Search

Background and objectivesFamily medicine clerkships depend heavily on community-based family physician preceptors to teach medical students. These preceptors have traditionally been unpaid, but in recent years some clerkships have started to pay preceptors. This study determines trends in the number and geographic region of programs that pay their community preceptors, identifies reasons programs pay or do not pay, and investigates perceived advantages and disadvantages of payment.MethodsWe conducted a cross-sectional, electronic survey of 134 family medicine clerkship directors at allopathic US medical schools.ResultsThe response rate was 62% (83/132 clerkship directors). Nineteen of these (23%) currently pay community preceptors, 11 of whom are located in either New England or the South Atlantic region. Sixty-three percent of programs who pay report that their community preceptors are also paid for teaching other learners, compared to 32% of those programs who do not pay. Paying respondents displayed more positive attitudes toward paying community preceptors, though a majority of non-paying respondents indicated they would pay if they had the financial resources.ConclusionsThe majority of clerkships do not pay their community preceptors to teach medical students, but competition from other learners may drive more medical schools to consider payment to help with preceptor recruitment and retention. Medical schools located in regions where there is competition for community preceptors from other medical and non-medical schools may need to consider paying preceptors as part of recruitment and retention efforts.

The changes in existing specialties and the demographic composition of medical school classes suggested that the predictive validity of the Myers-Briggs Type Indicator should be reexamined. MBTI scores of students at the University of North Carolina at Chapel Hill School of Medicine were cross-tabulated with their specialty choice. (MLW)

Background and Objectives: The study's objective was to determine whether participation in an international health rotation in a Spanish-speaking country (immersion) is associated with improved Spanish fluency compared to participation in domestic medical Spanish coursework alone., Methods: Participants matriculated at one US medical school in the years 2004--2008. At matriculation (baseline), all had intermediate to advanced Spanish fluency based on a standardized, oral fluency test. All took didactic coursework in years 1 and 2 of medical school. Some elected to participate in a post-year 1 immersion rotation in a Spanish-speaking Latin American country. Oral fluency was reassessed using the same method in years 2 and 4 by independent evaluators who were blind to individuals' immersion participation status and prior fluency scores. The authors compared participants' likelihood of demonstrating greater Spanish fluency over baseline among those who did post-year 1 immersion versus those who did US-based coursework alone (controls)., Results: The likelihood of having greater Spanish fluency at the second-year assessment was 80% (45/56) among immersion participants, compared with 46% (21/46) for controls. The likelihood of having increased fluency at the fourth-year assessment was 65% (13/20) among those who did immersion versus 28% (7/25) for controls. Odds of having improved fluency for immersion participants remained statistically significantly higher after adjusting for baseline fluency (AOR [95%CI]=4.3 [1.7, 10.6], at year 2 and 5.1 [1.2, 21.6], at year 4)., Conclusions: Among medical students with intermediate to advanced baseline Spanish fluency, participants in a post-year 1 Spanish language international health immersion rotation were more likely to improve their Spanish fluency than participants in US-based coursework alone.

Background and Objectives: Multiple choice examinations assess learners' attainment of medical knowledge. Developing multiple choice examinations that discriminate among learners is difficult and time-consuming. Many institutions avoid this effort by using the National Board of Medical Examiners (NBME) subject examinations, which can also provide comparisons to a national norm. The family medicine subject examination has been criticized, however, because the test's content does not reflect the learning expected during the clerkship. Additionally, the test results cannot guide clerkship directors sufficiently to help students study or to improve the curriculum., Methods: Family medicine clerkships at three different institutions used a common 75-item examination based on the textbook Essentials of Family Medicine, Fifth Edition, for one academic year. Data were pooled and analyzed. The Raush Item Response Theory assessed student and item performance., Results: A total of 451 students took the examination. Across the three schools: (1) item separations (Rasch) were high (8.64), indicating good spread in item difficulty, (2) person separations were lower (1.65), indicating that medical students are likely a relatively homogeneous group, (3) Rasch item reliabilities were strong (ranging from .96-.99), and (4) Rasch person reliabilities (.54-.73) were lower. True internal consistencies across items as measured by the Kuder-Richardson 20 (KR-20) reliabilities were just adequate at .71-.77., Conclusions: By pooling resources, clerkship directors can share the creation and implementation of a written examination that has acceptable reliability and greater face validity than the NBME subject examination. They also have more control over examination content and can guide students' learning and curriculum improvements more accurately.

The incidence of trichomoniasis (Trichomonas vaginalis) in the United States is estimated at 5 million cases annually; chlamydia (Chlamydia trachomatis) at 3 million; gonorrhea (Neisseria gonorrhoeae), 650,000; and syphilis (Treponema pallidum), 70,000. However, most sexually transmitted infections (STIs) are asymptomatic-contributing to underdiagnosis estimated at 50% or more. Diagnosis of an STI signals sexual health risk because an STI facilitates the transmission and acquisition of other STIs, including human immunodeficiency virus (HIV). In fact, comorbid STIs increase patients' susceptibility of acquiring and transmitting HIV by two- to fivefold. Several studies have shown that aggressive STI prevention, testing, and treatment reduces the transmission of HIV. The authors discuss common clinical presentations, screening, diagnosis, and treatment for trichomoniasis, chlamydia, gonorrhea, syphilis, and herpes simplex virus.