National study of internal medicine manpower XIV: patterns of residency and fellowship over time, 1987 update

Article Abstract:

A study comparing internal medicine trainees with those in other medical specialties has been conducted on an ongoing basis since 1972. This study chronicles the career paths of internal medicine specialists from the time of their residency programs. The 1987 updated statistics pertaining to this long-run study have been compiled and analyzed within the context of the National Study of Internal Medicine Manpower (NaSIMM). The study also traces the participation of women and minorities in internal medicine residency and fellowship training programs. Between 1972 and 1982 there was a 122 percent growth in primary care specialties such as internal medicine, family practice, obstetrics and gynecology, and pediatrics, as contrasted with a 65 percent growth in the physician pool as a whole. In 1972 there were 8,297 residents in internal medicine; by 1986 the total had reached 18,116, accounting for 25 percent of all medical residents on duty. This constitutes the largest group of residents training in any medical specialty. Of those who begin residency training after graduating from medical school, 33 percent begin their residencies in internal medicine; 75 percent of these internal medicine trainees will complete a third year of residency in this specialty. By the third year of residency about 30 percent will enter practice, 10 percent will enter additional residency, and 60 percent will go into fellowship training, becoming immersed in an internal medicine subspecialty such as cardiology, endocrinology, or oncology. Although the percentage of female internal medicine residents has risen from 20 to 28 percent over this period, minority representation has merely remained steady at 10 percent of first year residents. Minority representation in this specialty is very small in absolute numbers; 600 to 800 black and the same number of hispanic medical students graduate each year, and under 400 from each group enter first year internal medicine residency programs; even fewer go on to fellowship training. Only 10 to 20 percent of women and minorities will be engaged in fellowship training following their third year of residency, while half the men will become fellows at this point in their training. In the last three years fewer than 250 minority specialists have received fellowship training. Cardiology, gastroenterology, and pulmonology, the three largest subspecialties of internal medicine, were least represented by women and minorities. Apart from low rates of minority participation, the data reveal other areas for concern, namely a declining pool of trainees in the surgical specialties, dropping from 28 percent in 1972 to 19 percent in 1986, and a small decrease in the

Supply and demand, Surveys, Student financial aid, Internists

---

Where are the clinical role models?

Article Abstract:

Studies show that there is increasing public dissatisfaction with the medical profession, particularly concerning the interaction between patient and doctor. This may be due to superspecialization within the medical profession, which results in a patient being seen by numerous consultants, each focusing on one aspect of the patient's illness. Although this pattern should provide the most expert care, the responsibility of discussing emotional and other human needs or offering personalized, compassionate care may be diffused or lost among the many physicians. Medical students and residents are commonly trained by academic faculty, whose priorities lie in research endeavors instead of clinical care and teaching. Clinician teachers are responsible for advancing their research, as well as fulfilling clinical and teaching duties, and this places extraordinary demands on their time. As a result, patient care may suffer or a frustrated physician may inadvertently communicate feelings of ambivalence to the patient or student. In addition, because faculty tend to spend minimal time in clinical practice, the student may question the clinical credibility of the teacher. The lack of an appropriate clinical role model affects patient care both during and after the training of a medical student, and this contributes to the problems in patient-physician interaction. Ways in which relations between physician and patient can be improved are suggested. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical students, Physician and patient, Physician-patient relations, Physicians, Medical professions, Training, Public opinion, Medical education

---

Reliability and validity of an objective structured clinical examination for assessing the clinical performance of residents

Article Abstract:

The objective structured clinical examination (OSCE) was used to assess the clinical skills of internal medicine residents, including interviewing skills, data collection, identification of abnormal findings, differential diagnosis, and initial treatment plan. In the OSCE test, each resident is required to meet with 17 patients, and respond in writing to general questions about each patient. The resident prepares checklists of the clinical skills required for each case and answers questions in advance. The time spent on answering questions about each case is about four to five minutes. Under these conditions, the residents can be evaluated with a large number of patients within a reasonable length of time. Second-year residents performed better than third-year residents for five of six OSCE skills, whereas first-year residents scored better on three OSCE skills. The resident's scores for diagnosis and treatment plan and total scores increased on their second OSCE. Faculty ratings of the residents' clinical performance did not correlate with the OSCE scores. The American Board of Internal Medicine certifying examination scores were correlated with only OSCE scores for differential diagnosis. The results show that the 17-patient OSCE is a useful method for assessing the clinical performance of residents, although more cases should be added to improve the reliability of the test. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Graduate medical education

Similar abstracts:

• Abstracts: The nutritional status and dietary pattern of Chinese adolescents, 1991 and 1993. Socio-economic status and puberty are the main factors determining anaemia in adolescent girls and boys in East Java, Indonesia
• Abstracts: Micropipette aspiration of guinea pig megakaryocytes: absence of fragmentation and dependence on maturation stage
• Abstracts: Prevention of bacterial endocarditis. Pefloxacin treatment of meningitis caused by gram-negative bacteria
• Abstracts: Estimation of body fat in healthy Swedish women during pregnancy and lactation
• Abstracts: Estimation of body fat in healthy Swedish women during pregnancy and lactation. part 2 Nutrient intakes during pregnancy: observations on the influence of smoking and social class

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.