evaluation, Surveys and Questionnaires, United States, Education, Medical, Undergraduate standards, Staff Development methods, Teaching standards
- Abstract
This study assessed a dissemination approach to improve clinical teaching. We hypothesized that (1) physicians from a variety of institutions nationwide could be trained to conduct teaching improvement seminars for faculty colleagues; (2) such seminars would be perceived as highly useful; (3) pre/post self-evaluations by faculty participants and evaluations of faculty participants by house staff/students would indicate improved teaching performance. Selected medical faculty completed 1 month of facilitator training at the Stanford Faculty Development Program, Palo Alto, Calif. They then delivered teaching improvement seminars for other faculty. From 1986 to 1988, 12 facilitators from 12 institutions trained 107 faculty at their home institutions in their initial seminar series. Their seminars were rated as highly useful by participants. Both faculty self-assessments and house staff/student ratings indicated improved teaching performance. We concluded that this dissemination approach provides one possible mechanism for ongoing teaching improvement within institutions across the country.
- Published
- 1992
- Full Text
- View/download PDF
32. The experience of house officers. An area deserving further study.
- Author
-
Skeff KM
- Subjects
- Clinical Competence, Humans, Personnel Staffing and Scheduling, Reading, United States, Work Schedule Tolerance, Internal Medicine education, Internship and Residency standards
- Published
- 1990
33. Using the patient's history to estimate the probability of coronary artery disease: a comparison of primary care and referral practices.
- Author
-
Sox HC Jr, Hickam DH, Marton KI, Moses L, Skeff KM, Sox CH, and Neal EA
- Subjects
- Adult, Ambulatory Care Facilities, Chest Pain diagnosis, Coronary Angiography, Coronary Disease diagnostic imaging, Female, Follow-Up Studies, Health Maintenance Organizations, Hospitals, Veterans, Humans, Logistic Models, Male, Middle Aged, Probability, Risk Factors, Coronary Disease diagnosis, Primary Health Care, Referral and Consultation
- Abstract
Purpose: According to probability theory, the interpretation of new information should depend on the prior probability of disease. We asked if this principle applies to interpreting the history in patients with chest pain. We compared the prevalence of coronary artery disease (CAD) in patients who had similar histories but who came from populations with different disease prevalence., Patients and Methods: We studied two high-disease-prevalence populations (patients referred for coronary arteriography) and two low-disease-prevalence populations (patients from primary care practices). We used clinical characteristics of one arteriography population to develop a logistic rule for estimating the probability of coronary artery narrowing. The number of clinical findings determined the logistic score, which was proportional to the prevalence of CAD., Results: The prevalence of CAD was much lower in the primary care population than in the arteriography population, even when patients with similar logistic scores, and thus similar clinical histories, were compared., Conclusion: A clinician must take account of the overall prevalence of disease in the clinical setting when using the patient's history to estimate the probability of disease. Failure to observe this caution may lead to errors in test selection and interpretation.
- Published
- 1990
- Full Text
- View/download PDF
34. Symposium: Videotapes as teaching tools: three applications in medical education.
- Author
-
Gerbert B, Lipkin M Jr, Retchin S, and Skeff KM
- Subjects
- Clinical Clerkship, Interviews as Topic methods, Education, Medical methods, Teaching Materials, Videotape Recording
- Published
- 1984
35. Process and product in clinical teaching: a correlational study.
- Author
-
Skeff KM, Campbell M, and Stratos G
- Subjects
- California, Clinical Competence, Faculty, Medical standards, Learning, Videotape Recording, Teaching standards
- Published
- 1985
36. Assessment by attending physicians of a seminar method to improve clinical teaching.
- Author
-
Skeff KM, Campbell M, Stratos G, Jones HW 3rd, and Cooke M
- Subjects
- California, Education, Medical, Humans, Videotape Recording, Internship and Residency, Teaching
- Abstract
The authors in this article present assessments by attending physicians of a seminar method to improve clinical teaching. An experimental study was conducted to determine whether or not the seminar method (a) is perceived by attending physicians as beneficial, (b) modifies the physicians' attitudes toward teaching, (c) enables attending physicians to define needed teaching changes, (d) motivates them to improve their teaching performance, and (e) is perceived as having long-term benefits. Forty-six inpatient attending physicians from four California institutions participated in the study. The physicians were randomly assigned to an experimental group which attended a seminar on clinical teaching or to a control group which received no such intervention. Questionnaires completed by the physicians indicated that the teachers who experienced the seminar method perceived it as beneficial, improved their attitudes toward clinical teaching, determined needed teaching changes, attempted to implement new teaching approaches, and perceived long-term benefits.
- Published
- 1984
- Full Text
- View/download PDF
37. Tuberculous pneumonia with the syndrome of inappropriate secretion of antidiuretic hormone: cause of the adult respiratory distress syndrome.
- Author
-
Sahn SA and Skeff KM
- Subjects
- Aged, Blood Urea Nitrogen, Electrolytes blood, Humans, Male, Oxygen Inhalation Therapy, Radiography, Respiratory Distress Syndrome diagnostic imaging, Tuberculosis, Pulmonary diagnostic imaging, Pulmonary Fibrosis diagnostic imaging, Tuberculosis, Pulmonary complications, Vasopressins metabolism
- Abstract
Bilateral tuberculous pneumonia with the syndrome of inappropriate secretion of antidiuretic hormone was the cause of the adult respiratory distress syndrome in an elderly patient. Early recognition and prompt therapy enabled the patient to make a complete recovery without the necessity for mechanical ventilation. With the shift of care of tuberculous patients out of the sanitorium, the practicing physician should be aware of the varied manifestations of tuberculosis.
- Published
- 1977
- Full Text
- View/download PDF
38. Symposium: The study and improvement of clinical instruction.
- Author
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Stritter FT, Kappelman MM, Irby DM, and Skeff KM
- Subjects
- Clinical Competence, Education, Medical, Teaching methods
- Published
- 1983
39. Evaluation of attending physicians: three perspectives.
- Author
-
Skeff KM, Campbell M, and Stratos G
- Subjects
- Education, Medical, Self-Evaluation Programs, Teaching, Videotape Recording, Clinical Competence, Physician's Role, Role
- Published
- 1984
40. A study of the implicit criteria used in diagnosing chest pain.
- Author
-
Hickam DH, Sox HC Jr, Marton KI, Skeff KM, and Chin D
- Subjects
- Angina Pectoris diagnosis, Coronary Angiography, Humans, Nitroglycerin therapeutic use, Pain drug therapy, Risk, Coronary Disease diagnosis, Pain diagnosis, Thorax
- Abstract
Although previous studies have reported the prevalence of coronary artery disease among patients with typical and atypical angina, criteria for the definition of these chest pain syndromes have not been well described. We studied the implicit criteria used by physicians to classify patients with chest pain. Five internists reviewed the histories of 190 subjects admitted to the hospital for elective coronary arteriography and rated each history as indicating either high or low risk of coronary disease. We applied logistic discriminant analysis to these ratings to create a decision rule for the classification of patients with anginal syndromes. The prevalence of confirmed coronary artery disease in subjects classified by the rule as at high risk was 0.83; the prevalence was 0.57 in subjects classified as at low risk. These prevalences are similar to those found for typical and atypical angina in previous large studies. We conclude that this linear model represents the physicians' decisions and provides criteria for defining anginal pain syndromes in certain settings.
- Published
- 1982
- Full Text
- View/download PDF
41. Enhancing teaching effectiveness and vitality in the ambulatory setting.
- Author
-
Skeff KM
- Subjects
- Ambulatory Care, Ambulatory Care Facilities, Education, Medical, Faculty, Medical, Teaching methods
- Published
- 1988
- Full Text
- View/download PDF
42. Clinical teaching: three perspectives on faculty development.
- Author
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Medio FJ, Greenberg L, Skeff KM, and Wilkerson L
- Subjects
- Education, Medical, Internship and Residency, Students, Medical, Faculty, Medical, Teaching
- Published
- 1985
43. Evaluation of the seminar method to improve clinical teaching.
- Author
-
Skeff KM, Stratos G, Campbell M, Cooke M, and Jones HW 3rd
- Subjects
- Adult, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Random Allocation, Surveys and Questionnaires, Videotape Recording, Clinical Competence, Education, Medical, Teaching methods
- Abstract
The effects of a seminar method to improve the teaching of ward attending physicians were evaluated. Forty-six attending physicians from four institutions were randomly assigned to experimental and control groups. The method was evaluated to assess its effects on attending physicians' performances and attitudes, and impact on learners. Evaluation methods included ratings of videotapes of ward rounds, teachers' subjective assessments of both their teaching performances and their experiences in the study, and trainee ratings. Videotape ratings, the teachers' own assessments, and the trainees' assessments of the attending physicians' impact on learning were significantly different, favoring the experimental group (p less than 0.05). It is concluded that the seminar method can provide the basis for effective and feasible approaches for improving clinical teaching by attending physicians.
- Published
- 1986
- Full Text
- View/download PDF
44. Evaluation of a method for improving the teaching performance of attending physicians.
- Author
-
Skeff KM
- Subjects
- Adult, Aged, Attitude, Evaluation Studies as Topic, Humans, Learning, Middle Aged, Surveys and Questionnaires, Videotape Recording, Education, Medical, Physicians, Teaching methods
- Abstract
The effects of an intensive feedback method on the teaching performance of ward attending physicians were evaluated. Sixty-four attending physicians were randomly assigned to one of four experimental groups: (1) intensive feedback, (2) videotape control, (3) questionnaire feedback, or (4) questionnaire control. The method was evaluated using the teachers' subjective assessments, ratings of videotapes of ward rounds, and trainee ratings. Seventy-five percent of the intensive feedback group rated their treatment definitely beneficial in contrast to less than 13 percent of teachers in other groups (p less than 0.001). The intensive feedback group received higher post-treatment videotape ratings than the videotape control group, both on ratings of specific categories of teacher behavior (p = 0.03) and on ratings of overall teaching performance (p = 0.08). More intensive feedback teachers (40 percent) than videotape control teachers (6 percent) improved their personally identified problem teaching behaviors (p less than 0.05). Trainee ratings showed no significant difference between study groups. It is concluded that attending physicians can improve their teaching performance. Intensive feedback is one possible method of achieving that goal.
- Published
- 1983
- Full Text
- View/download PDF
45. Medical students look ahead.
- Author
-
Nossaman N, Ridgway EC, Slater C, Wilson L, Reiff MI, Carris CK, and Skeff KM
- Subjects
- Health Planning, Politics, United States, Comprehensive Health Care, Military Medicine, Students, Medical
- Published
- 1968
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